Advances in surgery
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Advances in surgery · Jan 2012
ReviewUse of computed tomography in the emergency room to evaluate blunt cerebrovascular injury.
BCVI remains a potentially devastating consequence of blunt-force trauma. However, over the past decades significant advances have been made in understanding the pathophysiology, risk factors, and natural history of BCVI. Given the initial asymptomatic period, there is time to diagnose and treat these lesions before the onset of neurologic insult. ⋯ In addition, given the high specificity of CTA and the decreased morbidity of BCVI with rapid institution of treatment, the authors recommend beginning a low-dose heparin drip (if there are no contraindications to anticoagulation) based on CTA findings while awaiting the confirmatory DSA. Despite advances in CTA technology in recent years, DSA currently remains the gold standard for the diagnosis of BCVI. All patients with standard risk factors for BCVI, or abnormal findings on CTA, should undergo DSA as the screening test of choice for BCVI.
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Advances in surgery · Jan 2012
ReviewHypertonic resuscitation after severe injury: is it of benefit?
There is a wealth of preclinical data suggesting potential benefit from the administration of hypertonic solutions after severe injury with hypovolemic shock, including improved tissue perfusion, improved flow through the microcirculation, and modulation of the inflammatory response, which may mitigate subsequent organ failure. However, despite these potential advantages, clinical trials of hypertonic resuscitation early after injury have failed to demonstrate significant benefit for resuscitation of hemorrhagic shock, and although there is no difference in overall mortality, there appears to be a trend toward earlier mortality among those receiving hypertonic fluids. ⋯ Further study is warranted in this patient population, as a longer period of hypertonicity may be required to show a clinical effect. Assessment of long-term neurologic outcome in this patient population remains the gold standard in determining benefit.