Preliminary discussion on the prevention and treatment of shock after severe burns / 中华烧伤杂志

Shock is one of the most common complications and one of the main causes of death after severe burns. The prevention and treatment of shock runs through the whole process of severe burn treatment. Shocks after severe burns, based on their causes, are mainly classified as follows: hypovolemic shock characterized by elevated hematocrit, also known as burn shock, and caused by serious leakage of intravascular fluid to body surface and interstitial spaces in the early stage of burns; hemorrhagic shock caused by large scale of incision and tension reduction, gastrointestinal stress ulcer, or large area of escharectomy and tangential excision surgery; septic shock caused by various microbial invasion; anaphylactic shock caused by infusion of drugs or blood. From the perspective of the reduction of effective circulating volume, burn shock and hemorrhagic shock are hypovolemic shocks, and septic shock and anaphylactic shock are vasodilatory shocks. As the aforementioned shocks vary in terms of occurrence timing, occurrence mechanism, and clinical manifestations, individualized strategies should be adopted for the prevention and treatment.

Temperature gradients in domestic cats over seven-years-old: descriptive analysis / Avaliação descritiva dos gradientes de temperatura em felinos domésticos com mais de sete anos

The temperature gradients are dynamic and noninvasive monitoring techniques that provide information on peripheral blood flow and have been related to the prognosis of patients with circulatory shock. This study evaluated 47 elderly domestic cats' temperature gradients, and we measured central (rectal) and peripheral (palmar, plantar and medial region of the radio) temperatures. Values found in this study are compatible with studies in young felines and differ from dogs and humans. The mean gradients found were 7.5°C for the central-peripheral; 5.6°C for the peripheral-environmental; 2.7°C for the skin-diff; and 0°C for the member-diff and the variables age and gender do not seem to influence these measurements. To the authors' knowledge, there is no description of temperature gradients in elderly domestic cats, so this study pretends to clarify the vasoconstriction response in this group of animals.(AU)

Os gradientes de temperatura são técnicas de monitoração dinâmicas e não-invasivas que fornecem informações sobre o fluxo sanguíneo periférico, e têm sido relacionados ao prognóstico de paciente com choque circulatório. O presente estudo avaliou os gradientes de temperatura em 47 felinos domésticos idosos aferindo as temperaturas central (retal) e periférica (palmar, plantar e região medial do rádio). Os gradientes encontrados foram 7,5°C para o centro-periférico; 5,6°C para o periférico-ambiental; 2,7°C para o skin-diff; e 0°C para o member-diff. As variáveis idade e sexo não pareceram influenciar as mensurações. Não há, em conhecimento dos autores, descrição prévia dos gradientes de temperatura em felinos domésticos idosos, e por isso esse estudo pretende contribuir com o entendimento sobre a capacidade de resposta de vasoconstrição nesse grupo de animais.(AU)

Pattern of road traffic accidents in Imphal.

In recent years the incidence of Road Traffic Accidents is increasing at an alarming rate throughout the world posing itself as a major epidemiological as well as medico-legal problem. In a study of 205 cases of Road Traffic Accidents brought to the mortuary of Regional Institute of Medical sciences, Imphal during September 2007 to August 2009, it was noted that males (75.13 %) outnumbered the females (24.87%). Majority of the victims were in the age group of 21 - 30 years (24.89%). It was also noted that majority of the accidents happened in the National Highways (59.51%) and pedestrians were the commonest victims (37.56%). Trucks were the most frequent offending vehicles (34.63%) followed by Buses (22.94%) The commonest cause of death was due to shock and haemorrhage (34.64%). large number of human lives can be saved if trauma centres are established along the National Highways equipped with well trained medical personnel and complete infrastructure of emergency care.

