Articles: trauma.
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Chin. J. Traumatol. · Nov 1998
The effects of mild hypothermia on patients with severe traumatic brain injury.
To investigate the protective effects of mild hypothermia (33-35 degrees C) on the outcome of patients with severe traumatic brain injury (TBI) (GCS<8). ⋯ Our clinical data have demonstrated that mild hypothermia is a useful method for management of patients with severe traumatic brain injury.
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Stimulation of the somatosensory system is more likely to evoke pain in patients with chronic pain after nervous system injury than in patients without somatosensory abnormalities. We now describe results of stimulation through a microelectrode at microampere thresholds (threshold microstimulation; TMIS) in the region of the human thalamic principal sensory nucleus (ventral caudal; Vc) during operations for treatment of movement disorders or of chronic pain. Patients were trained preoperatively to use a standard questionnaire to describe the location (projected field) and quality of sensations evoked by TMIS intraoperatively. ⋯ In both the core and the posterior-inferior regions, the proportion of sites where TMIS evoked pain was larger in pain-affected and unaffected areas than in control areas. The number of sites where thermal (warm or cold) sensations were evoked was correspondingly smaller, so that the total of pain-plus-thermal (sensation of warmth or cold) sites was the same in all areas. Therefore, sites pain where stimulation evoked pain in patients with neuropathic pain (i.e., pain following an injury to the nervous system) may correspond to sites where thermal sensations were evoked by stimulation in patients without somatosensory abnormality.
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Cerebral vasospasm is increasingly recognized as contributing to ischaemia after head injury. The reported incidence of post-traumatic vasospasm (PTV) varies between 10% and 90%, probably largely because of differences in patient selection, in definitions of vasospasm and in methods of detecting spasm. In severe head injury, based on studies with similar criteria, the incidence is approximately 40%. ⋯ There is evidence that calcium antagonists improve outcome in patients with head injury and tSAH; aminosteroids may also be effective here. Other strategies such as maintaining normocapnia and control of blood volume and pressure may also be useful. Further investigation of large cohorts is required to clarify fully the significance of PTV, its relationship with tSAH and outcome and possible treatment modalities.
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Curr Opin Anaesthesiol · Apr 1998
Fluid replacement for hypotensive injury victims: how, when and what risks?
Intravenous fluid administration is considered universally indicated for patients with post-traumatic hypotension of presumed hemorrhagic origin, regardless of the mechanism of injury, anatomic location, and whether hemostasis has been achieved. This premise is based primarily on animal studies in which blood loss results from a controlled catheter withdrawal. However, more recent hemorrhage models that incorporate a vascular injury, as well as recently completed clinical trials, have indicated that attempts to restore blood pressure before surgical hemostasis may have the undesirable effects of accentuating hemorrhage and mortality.