Surgery, gynecology & obstetrics
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We reviewed retrospectively 233 consecutive patients with retroperitoneal hematoma (RPH) resulting from blunt trauma. This study group represented 2.9 per cent of all admissions for blunt trauma and 13 per cent of all admissions for blunt abdominal trauma. Motor vehicle accidents predominated as the cause of injury. ⋯ Patients with zone III RPH associated with fractures of the pelvis should be explored only rarely--when main iliac vascular injury is suspected (4.6 per cent in this series). Otherwise, a systematic approach using external fixator devices and angiographic embolization should be used. The over-all morbidity and mortality rates of 59 and 39 per cent, respectively, emphasize the need for aggressive resuscitation, rapid control of hemorrhage and a multidisciplinary approach to the management of these patients.
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Surg Gynecol Obstet · Apr 1992
Traumatic brain injury attenuates the effectiveness of lactated Ringer's solution resuscitation of hemorrhagic shock in rats.
Traumatic brain injury suppresses spontaneous cardiovascular compensation for hemorrhage, prompting us to examine the possibility that trauma to the brain modifies hemodynamic response to therapy in hemorrhage. Thirty rats that were anesthetized were randomly assigned to four groups--hemorrhagic shock (H), hemorrhagic shock after brain trauma (TH), hemorrhagic shock treated with lactated Ringer's (LR) solution (HR), and hemorrhagic shock after brain trauma treated with LR (THR). After hemorrhage, group TH had significantly lower mean arterial pressure (MAP), cardiac index (CI) and stroke volume index (SVI) than group H. ⋯ Furthermore, neither brain trauma nor fluid replacement altered the content of water in the brain in hemorrhaged rats. These data indicate that brain trauma not only suppresses spontaneous hemodynamic recovery from hemorrhage, but also impedes the efficacy of LR resuscitation. The results of the current study suggested that a more aggressive fluid replacement may be needed to treat hemorrhagic shock in individuals with brain injury.