J Trauma
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The inability to normalize lactate predicts death after trauma, but lactate may not be immediately available in every center. We postulated that, in a normal acid-base environment, lactate would correlate with the anion gap and the base excess of an arterial blood gas. ⋯ There is no correlation between lactate, base excess, and anion gap after initial resuscitation. Neither anion gap nor base excess was capable of predicting lactate; therefore, lactate must be directly measured. The lack of correlation of anion gap with base excess or lactate suggests the presence of unmeasured anions, an impairment in acid-base regulation after injury and resuscitation, or both.
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Self-inflating bag-valve devices are commonly used for the ventilation of intubated patients, especially during resuscitation and transport. These devices are generally safe, but minor deviations in their recommended use can expose patients to airway pressures greater than 135 cm H2O. ⋯ We believe that this complication resulted from high airway pressures generated in the bag-valve device. The ability of the device in question to cause barotrauma was confirmed by bench-top measurements of the peak airway pressures generated by minor deviations from proper use of the device.
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Case Reports
Introduction of a new tracheostomy exchange device after percutaneous tracheostomy in a patient with coagulopathy.
Presented is a case of a 22-year-old male bone marrow transplant recipient who developed severe methotrexate-induced oropharyngeal mucositis and respiratory insufficiency caused by sepsis. Coagulopathy and severe thrombocytopenia precluded surgical tracheostomy; however, dilatational percutaneous tracheostomy was performed uneventfully. The tracheostomy tube was later changed using a newly developed exchange device permitting intraprocedural oxygenation and stomal redilatation. We conclude that severe thrombocytopenia and coagulopathy are not an absolute contraindication for percutaneous tracheostomy and that the new tracheostomy exchange device optimizes airway management and safety during this procedure.
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The goal of this study was to describe the epidemiology, clinical presentation, diagnostic methods, and outcome in a large series of children with blunt cardiac injury (BCI). ⋯ Pediatric BCI is usually diagnosed in the context of severe multiple system trauma and is less commonly an isolated event. Because of the lack of a standard, various diagnostic tests are used in the diagnosis of BCI, and these tests rarely agree. In hospitalized pediatric patients with BCI, unanticipated complications are rare. Significant sequela, although uncommon, do occur and follow-up of children with BCI should be ensured.