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Biomedical subjects

D D Trunkey

Publications and source records attributed to D D Trunkey.

At least 127 records · Page 7Linked to original sources
PubMed1980

A simple method of predicting severe sepsis in burn patients.

Twenty-six patients with major thermal injury were studied with sequential tests of immunocompetence. Five to 8 days after burn, 12 of 26 patients developed a marked depression in the phytohemagglutinin response (17 +/- 8 percent of baseline) and an increase in suppression of the normal mixed leukocyte response (70 +/- 13 percent suppression), which was followed by severe life-threatening sepsis 4 to 5 days later. Concomitant with this marked immunosuppression, the 12 patients developed red debris in the normally white mononuclear layer of the Ficoll-Hypaque density centrifugation gradients used to separate mononuclear cells. None of the 14 patients with minimal or no sepsis developed red debris in Ficoll-Hypaque gradients, nor did they show signs of immune depression by phytohemagglutinin or mixed leukocyte response assays. The only patients in the severe sepsis group who survived were those given aminoglycosides at the time red debris was observed on the Ficoll-Hypaque gradients. The presence of red debris on Ficoll-Hypaque separation appears to be a simple and reliable predictor of impending sepsis, which allows the use of antibiotics before the clinical onset of sepsis.

Adult↗
PubMed1980

Neurologic outcome after emergency room thoracotomy for trauma.

The charts of 168 patients undergoing resuscitative thoracotomy for trauma in the emergency room at the San Francisco General Hospital from 1972 through 1978 were reviewed to assess factors affecting neurologic recovery after cardiac arrest. Forty-nine patients survived resuscitation and definitive operation, but 8 of them died in the first 24 hours postoperatively. Four patients in this group made some neurologic recovery (two good recoveries, two severe disabilities) but died later (12 to 44 days postoperatively) of septic complications. Thirteen nonsurvivors made no neurologic recovery before death. There were 33 long-term survivors (19.6 percent), 10 of whom were agonal or had no vital signs when first admitted to the emergency room. A persistent vegetative state developed in two patients who later died of sepsis (10 days and 14 months postoperatively). The remaining 32 patients all made good neurologic recovery that was apparent within 12 hours postoperatively. Transient amnesia was present during recovery in three patients. Wakefulness was the best prognostic sign of full neurologic recovery. In conclusion, emergency room thoracotomy can save a substantial number of moribund trauma patients who can be expected to sustain full neurologic recovery if they awaken within 12 hours.

Adolescent↗
PubMed1980

Epidemiology of trauma deaths.

The records of all 437 persons who died from trauma in San Francisco in 1977 were examined. Sixty-five percent of the sample (285 younger than 50 years, and 119 were between ages 21 and 30. Gunshot wounds (140 or 32 percent) and falls (122 or 28 percent) were the most common causes of injury. Fifty-three percent of the sample were dead at the scene of injury before transport could be accomplished, 7.5 percent died in the emergency room, and 39.5 percent died in the hospital. Fifty-five percent of the 359 patients who died within the first 2 days died from brain injury, while 78 percent of the 55 late deaths were due to sepsis and multiple organ failure. In 10 cases (2 percent), death was due to delayed transport or to errors in diagnosis and treatment and was deemed preventable. The key areas in which advances are necessary in order to reduce the number of trauma deaths are prevention of trauma, more rapid and skilled transport of injured victims, better early management of primary brain injuries, and more effective treatment of the late complications of sepsis and multiple organ failure.

Adolescent↗
PubMed1980

Chest trauma.

Explore the source record for details and available documents.

Airway Obstruction↗
PubMed1980

The role of emergency room thoracotomy in trauma.

The charts of 175 patients who underwent emergency thoracotomy (ET) in the emergency room (ER) between 1972 and 1978 were reviewed to determine the efficacy of this procedure. Seven cases of nontraumatic cardiac arrest were excluded from analysis. Although 150 patients were transported to the ER within 1 hour of injury, 60% either had no vital signs (91 cases) or were agonal (20 cases) on admission to the ER. The trauma was blunt in 60 cases and penetrating in 108. The major sites of injury were heart, major vessels, head, liver, and lung. Thirty-six patients died in the ER, 83 died in the operating room, and eight of the remaining 49 patients who survived operation died acutely in the immediate postoperative period. Of the patients who survived beyond 24 hours after injury 80% recovered and left the hospital: overall 19.6% survived. If patients with irreversible head injuries are eliminated, 24% survived. Correlation of admission status with outcome revealed the following survival rates: no vital signs (6.6%); agonal (20%); profound shock (34.1%); and mild shock with subsequent deterioration (56.3%). Survival rates were higher for patients with stab wounds (40%), pericardial tamponade (38%), and injury to the heart (30%), or lungs (57%). A cost-benefit analysis revealed that total benefits were 2.4 times greater than total costs. Performing early thoracotomy in the ER is a life-saving measure for a substantial number of trauma patients who present to the ER in extremis.

