J Trauma
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Comparative Study
Resuscitation from hypovolemia in swine with intraosseous infusion of a saturated salt-dextran solution.
Prehospital fluid resuscitation of traumatic injury is limited by difficulty in delivering large volumes of fluid in the field and time delays associated with gaining vascular access. We addressed these limitations in 14 anesthetized swine by evaluating a highly efficient volume expander, a near-saturated salt-dextran solution (SSD) administered through a new device, which gains vascular access via intraosseous (IO) infusion into the sternal bone marrow. After a steady-state baseline was achieved, all animals were hemorrhaged to 45 mm Hg for one hour. ⋯ In addition, cardiac output was better sustained after 2 hours with SSD than with NS. No deleterious effects of IO infusion of SSD were observed. From the improvement in cardiovascular variables and the lack of significant sternal or pulmonary pathologic perturbations, these data suggest that IO infusion of SSD can effectively treat hypovolemia and may allow field treatment when logistic considerations make conventional resuscitation impractical.
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Burn injury produces acute gastrointestinal (GI) derangements that may predispose the burn victim to bacterial translocation (BT). We studied the effects of heparin on gastrointestinal (GI) anatomic alterations and BT after 25% and 32% total body surface area (TBSA), full-thickness murine burn injuries. Heparin (100 U/kg) was administered with 1 mL of normal saline (NS) resuscitation solution immediately postburn and 4 hours and 18 hours postburn in volumes of 0.5 mL NS. ⋯ After 32% TBSA burn injuries, BT was also decreased in heparin-treated animals (64.3% vs. 31.6%; p < 0.025). Analysis of mixed venous blood gases showed that heparin did not affect the severe metabolic acidosis that follows burn injury in this animal model, indicating that general tissue perfusion was not improved. Heparin administered in the acute postburn period ameliorates GI structural and functional damage in this murine burn model and decreases BT.
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The American College of Surgeons' (ACS) Committee on Trauma recommends drug and alcohol screening as "essential" for level I and II or "desirable" for level III trauma centers. ⋯ Despite available resources and repeated ACS recommendations, measurements of BACs and drug screens are routine in only 63.7% of level I and 40.0% of level II trauma centers.
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Review Case Reports
Unreduced dislocation of the elbow: case report and review of the literature.
A case report of an unreduced dislocation of the elbow requiring late open reduction is presented, and the literature is reviewed. Early reduction of elbow dislocation, by closed or open means, is of paramount importance if good functional results are to be obtained. Closed reduction of an elbow dislocation is unlikely to be successful if attempted later than 21 days after the injury. The results are acceptable if open reduction is undertaken within 3 months of the injury, but after 6 months the results are disappointing and arthroplasty is an alternative.