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Biomedical subjects

K L Mattox

Publications and source records attributed to K L Mattox.

At least 19 recordsLinked to original sources
PubMed1992

[Neck injuries].

Diagnostic work-up of neck injuries is dependent on vital signs, neurologic status and location of the wound. Patients who are haemodynamically unstable, who exhibit current arterial bleeding, expanding or pulsatile haematoma or respiratory distress after initial resuscitation are taken to the operating theatre without further delay. Patients who present stable vital signs or who are stable after resuscitation are subjected to further evaluation. Penetrating wounds below the cricothyroid membrane (zone I) and just below the clavicle and above the mandibular angle (zone III) are subjected to angiography. Explorations in these regions are associated with considerable morbidity and routine exploration is not warranted. Injuries between the cricothyroid membrane and mandibular angle are easily reached, and routine exploration is recommended. Selective diagnostic work-up with angiography, oesophagography and laryngotracheobronchoscopy is an alternative if available on a 24 hour basis. The common and internal carotid arteries are repaired in patients with focal or no neurologic deficit, and in patients with equivocal neurologic status secondary to hypoperfusion or intoxication. Ligation is performed if reconstruction is not feasible. Appropriate treatment of the comatose patient remains controversial. Oesophageal and tracheal injuries are primarily repaired.

Emergencies↗
PubMed1992

Abbreviated laparotomy and planned reoperation for critically injured patients.

The triad of hypothermia, acidosis, and coagulopathy in critically injured patients is a vicious cycle that, if uninterrupted, is rapidly fatal. During the past 7.5 years, 200 patients were treated with unorthodox techniques to abruptly terminate the laparotomy and break the cycle. One hundred seventy patients (85%) suffered penetrating injuries and 30 (15%) were victims of blunt trauma. The mean Revised Trauma Score, Injury Severity Score, and Trauma Index Severity Score age combination index predicted survival were 5.06%, 33.2%, and 57%, respectively. Resuscitative thoracotomies were performed in 60 (30%) patients. After major sources of hemorrhage were controlled, the following clinical and laboratory mean values were observed: red cell transfusions--22 units, core temperature--32.1 C, and pH--7.09. Techniques to abbreviate the operation included the ligation of enteric injuries in 34 patients, retained vascular clamps in 13, temporary intravascular shunts in four, packing of diffusely bleeding surfaces in 171, and the use of multiple towel clips to close only the skin of the abdominal wall in 178. Patients then were transported to the surgical intensive care unit for vigorous correction of metabolic derangements and coagulopathies. Ninety-eight patients (49%) survived to undergo planned reoperation (mean delay 48.1 hours), and 66 of 98 (67%) survived to leave the hospital. With the exception of intravascular shunts, there were survivors who were treated by each of the unorthodox techniques. Of 102 patients who died before reoperation 68 (67%) did so within 2 hours of the initial procedure. Logistic regression showed that red cell transfusion rate and pH may be helpful in determining when to consider abbreviated laparotomy. The authors conclude that patients with hypothermia, acidosis, and coagulopathy are at high risk for imminent death, and that prompt termination of laparotomy with the use of the above techniques is a rational approach to an apparently hopeless situation.

Acidosis↗
PubMed1992

Emergency center arteriography.

From 1983 through 1989, 1,882 emergency center arteriograms were performed on 1,802 patients suspected of having peripheral vascular injuries. The most common indication for emergency center arteriography (ECA) was the proximity of an injury to a major vascular structure. This was the only indication in 1,712 injured extremities (91%). There were 1,510 true negative arteriograms, 294 true positives, 7 false negatives, and 14 false positives. Accordingly, the sensitivity was 95.5% and the specificity was 97.7%. The remaining 57 arteriograms were either equivocal or technically inadequate. Further evaluation of these patients uncovered an additional 11 vascular injuries. Operative intervention was required for 196 (64.3%) injuries detected by emergency arteriography. The remaining 109 injuries were considered minor and were not repaired. No complications developed in 91 patients (88%) with minor vascular injuries who were available for a mean follow-up duration of 12 months. One thousand forty-eight patients (69.4%) with negative arteriograms were followed for a mean of 18 months, and no vascular complications were noted. Emergency center arteriography is a rapid, accurate, and cost-effective technique. It is of particular value in detecting the presence of occult arterial injuries when proximity of a major vascular structure is the sole indication for arteriography. When formal arteriographic support is either unavailable or time consuming, ECA is recommended.

Adolescent↗
PubMed1992

Emergency center thoracotomy: impact of prehospital resuscitation.

Emergency center thoracotomy was performed at our facility on 389 patients from 1984 through 1989. There were no patients excluded from the study, and survival for all patients was 8.3% with survival rates of 15.2% and 7.3% for stab and gunshot wounds, respectively. Emergency center thoracotomy was performed on 42 patients suffering from isolated extrathoracic injuries with 7% survival. There were no survivors of blunt trauma in this study. Fifty-three percent of the patients arrived with cardiopulmonary resuscitation (CPR) in progress. The average time of prehospital CPR for survivors was 5.1 minutes compared with 9.1 minutes for nonsurvivors. Of the survivors, prehospital endotracheal intubation prolonged successful toleration of CPR to 9.4 minutes compared with 4.2 minutes for nonintubated surviving patients (p less than 0.001). Emergency center thoracotomy is useful in the resuscitation of victims dying of penetrating truncal trauma. Prehospital endotracheal intubation significantly lengthened the time of successful CPR.

