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Biomedical subjects

K G Swan

Publications and source records attributed to K G Swan.

At least 37 records · Page 2Linked to original sources
PubMed1994

Surgical prophylaxis for pulmonary embolism.

The trauma patient population is at special risk for fatal pulmonary embolism. We experienced 11 fatalities in one 12-month period. Specific risk factors for both deep venous thrombosis and pulmonary embolism can be identified among trauma patients. The latter usually cannot be offered prophylactic anticoagulation, and the nature of their injuries (e.g., long bone fractures) makes not only bedside surveillance difficult but also precludes use of pneumatic compression, etc. We have developed a protocol for prophylactic inferior vena caval filtration for our trauma patients deemed at particular risk for pulmonary embolism. Since 1986 we have inserted 205 Greenfield filters in 201 patients. Two hundred were inserted prophylactically. There was no mortality, and morbidity was minimal. No patient with a Greenfield filter sustained a fatal pulmonary embolism during this period. Four patients died from pulmonary embolism before vena caval filters could be inserted. We believe that the trauma patient, at risk for pulmonary embolism, should be offered a Greenfield filter prophylactically as soon after hospitalization as logistically possible.

Adult↗
PubMed1993

The role of sigmoidoscopy in the management of gunshot wounds to the buttocks.

The charts of all patients (n = 70) admitted over 26 months after sustaining a gunshot wound to the buttocks were reviewed to assess the role of physical examination, routine radiologic studies, and sigmoidoscopy in the evaluation of these patients. There were 68 men and 2 women. Sixteen patients underwent sigmoidoscopy, which demonstrated a rectal injury in 7. Six of these patients had other abnormalities on either physical examination or plain pelvic radiographs that would have otherwise led to operation. There were no missed injuries and no morbidity in the remaining patients that were managed without sigmoidoscopy. Indications for sigmoidoscopy were gross blood on rectal examination in 2, bullet path with proximity to the rectum in 13, and persistent abdominal pain in 1. All patients with gross blood on rectal examination (n = 5) and blood at the urethral meatus (n = 2) had visceral injuries. One patient underwent celiotomy for an injury at 15 cm that was noted on sigmoidoscopy performed because the bullet trajectory was in proximity to the rectum. Sigmoidoscopy can be performed selectively in patients sustaining a gunshot wound to the buttocks when the proximity of the wound to the rectum is in doubt.

Abdomen↗
PubMed1992

Infrapopliteal arterial injury: prompt revascularization affords optimal limb salvage.

Sixty-nine limbs with infrapopliteal arterial injuries were evaluated in 68 patients. Thirty-five (50%) cases were complicated by acute limb-threatening ischemia. Management consisted of revascularization (26 limbs), ligation (15 limbs), fasciotomy only (2 limbs), observation (18 limbs), and primary amputation (8 limbs). Penetrating injuries (n = 35) had a 33% incidence of ischemia and a reduced frequency of associated injury. One delayed amputation (3%) was required. In contrast, blunt injuries (n = 34) had a 68% incidence of ischemia and a greater frequency of associated injury. There were 20 amputations in the blunt group, including eight primary amputations performed in limbs with profound ischemia, complex open fractures, severe soft-tissue damage, and neural injury. Observation or ligation of single arterial injuries resulted in no early amputations. Associated local injuries in both groups included fracture or ligamentous disruption (64%), severe soft-tissue damage (32%), and nerve dysfunction (36%). In both groups, 15 of 35 ischemic limbs were salvaged by prompt revascularization (11 penetrating and four blunt injuries). Aggressive revascularization with autogenous repair or bypass is recommended for management of penetrating trauma. Though a good outcome will be achieved in some patients with combined blunt trauma and infrapopliteal arterial injury, the probability of delayed amputation and prolonged disability must be consciously integrated into the decision to pursue limb salvage. The prognosis for blunt injury complicated by arterial ischemia is poor; thus the severity of associated local and remote injuries will affect the results of revascularization program.

Adult↗
PubMed1992

Cost containment in the operating room: use of reusable versus disposable clothing.

The need for fiscal austerity has prompted the re-evaluation of many aspects of medical care. Recent events in the northeastern United States have caused an increased awareness of the need for environmental responsibility as well. With these considerations in mind, the costs incurred by the operating suites of two comparable teaching hospitals in New Jersey, one of which uses disposable operating room attire, were examined; the other employs reusable scrub suits and gowns. The reusable scrub suits and gowns resulted in a savings in excess of $100,000 compared to the center using disposables. The authors conclude that hospitals should re-evaluate their use of disposable operating room attire to reduce operating costs and the amount of medical waste generated.

