J Trauma
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Comparative Study
Effects of increasing airway pressure and PEEP on the assessment of cardiac preload.
Cardiac preload is most commonly assessed by pulmonary artery wedge pressure. It was postulated that the right ventricular end-diastolic volume index (RVEDVI) derived by thermodilution would be a better predictor of preload in trauma patients with high airway pressures associated with positive pressure ventilation and positive end-expiratory pressure. ⋯ Unlike the pulmonary artery wedge pressure, RVEDVI is as reliable indicator of preload in the mechanically ventilated trauma patient. This is especially true when the right ventricular ejection fraction is not severely depressed.
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Pedestrian injury accounts for approximately 14% of all vehicular-associated mortality. We performed a retrospective review of 1,014 injured pedestrians admitted to our statewide trauma center between January 1, 1990, and December 31, 1994, to determine the pattern and severity of pelvic injury in injured pedestrians, the types of associated injuries relative to those pelvic injury patterns, and the relationship between pelvic fracture treatment modalities and patient outcome. ⋯ In conclusion, pelvic fracture appears to be a substantial factor in pedestrian morbidity and mortality. Although most pedestrian morbidity and mortality is not caused by the intrinsic nature of the pelvic fracture, the severity of these injuries is correlated with the degree of destructive energy imparted to the body as a whole, as manifested by the number and severity of associated injuries and the mortality rate.
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Although clavicular fractures are common, nonunion of the clavicle is a rare complication. However, it can be disabling, presenting mainly with pain, limitation of shoulder movement, and/or compression of the brachial plexus. The technical difficulty in securing adequate skeletal stabilization and the unique anatomic features of the clavicle pose a challenge for the orthopedic surgeon. ⋯ Plating and bone grafting of the clavicle is an effective method of management of painful nonunion, and it has minimal complications.
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We hypothesized that improvements in cellular immune function after hypertonic saline (HTS) resuscitation will alter the outcome of sepsis after hemorrhage. ⋯ HTS resuscitation leads to increased survival after hemorrhage and CLP. Marked improvements were observed in lung and liver injury compared with isotonic resuscitation. The better containment of the infection observed with HTS resuscitation corresponds to a marked decreased in bacteremia. HTS resuscitation stands as an alternative resuscitation regimen with immunomodulatory potential.
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To study myocardial oxygen balance during fluid resuscitation for uncontrolled hemorrhage. ⋯ For uncontrolled hemorrhage at initial bleeding rates of 100 mL/min or more, the time interval from injury to cardiac oxygen deficit is inversely related to the infusion rate. A detailed study of the myocardial oxygen balance provides a pathophysiologic rationale for fluid restriction in the initial management of uncontrolled hemorrhage.