J Trauma
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Comparative Study
Can ultrasound replace diagnostic peritoneal lavage in the assessment of blunt trauma?
Diagnostic peritoneal lavage (DPL) and computed tomography (CT) are the primary diagnostic modalities in the evaluation of patients with suspected blunt abdominal trauma (BAT). Diagnostic peritoneal lavage is fast and accurate but associated with complications. Computed tomography is also accurate, yet requires that patients be stable and transportable. ⋯ Six injuries were missed but only one was felt to be significant. If US had been used in all 200 patients, 199 would have had appropriate care. We conclude US is reliable in the detection of free intraperitoneal fluid and may be used in place of DPL or CT.
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Controversy exists whether early aggressive fluid therapy in the setting of uncontrolled hemorrhage worsens outcome by increasing blood loss from injured vessels. Since diaspirin crosslinked hemoglobin (DCLHb) is a vasoactive, oxygen-carrying solution, we compared the effects of DCLHb with other resuscitative fluids on blood loss, hemodynamics, and tissue oxygen delivery in a model of uncontrolled hemorrhage. Anesthetized rats (250-350 g) were subjected to a 50% tail transection and resuscitated 15 minutes later with 1:1 DCLHb, 3:1 lactated Ringer's solution (LR), 1:1 hypertonic saline (7.5% HTS), or 1:1 human serum albumin (8.3% HSA) based on initial volume of blood loss (average 4.7 +/- 0.3 mL/kg). ⋯ Although blood loss in DCLHb-treated animals was greater than in unresuscitated animals, it was no different from other resuscitative fluids and less than with HSA. There was no difference in 24-hour survival between all treatment groups. In conclusion, DCLHb elevates MAP but does not exacerbate blood loss or compromise tissue oxygen delivery compared with other resuscitative fluids in this model of uncontrolled hemorrhage.
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We devised a protocol to prospectively manage stab wounds to the back with the hypothesis that the triple contrast computed tomographic (CT) scan is an effective means of detecting occult injury in these patients. All wounds to the back in hemodynamically stable adults were locally explored. All patients with muscular fascial penetration underwent triple contrast CT scanning utilizing oral, rectal, and IV contrast. ⋯ Two CT scans documented significant injury and led to surgical exploration and therapeutic celiotomies. Although triple contrast CT scanning was able to detect occult injury in patients with stab wounds to the back it did so at considerable cost and the results rarely altered clinical care. Therefore, its routine use in these patients is not recommended.
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Extremity amputation is a devastating injury. Forty-two patients who sustained traumatic limb amputation were contacted 3-57 months (mean, 25 months; median, 24 months) after injury to evaluate residual disability and to determine what factors were associated with a good recovery. There were 35 men and 7 women with ages ranging from 5 to 73 years (mean, 34 years). ⋯ No patient with a AK amputation and only 1 (9%) patient with a work-related injury returned to work. Associated injuries or inpatient rehabilitation did not correlate with returning to work. Eighty-eight percent of patients were satisfied with their adjustment and could perform all activities of daily living.(ABSTRACT TRUNCATED AT 250 WORDS)
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In three patients with elbow dislocations after falls on an outstretched upper extremity, concurrent perilunate dislocation was found. Closed reduction of the elbow dislocation achieved excellent functional results. Open reduction and internal fixation for perilunate dislocation provided anatomic reduction and satisfactory functional recovery in two patients. In the third, a delay in diagnosis of a perilunate dislocation necessitated proximal row carpectomy at 6 weeks.