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At least 811 records · Page 45Linked to original sources
PubMed1983

Resuscitation of the multiply injured patient.

The resuscitation of the traumatized patient with multisystem injuries begins on the scene of the incident, continues into the emergency department, and finally includes the surgeon and the operating room. Treatment of the traumatized patient requires a systematic approach to best utilize all facilities and personnel while limiting duplication of service. The patient must go to the facility that best meets his or her needs. Stabilization in the emergency department should proceed in an orderly and organized fashion. Care must be taken when establishing the airway to protect the cervical spine. Massive hemothorax, tension pneumothorax, cardiac tamponade, intraabdominal bleeding, and retroperitoneal bleeding, as well as flail chest, must be remedied before stabilization and resuscitation can come to a successful outcome. Internal cardiac massage may need to be done for cardiac tamponade or when resuscitation has failed. Fluid repletion must be vigorous and aggressive. Albumin is probably of no benefit to the patient and, in fact, may be deleterious. Hetastarch may turn out to be a valuable addition to the fluid management of these patients. The patient is entitled to one physician who can call the consultants together. In addition, there should be a single physician for the patient who can control the timing of operative intervention as well as coordinate the overall management by the consultants.

Blood Transfusion, Autologous↗
PubMed1980

Alterations in cardiac rate and rhythm in miniature swine during simulated aerial combat maneuver +Gz stress.

Electrocardiograms (McFee-axial reference system) were recorded from 18 chronically instrumented, conscious, female miniature swine before, during, and after exposures to +Gz stress. The animals were exposed to five simulated aerial combat maneuver (SACM) type acceleration profiles which spanned approximately 106 s and included two 5-s +9Gz peaks. A 5-min rest period separated each SACM exposure. Maximum heart rates during +Gz decreased over the course of the 5 SACM's-241 +/- 4 b/m and 224 +/- 5 b/m for the first and last exposures, respectively. Resting heart rates obtained 5 min after each SACM exposure were steadily increased from a control of 86 +/- 5 b/m to a final of 129 +/- 8b/m. Of the 18 animals studied, 10 developed arrhythmias during +Gz, or within the first minute after +Gz exposure. Arrhythmias exhibited included premature atrial and ventricular contractions, intraventricular conduction defects, sinus arrhythmias, premature junctional contractions, atrial bigeminy, ectopic atrial and ventricular rhythms, complete A-V dissociation, left anterior arborization-block, and junctional rhythms with aberrant conduction. While arrhythmias were not uncommonly observed during +Gz, most occurred at the end of the SACM profile or immediately following the SACM.

Animals↗
PubMed1982

Cost-effectiveness of primary and secondary prevention of fatal pulmonary embolism in high-risk surgical patients.

Because death due to pulmonary embolism is relatively rare following general surgery, many question the need for prophylaxis. In addition, there has been reluctance to apply new interventions whose cost-effectiveness has not been adequately evaluated. A cost-effectiveness analysis based on over 1000 high-risk patients undergoing abdominothoracic surgery, with effectiveness measured in terms of numbers of deaths from pulmonary embolism averted, has shown subcutaneous administration of heparin in low doses starting 2 hours before the operation to be the most cost-effective of several active approaches to prophylaxis. It averted seven of the eight deaths expected without active prophylaxis per 1000 such patients and cost half as much as the traditional approach of intervening only when venous thromboembolism becomes clinically apparent. Intravenous administration of dextran, although effective, was expensive, and leg scanning with iodine-125-labelled fibrinogen was extremely expensive. Intermittent pneumatic compression of the legs was inexpensive, but, as with leg scanning, its effectiveness has not been determined in randomized trials.

Adult↗
PubMed1983

Evaluation of a Reverse Gradient Garment for prevention of bed-rest deconditioning.

