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Biomedical subjects

E E Moore

Publications and source records attributed to E E Moore.

At least 307 records · Page 17Linked to original sources
PubMed1989

The association of circulating endotoxin with the development of the adult respiratory distress syndrome.

Despite extensive investigation, the pathogenesis of the adult respiratory distress syndrome (ARDS) remains uncertain. As yet, there is no clear explanation of why some patients at risk for ARDS develop the syndrome, whereas others do not. Neutrophils and complement fragments have been implicated in the acute lung injury, but it is clear from published data that evidence of complement activation alone predicts neither the development nor the severity of ARDS. We investigated whether the combination of endotoxin, a leukocyte-priming agent, and complement fragments, leukocyte-stimulating agents, was associated with the development of ARDS. Ninety-eight patients were identified as being either at risk for the development of ARDS or having ARDS, and serial blood samples were obtained. There was no correlation between C5 fragments and the development of ARDS. C3 fragment levels were increased in 89% of the patients with ARDS, but they were also increased in 62% of patients at risk. Endotoxin was detected in 74% of the plasma samples obtained from patients at risk who subsequent developed ARDS and in 64% of the plasma samples obtained from the patients with ARDS. In contrast, only 22% of the plasma samples obtained from the patients at risk who did not develop ARDS had measurable endotoxin. We suggest that the combination of endotoxin and complement fragments may be one mechanism involved in the development of ARDS.

Adult↗
PubMed1989

Organ injury scaling: spleen, liver, and kidney.

The Organ Injury Scaling (O.I.S.) Committee of the American Association for the Surgery of Trauma (A.A.S.T.) was appointed by President Trunkey at the 1987 Annual Meeting. The principal charge was to devise injury severity scores for individual organs to facilitate clinical research. The resultant classification scheme is fundamentally an anatomic description, scaled from 1 to 5, representing the least to the most severe injury. A number of similar scales have been developed in the past, but none has been uniformly adopted. In fact, this concept was introduced at the A.A.S.T. in 1979 as the Abdominal Trauma Index (A.T.I.) and has proved useful in several areas of clinical research. The enclosed O.I.S.'s for spleen, liver, and kidney represent an amalgamation of previous scales applied for these organs, and a consensus of the O.I.S. Committee as well as the A.A.S.T. Board of Managers. The O.I.S. differs from the Abbreviated Injury Score (A.I.S.), which is also based on an anatomic scale but designed to reflect the impact of a specific organ injury on ultimate patient outcome. The individual A.I.S.'s are, of course, the basic elements used to calculate the Injury Severity Score (I.S.S.) as well as T.R.I.S.S. methodology. To ensure that the O.I.S. interdiffuses with the A.I.S. and I.C.D.-9 codes, these are listed alongside the respective O.I.S. Both the currently used A.I.S. 85 and proposed A.I.S. 90 are provided because of the obligatory transition period. Indeed, A.I.S. 90 contains the identical descriptive text as the current O.I.S.'s. The Abdominal Trauma Index and other similar indices using organ injury scoring can be easily modified by replacing older scores with the O.I.S.'s.(ABSTRACT TRUNCATED AT 250 WORDS)

Abbreviated Injury Scale↗
PubMed1989

Intraoperative cardiac sampling following penetrating wounds: a technique for early detection of traumatic intracardiac shunts--case report.

Intracardiac shunts complicating penetrating heart wounds may be unrecognized during the early postoperative period due to the insensitivity of noninvasive diagnostic tests. This case demonstrates the value of intraoperative cardiac sampling for oxygen saturation to identify an otherwise occult aorta-right ventricular fistula secondary to a precordial stab wound, ultimately progressing to a 1.9:1 shunt requiring operative repair.

Adult↗
PubMed1989

Presumptive antibiotics for penetrating abdominal wounds.