Adolescent↗
PubMed1992

Prospective evaluation of preoperative fluid resuscitation in hypotensive patients with penetrating truncal injury: a preliminary report.

Although intravenous (IV) fluid therapy is routinely prescribed for hypotensive injury victims, there are concerns that elevating the blood pressure before hemorrhage is controlled may be detrimental. This is a preliminary report of an ongoing randomized study designed to evaluate the effect fluid resuscitation, delayed until surgical intervention, has on the outcome for hypotensive victims of penetrating truncal injury. In the first year, 300 consecutive patients with gunshot or stab wounds to the trunk who had a systolic blood pressure of 90 mm Hg or less were entered into the study. Patients were excluded from the outcome analysis because of death at the scene or minor injury not requiring surgical intervention. The remaining study patients were randomized into (1) an immediate resuscitation group (n = 96) for whom IV fluid resuscitation was initiated in the ambulance and in the emergency center before surgical intervention, or (2) a delayed resuscitation group (n = 81) for whom IV fluid resuscitation was delayed until the time of surgical intervention. The two study groups were found to be well balanced with respect to anatomic injury severity, pretreatment vital signs, survival probability, and preoperative treatment times. There were no significant differences in the rate of survival to hospital discharge (immediate resuscitation group, 56%; delayed resuscitation group, 69%). There were no significant differences in the rate of postoperative complications. Further study is necessary to determine if it is advantageous to delay fluid resuscitation until surgical intervention.

Abdominal Injuries↗
PubMed1992

Invalidation of the APACHE II scoring system for patients with acute trauma.

The APACHE II scoring system has been promulgated as a useful tool in the assessment of the severity of injury and prognosis for acutely ill patients. The physiologic basis for stratification is weighted toward older patients with chronic medical conditions. Recently, the APACHE II system has been proposed as a method for determining diagnosis related group (DRG) reimbursement for individual trauma patients. The present study applied the APACHE II scoring system to 280 patients with blunt or penetrating trauma who had documented systolic blood pressure < 90 mm Hg. Fifty-seven (20%) died of their injuries within the first 24 hours. APACHE II scores were recorded both in the emergency room (ED) and at 24 hours following admission. Injury Severity Scores (ISS), Revised Trauma Scores (RTS), and TRISSCAN were calculated. The APACHE II (n = 223) recorded at 24 hours (2.5 +/- 0.2) was significantly less than that recorded in the ED (6.6 +/- 0.3, p < 0.05, Mann-Whitney analysis). Using regression analysis, there was no correlation between APACHE II and ISS if recorded in the ED (r2 = 0.06) or 24 hours following admission (r2 = 0.08). APACHE II also demonstrated a poor correlation with the length of hospital stay (r2 = 0.03 [ED], = 0.19 [24 hours]). Whereas APACHE II may be helpful in defining severity of disease among patients with acute-on-chronic medical conditions, the classification lacks an anatomic component, which is essential to assess the magnitude of acute injury in patients who are typically otherwise healthy.

Acute Disease↗
PubMed1992

Blunt cardiac injury.

Explore the source record for details and available documents.

Abbreviated Injury Scale↗
PubMed1991

Prehospital hypertonic saline/dextran infusion for post-traumatic hypotension. The U.S.A. Multicenter Trial.

The safety and efficacy of 7.5% sodium chloride in 6% dextran 70 (HSD) in posttraumatic hypotension was evaluated in Houston, Denver, and Milwaukee. Multicentered, blinded, prospective randomized studies were developed comparing 250 mL of HSD versus 250 mL of normal crystalloid solution administered before routine prehospital and emergency center resuscitation. During a 13-month period, 422 patients were enrolled, 211 of whom subsequently underwent operative procedures. Three hundred fifty-nine patients met criteria for efficacy analysis, 51% of whom were in the HSD group. Seventy-two per cent of all patients were victims of penetrating trauma. The mean injury severity score (19), Trauma Score plus Injury Severity Score (TRISS) probability of survival, revised trauma scores (5.9), age, ambulance times, preinfusion blood pressure, and etiology distribution were identical between groups. The total amount of fluid administered, white blood cell count, arterial blood gases, potassium, or bicarbonate also were identical between groups. The HSD group had an improved blood pressure (p = 0.024). Hematocrit, sodium chloride, and osmolality levels were significantly elevated in the Emergency Center. Although no difference in overall survival was demonstrated, the HSD group requiring surgery did have a better survival (p = 0.02), with some variance among centers. The HSD group had fewer complications that the standard treatment group (7 versus 24). A greater incidence of adult respiratory distress syndrome, renal failure, and coagulopathy occurred in the standard treatment group. No anaphylactoid nor Dextran-related coagulopathies occurred in the HSD group. Although this trial demonstrated trends supportive of HSD in hypotensive hemorrhagic shock patients requiring surgery, a larger sample size will be required to establish which subgroups of trauma patients might maximally benefit from the prehospital use of a small volume of hyperosmolar solution. This study demonstrates the safety of administering 250 mL 7.5% HDS to this group of patients.

