J Trauma
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One hundred forty-three patients with 163 upper extremity vascular injuries were reviewed. Penetrating trauma accounted for 94% of the injuries and blunt trauma for 6%. Absent pulses are not a completely reliable sign of upper extremity arterial injury. ⋯ The most common technique of vascular repair was end-to-end anastomosis, followed by vein graft interposition. No amputations were required. Despite excellent results of vascular reconstruction, functional impairment due to associated nerve injuries was a distressingly predominant finding.
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One hundred thirty-nine pediatric blunt trauma patients 12 years of age or less were cared for using a protocol designed to identify which patients require aggressive surgical therapy and those who can be managed nonoperatively. Sixteen patients (average MISS score, 33) failed to respond to an estimated 20 cc per kilogram of crystalloid fluid resuscitation. Fifteen died, a mortality rate of 94%. ⋯ Seventeen studies were positive. There were two complications (12%), but all 17 patients in this group were successfully managed nonoperatively. Our data suggest that quantitative crystalloid fluid resuscitation can identify pediatric blunt trauma patients suitable for nonoperative management and that ultrasound is a reliable tool for assessing intra-abdominal injury.
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Since the most common site of infection in burned patients is the burn wound, we have previously studied the biologic effect of burn wound blister fluid (BF) on control lymphocyte and neutrophil activity. BF will not support the phagocytosis of Pseudomonas by normal neutrophils, and a subset of the BF samples suppressed the maximal mitogen response of control lymphocytes by more than 50%. The current work was carried out to analyze in depth the composition of BF using crossed immunoelectrophoresis. ⋯ The elevation in C3 was secondary to the local activation of C3 and the generation of multiple C3 breakdown products. These changes in C3 are of potential biologic importance, since evidence has accumulated indicating that the various fragments of C3 can modulate both neutrophil and lymphocyte function. Thus, the results of this study suggest that local changes in the blister fluid may adversely affect local immunity and predispose the patient to burn wound sepsis.
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Central to the controversy that surrounds the treatment of accidental severe hypothermia is the question of how the method of rewarming affects myocardial performance, and therefore survival. We induced severe hypothermia and cardiac arrest in 15 mongrel dogs. Each dog was rewarmed by one of three methods: partial cardiac bypass (Group I); peritoneal dialysis (Group II); or external rewarming with a fluid-circulated blanket (Group III). ⋯ However, Group III had a significantly slower rewarming time and required significantly greater volumes of crystalloid and bicarbonate solutions. The sole procedural death occurred in Group III. Our results show that partial cardiac bypass, peritoneal dialysis, and the fluid-circulated blanket are equally effective in rewarming severely hypothemic dogs with cardiac arrest, provided that the cardiac arrest is relieved by partial cardiac bypass or standard mechanical CPR and that physiologic levels of intravascular volume, oxygenation, and pH are maintained.