J Trauma
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Case Reports
Thoracic aortic dissection with renal artery involvement following blunt thoracic trauma: case report.
Blunt thoracic aortic injury most often occurs beyond the left subclavian artery with subsequent transection and exsanguination. We present a case of an unrestrained driver involved in a high-speed motor vehicle crash who had a traumatic mid-thoracic aortic dissection involving the orifices of both renal arteries, resulting in anuria. This diagnosis should be considered in the presence of anuria following chest trauma.
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Splanchnic ischemia, leading to intestinal mucosal damage, is thought to be common in patients after severe trauma. The adequacy of mucosal oxygenation can indirectly be determined by gastric intramucosal pH (pHi) measurement. We prospectively examined the posttraumatic gastric pHi values in 15 multiple trauma patients. ⋯ Although intestinal ischemia was expected to be a common condition in multiple trauma patients, no consistent pattern of abnormal pHi measurements in the direct posttraumatic course could be discovered. No correlation was found between initial pHi values (at 6 hours) and ISS, shock, and lactic acidosis or APACHE II scores on admission. It is concluded that monitoring gastric pHi is useful in severely injured patients admitted to the ICU.
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Comparative Study
Blood transfusions: for the thermally injured or for the doctor?
Because of the inherent risks of blood transfusions, including the transmission of viral and other infectious diseases, it is important to re-evaluate blood transfusion policies. ⋯ Routinely transfused patients, on average, received over 5 units more blood than the selective group without any apparent clinical benefit. Thus, the results of this pilot study support a policy of selective blood transfusions in burn patients.
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Recent years have seen a renewed interest in the use of hypertonic-hyperoncotic solutions as plasma volume expanders for the treatment of hemorrhagic hypotension. In particular, a number of studies in experimental animals have addressed the efficacy and safety of small-volume infusions of 7.5% NaCl/6% dextran 70 (HSD). ⋯ In the few human field trials completed to date, HSD has been shown to be potentially beneficial in hypotensive trauma patients who require surgery or have concomitant head injury. Extensive toxicologic evaluations and lack of reports of adverse effects in the human trials indicate that, at the proposed therapeutic dose of 4 mL/kg, HSD should present little risk.