Journal of the American College of Surgeons
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Recent studies have challenged current guidelines for prehospital fluid resuscitation. However, long-term studies evaluating the consequences of fluid restriction in uncontrolled hemorrhagic shock are lacking. This study was done to examine the long-term effects of deliberate hypotension in the treatment of uncontrolled hemorrhage. ⋯ Attempts to achieve normal MAP during uncontrolled bleeding increased blood loss, hemodilution and mortality. Hypotensive resuscitation resulted in less acidemia and improved long-term survival.
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This study was done to determine the safety and success of orotracheal intubation with planned neuromuscular blockade in patients who are severely injured. The study was performed at Carle Foundation Hospital, designated Level I trauma center located in east central Illinois. ⋯ Orotracheal intubation with planned neuromuscular blockade and in-line cervical traction is a safe, effective method for airway control in patients who are severely injured. This technique is also indicated to expedite therapy in combative, uncooperative patients because of the high incidence of significant life-threatening injuries to the brain and other organs.
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Optimal management of patients with Zone II penetrating neck trauma for vascular injury remains controversial. Retrospective studies have demonstrated that physical examination alone may be as accurate as arteriography in detecting significant cervical vascular injuries requiring operative repair. This study was undertaken to evaluate prospectively the safety and accuracy of physical examination in determining the management of patients with penetrating Zone II neck trauma. ⋯ Patients with Zone II penetrating neck injuries and no definite signs of vascular injury can be safely and accurately managed on the basis of physical examination alone. Arteriography or ultrasonography are not needed to identify vascular injuries.
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Comparative Study
Improved ventilatory function in burn patients using volumetric diffusive respiration.
Volumetric diffusive respiration (VDR) offers theoretical advantages over conventional mechanical ventilation (CV) by using lower airway pressures, recruiting alveoli, and mobilizing secretions. ⋯ The VDR ventilator is more effective than conventional ventilation for maintaining optimal gas exchange at lower airway pressures in thermally injured pediatric patients.
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After the successful evolution of hepatic transplantation during the last decade, small bowel and multivisceral transplantation remains the sole elusive achievement for the next era of transplant surgeons. Until recently, and for the last thirty years, the results of the sporadic attempts of intestinal transplantation worldwide were discouraging because of unsatisfactory graft and patient survival. The experimental and clinical demonstration of the superior therapeutic efficacy of FK 506, a new immunosuppressive drug, ushered in the current era of small bowel and multivisceral transplantation with initial promising results. ⋯ Although intestinal transplantation has gone through the feasibility phase, strategies will be required to increase its practicality. One possibility is to combine intestinal transplantation with contemporaneous autologous bone marrow transplantation.