J Trauma
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Transcutaneous oxygen (PtcO2) monitoring with miniaturized heated electrodes has been shown to continuously track arterial oxygen tension (PaO2) noninvasively in stable infants. However, the correlation between the two is less marked in unstable adults, and PtcO2 appears to be additionally influenced by perfusion. The ability of PtcO2 to detect alterations in cardiac index (CI) was evaluated in 19 critically ill adult patients. ⋯ All instances of improvement in PtcO2 readings were associated with improvement in PaO2 or hemodynamic status. Because of its high sensitivity, continuous noninvasive PtcO2 monitoring should allow reduction in routine PaO2 and CI determinations. However, a decrease in PtcO2 requires immediate in-depth evaluation of the patient's PaO2 and CI because of its lack of specificity.
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A series of 23 above-knee and below-knee amputees who sustained an ipsilateral lower extremity fracture was qualitatively evaluated with respect to the nature of the injuries sustained, associated problems, and results of fracture treatment. The overall incidence of these fractures was 3% in a population of lower-extremity amputees. ⋯ Most femur fractures were successfully treated by nonoperative means, and most of the hip fractures were treated operatively. The final rehabilitated status of the dysvascular amputees was the poorest: one half of those who were previous household ambulators remained wheelchair confined postinjury.
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Burns as a result of priming carburetors with gasoline resulted in 4% of all burn admissions to the Oregon Burn Center from 1980-1982. The burns most frequently involved the head and neck and upper extremities. ⋯ This type of preventable accident inflicts substantial morbidity and may be a major financial burden. Professional and public awareness of the risk of serious gasoline burns incurred during carburetor priming should decrease its incidence.
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Thirty-three trauma patients presenting with hypoxemia and normo- or hypocarbia were treated with continuous positive airway pressure (CPAP) via a snug-fitting face mask. All patients had demonstrated continued hypoxemia despite supplemental oxygen administration before institution of CPAP therapy as the primary mode of ventilatory support. ⋯ Two patients (6%) required intubation, but neither for elevation in PaCO2. CPAP mask appears an effective means of support for mild to moderate post-traumatic respiratory insufficiency.
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Comparative Study
Limitations of computed tomography in the evaluation of acute abdominal trauma: a prospective comparison with diagnostic peritoneal lavage.
There has been recent enthusiasm for computed tomography (CT) to supplant diagnostic peritoneal lavage (DPL) in the detection of abdominal injuries. We prospectively compared CT to DPL following acute blunt trauma or stab wound to the abdomen. Patients with hemodynamic instability or overt signs of intraperitoneal pathology underwent urgent laparotomy and were excluded from study. ⋯ In particular, CT missed seven solid visceral (five liver, two spleen), five hollow visceral, one major vascular, and three diaphragmatic lesions requiring operative intervention. In our experience, CT demonstrated an alarming incidence of false-negative studies. Given the widespread variability of CT equipment and personnel we would argue strongly against the use of CT alone in the evaluation of acute abdominal trauma and continue to support DPL as the most accurate and reliable instrument of detection.