J Trauma
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When administered in sufficient amounts, normal saline and Lactated Ringer's Solution are equally effective in maintaining adequate circulatory volumes despite severe blood loss and resultant hypoproteinemia. Arterial pH is maintained within normal limits when either solution is used for resuscitation provided the circulatory volume has been re-expanded to adequate levels for good tissue perfusion and support of aerobic metabolism. The pH of the infused solutions has no effect on blood pH under these circumstances. ⋯ Of the 14 subjects, 13 were long-term survivors. The one death was associated with a technical mishap shortly after completion of the experiment. Because banked blood imposes a "net" alkaline metabolic load (sodium citrate), patients expected to be transfused with large volumes of stored blood might be better resuscited with normal salin than with Ringer's Lactate Soultions, to minimize or avert the otherwise resultant metabolic alkalosis.
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A retrospective study has been reported of a 15-year experience with electrical burns of the mouth in children. Addtionally, a method has been described by which the surgical results to date can be measured. It seems that the means of initial treatment (excision vs. conservative) does not influence the final results, but rather the extent of injury is probably the crucial factor. Because of a high incidence of significant bleeding from the labial artery, and the concept of early wound excision to diminish late scaring, we continus to favor initial delayed primary excision.
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The immediate hemodynamic response to a high-velocity missile wound was studied in the hind legs of dogs. A spherical missile of constant mass and velocity was used. ⋯ In addition to these local changes there was also a generalized effect with decreased blood pressure without a compensating increase in hear rate. This may be explained by the specific character of the trauma that a high-velocity missile produces.
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Organizations prepared to respond to war, fire, flood, earthquake, or attack are essential for effective disaster control. "Valley Triage" the San Fernando Valley Medical Triage Team in Los Angeles, was formed to meet this need. The team is a mobile medical unit staffed by physicians and coordinated with civilian and military emergency services. ⋯ The primary aim of Valley Triage is to provide on-site medical attention to disaster victims, and to coordinate their transfer to adequately staffed and equipped hospitals. Valley Triage offers a new approach to disaster management and can serve as a model for the development of other teams throughout the nation.