The Journal of surgical research
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E- and P-selectins are adhesion molecules that effect neutrophil-mediated reperfusion injury. Our hypothesis was that the expression of E- and P-selectins is dependent on the type of fluid used for resuscitation and that lactated Ringer's (LR) solution would result in an early upregulation of these molecules. ⋯ LR resuscitation and LR infusion without hemorrhage are associated with early increased expression of E- and P-selectin molecules in the lung and spleen.
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The usual surgical antisepsis involves scrubbing the skin with antiseptic solutions. This procedure can damage the skin, with the subsequent risk of infection for the patient. There are several efficient and quick-acting antiseptic alcohol solutions that require no scrubbing. ⋯ Because of its efficacy, persistent effect, and skin protection, we advise that scrubbing with classic antiseptic solutions be replaced with gentle washing with an alcohol solution such as N-duopropenide in alcohol.
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Clinical Trial Controlled Clinical Trial
Trauma mannequin assessment of management skills of surgical residents after advanced trauma life support training.
We tested the effectiveness of Advanced Trauma Life Support (ATLS) training among surgical residents using a specially designed mannequin. ⋯ Using a trauma mannequin, for assessment, surgical residents completing the ATLS course demonstrated superior resuscitation skills compared with a non-ATLS group.
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Early sepsis leads to renal hypoperfusion, despite a hyperdynamic systemic circulation. It is thought that failure of local control of the renal microcirculation leads to hypoperfusion and organ dysfunction. Of the many mediators implicated in the pathogenesis of microvascular vasoconstriction, arachidonic acid metabolites are thought to be important. ⋯ This study demonstrates that sepsis leads to increased renal vascular resistance. This response is in part mediated by metabolites produced by metabolism of arachidonic acid within the kidney. The ability of drugs to modulate arachidonic acid metabolism and so alter the renal response to sepsis suggests a possible role for these agents in protecting the renal microcirculation during sepsis.
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Hemorrhagic shock produces a marked decrease in hepatic ATP, adenylate energy charge, and total adenosine nucleotides. This is followed by slow recovery to normal levels after resuscitation. Nucleotide metabolites are increased following shock and resuscitation. Previous experimental work has shown that supraphysiologic doses of insulin have salutary effects in animals with hemorrhagic shock and in cardiac patients. It appears that insulin causes increased availability of glucose and energy-producing substrates. This study examined whether resuscitation with glucose and insulin after hemorrhagic shock would alter the changes previously seen to occur in hepatic ATP levels, adenylate energy charge, or nucleotide metabolites. ⋯ Resuscitation with insulin and dextrose significantly increased hepatic ATP and adenylate energy charge after hemorrhagic shock in rats. Total nucleotide pool levels were not different between groups, indicating that there was a shift of the equilibrium away from the metabolites toward ATP and ADP in the insulin-treated group. Insulin treatment had no significant effect on blood pressure or TNF-alpha. However, it caused significant hypoglycemia and hypokalemia.