J Trauma
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Comparative Study
Early resuscitation with low-volume PolyDCLHb is effective in the treatment of shock induced by penetrating vascular injury.
To study the efficacy of an oxygen-carrying solution in early resuscitation of hemorrhagic shock induced by penetrating vascular injury. ⋯ Early resuscitation with low-volume hemoglobin is effective in restoring tissue perfusion and improving survival in uncontrolled hemorrhagic shock.
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The inability to normalize lactate predicts death after trauma, but lactate may not be immediately available in every center. We postulated that, in a normal acid-base environment, lactate would correlate with the anion gap and the base excess of an arterial blood gas. ⋯ There is no correlation between lactate, base excess, and anion gap after initial resuscitation. Neither anion gap nor base excess was capable of predicting lactate; therefore, lactate must be directly measured. The lack of correlation of anion gap with base excess or lactate suggests the presence of unmeasured anions, an impairment in acid-base regulation after injury and resuscitation, or both.
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Case Reports
Introduction of a new tracheostomy exchange device after percutaneous tracheostomy in a patient with coagulopathy.
Presented is a case of a 22-year-old male bone marrow transplant recipient who developed severe methotrexate-induced oropharyngeal mucositis and respiratory insufficiency caused by sepsis. Coagulopathy and severe thrombocytopenia precluded surgical tracheostomy; however, dilatational percutaneous tracheostomy was performed uneventfully. The tracheostomy tube was later changed using a newly developed exchange device permitting intraprocedural oxygenation and stomal redilatation. We conclude that severe thrombocytopenia and coagulopathy are not an absolute contraindication for percutaneous tracheostomy and that the new tracheostomy exchange device optimizes airway management and safety during this procedure.
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A series of 168 civilian cases of tangential gunshot wounds to the head is presented. Neurologic deficits on presentation were generally minimal. ⋯ Serious sequelae of tangential injuries are described even with patients who initially have no neurologic abnormality. We suggest that a CT scan is warranted in all cases of tangential gunshot wounds to the head.