Arch Surg Chicago
-
Fibrin glue (FG), made with highly concentrated human fibrinogen and clotting factors, was used to achieve parenchymal organ hemostasis in patients with disordered coagulation secondary to massive transfusion, chronic disease, and disseminated intravascular coagulation; it was effective in controlling liver hemorrhage in seven patients and in the performance of a splenorrhaphy in one other patient. The coagulation profile was grossly abnormal in all patients, and the mean +/- SD intraoperative blood loss was 5.1 +/- 4.2 L; patients received 14 +/- 10 U of blood perioperatively. ⋯ Two patients died postoperatively secondary to cardiac arrest and adult respiratory distress syndrome. Because FG does not depend on adequate platelet or clotting factor levels to be effective, it is especially useful in patients with parenchymal organ hemorrhage and disordered coagulation.
-
Computed tomography and diagnostic peritoneal lavage in blunt abdominal trauma. Their combined role.
We reviewed medical records and films of all 196 trauma patients who underwent computed tomography (CT) between June 1982 and October 1986 to see whether CT achieved the level of accuracy attributed to it, whether diagnostic peritoneal lavage (DPL) performed in conjunction with CT was a useful diagnostic test for blunt abdominal trauma, and whether laparotomy was mandatory when pelvic fluid collections were seen by CT after blunt trauma. A total of 36 patients underwent DPL, 29 before and seven after CT. There were seven false-negative CTs that were clinically significant. ⋯ Although overall accuracy was excellent, CT was not reliable in detecting bowel injury. Diagnostic peritoneal lavage was helpful in detecting injuries missed by CT. Most stable patients with moderate or large intraperitoneal fluid collections on CT accompanying solid viscus injury were treated successfully without laparotomy.
-
Comparative Study
Early burn wound excision and skin grafting postburn trauma restores in vivo neutrophil delivery to inflammatory lesions.
This study assessed the effect of early vs delayed postburn wound excision and skin grafting on the in vivo neutrophil delivery to a delayed-type hypersensitivity (DTH) reaction and a bacterial skin lesion (BSL). Male Lewis rats were presensitized to keyhole-limpet hemocyanin. Group 1 comprised sham controls. ⋯ Waiting one week to excise and skin graft a burn wound resulted in no improvement in neutrophil delivery to DTH and BSL dermal lesions. It was concluded that burn wound excision and skin grafting immediately after burn trauma restored in vivo neutrophil delivery to a BSL and DTH dermal lesion. This may, in part, explain the beneficial effect of early aggressive burn wound debridement in patients with burn injuries.
-
The fluid required for initial resuscitation of trauma patients should reflect, at least in part, the severity of the original injuries and shock. We examined the hypothesis that the initial fluid requirements might also predict development of subsequent pulmonary failure and death. Fluid balances were calculated for the first 24 hours in the intensive care unit for 100 high-risk trauma patients. ⋯ The predictive value of the fluid balance was independent of other prognostic indicators, such as revised trauma scores, injury Severity Scores, and modified APACHE II scores. This simple measurement should help in allocating intensive care unit resources, as patients in positive fluid balance are likely to require Swan-Ganz catheterization and are likely to require long-term mechanical ventilation. The fluid balance should also be useful in stratifying patients for entry into clinical trials.
-
Between 1982 and 1986, 108 patients with penetrating wounds in proximity to the heart and no obvious signs of cardiac injury underwent a diagnostic subxiphoid pericardial window procedure. Eighty-four patients had stab wounds, 22 had gunshot wounds, and two had shotgun wounds. The subxiphoid pericardial window procedure produced positive results in 30 patients (28%) and negative results in 78 patients (72%). ⋯ There were no known missed cardiac injuries, and there were no deaths in the series. Some patients with penetrating wounds to the heart have no overt signs or symptoms of cardiac injury. A subxiphoid pericardial window procedure quickly identifies or excludes cardiac injuries and can be performed with minimal morbidity, even when there is contamination from the gastrointestinal tract.