Cir Cir
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Vasodilatory refractory shock is common in patients with severe burns. It is defined by resistance to high doses of volume and vasopressor therapy. ⋯ After administration of vasopressin, systemic vascular resistance index (SVRI) and pre-arrest morbidity (PAM) were significantly increased (p < 0.05). We observed a significant decrease in dopamine and norepinephrine requirements (p < 0.005). Norepinephrine was discontinued at 72 h and dopamine infusion was continued at low dose. Urine output, urinary sodium, and serum bicarbonate were significantly increased. deltaCO2 was increased and this finding was associated to decrease in norepinephrine and dopamine requirements; this effect translated in to better splachnic perfusion. Left ventricular function indexes were normal. Patients did not develop evidence of myocardial, splachnic, or limb ischemia during vasopressin infusion. In all patients vasopressin was weaned at 24 h and removed. In five patients, it was necessary to reinitiate vasopressin infusion for another 96 h without complications. Low-dose vasopressin infusions (0.04 IU/min), are a useful therapy to severely burned patients with vasodilatory refractary shock and who are devoid of adverse effects.
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Multicenter Study
[Penetrating cardiac trauma. A nine-years experience in Cancún, Mexico].
Early patient intubations, rapid transportation, thoracotomy in the emergency room, and tamponade are the main reasons why patients with cardiac trauma survive at present. This paper describes the experience with cardiac trauma in Cancun, Quintana Roo, Mexico, during period of 9 years by general surgeons. ⋯ Cardiac trauma presents in a wide range of clinical situations. Tamponade was observed as a positive prognostic factor, mortality was due to principally lesions caused by firearms and to ascending aorta trauma. Extracorporeal circulation pump is rarely required.