Liver Injury in Abdominal Trauma: Management and Association with Other Solid Abdominal Organ Injury

Background and objective : Blunt abdominal injury remains one of the commonest injuries. The solid organs, namely the Liver, Spleen & Kidney are the most commonly injured intra-abdominal organs. Non operative line of management is now considered the line of treatment for patients with intra-abdominal organ injury who are hemodynamically stable. In the case of polytraumatized patients with open or blunt abdominal trauma, the liver is the most frequently injured abdominal organ. Earlier, surgical treatment was the standard procedure globally for all kinds of trauma-related liver injuries. However, development of new interventional radiological techniques has changed the paradigm towards a non-surgical patient management. Methodology: An observational study of 50 patients with solid organ injuries of the abdomen following abdominal trauma admitted over a period from July 2018 up to August 2020 was carried out. Patient management either operative or conservative was decided on basis of hemodynamic status and they were divided in groups OP (Operated) and NOM (Non Operative Management). Interpretation and conclusion : In our study, majority of liver injury were treated conservatively. Splenic injury patients were mostly managed by operative intervention and renal injury patients were managed according to grading of organ injury.

Comparing the Rates of Dopamine Hemodynamic Effect Onset after Infusion through Peripheral Veins in Three Regions / 대한구급학회지

BACKGROUND: Dopamine is an inotropic agent that is often selected for continuous infusion. For hemodynamic stability, the rate of infusion is controlled in the range of 5-15 µg/kg/min. This study aimed to compare the time intervals from the administration of dopamine to the onset of its hemodynamic effects when dopamine was administered through three different peripheral veins (the cephalic vein [CV], the great saphenous vein [GSV], and the external jugular vein [EJV]). METHODS: Patients in group 1, group 2, and group 3 received dopamine infusions in the CV, GSV, and EJV, respectively. A noninvasive continuous cardiac output monitor (NICCOMO™, Medis, Ilmenau, Germany) was used to assess cardiac output (CO) and systemic vascular resistance (SVR). Six minutes after intubation, baseline heart rate (HR), systolic blood pressure (BP), diastolic BP, mean arterial pressure (MAP), CO, and SVR values were recorded and dopamine infusion was initiated at a dose of 10 µg/kg/min. Hemodynamic changes at 0, 4, 8, 12, and 15 minutes postinfusion were recorded. RESULTS: No statistically significant differences were observed among the three groups with respect to the rate of hemodynamic change. In all groups, systolic BP, diastolic BP, MAP, and SVR tended to increase after decreasing for the first 4 minutes; in contrast, HR and CO decreased until 8 minutes, after which they tended to reach a plateau. CONCLUSIONS: For patients under general anesthesia receiving dopamine at 10 µg/kg/min, there were no clinical differences in the effect of dopamine administered through three different peripheral veins.

Comparing the Rates of Dopamine Hemodynamic Effect Onset after Infusion through Peripheral Veins in Three Regions / 대한중환자의학회지

BACKGROUND: Dopamine is an inotropic agent that is often selected for continuous infusion. For hemodynamic stability, the rate of infusion is controlled in the range of 5-15 µg/kg/min. This study aimed to compare the time intervals from the administration of dopamine to the onset of its hemodynamic effects when dopamine was administered through three different peripheral veins (the cephalic vein [CV], the great saphenous vein [GSV], and the external jugular vein [EJV]). METHODS: Patients in group 1, group 2, and group 3 received dopamine infusions in the CV, GSV, and EJV, respectively. A noninvasive continuous cardiac output monitor (NICCOMO™, Medis, Ilmenau, Germany) was used to assess cardiac output (CO) and systemic vascular resistance (SVR). Six minutes after intubation, baseline heart rate (HR), systolic blood pressure (BP), diastolic BP, mean arterial pressure (MAP), CO, and SVR values were recorded and dopamine infusion was initiated at a dose of 10 µg/kg/min. Hemodynamic changes at 0, 4, 8, 12, and 15 minutes postinfusion were recorded. RESULTS: No statistically significant differences were observed among the three groups with respect to the rate of hemodynamic change. In all groups, systolic BP, diastolic BP, MAP, and SVR tended to increase after decreasing for the first 4 minutes; in contrast, HR and CO decreased until 8 minutes, after which they tended to reach a plateau. CONCLUSIONS: For patients under general anesthesia receiving dopamine at 10 µg/kg/min, there were no clinical differences in the effect of dopamine administered through three different peripheral veins.