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R N Townsend

Publications and source records attributed to R N Townsend.

26 records · Page 2Linked to original sources
PubMed1992

The use of transesophageal echocardiography in the evaluation of chest trauma.

Transesophageal echocardiography (TEE) has been used over the last 10 years (1982-1992) to study the heart and thoracic aorta. We set out to evaluate the diagnostic applications of TEE in patients with thoracic trauma. Specifically, TEE was performed on patients suspected of having either a cardiac contusion or an injury of the thoracic aorta. Fifty-eight patients admitted with thoracic trauma underwent TEE. Fifty of those patients suspected of having a cardiac contusion also underwent transthoracic echocardiography (TTE). The two diagnostic modalities were compared. In 21 of these patients a wide mediastinum was apparent on admission chest x-ray films. Nineteen of this latter group underwent thoracic angiography in addition to TEE. Two patients underwent post-mortem examination. Of the 50 patients undergoing both TEE and TTE, a cardiac contusion was detected by TEE in 26 patients. Transthoracic echocardiography detected only six contusions in this group. Of the 21 patients with a wide mediastinum, TEE detected three obvious aortic disruptions. These findings were confirmed in each case by angiography. In 16 cases TEE showed the aorta to be normal. This was confirmed on the angiogram in 14 cases and by autopsy in two cases. Transesophageal echocardiography revealed an aortic intimal irregularity distal to the left subclavian artery in two cases. The results of aortography were normal in these last two cases. As a diagnostic modality, TEE more accurately detected cardiac contusions than TTE (p less than 0.001) and was a very sensitive screening tool in the early evaluation of patients with a wide mediastinum.

Adolescent↗
PubMed1991

Transesophageal echocardiographic examination of a patient with traumatic aortic transection from blunt chest trauma: a case report.

Traumatic aortic disruption is an injury associated with high mortality. Early recognition, diagnosis, and surgical repair are important in order to salvage patients with this injury. We report a case in which transesophageal echocardiography, a rapid, minimally invasive diagnostic technique, was used to identify an acute disruption of the proximal descending aorta in a patient with blunt chest trauma.

Adult↗
PubMed1990

Traumatic rupture of the aorta--critical decisions for trauma surgeons.

The diagnosis and initial stabilization of patients with traumatic rupture of the aorta (TRA) is performed by trauma surgeons. The resuscitations of 54 TRA patients at a Level I trauma center are reviewed. Although the survival of patients who underwent attempted repair was good (75%), 21/27 (78%) deaths occurred during phases of treatment controlled by a trauma surgeon. The techniques and sequencing of resuscitation can affect outcome. Pneumatic antishock garments were not beneficial in the prehospital setting for patients with TRA. In fact, PASG were on and inflated in all patients who presented in cardiac arrest. Awake, unanesthetized intubation caused fatal aortic rupture in three patients. Pharmacologic control of blood pressure during intubation is necessary. The amount of fluid, blood transfusion, and changes in blood pressure secondary to therapy did not statistically affect outcome. The average time from arrival in the ER to angiogram was 64.7 minutes. The average time ER to operating room was 159.7 minutes. Seven cases of TRA had delayed diagnosis usually for a misinterpreted CXR (5/7). Delay in diagnosis did not directly contribute to any deaths. Associated abdominal injuries are a common cause of preventable deaths. Fourteen patients with combined abdominal injuries and TRA were identified. Four of six deaths occurred with potentially reparable injuries. Operative and diagnostic sequences must be adjusted to allow rapid control of all potentially fatal injuries.

Adolescent↗
PubMed1990

Organ donor management and organ outcome: a 6-year review from a Level I trauma center.

A retrospective review of 114 solid organ donors over a 6-year period (1982-1987) was undertaken to identify problems in organ donor management and determine outcome of donated organs. Admission GCS was less than or equal to 4 in 84% of the donors. Complications included hypotension (81%), multiple transfusion requirements (63%), diabetes insipidus (53%), DIC (28%), arrhythmias (27%), cardiac arrest requiring CPR (25%), pulmonary edema (19%), hypoxia (11%), acidosis (11%), seizures (10%), and positive bacterial cultures (10%). Only 18% of organs were procured within 3 hours of brain death; 23% were procured more than 6 hours later. Six patients excluded from this study suffered cardiovascular collapse before their organs could be retrieved. From 114 organ donors, consent was obtained to procure 224 kidneys, 77 livers, 62 hearts, 35 pancreata, and ten heart-lung units. All 224 donated kidneys were procured and 202 were ultimately transplanted. Of 77 donated livers, 32 were procured; 31 transplanted. Of 62 donated hearts, 38 were procured; 29 transplanted and nine used for valves. Ten heart-lung units were donated; six were procured and transplanted. Of 35 donated pancreata, 11 were procured; only five were transplanted. Reasons for failure of donated organs to be procured or transplanted included abnormal organ characteristics, lack of compatible recipients, unavailability of surgical teams, organ injury during procurement, intraoperative arrest, and anatomic limitations precluding multiple organ procurement. This study identifies characteristics of organ donors and common organ-threatening complications. Rapid and continuing resuscitation of clinically brain dead trauma victims is mandatory.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