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Biomedical subjects

C J McCabe

Publications and source records attributed to C J McCabe.

At least 73 records · Page 4Linked to original sources
PubMed1992

Acute traumatic disruption of the thoracic aorta: emergency department management.

STUDY OBJECTIVE: To evaluate the safety and effectiveness of temporary IV antihypertensive therapy in patients with acute traumatic thoracic aortic disruption. DESIGN: Retrospective chart review of all patients treated for proven traumatic aortic disruption during the ten-year period of 1980 through 1989. SETTING: Emergency department of a large, urban, Level I trauma center. INTERVENTIONS: Preoperative IV beta-blockade and nitroprusside after initial resuscitation in hemodynamically stable patients. RESULTS: Thirty-seven patients with angiographically proven aortic disruption were separated retrospectively into one of three groups. Group 1 (15 patients without preoperative antihypertensive therapy) had two deaths. Group 2 (15 patients treated for two to seven hours [mean, 3.8 hours] before surgery with antihypertensives) had one death. Group 3 (seven patients treated with antihypertensives for 24 hours to four months before surgery to allow recovery from associated severe injuries) had one death. There were no complications resulting from antihypertensive therapy. CONCLUSION: Temporary antihypertensive therapy appears to be safe and effective in patients with aortic disruption.

Adolescent↗
PubMed1988

Rectal necrosis after pelvic crush injury.

A case is described in which transmural necrosis of the rectum occurred following a severe pelvic crush injury in an obese man. The necrosis presumably resulted from occlusion of both internal iliac arteries, disruption of the pelvic collateral circulation, and as a result of direct rectal contusion.

Adult↗
PubMed1987

Pediatric splenic trauma: predicting the success of nonoperative therapy.

The charts of all pediatric patients discharged from the Massachusetts General Hospital with a diagnosis of a ruptured spleen were reviewed over a six-year period to determine if any factors could be used to predict which children could be managed safely without operation. Seventy-five percent of these injuries were so managed. The patients who required surgical intervention were older (mean age, 17 years), had multiple injuries (mean ISS, 41), presented with more blood loss (mean hematocrit, 23.5%), and suffered their injuries as a result of a motor vehicle accident. The patients who were successfully managed nonoperatively were younger (mean age, 12 years), had fewer associated injuries (mean ISS, 18), required fewer blood transfusions, and suffered their traumas secondary to falls, sporting events, or altercations. We propose that the injury severity score, the number of units of blood transfused, patient age, as well as the type of trauma suffered be used to predict which patients can be safely managed nonoperatively.

Abdominal Injuries↗
PubMed1987

Peritoneal lavage and the surgical resident.

Peritoneal lavages performed in 161 patients who had sustained blunt (93 per cent) and penetrating (7 per cent) trauma were prospectively studied in order to assess our indications and technique, as well as to document the accuracy and complication rate in the hands of an Advanced Trauma Life Support trained resident staff. The most common indication for the performance of a lavage was blunt trauma to the abdomen associated with an altered mental status due to injury to the head or substance abuse. The semiopen technique was used 91.0 per cent of the time with a complication rate of 0.6 per cent. The open technique was used 9 per cent of the time on patients who had undergone previous limited abdominal operations, those who were pregnant, those with dilated intestine and for those patients with evidence of portal hypertension. Aspiration of greater than 10 milliliters of gross blood, an erythrocyte count greater than 100,000 per millimeter to the third power, or a white blood cell count greater than 500 per millimeter to the third power or an elevated amylase or bilirubin level in the lavage effluent, were the criteria used for a positive result in blunt trauma. The accuracy rate was 93 per cent with eight false-positive and three false-negative examinations. The sensitivity rate was 94 per cent and the specificity rate was 93 per cent. While most reported series classify lavage results as true-positive when intraperitoneal blood is found at exploration, even if secondary to trivial injuries which do not require surgical therapy (nontherapeutic laparotomy), we believe that these should be classified as false-positive results, as was done in this study. Computerized tomographic scanning may be more useful than peritoneal lavage in the evaluation of patients with pelvic fractures or other retroperitoneal injuries which often result in false-positive lavage. Peritoneal lavage is often an inaccurate indicator of isolated intestine and diaphragmatic or retroperitoneal injury. Given its simplicity, low complication rate and accuracy, peritoneal lavage can be safely performed by surgeons in training to evaluate the victim of trauma.