Adolescent↗
PubMed1980

Autopsy of a disaster: the Martinez bus accident.

On 21 May 1975 a chartered bus carrying 51 members of a student choir rolled from a sharply curved freeway off-ramp and fell 22 feet, landing on its roof, which collapsed. Twenty-nine passengers died (25 before extrication) and 22, plus the driver, survived. An analysis of factors leading up to the accident reveals several contributing causes, among them inadequate design of the ramp, poor warning signs, driver inexperience with the bus, and deficient bus maintenance. Bus design itself contributed to the lethality of the event. Structural support for the roof was inadequate and no access was available to the interior for extrication of victims. Problems with organization at the scene, triage, and communications among agencies involved in the rescue and receiving hospitals contributed to confusion in the transport of victims, although it appears this had little impact on outcome. An analysis of the accident allows several lessons to be learned which might prevent, or reduce, the fatalities from future accidents involving multipassenger vehicles, and other disasters with 10 to 25, or more than 25 fatalities. In the present report ten of 25 killed were judged possibly salvageable with immediate extrication.

Accidents, Traffic↗
PubMed1979

Systems of trauma care. A study of two counties.

Cases of motor vehicle trauma victims who died after arrival at a hospital were evaluated in both Orange County (90 cases) and in San Francisco County (92 cases), Calif. All victims in San Francisco County were brought to a single trauma center, while in Orange County they were transported to the closest receiving hospital. Approximately two thirds of the non-CNS-related deaths and one third of the CNS-related deaths in Orange County were judged by the authors as potentially preventable; only one death in San Francisco County was so judged. Trauma victims in Orange County were younger on the average, and the magnitude of their injuries was less than for victims in the San Francisco County. We suggest that survival rates for major trauma can be improved by an organized system of trauma care that includes the resources of a trauma center.

Accidents, Traffic↗
PubMed1979

Predicting fatal sepsis in burn patients.

The high morbidity after severe thermal insult is believed to be related partially to a resultant decrease in immunocompetence. We tested the ability of phytohemagglutinin (PHA) and Concanavalin (Con A) to stimulate lymphocyte transformation in 17 patients with moderate to severe thermal injury (greater than 25% BSA). The patients acted as their own controls and the per cent change in their mitogen response was measured over time. Eight acutely burned patients who subsequently developed severe sepsis (Group I) had decreased ability (mean, 12% of normal) to proliferate in response to PHA, and six of these died of severe sepsis. The depressed response appeared 4 to 7 days postinjury and predated clinical evidence of sepsis by 2 to 4 days. Cells from four patients who had mild infectious complications (Group II) demonstrated greatly augmented mitogen responses (mean + 243%) approximately 7 to 10 days postinjury. Five burn patients whose clinical course was sepsis free (Group III) exhibited only minimal changes in their mitogen responses (mean +30%). Although the Con A responses of the patients' cells corresponded less to their pathology, Group I patients whose cells exhibited depressed PHA responsiveness also had diminished Con A responses. Group II patients' cells also showed increases in Con A-induced stimulation. Group III patients, who had only slightly augmented PHA responses, had minimal decreases of the Con A-induced lymphocyte transformation. Many severely burned patients develop septicemia as a result of their large wound surfaces. The appearance of decreases in mitogen-induced proliferation, however, appears to characterize those patients who will be unable to handle the septic challenge.

Adult↗
PubMed1979

The effect of septic shock on skeletal muscle action potentials in the primate.

Techniques developed for the in vivo study of cellular physiology have been applied to septic shock in primates. Measurements of skeletal muscle transmembrane resting and action potentials were correlated with an analysis of fluid and electrolyte changes in the intracellular and extracellular compartments of skeletal muscle. The data obtained indicated a marked depletion of muscle extracellular water and an increase in intracellular sodium chloride and water content during shock. The significant decrease of resting membrane potential was associated with a decrease in amplitude of the action potential and prolongation of both the repolarization and depolarization time. In addition, there was a decrease of muscle intracellular potassium concentration during shock. This study demonstrates that the alterations in cellular membranes in hemorrhagic shock and septic shock are similar.

Action Potentials↗