Adolescent↗
PubMed1991

Outcome for delayed operation of penetrating colon injuries.

It has been stated that delay in operative repair of penetrating injuries to the gastrointestinal tract will result in a high rate of complications related to infection. To test this assertion, a group of patients with penetrating injuries to the colon were analyzed who had operative repair delayed (usually because of triage considerations) more than 6 hours after admission to the hospital. Nine hundred six patients who survived at least 48 hours after injury were divided into two groups. The immediate group of 769 patients was treated within 6 hours of admission and the delayed group of 137 patients was treated more than 6 hours after admission. The mortality for the immediate group was 4.0% vs. 1.5% for the delayed group. Colon-related infectious complications, defined as abscess or colon suture-line failure, occurred in 10% of the immediate group and 4.4% of the delayed group. To eliminate the effect of associated injuries, the group of patients with colon injuries only was analyzed separately. There was no mortality for 128 patients with colon injuries only operated on within 12 hours of injury, and the colon-related infectious morbidity rate was 3%. Eleven patients with colon injuries only were treated after 12 hours with a mortality of 9% and colon-related infectious morbidity of 18%. These data demonstrate that even patients with fecal contamination can have operative repair delayed for up to 12 hours without undue morbidity related to infection.

Adult↗
PubMed1979

Intravascular migratory bullets.

The estimated course of a penetrating missile provides some clues to planning intraoperative priorities and management. However, missiles which become intravascular emboli present diagnostic and therapeutic dilemmas. Twenty-eight patients have been seen with bullet emboli. Five patients had emboli to the lungs, two of which were removed. Two large bullets embolized from a right heart injury down the inferior vena cava, one to a hepatic vein and one to the right renal vein. Fourteen patients had arterial bullet emboli, four originating in the heart, four in the thoracic aorta, and six in the abdominal aorta. Two patients died, one of cerebral infarction secondary to bullet embolus to the right carotid artery and one of an unrecognized traumatic intracardiac defect. Complications were secondary to associated injuries rather than a result of removal of bullet emboli.

Adolescent↗
PubMed1979

Mycotic aneurysm of the inferior mesenteric artery.

This is the first reported case of successful management of a mycotic aneurysm of the inferior mesenteric artery. The only helpful clinical manifestations were episodes of previous abdominal pain and a history of bacterial endocarditis. The surgical management involved simple excision without revascularization of the inferior mesenteric artery.

Adult↗
PubMed1979

Major complications of percutaneous subclavian vein catheters.

New and reportedly safet techniques for subclavian venipuncture with the passage of central venous catheters appear regularly in the surgical literature [55--59]; yet reports of major complications continue to appear as well. We have reported on eight patients with major complications of percutaneous subclavian vein catheters, two of whom died. In our own hospital an improved educational program for junior house staff and nurses has been instituted. Better supervision of junior house staff when performing this potentially lethal technique is necessary. Daily inspection of catheters, early removal of unnecessary catheters, and improved equipment should help to prevent these complications in the future.

Adult↗
PubMed1979

Surgical management of traumatic intracardiac injuries.

Today, surgeons are able to manage both blunt and penetrating wounds of the heart with increasing success, including those with associated intracardiac injuries. After diagnosis by cardiac catheterization, substantial intracardiac lesions are repaired using cardiopulmonary bypass. Among more than 300 patients treated for cardiac wounds in our city-county hospital in recent years, 15 were found to have marded intracardiac defects. These defects included ventricular septal defects, aorta--right ventricle fistulas, aortic valve injuries, a mitral valve injury, and a coronary artery--right ventricle fistula. Thirteen of the 15 patients required repair of the intracardiac defects. One was repaired acutely and 12 were repaired electively. All 15 patients were alive and asymptomatic at the time of writing.

Adult↗
PubMed1979

Laparotomy in the emergency department.

Reports of advancements in emergency department operative resuscitative skills have included craniotomy, thoracotomy, cardiorrhaphy and even cardiopulmonary bypass. The efficacy and advisability of laparotomy in the emergency department remain in question. Between July, 1972, and July, 1977, adhering to an established protocol, resuscitative laparotomy was performed on 51 patients in the emergency department. All 51 patients underwent emergency thoracotomy also. Twenty-four patients were victims of gunshot wounds, 24 had sustained blunt trauma, and three had abdominal stab wounds. Injuries to the liver, major vessels, and spleen were most common. Control of hemorrhage by clamps, packs or pressure was the primary objective of laparotomy. Control of exsanguinating hemorrhage with precise application of vascular clamps was possible in all but 15 patients. Because of extensive multiple injuries and inability to achieve cardiovascular stability, only 11 patients reached the operating room, and none survived to leave the hospital. Although technically possible, laparotomy in the emergency center did not alter the fatal outcome of moribund patients in this series.

Abdominal Injuries↗