Surgery, gynecology & obstetrics
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Ninety-four consecutive elderly patients with blunt trauma injuries were studied to determine what impact advanced age had on patient outcome. The current study included patients ranging from 65 to 100 years of age who were admitted to our service from July 1986 to December 1988. Follow-up evaluation was conducted on all patients one to three years after the patient was discharged from the hospital. ⋯ Twelve of the 22 patients who required institutional care after discharge from the hospital were eventually able to return home. A prolonged stay in intensive care was not associated with an unfavorable long term outlook. This high hospital survival rate (87 percent) and percentage of patients living independently at home after hospitalization (87 percent) suggests that the expenditure of extensive resources for the care of the elderly trauma patient is worthwhile.
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Surg Gynecol Obstet · May 1993
The failure of conventional methods to promote spontaneous transpyloric feeding tube passage and the safety of intragastric feeding in the critically ill ventilated patient.
Nasoenteral tube feedings are often recommended in critically ill patients when gastrointestinal tract function is intact. Conventional methods of placement include turning the patient on the right side and the use of drugs that stimulate peristalsis to promote transpyloric passage. A prospective study was initially performed to assess the success of conventional methods used to promote transpyloric feeding tube placement in patients requiring assisted ventilation admitted to the Surgical Intensive Care Unit (SICU) (Part I of the study). ⋯ The presence of complications was not related to age, gender, admitting diagnosis, infusion method or type of formula used. Duodenal intubation using conventional methods in critically ill ventilated patients is unsuccessful in most patients. Nasogastric feeding in this group of patients can be safely administered in selected instances.
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Surg Gynecol Obstet · May 1993
Randomized Controlled Trial Comparative Study Clinical TrialKetorolac and patient controlled analgesia in the treatment of postoperative pain.
Ketorolac tromethamine (Toradol [Syntex, Palo Alto]), a new commercially available nonsteroidal antiinflammatory drug (NSAID), has appropriate solubility and minimal tissue irritation, making it suitable for intramuscular injection. Previously, NSAID have only been available for oral use in the United States for the treatment of pain. Ketorolac, the most potent NSAID known, relieves pain through inhibition of arachidonic acid synthesis at the cyclooxygenase level and has no central opioid effects. ⋯ However, narcotic requirements of the patients were decreased by an average of 45 percent. Ketorolac and narcotics in combination provide effective postoperative pain relief and significantly decrease narcotic requirements. This combination may be particularly beneficial in the subpopulation of patients especially prone to narcotic related complications.
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Surg Gynecol Obstet · May 1993
Comparative StudyThe use of oximetry in determining intestinal blood flow.
The intraoperative evaluation of intestinal ischemia and viability is often subjective and unreliable. The results of recent reports of pulse and surface oximetry have suggested that these techniques may be useful in assessing intestinal blood flow. In the current study, we evaluated and compared the ability of intestinal tissue oxygen saturation (as measured by pulse oximetry) and intestinal surface oxygen tension (as measured by surface oximetry) to determine the actual intestinal tissue blood flow (as measured with a radiolabeled microsphere technique). ⋯ Intestinal surface oxygen tension decreased more steeply, from a basal value of 97 +/- 1 to 80 +/- 6 (p < 0.05) and then to 64 +/- 7 millimeters of mercury (p < 0.05) with the same two reductions in tissue blood flow. Both techniques were capable of estimating tissue blood flow, but pulse oximetry was quicker and simpler to use. We conclude that the pulse oximeter has the potential to be of value in the intraoperative assessment of intestinal blood flow.
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Surg Gynecol Obstet · Apr 1993
Ritual head computed tomography may unnecessarily delay lifesaving trauma care.
Examination of 462 consecutive patients with blunt trauma suggested reassessment of the timing of head computed tomographic (CT) scanning in the critical care of the seriously injured. Even though potential brain injury was the most common reason for admission, few (5 percent) of the patients required neurosurgical intervention. It is apparent that the more common non-neurosurgical procedures that were used to squelch hemorrhage and provide hemodynamic stability and airway control should not be delayed to obtain "routine" head CT scans.