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OBJECTIVE To define the incidence, prophylaxis, and treatment of intra-abdominal hypertension (IAH) and its relevance to gut mucosal pH (pHi), multiorgan dysfunction syndrome, and the abdominal compartment syndrome (ACS). METHODS Seventy patients in the SICU at a Level I trauma center (1992-1996) with life threatening penetrating abdominal trauma had(More)
Blunt and penetrating injuries of the extrahepatic biliary system are rare and appear to be increasing in frequency. The severe morbidity associated with these lesions is related to incomplete efforts at diagnosis and errors in therapeutic decisions. The morbidity may be minimized by a high index of suspicion and awareness of these lesions; complete(More)
In 18 months, 44 patients underwent thoracotomy in an emergency department (ED) for penetrating thoracic injuries. Of 14 patients resuscitated, seven (50%) survived, and all were neurologically intact. Patients were classified according to the quality of signs of life in transit or upon arrival at the ED. Identical survival rates of 29% were noted for(More)
Analysis of 228 patients who sustained penetrating cardiac injuries (1963-1983) reveals that among patients who arrived with vital signs, survival was 73 per cent as opposed to 29 per cent of patients who arrived in extremis; and delay in thoracotomy contributed to an increased mortality among patients in profound shock who failed to respond promptly to(More)
To study the value of advanced life support (ALS) compared with basic life support (BLS) for penetrating and motor vehicle crash (MVC) patients, data were collected from eight hospitals over 24 months on 781 consecutive patients with Injury Severity Scores > or = 10 as well as on a subset of 219 hypotensive patients. Initial prehospital Revised Trauma(More)
To determine whether blood transfusion influences infection after trauma, we analyzed data on 5366 consecutive patients hospitalized for more than 2 days at eight hospitals over a 2-year period. The incidence of infection was significantly related to the mechanism of injury: penetrating injuries, 8.9%; blunt injuries, 12.9%; and low falls, 21.4%. Stepwise(More)
The results of 163 patients (49 SWs, 85 GSWs, 29 blunt trauma) who had resuscitative thoracotomy in the emergency room (ERT) were reviewed to reassess the indications for the procedure. The Revised Trauma Score (RTS) of the patients ranged from 0 to 3 in 138, 4 to 8 in 21, and greater than 8 in four. No patient with blunt trauma survived. Sixteen patients(More)
BACKGROUND Gastric tonometry, as a method of organ-specific monitoring of the status of the splanchnic circulation, has demonstrated prognostic and therapeutic implications in critically ill patients. The experience with this method in patients with trauma has been limited. STUDY DESIGN Fifty-seven patients were prospectively randomized into two groups:(More)
To evaluate the results of a conservative approach to gunshot wounds of the spine with a transperitoneal trajectory, we analyzed our 4-year experience with 21 patients. The management protocol consisted of standard treatment of the intra-abdominal injuries, vigorous irrigation of the missile track, and a 48-hour course of antibiotic therapy. The lumbar(More)
OBJECTIVE To critically reevaluate the indications for fasciotomy in vascular trauma of the extremities. DESIGN Case-control study. SETTING Level I trauma center. MATERIALS AND METHODS One hundred sixty-three vascular injuries to the extremeties were analyzed. Fasciotomy as an adjunct to vascular repair was performed in 45 limbs (28%), based either on(More)