The optimal antimicrobial agent or agents for penetrating abdominal injuries remains undetermined. During the three year period ending August 1987, 317 consecutive patients undergoing celiotomy for penetrating abdominal trauma were prospectively randomized to receive either mezlocillin, 4 grams every six hours, or clindamycin, 600 milligrams every six hours, and gentamicin, loading dose of 2.0 milligrams per kilogram, then 1.5 kilograms every eight hours. Antibiotics were begun in the emergency department with duration of coverage based on the pattern of injury: the colon, five days; other hollow visceral injury, two days, and all others, one day. Twenty-three patients were excluded because of breach of protocol and 16 others died within 72 hours of presentation. The two study groups, 136 patients receiving mezlocillin and 142 patients receiving gentamicin and clindamycin, were comparable with respect to age, sex, mechanism of injury, shock, intraoperative replacement of blood, abdominal trauma index and distribution of hollow visceral injuries. The over-all incidence of septic morbidity was similar: infections developed in 21 (15 per cent) of the patients receiving mezlocillin compared with 19 (13 per cent) of patients receiving gentamicin and clindamycin. There was no significant difference in major infections (lobar pneumonia and intra-abdominal abscess), with 13 per cent in each group. The offending pathogens were similar. The most common isolates in intra-abdominal abscess were Escherichia coli, Klebsiella and Enterococcus species and anaerobic Bacteroides species. Mezlocillin, an extended spectrum penicillin, achieved similar results, compared with the expensive and potentially toxic combination regimen in patients with penetrating abdominal injuries.

Abdominal Injuries↗
PubMed1989

The benefits of 7.5% NaCl/6% dextran 70 (HSD) for prehospital resuscitation of hemorrhagic shock: improved oxygen transport.

The purpose of this study was to compare the benefit of small volume hypertonic saline/dextran (HSD) versus the risk of obligatory time to administer it on-scene in a model of acute hemorrhagic shock. Dogs were bled to a mean arterial pressure (MAP) of 20 mmHg and then randomized to either: a) direct transport to the emergency department (ED) or b) 10 min delay to insert an iv HSD (4 ml/kg) infusion over 5 min, and then transport. The animals receiving HSD had improved (P less than 0.05) cardiac work and oxygen consumption during transport (MAP = 59 +/- 3 vs 38 +/- 4 mmHg; cardiac index (CI) = 3.2 +/- 0.2 vs 1.3 +/- 0.1 L min-1 M-2; O2CI = 115 +/- 7 vs 104 +/- 7 ml min-1 M-2), paralleled by reduced serum lactate (5.3 +/- 0.8 vs 7.0 +/- 2.3 mmol/L) and decreased metabolic acidosis. The benefits of HSD in attenuating shock-induced oxygen debt were corroborated by lower O2CI (98 +/- 4 vs 112 +/- 5 ml min-1 M-2) and higher pH (7.30 +/- 0.01 vs 7.24 +/- 0.02) in the postresuscitation period.

Animals↗
PubMed1988

Trauma angiography of the extremity: the impact of injury mechanism on triage decisions.

A review of angiographic studies of 227 consecutive injured patients suspected of having sustained extremity arterial trauma was done to determine whether knowledge of the mechanisms of injury was of use in the establishment of priority in multiply injured patients. Stab wounds and other lacerations occurred in 32 patients. Major arterial injury occurred in only 3 (12%) cases; in no case was arterial occlusion present or limb viability threatened. These injuries may be angiographically evaluated on a nonurgent basis. Alternatively, patients with gunshot wounds (130 patients) and blunt injuries (63 patients) had a high incidence of major arterial injury (18 and 38%, respectively), especially arterial occlusion (15 and 24%, respectively) as well as a significant incidence of threatened limb viability (5 and 21%, respectively). Disproportionately increased risk of arterial injury occurred in patients with high-energy gunshot wounds (75%), motorcycle accidents (62%), and crush injuries (63%). Patients who sustain gunshot wounds or blunt injuries and have an abnormal vascular physical examination should be evaluated angiographically on an urgent basis.

Accidents, Traffic↗
PubMed1988

Ipsilateral retrograde arterial contrast injection in unilateral lower extremity trauma.

