J Trauma
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Case Reports
Lethal complication from insertion of nasogastric tube after severe basilar skull fracture.
An unusual complication is presented arising from the use of a nasogastric tube in a patient with a massive basilar skull fracture. Intracranial passage of the NG tube resulted. Therefore, in the presence of a severe basilar fracture and/or significant maxillofacial trauma where the integrity of the base of the skull may be in question, one should be very hesitant to insert tubes into the nasopharynx.
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In hot climates, only high temperature fluids (are greater than 100 F) may be available for treatment of blood loss shock in combat casualties. Can the hot fluid be used safely and effectively? We compared hot Ringer's lactate (51.7% C/125 F) resuscitation (n=10) to body-temperature (100 F) fluid resuscitation (n=10) in a hemorrhagic shock dog model. ⋯ All animals in both groups survived. These findings suggest that battlefield use of hot fluids in controlled amounts can be safe and effective for treatment of blood loss shock in human combat casualties.
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An unusual case of abdominal impalement is presented. In such patients intra-abdominal injury must be suspected, and the impaling object must not be manipulated until the proper moment in the operating room. An approach involving various subspecialties, such as urology, neuro-, and vascular surgery, is often required.
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The role of late restitution of blood volume after hemorrhage in cardiovascular stabilization was examined in awake, splenectomized dogs. Cardiovascular variables were measured: at 2 hours after hemorrhage, changes were noted in cardiac output, mean arterial pressure, heart rate, stroke volume, arterial pressure, and CVP in three hemorrhage groups (p less than 0.05), and in total peripheral resistance for 15 ml/kg and 22.5 ml/kg hemorrhage groups (p less than 0.05). At 24 hours after hemorrhage, the degree of restitution of blood volume was correlated with cardiac output (p less than 0.01), stroke volume (p less than 0.02), and total peripheral resistance (p less than 0.01). ⋯ Blood volume restitution was correlated with degree of hemorrhage throughout the 24-hour period of investigation. Plasma protein content restitution and blood volume restitution were correlated with changes in osmolality. The results suggest thatcardiovascular stabilization after hemorrhage is a function of the degree of restitution of blood volume mediated through a shift of fluids to the interstitutium, mediated in turn by extracellular hyperosmolality.