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PubMedDate not supplied

[Nuclease activity in multiple trauma].

Activities of acid and alkaline DNAses and RNAses as well as content of insulin were studied in blood of patients with severe mechanical trauma. Distinct alterations in activities of acid and alkaline DNAses were observed in the acute period of the disease and the activity was normalized within 14-21 days. The RNAase system exhibited the most pronounced response to the trauma, while activity of acid RNAase exceeded the normal level by 52% within 21 days of the posttraumatic period. Activities of acid and alkaline RNAases were increased simultaneously with elevation of the insulin content in blood within 14-21 days of the disease. Thus, alterations in the nucleases activity proved to be a sensitive response of a body to mechanical trauma.

Adult↗
PubMedDate not supplied

Aminopeptidase and cathepsin A activity in vitreous humor in relation to causes of death.

Brain autolysis happens rapidly, especially when environmental temperatures are high, and poses serious limitations for evaluating damage using morphologic methods. In the present study we have measured total proteins, cathepsin A and aminopeptidase activity in the vitreous humor in relation to cause of death and survival time. We have studied vitreous humor samples from 106 cadavers autopsied in the I.A.F. of Granada. The samples were classified according to causes of death as follows: myocardial infarction; hanging; other mechanical asphyxias; multiple trauma; craniocerebral trauma; other violent death; pulmonary functions; and other natural deaths. Total protein was measured by Lowry's method, and cathepsin A and aminopeptidase activity by the Bowen and Davison (1973) and Greenberg (1962) methods, respectively. Results are expressed in IU/l and in mIU/mg of protein. We found higher values of aminopeptidase and cathepsin A activity in groups with severe brain damage (craniocerebral trauma, multiple trauma, etc.) and lower values in groups of natural deaths. We believe, therefore, that aminopeptidase activity in vitreous humor may be a useful parameter for evaluating brain damage.

Aminopeptidases↗
PubMed2001

Acute trauma with multiple injuries.

Trauma with multiple injuries is a leading cause of death. It presents a diversity of challenges and requires many healthcare workers to care for its victims. Advances continue in the organization of pre-hospital care, the techniques of trauma surgery and critical care, and understanding the pathophysiology of traumatic injuries.

Journal Article↗
PubMed1991

[Multiple organ failure. Reflection of generalized cell damage of all organs following severe trauma].

Multiple organ failure (MOF) is presently recognized as the most severe, and often lethal, complication after multiple trauma. Causal factors and pathomechanisms remain unclear, however. Generalized inflammatory cell tissue injury with a subsequent increase in permeability in all organs has been suggested. For this reason, 38 polytraumatized patients were examined in a prospective study. Organ function was analyzed, and specific clinical and histological studies were performed to check for generalized cell tissue damage and increased respiratory permeability. In all organs we found signs of tissue damage immediately after trauma. Disturbances of organ function were seen consistently, starting precisely from day 4. It was not possible to confirm an influence of blunt organ trauma on organ function during follow-up. The severity of injury (especially intrathoracic and intraabdominal) and massive bleeding increases the risk of MOF. MOF was not always associated with the onset of sepsis, and no temporal dependence could be shown. Histological studies demonstrated an inflammatory change in organ tissues, which is probably the result of toxic substances (endotoxin, TNF, oxygen radicals, proteases and eicanosoids) released into the blood circulation after trauma. Insufficient neutralization of these toxic metabolites leads to generalized permeability damage and consequently to progressive organ failure. Therefore, even with optimized initial treatment of multiple trauma patients, MOV and mortality can only be reduced with a causal approach to therapy.

Adolescent↗
PubMed1982

[Diagnosis and differential diagnosis of the compartment syndrome].

