J Trauma
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Case Reports
Aortoventricular fistula secondary to blunt trauma: a case report and review of the literature.
An aorto-right ventricular fistula secondary to nonpenetrating trauma is described. Review of the literature is reported. ⋯ Blunt cardiac injury is a frequent concomitant injury and contributes to the high mortality of this lesion. Prompt surgical intervention is required for survival.
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Prehospital guidelines for the treatment of penetrating trauma recommend rapid volume resuscitation to normal blood pressure. There is evidence, however, that fluid resuscitation to normal blood pressure in the setting of uncontrolled hemorrhagic shock (UHS) causes increased bleeding, hemodilution, and mortality. To test this hypothesis, we evaluated the effects of blood pressure and hemodilution on survival in a rat model of UHS. ⋯ The effects of blood pressure alone, hemodilution alone, and their interaction were significantly related to base deficit and arterial pH. Hemodilution, but not blood pressure as an end point in resuscitation, was significantly related to lactate levels. The high mortality in this model of uncontrolled hemorrhage was attributable to the effects of blood pressure, hemodilution, and the interaction between the two variables, rather than simply continued blood loss from increased hydrostatic pressure.
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Comparative Study Clinical Trial
Effect of alcohol on the utility of base deficit in trauma.
Base deficit (BD) is an indicator of metabolic acidosis and is used as an index of shock and resuscitation for trauma patients. Ethanol causes an increase in lactate production and may cause metabolic acidosis in otherwise normal patients. The effects of alcohol on BD have not been investigated. This study was performed to determine the effects of ethanol on the utility of BD for assessing shock and resuscitation among trauma patients. ⋯ Ethanol can contribute significantly to metabolic acidosis among trauma patients and may confound the utility of BD to some degree. There was no difference in intensive care unit or overall length of stay, however, regardless of ethanol level, and the majority of patients with a BD < or = -6 still required transfusion. Even in the presence of ethanol, a BD < or = -6 remains a powerful indicator of major injury, increased length of stay, and transfusion requirement.
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Head, face, and neck injuries (HFNI) occur during animal-related trauma. We compared patients with HFNI and without HFNI after animal-related injuries to determine the significance of these injuries. ⋯ HFNI occur in females and young people and produce lower GCS score, higher ISS, higher AIS Head/Neck, higher AIS Face, and higher mortality. Most occur during recreational horseback riding. Protective headgear should be mandated.
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Many new types of expanding or fragmenting handgun ammunition have been developed. Knowledge of these unusual bullets may aid in the management of patients and their wounds. ⋯ Expanding/fragmenting bullets produce larger, shallower wounds than do full metal jacketed bullets. Recognition of the wound and roentgenographic appearances of these unusual bullets will help the trauma surgeon to properly treat gunshot victims. Because of the occurrence of jacket separation in water, ordnance gelatin should be used for optimal evaluation of bullet performance.