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Biomedical subjects

D D Trunkey

Publications and source records attributed to D D Trunkey.

At least 145 records · Page 8Linked to original sources
PubMed1978

Myocardial depression in acute thermal injury.

Previous studies have shown myocardial depression to occur secondary to toxic extracts of burned mouse and human skin and secondary to toxins present in acute human burn serum. The present report describes myocardial depression in an arterially perfused rabbit interventricular septum as a result of toxins present in acute burn plasma. New Zealand white rabbits subjected to a 25% BSA full-thickness burn were heparinized and exsanguinated 2 hours postinjury. Cellular elements and plasma were separated and the plasma frozen. Rabbit myocardial septa were then perfused with normal or burn plasma. Rabbit red cells were added to restore hematocrit to 20 degrees, and the plasma-red cell mixtures were equilibrated with 98% O2 plus 2% CO2. Temperature (28 degrees C), pH (7.40), and flow rate (1 ml/min) were constant for all trials. All normal plasma preparations showed an improvement in developed tension (DT) during the 30-60 minute perfusion period with mean % change equal to + 10.5. A corresponding increase in dP/dt was also noted for all normals (mean % change equal to + 14.3); all septa perfused with acute burn plasma showed a decline in myocardial performance during a similar perfusion period. Mean % change in DT for burn plasma preparations was - 57.5, and in dP/dt for these septa was - 59.5. Significant myocardial depression occurs in arterially perfused rabbit septa when acute burn shock plasma is used as the perfusate.

Acute Disease↗
PubMed1978

Myocardial depression in sepsis.

Myocardial failure is uniformly fatal when associated with post-traumatic sepsis and multisystem failure. Controversy exists as to whether endotoxin has a direct effect on the myocardium. A nonanoxic isolated arterially perfused rabbit interventricular septum was used in this study to evaluate the effects of endotoxin, live E. coli, and endotoxin/septic shock plasma on myocardial function and ultrastructure. Purified E. coli endotoxin and live E. coli bacteria did not have a significant direct effect on rabbit cardiac muscle function or ultrastructure. Perfusion of the rabbit septum with plasma from rabbits exsanguinated following a 2-hour septic or endotoxin shock insult, however, caused significant (p less than 0.02) myocardial depression when compared with control septa perfused with normal rabbit plasma. Septa perfused with shock plasma demonstrated ultrastructural alterations of mitochondria that were not noted in control preparations.

Animals↗
PubMed1978

Ionized calcium and magnesium in the baboon: hemorrhagic shock and resuscitation.

Ionized calcium (Ca2+) and ionized magnesium (Mg2+) are important intracellular "second messengers" and control excitation-contraction coupling excitation-secretion coupling, oxidative phosphorylation, and mitochondrial acid-base balance. This study examines the effect of hemorrhagic shock on serum Ca2+ and Mg2+. Eight baboons were subjected to severe hemorrhagic shock and then resuscitated. Ca2+ was measured by the Orion SS-20 flowthrough calcium electrode and Mg2+ was calculated by the method of Killen. Other measurements included: total calcium, bound calcium, total magnesium, bound magnesium, albumin, globulin, total protein, phosphate, pH, and hematocrit. This study shows that there are significant disturbances of Ca2+ and Mg2+ during resuscitation from hemorrhagic shock. These disturbances may in part explain cellular dysfunctions during shock, including decreased myocardial contractility, inappropriate secretion of endocrine cells, decrease in oxidative phosphorylation, and mitochondrial acidosis.

Animals↗
PubMed1977

Postoperative treatment of patients after liver resection for trauma: a follow-up study.

In the last ten years, 89 hepatic resections were performed for trauma. Thirty-three patients survived and were followed up for one month to seven years: 15 patients had right lobectomy, nine left lobectomy, and nine left lateral segmentectomy. Complications were primarily pulmonary. All patients had transient derangement of liver function tests, but only three patients had liver dysfunction. Long-term follow-up showed no ill effects from the liver resection. Important postoperative treatment includes (1) adequate dependent drainage, (2) maintenance of blood volume, (3) intravenous albumin and glucose, (4) adequate nutritional support, and (5) selective use of intravenous glucagon.

Adolescent↗
PubMed1977

Trauma centers: a pragmatic approach to need, cost, and staffing patterns.

Based on the recommendations of the Health Services Administration and the Committee on Trauma of the American College of Surgeons, optimal staffing patterns for a trauma center are unrealistic in cost and personnel needs for all but a few large, urban teaching hospitals. As an alternative, the staffing pattern for a trauma program for a nonuniversity community hospital consists of one general surgeon, an anesthesiologist and one emergency physician. In addition, surgical subspecialists in thoracic surgery, urology, obstetrics and gynecology, ophthalmology, otolaryngology and plastic surgery would be on call within 30 minutes. A paid, part-time program director and paid coordinator of nursing and allied health personnel would be on staff. Need for trauma centers versus trauma programs can be assessed by using 5% of the number of motor vehicle accidents in an area to forecast the number of traumatic injuries. This is done in California as an example.

Accidents, Traffic↗
PubMed1977

Sepsis in the baboon: factors affecting resuscitation and pulmonary edema in animals resuscitated with Ringer's lactate versus Plasmanate.

Septic shock and the formation of pulmonary edema were studied in 19 baboons. Four animals served as controls. Four were subjected to deep septic shock by infusion of live E. coli and then deliberately killed while in deep shock. Four were subjected to septic shock, resuscitated with Ringer's lactate (RL), and then killed 11/2 hours after resuscitation was started. Seven were subjected to shock and resuscitation attempted with Plasmanate (PL). Resuscitation with RL was successful for 11/2 hours in all four RL-animals. Resuscitation with PL was successful for 11/2 hours in three of the 7 PL-animals. There was an increased tendency for albumin to extravasate into the interstitium of the lungs after resuscitation. The amount of pulmonary edema, measured by both the thermodye technique and by analysis of post-mortem lung composition, was the same in animals resuscitated with RL and PL. Administration of pure colloid offers no protection to the lungs in resuscitating patients from septic shock.

Animals↗