Early diagnosis of compartmental syndromes after trauma and surgery can be made from clinical symptoms and signs in most cases. These include burning, deep-seated pain, weakness and pain on passive stretch of the compartment muscles, hypo-esthesia in the area of peripheral nerves, swelling and tense fascial boundaries. Clinical examination should be performed at frequent intervals, with the limb free from all dressings and placed at heart level. In high risk cases with severe soft tissue trauma, multiple trauma or ventilator treatment, intracompartmental pressure is measured by methods of Whitesides or Matsen, which indicate fasciotomy at pressures above 40 mm Hg. From 1975 to 1982, 96 compartmental syndromes were treated, with early diagnosis in 71.

Aged↗
PubMedDate not supplied

Ventilatory support for pulmonary failure of the head trauma patient.

Severe head trauma patients frequently develop pulmonary failure. The aetiology of this respiratory distress may be central (neurogenic pulmonary oedema, delayed neurogenic pulmonary dysfunction, abnormal respiratory patterns) or peripheral, due to chest trauma, multiple trauma or lung infection. Hypoxia and hypercarbia alter cerebral haemodynamics, increase intracranial pressure and cause secondary deterioration of neurological function. Ventilatory support is of utmost importance in supportive care of head trauma patients. Continuous mechanical ventilation and intermittent mandatory ventilation are most frequently employed. Hyperventilation is used to lower intracranial pressure and positive end-expiratory pressure (PEEP) is applied in lung disorders characterized by interstitial oedema and alveolar collapse. The effects of PEEP on cerebral perfusion pressure and on intracranial pressure depend on the interaction of pulmonary compliance, cerebral pressure/volume relationship and cerebral vascular autoregulation. High levels of PEEP may be deleterious in patients with altered cerebral autoregulation. High frequency ventilation theoretically has less influence on intrathoracic pressures and on cerebral haemodynamics but has not been shown superior in the respiratory support of severe head trauma patients.

Animals↗
PubMed1987

Rupture of the pericardium with luxation of the heart after blunt trauma.

Two multiple trauma patients with total rupture of the pericardium and luxation of the heart into the left pleural cavity after blunt trauma are presented. One of the patients also had rupture of the posterior wall of the left ventricle with abundant bleeding. Both patients had intra-abdominal organ injuries, and emergency laparotomy was the first surgical procedure. The pericardial injury in one patient was diagnosed and treated by immediate thoracolaparotomy, in the other by left thoracotomy within 1 hour after laparotomy: both patients recovered. Awareness of possible pericardial lesions in multiple trauma patients with symptoms of hemodynamic failure is stressed.

Adult↗
PubMedDate not supplied

[Mechanisms and evaluation of multiple organ and system failure after trauma].

Multiple organ failure (MOF) is a major cause of death of ICU trauma patients. Despite intensive clinical and experimental investigation, the exact physiopathology of this syndrome is unclear. Although diverse cellular and humoral mediators have been identified, their mechanistic role is still debated. In this article the authors discuss recent results of this investigation. They present recently published criteria for MOF quantification, and focus on the mechanisms and mediators of MOF syndrome, emphasizing the role of sepsis, the intestinal ischemia/reperfusion MOF model, the role of polymorphonuclear neutrophil, and the relationship between adult respiratory distress syndrome (ARDS) and the development of MOF syndrome.

Animals↗
PubMedDate not supplied

Management of patients with head injuries and multiple other trauma.

The management of patients with multiple trauma including head injuries is a complex task. The prime goal is to minimize secondary neuronal injury. Attention to establishment of an airway, assurance of adequate gas exchange, and circulatory resuscitation is mandatory to minimize any secondary neuronal injuries. Once these principles of resuscitation have been applied and the primary neuronal injury is treated, additional etiologies of secondary brain trauma, such as hypoglycemia and hypothermia, should be addressed. Continual monitoring of oxygenation and perfusion is mandatory optimizing the outcome of these patients.

Craniocerebral Trauma↗
PubMed1990

The pathophysiology of multi-system organ failure in the trauma patient.

Multiple trauma mortality in the critical care setting most often occurs as a result of multi-system organ failure (MSOF). Mortality rates increase exponentially as successive organ systems fail. Although the role of shock in determining patient outcome has been extensively investigated, inflammatory factors and sepsis are becoming increasingly implicated in the development of MSOF. The physiologic effect of these factors on individual organ systems is explained. Signs, symptoms, and key criteria for determining organ system failure also are presented to assist the nurse in recognition and prevention.

