Multiple trauma and paraplegia; (case P2).
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The paper deals with a new aspect in patients with polytrauma using a method to distinguish between myocardial or skeletal muscle damage. The isoenzyme CKMB of kreatine kinase is found to be characteristic for myocardial damage when increasing to more than 10% of the whole enzyme activity. It should be mentioned that this elevation is also seen in other disorders. Therefore the correlation to ECG changes is important in considering the diagnosis.
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Premature ventricular contractions and ventricular tachycardia were detected in 10 dogs 1 to 48 hours after trauma. All dogs were treated aggressively if the arrhythmias became severe. One dog died, 8 were discharged with stable cardiac rhythm, and 1 was euthanatized. Necropsy revealed gross and microscopic lesions of acute myocardial necrosis, probably of ischemic origin. Cardiac arrhythmias were associated with thoracic trauma, neurologic injury, severe shock, and/or extensive tissue trauma.
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In a series of 75 patients review for injuries of the gastrointestinal tract, a consistent degree of hypokalemia and hypofibrinogenemia was noted. The degree of hypokalemia was associated with the severity of trauma and subsequent mortality. The degree of hypofibrinogenemia was associated more with mortality than with severity of trauma.
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