A Reverse Gradient Garment (RGG) was used to intermittently induce venous pooling in the extremities of a magnitude similar to that seen in going from a lying to standing position during the course of a 15-d period of horizontal bed rest. Venous pooling failed to improve bed-rest-induced losses in +2.5 Gz and +3.0 Gz centrifugation tolerance or to prevent increased heart-rate responses to lower-body negative pressure (LBNP). Four subjects served as controls, four were treated. Tests during the 7-d recovery period showed fluid/electrolyte and body composition values to have returned to pre-bed-rest levels with continued depression of acceleration tolerance times (56% decreased at +2.5 Gz and 74% decreased at +3.0 Gz compared to pre-bed-rest levels) and exaggerated blood insulin response on glucose tolerance testing (blood insulin for treated group increased 95% at 1 h before bed rest and 465% during recovery). This study demonstrates that the physiologic changes after bed rest persist for significant periods of time. Acceleration tolerance time proved to be a sensitive test for the deconditioning process.

Acceleration↗
PubMed1983

MAST: medical antishock trousers.

MAST are a simple, safe and sound device with applicability in all shock states; they provide a number of benefits to the hypotensive patient. The main benefits seem to be autotransfusion of peripherally pooled blood originating from the MAST encased areas, increase in peripheral vascular resistance, external tamponade of bleeding vessels and an aid to stabilization of fractured bones of the pelvis and lower extremities. Because an area of hypoperfusion can lead to complications, the pathophysiologic effects of MAST must be understood. The greatest complications occur when MAST are too rapidly removed. They must be removed in an appropriate place by trained physicians under controlled conditions. The key is to deflate the MAST over a prolonged period of time using a gradual release of external pressure. Volume status and acid-base balance must be carefully monitored. In the last few years MAST have had an ever expanding role in both the pre-hospital and hospital phases of care of the critically ill and injured patients. All physicians involved in the care of these patients must be familiar with this device. Applied and removed properly, MAST will sustain blood pressure and save lives.

Acid-Base Imbalance↗
PubMed1984

Effects of positive end expiratory pressure and counterpressurization on circulating prostaglandins in the dog.

The effects of the application of positive end expiratory pressure (PEEP) ventilation, with and without body counterpressure (CP), on circulating prostaglandin-like substances (PGL) were studied in chloralose anesthetized dogs. The normal respiratory movements were paralysed with succinylcholine chloride. Arterial levels of PGL were continuously bioassayed using Vane's blood superfusion method. PEEPs of 10 and 20 mm Hg elicited PEEP-related increases in functional residual capacity and circulating PGL levels and decreases in blood pressure, left ventricular dP/dt, and heart rate. The PGL appeared to be PGE or prostacyclin in character. When PEEP and CP were simultaneously applied, the increments or decrements of indices described above were reduced. It is concluded that increases in the levels of circulating PGL are attributable, at least in part, to hyperexpansion of the lungs during PEEP and that some of the cardiovascular deterioration observed during and after PEEP may be the result of the vasodilating and cardiodepressing effects of PGL.

Animals↗
PubMed1983

Disorders of the chest wall and diaphragm.

The clinical presentations of chest wall and diaphragmatic disorders are extremely diverse, and the attention of the emergency physician is often directed to a more obvious problem. The common denominator of these disorders is their effect on respiratory mechanics, a discussion of which precedes the review of specific disorders.

Accidents, Traffic↗
PubMed1983

Hemodynamics of cardiac massage.

The introduction of closed chest massage in 1960 initiated a widespread interest in cardiopulmonary resuscitation. Until that time, open chest cardiac massage was the standard for CPR. Initial explanations for blood flow during closed chest CPR were based upon direct compression of the heart. This explanation has given way to demonstrations that blood flows during CPR because of changes in intrathoracic pressure. Changes in intrathoracic pressure that create blood flow have been created by simple maneuvers such as coughing. More involved methods of affecting intrathoracic pressure, in an attempt to improve upon standard closed chest massage, have included applying positive pressure to the airway, binding of the abdomen, and the use of MAST. Cardiac output with closed chest massage is approximately one fourth of normal, and cerebral perfusion is approximately one tenth of normal. Cardiac output with open chest massage is approximately double that obtained by closed chest massage. Cerebral blood flow during open chest massage approaches physiologic values. The use of drugs possessing alpha adrenergic activity and maneuvers that augment intrathoracic pressure improve vital organ perfusion.

