J Trauma
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Comparative Study
Resuscitation from hypovolemia in swine with intraosseous infusion of a saturated salt-dextran solution.
Prehospital fluid resuscitation of traumatic injury is limited by difficulty in delivering large volumes of fluid in the field and time delays associated with gaining vascular access. We addressed these limitations in 14 anesthetized swine by evaluating a highly efficient volume expander, a near-saturated salt-dextran solution (SSD) administered through a new device, which gains vascular access via intraosseous (IO) infusion into the sternal bone marrow. After a steady-state baseline was achieved, all animals were hemorrhaged to 45 mm Hg for one hour. ⋯ In addition, cardiac output was better sustained after 2 hours with SSD than with NS. No deleterious effects of IO infusion of SSD were observed. From the improvement in cardiovascular variables and the lack of significant sternal or pulmonary pathologic perturbations, these data suggest that IO infusion of SSD can effectively treat hypovolemia and may allow field treatment when logistic considerations make conventional resuscitation impractical.
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Burn injury produces acute gastrointestinal (GI) derangements that may predispose the burn victim to bacterial translocation (BT). We studied the effects of heparin on gastrointestinal (GI) anatomic alterations and BT after 25% and 32% total body surface area (TBSA), full-thickness murine burn injuries. Heparin (100 U/kg) was administered with 1 mL of normal saline (NS) resuscitation solution immediately postburn and 4 hours and 18 hours postburn in volumes of 0.5 mL NS. ⋯ After 32% TBSA burn injuries, BT was also decreased in heparin-treated animals (64.3% vs. 31.6%; p < 0.025). Analysis of mixed venous blood gases showed that heparin did not affect the severe metabolic acidosis that follows burn injury in this animal model, indicating that general tissue perfusion was not improved. Heparin administered in the acute postburn period ameliorates GI structural and functional damage in this murine burn model and decreases BT.
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The American College of Surgeons' (ACS) Committee on Trauma recommends drug and alcohol screening as "essential" for level I and II or "desirable" for level III trauma centers. ⋯ Despite available resources and repeated ACS recommendations, measurements of BACs and drug screens are routine in only 63.7% of level I and 40.0% of level II trauma centers.
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We describe 14 patients with adrenal injuries from penetrating (ten) or blunt (four) trauma. The severity of their injuries was evidenced by the high incidence of hypovolemic shock (57%), mean Trauma Score (11), mean transfusion requirement (18 Units), number of associated injuries (4.9 per patient), complication rate (57%), and deaths (14%). Twelve patients required surgical exploration; adrenal repair, rather than removal, was possible in seven. Although adrenal insufficiency was suspected in three patients, it was not documented and no patient required corticosteroid replacement.
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All patients with a diagnosis of knee dislocation during a 7 1/2-year period (1984-1991) were reviewed retrospectively. There were 37 knee dislocations (KDs) in 35 patients. The mechanism of injury was predominantly motor vehicle or pedestrian crashes. ⋯ Arterial injuries were treated with interposition (five of six) or bypass graft (one of six) and fasciotomies (six of six). Amputation was required in one of six of the vascular injury group and none of 31 of the remainder of the patients with no vascular injury. We recommend the selective use of arteriography in patients with KDs based on a history or clinical findings of ischemia and do not recommend routine arteriography for all patients with KD.