J Trauma
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We hypothesize that during severe normothermic hemorrhagic shock (HS), induction of profound hypothermic circulatory arrest (PHCA) of 60 minutes to allow repair of otherwise lethal injuries in a bloodless field, can be survived without brain damage. In previous dog studies, normothermic HS with mean arterial pressure (MAP) of 40 mm Hg for 30 minutes, followed by PHCA of 2 hours at brain (tympanic membrane) temperature of 5 to 10 degrees C and core temperature of 10 degrees C, induced and reversed with cardiopulmonary bypass, resulted in survival with mild histopathologic brain damage. This study was designed to determine the severity of HS that can safely allow 1 hour of PHCA. In pilot studies with HS at MAP 30 mm Hg for 90 minutes with or without subsequent PHCA of 60 minutes there were no survivors. ⋯ The critical level of hypotension during 60 minutes normothermic HS that is compatible with survival in dogs is a MAP of between 30 and 40 mm Hg. After otherwise survivable severe normothermic HS of 60 minutes, PHCA of 60 minutes does not add brain damage or mortality, and may allow survival from injuries that would otherwise be irreparable.
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It is known that blast wave and fragments are the primary causes of casualties from explosive weapons. To study the characteristics of blast-fragment combined injuries, functional and morphological changes were investigated in three groups of anesthetized dogs with blast injury, high velocity fragment extremity injury, and combined injuries of both types. The same parameters were also examined in a control group. ⋯ It is concluded that extremity injury from high velocity fragment will aggravate lung blast injury. Changes in the levels of PGI2 and TXA2, can be used to determine the extent of injury in the three kinds of wounds. This may be useful for early diagnoses and rational treatment of the victims of explosion.
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Review Case Reports
Nonoperative management of a splenic tear in a Jehovah's Witness with hemophilia.
Splenic laceration, the most common visceral lesion following blunt abdominal trauma, can be treated in a nonoperative fashion in only a select group of stable patients with minimal injury. We report a unique case of life-threatening splenic trauma in a Jehovah's Witness with hemophilia that was successfully managed without surgery.
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Since 1990, Florida has used a uniform set of eight triage criteria, known as the trauma scorecard, for triaging adult patients with trauma to state-approved trauma centers. If any one of the eight criteria are met, paramedics classify the patient as a "trauma alert" and transport to a state-approved trauma center. ⋯ Thus, the Florida Department of Health and Rehabilitative Services, Office of Emergency Medical Services initiated a research effort to assess the effectiveness of the state-adopted trauma triage criteria for adults, giving special attention to geriatric trauma. The results of the Florida Trauma Triage Study indicate that the eight triage criteria comprising the trauma scorecard produce unacceptable levels of undertriage in elderly patients (age 55 years or older) with life-threatening injuries.
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Comparative Study
Early resuscitation with low-volume PolyDCLHb is effective in the treatment of shock induced by penetrating vascular injury.
To study the efficacy of an oxygen-carrying solution in early resuscitation of hemorrhagic shock induced by penetrating vascular injury. ⋯ Early resuscitation with low-volume hemoglobin is effective in restoring tissue perfusion and improving survival in uncontrolled hemorrhagic shock.