Abdominal Injuries↗
PubMed1986

Esophageal obturator airway, ET tube, and pharyngeal-tracheal lumen airway.

Prior to approval of the EOA, this device had not been documented to be effective in oxygenation and ventilation in the pre-hospital arena. The studies quoted to demonstrate its usefulness were done in the very controlled environment of the operating room or of the emergency department. Indeed, the studies on blood gases obtained immediately upon entry into the emergency department would indicate that the esophageal obturator airway is an inadequate and ineffectual pre-hospital airway. The ability of the device to obstruct the esophagus, has been questioned. In a recent review of the EOA, Smith et al state that "How the EOA gained widespread popularity for use in patients requiring CPR without any evidence of its effectiveness is worthy of investigation". The Food and Drug Administration "grandfathered" the EOA as an acceptable device. This approval was to be reviewed with time, and if complications were reported, a second evaluation of the esophageal obturator airway was to be undertaken. Unfortunately, this has never occurred. We are now faced with the pharyngeal-tracheal lumen airway, which is being marketed for use in the pre-hospital area. The Food and Drug Administration approved the marketing and use of this device based on its similarity to the esophageal obturator airway. The PTL, is a device in many respects similar to the EOA. It has been tested in the operating room and the emergency department. In a study done on unsuccessfully resuscitated patients, it was as effective as an ETT. However, no study has shown that the PTL can be used successfully in the pre-hospital setting by ambulance personnel.(ABSTRACT TRUNCATED AT 250 WORDS)

Emergencies↗
PubMed1985

Fatal overwhelming postsplenectomy infection.

A total of 776 patients underwent splenectomy at the Massachusetts General Hospital between 1962 and 1972. Follow-up information was obtained on 637 patients (82 percent), including 584 adults and 53 children. There was a total of 4,837 person-years of follow-up with a mean observation interval of 8.4 years. Four cases of fatal overwhelming postsplenectomy infection were identified. In our pediatric population, the incidence of fatal overwhelming postsplenectomy infection was 3.77 percent, which was significantly higher than the incidence of 0.34 percent in our asplenic adults. Overwhelming postsplenectomy infection is a unique clinical entity distinguishable from other infections. It may occur during the lifetime of any asplenic patient and especially in those patients who have had a splenectomy in childhood. In asplenic adults, the incidence is low. The aggressive approach to splenic preservation in the adult should be tempered by these results.

Adolescent↗
PubMed1985

Comparison of sonography and plain films in evaluation of the acute abdomen.

In 95 patients with acute abdominal pain seen in the emergency ward of a large urban teaching hospital, real-time sonography was performed in conjunction with a plain film of the abdomen in order to detect what, if any, added information was provided by the sonographic examination. In 20 patients (21%) the sonogram contributed important diagnostic information not provided by the plain film of the abdomen. Most of these patients had pathology referable to the biliary tract (14 of 20). In 28 patients (30%), the sonogram confirmed the diagnosis by abdominal film. In 39 (41%) the sonogram added no relevant information, and in three (3%) it was deleterious. In five (5%) the plain film provided more information than the sonogram.

Abdomen, Acute↗
PubMed1984

Emergency intravenous access through the femoral vein.

A study was undertaken to assess the efficacy and safety of femoral venous catheterization for resuscitation of critically ill patients in the emergency department setting. From May 1982 to April 1983, 100 attempts were made at percutaneous insertion of a large-bore catheter into the femoral veins of patients presenting to our emergency department in cardiac arrest or requiring rapid fluid resuscitation. Eighty-nine attempts were successful. Insertion was generally considered easy, and flow rates were excellent. The only noted complications were four arterial punctures and one minor groin hematoma. This study suggests that short-term percutaneous catheterization of the femoral vein provides rapid, safe, and effective intravenous access.

Adolescent↗