Cost Savings↗
PubMed1992

Where have all the captains gone? A comparison of active and reserve MC ranks and ages, Vietnam to Desert Storm.

An analysis of ages and ranks of hospital-based physicians in one area of the Persian Gulf War was used for a comparison with similar data from the Vietnam War. Mean age in the latter was 33.4 years; rank was Captain (0-3.24). In Desert Storm, mean age and rank significantly increased to 46.0 years and close to Lieutenant Colonel (0-4.73), respectively. The large proportion of Reserve Component Physicians (75%) in the Persian Gulf War is the probable explanation for these findings. Medical Corps recruitment and retention problems may result from this most recent war and pose potential threats to success in future U.S. conflicts.

Age Factors↗
PubMed1992

Flawed scalpel.

Explore the source record for details and available documents.

Military Medicine↗
PubMed1992

Cold-induced hypercoagulability in vitro: a trauma connection?

Injury severity score and hypothermia can lead to a high level of mortality when combined clinically. In acute trauma, the presence of a coagulopathy is difficult to treat and the aim is prevention. Aliquots of whole blood from healthy human volunteers (n = 9) were added to saline (control) and saline plus endotoxin (activated). The control and activated groups were divided and subjected to 60 minutes of normothermia (24 degrees C) or hypothermia (0 degrees C). The samples were returned to 37 degrees C; then the recalcification times were determined using fibrin formation and the viscous drag as the determining factors. The activated hypothermic group showed a decreased recalcification time of 345 (+/- 48.9) seconds compared to 405 (+/- 60.8) for the activated normothermic group (P less than 0.001). When the normothermic and hypothermic groups were compared without endotoxin added, the differences were not significant. The authors conclude that the effects of endotoxin on clotting time are worsened by hypothermia in vitro and act synergistically to possibly cause the coagulopathy seen in trauma patients.

Bacteremia↗
PubMed1991

Principles of ballistics applicable to the treatment of gunshot wounds.

Ballistics is the science of the motion of a projectile through the barrel of a firearm (internal ballistics), during its subsequent flight (external ballistics), and during its final complicated motion after it strikes a target (terminal ballistics). Wound ballistics is a special case of terminal ballistics. Although wound ballistics is at best sets of approximations, its principles enter usefully into an evaluation of a gunshot wound and its treatment. A special consideration in these cases is their medicolegal aspects. At a minimum, the medical team receiving the patient should exert care not to destroy the clothing and in particular to cut around and not through bullet holes, to turn over to law enforcement officials any metallic foreign body recovered from the patient, and to describe precisely, or even to photograph, any entrance or exit wounds.

Firearms↗
PubMed1991

Gunshot wounds to the extremities. Experience of a level I trauma center.

Gunshot wounds to the extremities are more common today, largely because civilian handgun injuries have increased. Such injuries, which are usually caused by low-velocity missiles, should be treated differently from those caused by high-velocity (military) missiles. Bone involvement, including fractures and joint injuries, necessitates orthopaedic management. At the University of Medicine and Dentistry of New Jersey-New Jersey Medical School's (UMDNJ-NJMS) University Hospital, a level I trauma center, 44 gunshot wounds (32 lower-extremity and 12 upper-extremity) with orthopaedic complications were treated between January 1986 and December 1988. The protocol/questionnaire used by the UMDNJ-NJMS is presented here to assist the orthopaedic surgeon in the evaluation and treatment of these problematic injuries.

Adolescent↗
PubMed1991

Resuscitative thoracotomy and combat casualty care.

Over the past few years, the indications for resuscitative thoracotomy in civilian trauma have been refined. The use of this procedure for military casualities has received only brief mention. We have described our experience with 93 consecutive thoracotomies performed in a level I trauma center and have attempted to better define the indications for this procedure in military medicine.

Adolescent↗
PubMed1990

The hilar snare, and improved technique for securing rapid vascular control of the pulmonary hilum.

