J Trauma
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Randomized Controlled Trial Comparative Study Clinical Trial
Hypertonic saline fluid therapy following surgery: a prospective study.
Successful resuscitation of the injured may be achieved more rapidly and with less fluid using hypertonic crystalloid solutions than with isotonic solutions. This randomized, double-blind study compared 0.9% normal saline (NS) to 1.8% hypertonic saline (HS) in 20 postoperative coronary artery bypass patients suffering uniform injury. Study solutions were administered to maintain physiologic endpoints: heart rate, blood pressure, and pulmonary capillary wedge pressure. ⋯ No deaths occurred and no complication was attributed the hypertonicity of the solution. We conclude that 1.8% hypertonic saline is a safe alternative to isotonic crystalloid therapy in the fluid management of postoperative patients. Decreased third-space losses may occur with HS as suggested by the lower thoracic losses in the HS group; 1.8% NaCl may be the preferred solution in situations where excess free water administration is not desired, and where interstitial edema is detrimental to function and/or survival.
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The authors report the case of a patient presenting with an acute extradural hematoma and diffuse axonal injury. Control CT scan performed 4 hours later showed the complete resolution of the extradural collection together with increased evidence of shearing injuries. The mechanism of the hematoma resolution may probably be related to the concomitant acute brain swelling.
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A subluxation of an unstable cervical spine injury occurring during swimmer's positioning is described. Based on this experience, it is recommended that the initial radiographs be obtained and reviewed without traction or swimmer's positioning. With clinical or radiographic evidence of cervical injury, bilateral oblique views, plain lateral tomography, or computerized axial tomography may be required to evaluate the C7-T1 junction.
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Rapid fluid administration is the cornerstone of successful trauma resuscitation. Percutaneous insertion of catheter introducers has gained wide acceptance as a quick and reliable means of rapid intravascular volume expansion. Factors that affect rapid fluid resuscitation with these devices include catheter introducer kinking, the type and temperature of infusate, and diameter of co-apted administration tubing. ⋯ Piggybacking blood into an existing IV line instead of infusing it directly into the catheter can decrease blood flow 94% (340 cc/min vs. 20 cc/min). It is concluded that a large-bore catheter, by itself, does not guarantee high flow rates. Physician recognition of these concepts can result in improved resuscitation of hypovolemic patients.
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From 1975 to 1987, 19 patients (pts) were operated on for a traumatic lesion of the heart or of the ascending aorta. There were 15 males and four females with a mean age of 42 years. Twelve lesions (Group I) were penetrating and seven (Group II) blunt. ⋯ Intrapericardial lesions are relatively rare in our Canadian experience. High survival can be obtained in penetrating injuries, while blunt injuries are more complex and remain highly lethal. ECC should be available for definitive treatment.