J Trauma
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The effects of blood alcohol on injury after crash are controversial, and safe limits are not settled. We examined if a positive blood alcohol concentration, even in a nontoxic range, affects management and outcome of injured patients after road crashes. ⋯ In injured patients after a road crash, a positive blood alcohol concentration increases the chance that the final diagnosis will include more injuries than initially documented. More careful monitoring is needed in alcohol-positive trauma patients, independent of clinical status, injury severity, and overt symptoms of alcohol intoxication.
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In previous studies, mild hypothermia (34 degrees C) during uncontrolled hemorrhagic shock (HS) increased survival. Hypothermia also increased mean arterial pressure (MAP), which may have contributed to its beneficial effect. We hypothesized that hypothermia would improve survival in a pressure-controlled HS model and that prolonged hypothermia would further improve survival. ⋯ Brief hypothermia had physiologic benefit and a trend toward improved survival. Prolonged mild hypothermia significantly increased survival after severe HS even with controlled MAP. Extending the duration of hypothermia beyond the acute phases of shock and resuscitation may be needed to ensure improved outcome after prolonged HS.
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Published contraindications to nonoperative management (NOM) of blunt splenic injury (BSI) include age > or = 55, Glasgow Coma Scale score < or = 13, admission blood pressure < 100 mm Hg, major (grades 3-5) injuries, and large amounts of hemoperitoneum. Recently reported NOM rates approximate 60%, with failure rates of 10% to 15%. This study evaluated our failures of NOM for BSI relative to these clinical factors. ⋯ Inclusion of all high-risk patients increased the NOM rate while maintaining a low failure rate. Although age > or = 55 and major BSI were independently associated with failure of NOM, approximately 80% of these high-risk patients were successfully managed nonoperatively. There was no increased mortality associated with failure. Although these factors may indeed predict failure, they do not necessarily contraindicate NOM.