Massive hemorrhage from pulmonary injuries is often refractory to hilar crossclamping. We report a simple technique, the hilar snare, to control such injuries and compare it to the standard technique of hilar occlusion with a vascular clamp. Standardized lacerations were made in the lung in each of six adult dogs. Blood loss from the injured lung was measured before and after placement of the hilar snare and compared to that following hilar occlusion with a Satinsky clamp (occlusive surface, 5.5 cm). The rate of blood loss before control was not significantly different between the two groups. Blood loss from the lacerated lung was significantly less (p less than 0.05) in the Hilar Snare group (9 +/- 4 ml/min) when compared to the Satinsky group (46 +/- 14 ml/min). The snare's flexible nature ensures complete occlusion of the hilar vessels and is a useful adjunctive technique to present methods of controlling severe pulmonary hemorrhage.

Adult↗
PubMed1990

Reduced dependency on arteriography for penetrating extremity trauma: influence of wound location and noninvasive vascular studies.

Indications for arteriography in penetrating extremity trauma remain controversial. We reviewed our clinical experience in 454 patients (514 extremities) with penetrating trauma admitted during a prior 3 1/2-year period. Injuries were caused by stab wounds in 60 (11.7%) extremities and by gunshot wounds in 454 (88.3%) extremities. Thirty-three of the 60 stab wounds (55%) required urgent exploration, and 27 underwent arteriography. No arteriograms were positive for unsuspected arterial injury in this group. Forty-two of 454 gunshot wounds (9.3%) underwent mandatory exploration; arteriograms were performed on 412 extremities. Forty-four arteriograms (10.7%) demonstrated evidence of unsuspected arterial injuries. During the last year, randomly selected extremities (n = 23) have been studied with B-mode ultrasonography and segmental Doppler pressure measurements. Using the subsequent arteriography as the "gold" standard, sensitivity was 83% and specificity was 100%. Gunshot wounds were categorized according to location and positive arteriograms. Injuries to the lateral thigh and arm resulted in no positive arteriograms, while positive studies were observed in 11% of medial and posterior arm, 14% of antecubital fossa, 25% of forearm, 7.5% of medial and posterior thigh, 8% of popliteal fossa, and 26% of calf injuries. We recommend arteriography for gunshot injuries to identified high-risk areas, while clinical evaluation alone is accurate in all stab wounds to the extremities and gunshot wounds to the lateral thigh and outer arm. Preliminary data suggest expanded use of B-mode ultrasonography may further reduce our dependency on arteriography in these cases.

Adolescent↗
PubMed1990

Penetrating extremity trauma: identification of patients at high-risk requiring arteriography.

Indications for arteriography in patients with penetrating trauma to the extremities remain controversial. Some clinicians have recommended universal use of arteriography, whereas others prefer to rely on physical findings alone. To better define our indications for contrast studies, we reviewed clinical data on 306 patients (349 extremities) with penetrating trauma who were admitted during a prior 2-year period (1985 to 1987). Injuries were caused by stab wounds in 50 (14.3%) extremities and by gunshot wounds in 299 (85.7%) extremities. Twenty-seven of the 50 stab wounds (54%) required urgent exploration based on physical findings, whereas 23 underwent arteriography. None of these studies showed unsuspected arterial injury. Twenty-nine of 299 gunshot wounds (9.7%) underwent mandatory exploration, and arteriograms were performed on 270 extremities; findings in 30 studies (11.1%) were positive for unsuspected arterial injuries. Gunshot wounds were categorized according to location and number of arteriograms with positive results. Arteriograms of lateral thigh and upper arm injuries resulted in no positive outcomes. Positive study results were recorded in 22.9% of calf injuries, 20% of forearm and antecubital injuries, 9.5% of popliteal fossa injuries, 9.0% of medial and posterior thigh injuries, and 8.3% of medial and posterior upper arm injuries. We recommend arteriography for penetrating injuries to these high-risk areas. However, clinical evaluation alone is accurate for identification of arterial trauma with lateral thigh or upper arm wounds and stab wounds to the extremities.

Adolescent↗
PubMed1990

Trauma recidivism.

Surgeons have long recognized that a proportion of hospitalized trauma patients present with a history of a previous admission for trauma, termed by the authors as "trauma recidivism." The incidence of trauma recidivism was addressed by a review of 150 consecutive admissions to a level I Trauma Center. This study identifies this subset of trauma patients, establishes their magnitude, and analyzes mechanisms of injury and hospital courses. The implications for those who care for trauma patients is discussed.

Adolescent↗