J Trauma
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Injured patients whose treatment included the use of radiologic catheter techniques were reviewed to determine the clinical utility of radiologic intervention. In the past 4 years, 51 patients have undergone 53 radiologic procedures, predominantly angiographic hemostasis. ⋯ Twenty-eight of the 31 patients with shock or with life-threatening hemorrhage or sepsis, treated by the radiologist, were salvaged. Based on our results, we believe that a radiologist, knowledgeable about trauma and expert in catheter techniques, plays a vital role in improving patient survival and should be integrated into the trauma team approach.
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A unique case of traumatic rupture of the internal mammary artery secondary to blunt deceleration injury of the chest is reported. The injury, which produced changes consistent with great vessel disruption on the plain chest radiograph, was treated by percutaneous transcatheter embolization of Gianturco steel coils. The importance of surveying all arteries visualized during thoracic aortography in patients with widened mediastinum following deceleration injury to the chest is reinforced. Embolotherapy of this noncritical chest wall vessel is demonstrated.
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A patient with stab wounds to the chest may have negative physical findings, and normal radiologic examinations and still develop delayed pneumothorax or hemothorax. The frequency and time intervals of these complications have not been established. One hundred ten asymptomatic patients with chest stab wounds were prospectively studied. ⋯ Ten patients (9%) developed a delayed pneumothorax or hemothorax. Careful radiologic examination using inspiratory and expiratory chest films revealed all positive findings by 6 hours postadmission. Asymptomatic patients with chest stab wounds can be safely managed without hospitalization.
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Pulmonary dysfunction is a well-recognized sequela of sepsis, which has been quantitated by calculation of intrapulmonary shunt (Qs/Qt) and, more recently, by measurement of extravascular lung water (EVLW). We sought to demonstrate the relationship between Qs/Qt and EVLW in sepsis. Nine pigs were given live E. coli infusions and five control pigs received only crystalloid. ⋯ Regression analysis of Qs/Qt or EVLW yielded a correlation coefficient of r = 0.48. We concluded that while sepsis can result in both increased EVLW and Qs/Qt, the correlation is not sufficiently strong to account for the increased Qs/Qt on the basis of elevated EVLW alone. The possible relationships of arterial hypoxemia and pulmonary edema, ventilation-perfusion mismatch, and alterations in the normal hypoxic vasoconstrictive response in sepsis are considered.
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Passive leg raising is widely used to treat hypotension associated with hypovolemia. Presumably gravity causes a central translocation of leg venous blood and an increase in filling pressure, cardiac output, and arterial pressure. Ten healthy volunteers, 25 to 35 years old, had measurements of heart rate, blood pressure, and cardiac output in the supine position after 20 sec and 7 min of 60 degrees passive leg elevation. ⋯ After 45 min supine, leg raising had no effect on stroke volume or cardiac output but increased blood pressure (4 mm Hg) by increasing peripheral resistance (15%). Thus, leg raising, like application of the MAST trousers, fails to produce any sustained increase in cardiac output or stroke volume. Small venous leg volumes and time-dependent changes in the distribution of venous volume and compliance may explain the absence of any sustained 'autotransfusion' effect.