Education, Nursing, Continuing↗
PubMed1996

Pattern of organ failure following severe trauma.

Multiple organ failure (MOF) is considered to be the leading cause of death after severe trauma. Although there is extensive literature on MOF, little is known about the pattern, sequence, and onset of this clinical syndrome. The first goal of this clinical study was to define MOF; the second was to assess the typical onset, sequence, and pattern of MOF; and the third was to define certain risk factors for the development of MOF in 342 multiple trauma patients. Patients with an Injury Severity Score (ISS): > 20 (mean 35.7) were included. Three well established MOF scoring methods were used to give strict definitions of MOF: 11.4% of the total patient population developed MOF, and 88.6% did not. Respiratory failure was most frequent in patients developing MOF (74.4%), and these patients had the highest mortality rate (65.5%) compared to patients with failure of other organ systems (liver, cardiovascular system). Generally, the lung is the first organ to fail after injury (failure after 3.7 +/- 2.8 days). Significant renal failure and the need for dialysis decreased to < 5%; other signs of organ dysfunction (gastric, central nervous system) are difficult to verify. Typical risk factors for the development of MOF after severe trauma are the severity, type, and distribution of injury as well as the indicators of prolonged hemorrhagic shock (elevated lactate levels). The main therapeutic efforts, therefore, should be the effective treatment of traumatic hemorrhagic shock during the initial phase, adequate resuscitation, optimal oxygenation, and early surgical treatment.

Adolescent↗
PubMed2002

Painful discrimination: the differential use of analgesia in isolated lower limb injuries.

Our primary objective was to compare use of analgesia for patients with and without fracture as a result of isolated lower extremity trauma, in the emergency department (ED). Our secondary objective was to compare the analgesic practices of emergency physicians (EPs) with that of physician assistants (PAs). We performed a prospective, blinded cohort study with the presence of fracture as the risk factor and provision of any pain medication while in the ED as the primary outcome. Included in the study were all patients who presented to a 90,000 visit suburban teaching hospital with an isolated lower extremity injury who received a radiograph of the foot or ankle over a 9-week period. We excluded patients without trauma, with multiple trauma, admitted, or seen by one of the investigators. Patients admitted and those with multiple trauma were excluded because these patients had contacts with multiple physicians and it is unlikely they would be able to differentiate which physician prescribed medication and if they were emergency personnel. We defined analgesia as any pain medication at any dose. One investigator preformed follow-up interviews using a standardized questionnaire 3 days after the visit. Patients expressed their recollection of their degree of pain using a verbal analog scale of 1 to 10. We report crude and adjusted odds ratios (OR). Of 516 consecutive patients, 111 met exclusion criteria and 3 had incomplete data. Of the remaining 405, we contacted 384 (95%) in an average of 3 +/- 1 days. Patients with and without fractures recalled their initial degree of pain similarly, with the mean initial pain scores on the verbal analog scale of 6.6 +/- 2.5 versus 6.8 +/- 2.1 respectively. Patients with a fracture were more likely to receive pain medication while in the ED (23% v 15% P =.047, OR 1.75 (CI 95% 1.02, 2.99). EPs gave some form of ED analgesia to 29% of patients, as compared with 10% of patients seen by PAs (OR = 3.58 CI 95% 2.05, 6.24). EPs provided a prescription to 44% of patients versus 21% of patients seen by PAs (OR = 2.91 CI 95% 1.85, 4.57). Our estimated adjusted ORs for providing analgesia in the ED were: fracture = 2.0 (CI 95% 1.13, 3.58); EP: 3.52 (CI 95% 1.98, 2.99); and for every additional point on the verbal pain scale: 1.28 (CI 95% 1.11, 1.48). Patients with fracture were more likely to receive pain, despite reporting identical degree of pain. EPs were more likely to provide analgesia than PAs.

Adolescent↗