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Biomedical subjects

M L Hawkins

Publications and source records attributed to M L Hawkins.

At least 37 records · Page 2Linked to original sources
PubMed1989

Percutaneous peritoneal lavage in blunt trauma patients: a safe and accurate diagnostic method.

We reviewed the records of 395 patients seen from January 1983 through May 1988, who after sustaining blunt thoracoabdominal trauma had diagnostic peritoneal lavage (DPL) performed percutaneously by the Seldinger wire technique of Lazarus and Nelson. The test was considered grossly positive if 10 cc of blood were aspirated from the catheter immediately after its insertion into the peritoneal cavity. Microscopic criteria for positivity included more than 100,000 RBC or 500 WBC/cc of lavage return, elevated amylase or bilirubin, or the presence of vegetable fibers or bacteria. Seventy-two (18%) of the patients were true positives and 315 (80%) were true negatives. There were four false positives (1.3%) and one false negative (0.2%), giving the test a sensitivity of 99% and a specificity of 98%. Complications occurred in three patients, for a rate of 0.8%, and included catheter insertion into a large ovarian dermoid cyst, needle perforation of the ileum, and needle perforation of the sigmoid colon. This technique of DPL can consistently be performed much more rapidly than the open method. Therefore we conclude that percutaneous DPL is as accurate as, as safe as, and quicker than open DPL for determining intra-abdominal injury in blunt trauma patients.

Abdominal Injuries↗
PubMed1989

Posttraumatic phlegmasia cerulea dolens: an indication for the Greenfield filter.

Phlegmasia cerulea dolens (PCD) can be a threat to both life and limb and therefore must receive prompt treatment. In most clinical settings, anticoagulant therapy is standard treatment for PCD. Iliofemoral thrombectomy has been recommended as surgical treatment of massive thrombosis where venous gangrene may occur. In the severely traumatized patient, however, massive venous occlusion presents difficulties in management in a complex clinical setting. We have described a 52-year-old white man who had a posterior fracture dislocation of the right hip, with a pulseless, cyanotic, swollen right leg. A Greenfield filter was placed via the internal jugular vein approach, followed by leg and thigh fasciotomy and iliofemoral thrombectomy. Femoral arteriotomy revealed good inflow, and arterial thrombectomy yielded very little thrombus. He subsequently required an above-knee amputation for venous gangrene. In cases of PCD, iliofemoral thrombectomy should be considered early when the threat of venous gangrene exists. We propose internal jugular vein placement of a Greenfield filter before venous thrombectomy. The Greenfield filter has proven to be a safe and effective prophylaxis for thromboembolism should a clot migrate or detach during thrombectomy. Additionally, placement of the filter in the early post-traumatic period would safeguard against pulmonary emboli during a period in which anti-coagulant therapy would be contraindicated.

Accidents, Traffic↗
PubMed1989

Tracheostomy in the intensive care unit: a safe alternative to the operating room.

Severely injured patients frequently require endotracheal intubation, either by the nasotracheal (NT) or orotracheal (OT) route, for airway control and/or ventilatory support. If intubation is required for more than two to four weeks, an elective tracheostomy is usually indicated. Transferring these patients to the operating room is difficult, and it impairs their continued monitoring and care. Over a period of 48 months at our institution, 74 patients had tracheostomy done in the intensive care unit (ICU) by a surgical resident (PG2 level) assisted by a chief resident or attending faculty member. Local anesthesia was supplemented with intravenous sedatives, and operating room technique was used, with complete surgical instrument pack and adequate lighting. There were no deaths from the procedure. There were no complications specifically attributed to the performance of tracheostomy in the ICU, though one patient each suffered tracheitis, tracheostomy tube dislodgement, and tracheomalacia. Tracheostomy in the ICU avoids the risks of moving these patients with all their monitoring and infusion lines, and saves operating room time and charges. Trained surgical personnel using adequate instruments and lighting can safely perform a tracheostomy in the intensive care unit.

Combined Modality Therapy↗
PubMed1989

Endoscopically assisted nasojejunal feeding tube placement.

Enteral nutrition is best delivered via a small bore feeding tube whose tip lies in the proximal jejunum. A major obstacle to tube placement is the lack of a reliable means of assuring passage through the pylorus. A simple, quick method of tube placement using endoscopic assistance that was successful in 18 of 20 (90%) attempts is described.

Endoscopy↗
PubMed1989

Ultrarapid diagnostic peritoneal lavage.

