J Trauma
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Comparative Study
Effect of small-volume resuscitation on intracranial pressure and related cerebral variables.
Head injury outcome is adversely affected by the presence of hypotension. Therapies directed at rapidly correcting hypotension may improve outcome. ⋯ Small-volume resuscitation with hypertonic saline and dextran and diaspirin cross-linked hemoglobin significantly improved mean arterial pressure and cerebral perfusion pressure compared with Ringer's lactate. These data suggest that small-volume resuscitation with hypertonic saline and dextran or diaspirin cross-linked hemoglobin may effectively limit or prevent secondary ischemic brain injury after head injury and shock.
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The use of surgical cricothyrotomy (SC) in the prehospital setting is controversial, and the need to teach this procedure to paramedics and intermediate emergency medical technicians remains unclear. The purpose of this study is to define the efficacy, complication rate, and overall survival after SC performed in the prehospital setting. ⋯ (1) Prehospital SC can be performed effectively with few complications after training on animal models (2) Good neurologic outcome is rare after the use of this procedure. (3) Although it is effective, clear indications must be developed and followed for the prehospital use of SC.
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Considerable skepticism still exists about the role of diagnostic laparoscopy in the evaluation of penetrating abdominal trauma. The reported experience with therapeutic laparoscopy has been limited. ⋯ Laparoscopy has an important diagnostic role in stable patients with penetrating abdominal trauma. In carefully selected patients, therapeutic laparoscopy is practical, feasible, and offers all the advantages of minimally invasive surgery.
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Fetal mortality after trauma is significant. This study was aimed at identifying factors responsible for this high fetal mortality. ⋯ Apart from ISS, blood loss, and abruptio placentae; the presence of DIC was the most significant predictor of fetal mortality. This finding may represent stimulation of DIC by placental products entering the maternal circulation after significant intrauterine injury.
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Multiple organ failure is regarded to be the major complication of trauma victims treated in the intensive care unit. Long-term rehabilitation results of this special group of patients have not been analyzed so far. ⋯ Patients with multiple injuries, who survived multiple organ failure during their long-term intensive care treatment, show an excellent functional and occupational rehabilitation result. They show no major sequelae in their organ function even years after the trauma. Although often these patients suffer from permanent central or peripheral paralysis and decreased range of motion, this finding does not correlate with the patients' ability to return to work.