Animals↗
PubMed1984

Pneumatic antishock trousers.

While pneumatic antishock trousers are a useful adjunct for the initial management of hypotension, they do not replace, but can augment, fluid replacement and other resuscitative procedures. They can be applied quickly and are relatively safe when used in the manner recommended. They must not be used in a patient with congestive heart failure. Finally, it is imperative that they are not removed suddenly from the hypovolemic, hypotensive patient.

Child↗
PubMed1984

Shock trauma.

Trauma - accidental or intentional injury - is a major health and social problem. It is still the chief cause of death in people between the ages of 1 and 38 years. In the United States, the mortality due to trauma between the ages of 15 and 24 years increased by 13% from 1960 to 1978. During the same period, the mortality for people aged 25 to 64 years declined by 16%. Murders have increased from 8464 in 1960, to 26 000 in 1982. The overall death rate of American teenagers and young adults is 50% higher than that of their counterparts in Britain, Sweden and Japan. Trauma affects young, productive citizens, and the estimated costs for death, disability and loss of productivity exceed $230 million a day. The most tragic statistic is that at least 40% of the deaths are needless and preventable if better treatment and prevention programs were available. Trauma deaths that might be prevented are those due to motor vehicle accidents, homicide, burns, and alcohol and drug abuse. In this paper suggestions for prevention are made. They include improved crash worthiness of motor vehicles, revocation of drunk drivers' licences, use of devices that limit drunk drivers, increased tax on alcohol and random breathalyser tests, and the use of seat belts and motorcycle helmets. Control of hand-guns and burn characteristics of cigarettes could also reduce deaths. The problems and issues in trauma care can be divided into two broad categories: system and professional. System problems include prehospital care, in-hospital care, rehabilitation and prevention. Professional problems include education, research, economics, and quality.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Traffic↗
PubMed1984

Prehospital trauma care.

The past two decades have been a period of increased concern over the improvement of prehospital emergency medical care. Training of basic and advanced EMTs to a level of professionalism that includes a distinct body of knowledge and the use of assessment and management skills is only one component of the prehospital system. Communications systems, transportation deployment plans, and improved links with hospitals have contributed to the refinement of emergency medical systems. The management of the trauma victim is an organized plan of controlling the airway, restoring breathing, and supporting ventilation, followed by a secondary survey of the less life-threatening problems. The role of EMTs or paramedics, therefore, is to assess, manage, extricate, and transport.

Abdominal Injuries↗
PubMed1984

Pediatric trauma.

Although the pathophysiology of trauma is the same in all ages, the injured child presents special problems in regard to vascular access, airway control, and the greater vulnerability of certain organs to injury. Special guidelines are given regarding the technical aspects of circulatory support and airway management. Selective early use of MAST is stressed. Evaluation of each organ system is designed to facilitate progressive decision making, particularly in regard to when an injured child should be taken to the operating room and when he should be treated conservatively.

Child↗
PubMed1983

The clinical use of antishock trousers.

In 34 (71%) of 48 consecutive patients who were in shock (systolic blood pressure less than 80 mm Hg) the application of antishock trousers by ambulance personnel or emergency room staff produced rapid increases of 20 mm Hg or more in the systolic blood pressure. The trousers were applied to a 49th patient only to stabilize a fractured femur. The most common indication for the device was shock resulting from hemorrhage in the upper gastrointestinal tract. Of 20 such patients, 17 (85%) responded rapidly, as did all 5 patients who were treated for a ruptured abdominal aortic aneurysm. The proper application and management of antishock trousers are simple enough for use in the field, although deflation of the device before adequate replacement of fluids would precipitate a return to a state of shock.

Aged↗