Diagnostic peritoneal lavage is an important adjunct in the evaluation of blunt trauma. The open technique has proven to be safer, though more time consuming, than the closed percutaneous technique. A significant time-consuming aspect of the procedure is the infusion and drainage of the peritoneal lavage fluid. With the use of cystoscopy irrigation tubing, infusion time for one liter of Ringer's lactate averaged 2.9 minutes compared to 14.4 minutes when using IV fluid tubing. Similarly, effusion time was 2.3 times rather than 9.8 minutes. These differences are significant at the 0.0001 level. The average time saved was 19 minutes, allowing more rapid assessment and treatment of these critically injured patients.

Abdominal Injuries↗
PubMed1988

Diagnostic peritoneal lavage in blunt trauma.

We reviewed the records of 274 trauma patients who had 275 diagnostic peritoneal lavages from Feb 1, 1983 through Jan 31, 1986. Lavage was done in 271 of 560 (48%) cases of blunt trauma and three of 245 (1%) penetrating injuries (gunshot wounds to the chest). The open lavage technique was used, and results were considered grossly positive if there was 10 ml of gross blood. Results were considered microscopically positive if there were more than 100,000 RBCs or 500 WBCs/cu mm, an elevated amylase or bilirubin value, or bacteria or vegetable fibers. Lavage was negative in 193 cases, including false-negative results (1%), and positive in 78, with three false-positive results (3.8%). Open peritoneal lavage is safe, rapid, readily available, and accurate in the evaluation of blunt abdominal trauma.

Child↗
PubMed1988

Pulmonary artery disruption from blunt thoracic trauma.

Blunt chest trauma occurs in up to 50 per cent of all fatal motor vehicle accidents and is the primary cause of death in 12-25 per cent; yet only 15 per cent of patients with chest trauma arriving alive to the emergency department require early thoracotomy. Pulmonary artery disruption from blunt trauma is extremely rare. Two patients both women, older and obese with multiple rib fractures and little pulmonary parenchymal damage are reported. Neither had injury to the aorta, heart or intra-abdominal organs. One patient survived after lateral repair of the left main pulmonary artery and the other exsanguinated from a laceration of the right main pulmonary artery. Intrapericardial exposure of the proximal pulmonary arteries may be necessary for control of hemorrhage. Trauma surgeons should be familiar with this technique. Indications for immediate thoracotomy should include: massive hemothorax (greater than 1000 ml), continued bleeding greater than 300 ml in the first hour, bleeding greater than 200 ml/hr for 5 hours, or increasing hemothorax in spite of tube thoracostomy. Close adherence to these guidelines would have allowed both patients to be explored earlier.

Accidents, Traffic↗
PubMed1988

The trauma score: a simple method to evaluate quality of care.

In recent years, trauma care delivery has come under close scrutiny from within and outside the medical profession. With the development and designation of trauma centers, two problems have become evident. First is a reliable, simple means of triaging patients to the appropriate facility. The second problem is evaluation of the quality of care provided. The assessment of results is difficult due to the large number of variables, such as mechanisms of injury, anatomic sites of injury, and comorbidity found in these patients and has led to the use of complex statistical analysis. The trauma score, originally developed as a triage tool, has also proven to be a reliable, simple means of assessing the quality of care. The expected survival for each trauma score value has been established and each hospital's or surgeon's results can, therefore, be evaluated against that standard. A deviation from the expected survival curve may or may not be clinically significant as determined by careful review of those patients. From July 1, 1985 through June 30, 1986, 495 patients were admitted to the trauma service at the Medical College of Georgia. All patients were given a trauma score on arrival to the emergency department. The trauma score can be used as a quality assurance tool by any physician or hospital providing trauma services as will be demonstrated by analyzing our data.

Adult↗
PubMed1987

Trauma victims: field triage guidelines.

Trauma kills more Americans from age 1 to 34 than all diseases combined. Until recently, trauma care in the United States was delivered in a nonorganized, nonintegrated fashion, with trauma victims being transported to the medical facility closest to the scene of the accident. Many recent studies confirm an unacceptably high incidence--up to 75% in some studies--of preventable deaths in trauma victims treated under the nearest hospital system. This has resulted in the development of specialized trauma centers. The concept of a regional trauma center requires restrictive medical practice in which a limited number of hospitals and physicians provide care for those 5% to 12% of patients who are critically injured. The decision on whether to take a patient to the closest hospital or to the regional trauma center is a form of triage, with far-reaching consequences medically, ethically, and financially. Various triage instruments have been developed to try to identify those patients who would benefit from the resources of a trauma center, and to avoid overcrowding those centers with patients having less serious injuries. These triage tools are based on a combination of mechanism of injury, anatomic criteria, physiologic criteria, and co-morbidity factors.

Child↗