Surgery, gynecology & obstetrics
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Surg Gynecol Obstet · Dec 1991
Base deficit as a sensitive indicator of compensated shock and tissue oxygen utilization.
To determine the relationship of the arterial base deficit (BD) to physiologic indicators of shock and resuscitation--heart rate, mean arterial pressure (MAP), cardiac output (CO), arteriovenous oxygen difference (AVO2), mixed venous oxygen saturation (VSAT) and oxygen delivery to consumption ratio (RATIO)--16 swine were monitored invasively, bled 40 per cent of their calculated blood volume and resuscitated with crystalloid and blood. During hemorrhage, the MAP, CO, VSAT and RATIO decreased and the BD and AVO2 increased. One hour after hemorrhage, but before crystalloid infusion, the MAP, VSAT and RATIO had increased significantly from previous levels and the AVO2 had narrowed significantly, while the BD showed no significant change. ⋯ BD accurately reflected the hemodynamic and tissue perfusion changes associated with hemorrhagic shock and resuscitation in this model. BD can be used as an indicator of the severity of the shock state and the efficacy of resuscitation when invasive monitoring is impractical or not available. BD was more reflective of the true volume deficit during compensated shock than other physiologic variables in this study.
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Surg Gynecol Obstet · Nov 1991
Comparative StudyThe outcome of pregnancies complicated by bleeding during the second trimester.
Vaginal bleeding during the second trimester has historically been associated with high perinatal mortality rates (33 to 82 per cent). Because this topic has not been specifically studied since the advent of obstetric ultrasound and electronic fetal heart rate monitoring, we reviewed the experience at the University of Utah with second trimester vaginal bleeding from 1 January 1983 through 15 June 1989. The cause of the bleeding was found to fit into four general categories. ⋯ Midtrimester bleeding is still associated with a high perinatal mortality rate (22.3 per cent), being highest when associated with placental abruption (36.6 per cent) and lowest with placenta previa (7.4 per cent). For the entire series, pregnancies maintained into the third trimester were associated with a much lower perinatal mortality rate than those in which delivery occurred during the second trimester (7.1 versus 54.5 per cent). These relatively improved outcomes suggest that aggressive obstetric management is warranted in most instances.
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Surg Gynecol Obstet · Oct 1991
Comparative StudyComputed tomography in the evaluation of blunt abdominal trauma.
The role of computed tomography (CT) in the evaluation of victims of blunt abdominal trauma remains controversial. This study was done to assess the reliability of CT in the evaluation of blunt abdominal trauma at our institution, to determine if the incidence of nontherapeutic laparotomy has decreased with the use of CT scan and to review the time necessary to complete the scans. Of the 325 patients studied, 37 per cent were found to have abdominal injury on CT scan. ⋯ Excluding transport time, abdominal CT scan required 55 +/- 20 minutes to complete. Abdominal CT was accurate when read by attending physicians (97.5 per cent). Major shortcomings included the commitment of time and personnel, transfer of the patient from a critical care area and reliance on experienced interpretation.
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Of 457 patients with multisystem injuries undergoing abdominal computed tomographic (CT) scan, 26 patients were found to have 31 pneumothoraces. None of these were apparent on prior roentgenograms of the chest. Each pneumothorax was quantified by measuring its maximal width in millimeters and the number of 10 millimeter CT sections on which it appeared. ⋯ The percentage of pneumothoraces in each group with positive pressure ventilation was 55 and 77 per cent, respectively. Our results suggest that such occult pneumothoraces may be managed with close observation if they measure less than 5 X 80 millimeters, whether or not the patient is to receive positive pressure ventilation. Larger pneumothoraces and those associated with more than two rib fractures may require early treatment.
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Surg Gynecol Obstet · Aug 1991
Continuous intercostal nerve block for postoperative analgesia after surgical treatment of the upper part of the abdomen.
Continuous intercostal nerve block can be used effectively for pain relief after abdominal operations. We have developed a greatly simplified technique instituted by the surgeon at operation using bupivacaine hydrochloride (Marcain, ASTRA). ⋯ In addition, no postoperative pulmonary complications or adverse reactions to bupivacaine hydrochloride or the procedure were encountered. This method proved to be a success in postoperative pain relief and we highly recommend that it be used routinely.