Angiographic evaluation must be prompt in an injured patient with a threatened limb, marginal hemodynamic stability, or severe concomitant trauma. Nine patients with unilateral distal lower extremity trauma and suspected arterial injury were evaluated using retrograde contrast injection within the ipsilateral external iliac artery followed by distal serial filming. On the average, this technique used approximately 25 to 30 minutes less time than more conventional approaches.

Contrast Media↗
PubMed1988

Traumatic injuries of the brachial artery.

Sixty-four patients with traumatic brachial artery injuries were treated. Fifty had penetrating and 14 had blunt injuries. Associated extremity and torso injuries were common. Despite an excellent vascular patency rate of 97 percent, limb loss resulted from severe soft-tissue injury and functional disability occurred due to nerve injury.

Adolescent↗
PubMed1988

Hypothermia-induced coagulopathies in trauma.

Hemorrhage accounts for 90 per cent of deaths after abdominal injury, and half of these deaths are secondary to a recalcitrant coagulopathy. This review concentrates on our present knowledge of the role of hypothermia in trauma-related coagulopathies and notes that preventing as well as treating these disorders remains the focus and the challenge of many investigators in the field of trauma.

Animals↗
PubMed1988

Hemodynamic effect of mannitol in a canine model of concomitant increased intracranial pressure and hemorrhagic shock.

The use of mannitol in the management of head injury has been considered a threat to hemodynamic stability in hypotensive multiply injured patients. To evaluate this contention, we compared mannitol with normal saline administration in a canine model combining elevated intracranial pressure (ICP) and hemorrhagic shock. Mongrel dogs were bled to and maintained at a mean arterial pressure (MAP) of 60 mm Hg for 30 minutes. Following this, ICP was elevated to and sustained at 25 mm Hg for 45 minutes by inflating an epidural balloon. The dogs were then randomized to resuscitation with 2 g/kg of mannitol in saline (total volume, 20 mL/kg; n = 5) or 20 mL/kg of normal saline alone (n = 5). All dogs were successfully resuscitated, and MAP returned to baseline levels in both groups. ICP was significantly lower and urine output significantly higher in the mannitol group than in saline controls (P less than .01). Moreover, cerebral perfusion pressure, cardiac index, and left ventricular stroke work index were significantly improved in dogs given mannitol versus controls during the first hour of resuscitation (P less than .05). Mannitol ameliorates increases in ICP without compromising hemodynamic resuscitation in a canine model of concomitant increased ICP and shock.

Animals↗
PubMed1988

Toxic shock syndrome following diagnostic peritoneal lavage.

We report the case of a 15-year-old girl who developed high fever, syncope, abdominal pain, nausea and vomiting, myalgia, pharyngitis, and a desquamating rash eight days after a diagnostic peritoneal lavage. The diagnostic peritoneal lavage wound was erythematous and tender. Incision of the site yielded 10 mL of exudate that cultured Staphylococcus aureus. The patient was treated with a first-generation cephalosporin and recovered without sequelae. To our knowledge, this is the first reported case of toxic shock syndrome following diagnostic peritoneal lavage.

Abdominal Injuries↗
PubMed1988

Incomplete fractures associated with penetrating trauma: etiology, appearance, and natural history.

Patient charts and radiographs of 12 patients noted to have an incomplete fracture due to a penetrating injury were reviewed to evaluate the natural history of these fractures. One cortical chip fracture was due to a stab wound; the remainder were due to low-energy handguns. Morphologically, two patterns existed: drill hole fractures through the central metaphyseal region of long tubular bones, and divot fractures of the margins of long bone metaphyses and flat bones. Drill hole fractures and divot fractures complicated by fracture line extension required a weight bearing cast or functional brace while healing. The chip fracture and uncomplicated divot fractures were managed symptomatically. Chip, drill hole, and divot fractures followed a benign course and healed by formation of cortical bone along the defect rim.

Adolescent↗