J Trauma
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Metropolitan Houston with a population of four million has the nation's poorest freeway system. Its two Level I trauma centers are adjacent within a centrally located freeway loop, therefore the city is ideally suited for a trauma scene helicopter transport service. During 1981 there were 577 flights to the scene of injury (blunt, 466; penetrating, 111). ⋯ Scene treatment (intubation, hyperventilation and, when appropriate, mannitol administration) was routinely initiated for patients with severe head injuries. Two hundred seventy-nine patients required cardiopulmonary resuscitation, tracheal intubation, chest-tube placement, or other invasive procedures. Based upon these resuscitative efforts and invasive procedures, a physician in attendance was deemed medically desirable for one half of the flights.(ABSTRACT TRUNCATED AT 250 WORDS)
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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.
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In recent years, there has been increased debate on the indications for and value of thoracotomies done in the Emergency Department for victims of trauma. The current literature, unfortunately, does not resolve many points of contention surrounding this procedure. Using strict terms to define Emergency Bay Thoracotomy (EBT), 89 consecutive patients seen over a 2-year period in a Trauma Unit were retrospectively reviewed and analyzed. ⋯ A progressive increase in survival rate was observed with increased use of the procedure. A review of the prognostic factors found in this study and comparison with other published studies indicates that clear definition of the patient population and patient status is essential before aggregated data are used as a basis for therapeutic policies. Educational and research efforts must focus on determining which patients have zero prognosis after initiating resuscitation, rather than on denying care to any group, even when only a few will respond.
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Liver lacerations are the most common intra-abdominal injury that leads to death, and control of hemorrhage remains the primary problem in lowering mortality from severe hepatic trauma. We retrospectively reviewed operative trauma cases in which liver packing and planned reoperation were used as temporizing measures in hemodynamically unstable patients. ⋯ Preliminary data support our contention that liver packing and planned reoperation is a valuable adjunct for the management of hemorrhage from severe hepatic injury without incurring increased morbidity or mortality. This technique is useful for the experienced trauma surgeon to arrest hemorrhage and gain hemodynamic stability before attempting definitive care and for the community hospital surgeons who after gaining hemodynamic control would like to transfer the patient to a tertiary care facility.