J Trauma
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Randomized Controlled Trial Clinical Trial
Esophageal tracheal combitube, endotracheal airway, and mask: comparison of ventilatory pressure curves.
The esophageal tracheal Combitube (ETC) is a new airway especially designed for airway maintenance and ventilation in unconscious patients such as those requiring CPR. The ETC may be used as an esophageal obturator or an endotracheal airway. Previous studies yielded a significantly higher mean arterial oxygen tension (PaO2) during ventilation using an ETC in the esophageal position compared to a conventional endotracheal airway (ETA). ⋯ The following differences in intratracheal pressure and flow could be found for ETC when compared to ETA: smaller rising pressure during inspiration, prolonged expiratory flow time, and formation of a small positive end expiratory pressure (PEEP). These factors may be responsible for the improved oxygen tension with ETC. Comparing mask to ETC ventilation, PaO2 did not differ; however, mean arterial carbon dioxide tension was higher during mask ventilation.
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The effect of pentobarbital on nitrogen and energy metabolism was evaluated in seven severely head-injured patients (Glasgow Coma Scale 4.7 +/- 1.7) within the first week postinjury. Measured energy expenditure (% of predicted) was significantly lower in the pentobarbital group (n = 4) versus control (n = 3) (76 +/- 23% versus 132 +/- 28%, respectively, p less than 0.01). Similarly, 24-hour urinary nitrogen excretion was lower for the barbiturate group compared to control (11.2 +/- 4.0 gm versus 19.5 +/- 3.3 gm, respectively, p less than 0.01). ⋯ S.). Barbiturate therapy decreases measured energy expenditure and reduces nitrogen excretion without significantly altering 3-methylhistidine excretion in head-injured patients. The metabolic effects of pentobarbital may enable the ability to achieve energy and nitrogen equilibrium during metabolic support of acutely head-injured patients.
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This study examined the characteristics of pain experienced by burned patients. Sources of inter-individual variations were also studied and the interrelationships between anxiety, depression, and pain were investigated. Forty-two adult patients hospitalized for burn injuries participated in the study. ⋯ The extent of the burns was a significant predictor of pain but only in the first week after the injury. High levels of anxiety or depression were not necessarily associated with higher pain scores during therapeutic procedures but the patients who were more anxious or depressed tended to report more pain when at rest. These results are discussed in relation to pain management strategies, with particular emphasis on the need for the analgesic therapy to be highly individualized and frequently adjusted.
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Case Reports
In extremis use of staples for cardiorrhaphy in penetrating cardiac trauma: case report.
Patients in extremis following penetrating cardiac injury must be rapidly and effectively resuscitated. Treatment priorities are relief of tamponade with control of hemorrhage. Rapid closure of cardiac wounds is necessary to achieve hemostasis and preservation of cardiac function. A simple and rapid technique of emergency cardiorrhaphy is described utilizing the skin stapling device.
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Presented is a case report of a multiple trauma patient whose post-traumatic course was complicated by neuroleptic malignant syndrome triggered by therapeutic haloperidol treatments. Once the syndrome was recognized and treated, a dramatic recovery was achieved.