The Australian and New Zealand journal of surgery
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A retrospective review of 102 cases of hepatic trauma in the Auckland area between 1979 and 1985 is presented. Particular attention has been focused on those cases where there was massive bleeding, and the prognostic factors that govern outcome have been determined. Mechanism and multiplicity of injury, and the presence of severe hypotension (systolic blood pressure less than .80 mmHg) either at presentation or following induction of anaesthesia were the four most important determinants of prognosis. ⋯ It is concluded that the mortality of liver injury from blunt trauma far exceeds that of penetrating trauma, and that severe hypotension at the time of presentation indicates a poor prognosis. A good outcome is possible in those patients who have a significant disruption of the liver architecture of one lobe following resection of devitalized tissue. Caval or retrohepatic venous-type injuries carry a grave prognosis.
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This study is based on a 12 month prospective analysis of 598 paediatric trauma admissions, drawn principally from an urban environment. The spectrum of trauma is described, highlighting the minor nature of most injuries and the rarity of penetrating trauma. A subgroup of seriously injured children was identified and further analysed. ⋯ Of children admitted following pedal cycle accidents, 86% of the total and 91% of seriously injured children were not wearing a helmet. Of passengers in a motor car, 37% of the total number were unrestrained. The results suggest triage in children requires more than a physiological measure (TS) or MOI.(ABSTRACT TRUNCATED AT 250 WORDS)
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The effectiveness of pain control following surgery is notoriously difficult to assess, but objective assessment by nursing staff has been found to correlate reasonably well with subjective patient assessment. A study was designed to investigate the attitudes and knowledge of 86 qualified nursing staff in relation to postoperative pain management. ⋯ Additionally, almost three-quarters of staff felt that, in general, postoperative patients received adequate pain relief, while the great majority felt that prescription writing could be improved, mainly by improved legibility and clarity of actual instructions. The results suggest that the aim of postoperative pain management--that is, the provision of adequate analgesia--may need to be more strongly defined in nursing education.
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Thirty-five patients requiring tracheostomy or endotracheal intubation, following thyroidectomy are reviewed. Conditions included 30 patients with multinodular goitre, three patients with Graves's disease and two patients with carcinoma of the thyroid. Early in the series, emergency tracheostomy was performed in three patients with airway obstruction following thyroidectomy. ⋯ Emergency endoctracheal intubation was performed on one patient and prophylactic intubation was carried out in 20 patients. The morbidity and length of hospital stay in this latter group was considerably less than those requiring tracheostomy. It is concluded that patients with potential airway obstruction following thyroidectomy should have prophylactic endotracheal intubation, in preference to tracheostomy.
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Randomized Controlled Trial Comparative Study Clinical Trial
A double-blind comparison of the relative efficacy, side effects and cost of buprenorphine and morphine in patients after cardiac surgery.
The analgesic efficacy, side effects and cost of administration of regimens of intravenous buprenorphine and intravenous morphine were compared in a randomized double-blind trial performed during the first 24 h after cardiac surgery. Seven patients received buprenorphine by intermittent intravenous injection and six received morphine by continuous infusion. Both these regimens provided good analgesia for the entire 24 h period, with only mild pain at rest and moderate pain on vigorous coughing. ⋯ Buprenorphine had no narcotic code restriction and could be given by intermittent intravenous injection, whereas morphine required checking and handling as a restricted drug and administration by continuous intravenous infusion. When labour and material costs were computed, over the first 24 postoperative hours, it cost $19.76 per patient to administer morphine, but only $3.16 to administer buprenorphine. Thus the use of buprenorphine injections for the first 24 h after cardiac surgery produced pain relief and respiratory depression comparable to that produced by a morphine infusion, but with a significant cost saving in terms of labour and materials.