J Trauma
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Data on venous injury in blunt extremity trauma are scarce. The nature of injury and results of therapy in 22 patients presenting with blunt venous extremity injury at MIEMSS and KUMC in a 10-year period are presented. Comparisons of the outcome with venous ligation and repair, the use of anticoagulants, and the use of fasciotomy, led to the development of guidelines for the therapy of blunt venous injury in both upper and lower extremity trauma.
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Autotransfusion is an accepted adjunct to the treatment of massive bleeding associated with intra-abdominal trauma. We describe a case of massive air embolism during autotransfusion for a gunshot wound to the vena cava. Treatment required thoracotomy and direct aspiration of air. The patient recovered without sequelae.
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The use of indirect calorimetry in assessing and monitoring nutritional support in burn patients is reported. Twenty-nine patients with a mean burn size of 35% TBSA were monitored with 228 measurements of resting energy expenditure (REE), calculations of respiratory quotient (RQ), and substrate metabolism. Daily weights, nitrogen balance determinations, and routine laboratory tests were also obtained. ⋯ Protein accounted for 17 +/- 3% of total metabolism, corresponding to a calorie:nitrogen ratio of 128:1. Practically, however, provision of this much protein proved difficult. Routine use of indirect calorimetry permits tailoring of nutritional support for burn patients, and is valuable in the early detection of significant under- or overnutrition.
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Prehospital resuscitation and stabilization of major trauma victims is increasingly employed. To evaluate the benefits of one such maneuver, fluid administration, we reviewed 52 consecutive trauma cases in which patients had a blood pressure of less than 100 mm Hg either at the scene or on arrival to hospital. ⋯ A percentage of patients with correctable surgical lesions might have been salvaged had prompt transport been instituted. Field maneuvers in critically injured patients should be minimized to decrease ultimate mortality.
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The hypothermic effect of resuscitation solution temperature on epicardial and core temperatures in 15 dogs during hemorrhagic shock was studied. Hemorrhagic shock was induced and dogs were then resuscitated with either body-temperature lactated Ringer's, room-temperature lactated Ringer's, 4 degrees C blood, warmed blood, or cold blood mixed with 50 degrees C lactated Ringer's. ⋯ Baseline temperatures were not significantly changed with the use of warmed blood or body-temperature lactated Ringer's. The results of this study support the use of warmed blood or body-temperature lactated Ringer's during resuscitation from hemorrhagic shock.