Triage, temperatura, frecuencia cardíaca y saturación de O2, en la clasificación de pacientes en un servicio de urgencia pediátrico / Weight of triage, temperature, cardiac rate, and oxigen saturation in the classification of patients seen in a pediatric emergency service

This study evaluates the association of Triage (Tr), body temperature (t) and Oxygen saturation (SatO2) at the time of admission to a Pediatric Emergency Service (PES) with discharge home or hospitalization. Method: 1 863 patients admitted to a PES in June and July of 2007 were included, stratified by age (< 2 mo, 3-12 mo, 13-36 m, 37-60 mo, 61-120 mo, 121-187 mo). Chi Square test was used, screening for p < 0.05. Results: Hospitalization was most likely for children under 6 months old, (5.42, range 3.9-7.6), scoring Triage < 2 (6.9, range 4.7-10.2), or a Saturation level below 93 percent (23.68, range 14.6-38.3). No significant association was seen between fever and hospitalization (1.31, range 0.9-1.8). SatO2 < 93 percent was associated to tachycardia in all ages (3.62, range 2.09-5.79), so did fever (6.74, range 5.07-8.67). Over half (51.8 percent) of children with fever showed tachycardia, 22.8 percent of afebrile cases were associated to this symptom. Discussion: Risk of hospitalization is higher if a child is younger than 6 months old, with Oxygen Saturation below 93 percent or Triage level < 2. Over 600 children presented tachycardia (33 percent); none progressed to Shock even with SatO2 < 93 percent or Triage level < 2. Tachycardia, as an isolated sign, does not appear to be forecast significant hemodynamic change or need to be treated as such.

Se indagó la asociación Triage (Tr)- temperatura corporal (T°) y saturación de oxígeno (SO2) al consultar en Urgencia, con alta u hospitalización y se postuló asociaciones de taquicardia con T° y SO2. Pacientes y Método: Se configuró un grupo de 1 863 pacientes, de quienes acudieron en junio y julio 2007. Se emplearon razones de riesgo (OR) con IC95 por ciento y análisis estratificado por grupos de edad: < 2 m; 3-12 m; 13-36 m; 37-60 m; 61-120 m; 121-187 m. Se empleó X2 y p ≤ 0,05. Resultados: La probabilidad de hospitalización fue mayor al ser < de 6m (OR = 5,42; IC95 por ciento = 3,9-7,6), tener Triage ≤ 2 (OR: 6,94; IC95 por ciento: 4,7-10,2) o SO2 < a 93 por ciento (OR = 23,68; IC95 por ciento = 14,6-38,3). No se encontró asociación entre fiebre y hospitalización (OR = 1,31; IC95 por ciento = 0,9-1,8; NS) La SO2 < 93 por ciento, se asoció con taquicardia en todas las 3,62; IC95 por ciento = 2,09-5,79; p < 0,000), igual ocurre cuando hubo fiebre (OR = 5,07-8,67; p < 0,000). El 51,8 por ciento de los casos febriles estaban taquicárdicos y el edades (OR ponderado = ponderado = 6,74; IC95 por ciento 22,8 por ciento de los afebriles. Comentario: El riesgo de hospitalización en un niño es mayor si tiene < 6 m, ≤ SO(2)93 por ciento o Triage ≤ 2. En más de 600 niños taquicárdicos (33 por ciento) ninguno evolucionó al shock, incluso si tuvieron Triage ≤ 2 y SO2 ≤ 93. La taquicardia como signo relativamente aislado, no permite plantear alteración hemodinámica de magnitud y menos tratarla como si fuere.

Noradrenalina na terapêutica do choque: recomendações atuais e novas perspectivas: [revisão] / Norepinephrine in shock treatment: current recommendations and new perspectives: [review]

Objetivos: revisar os principais aspectos do uso noradrenalina no tratamento do choque, em especial nos pacientes pediátricos. Fontes de dados: revisão bibliográfica no banco de dados MEDLINE, utilizando os termos norepinefrina/noradrenalina, sepse, choque e uso precoce. Sintese dos dados: a noradrenalina vem sendo utilizada como tratamento adjuvante do choque em pacientes nos quais a resposta à ressuscitação volumétrica não seja satisfatória. Estudos experimentais da última década apontaram para o uso precoce dessa droga no tratamento do choque, com resultados satisfatórios no que diz respeito à melhor perfusão de orgãos e menor necessidades de volume mara manter a função renal. Conclusões: restam muitas dúvidas acerca da repercussão clínica do uso precoce de noradrenalina no choque, principalmente na população pediátrica. São necessários mais estudos sobre o assunto, em especial prospectivos e randomizados. Contudo, Já há evidências sobre.

Laboratory evaluation of new shock absorbent material for mouth guards

This study evaluated the physicomechanical properties of photopolymerized urethane diacrylate "Lite Line" as a new mouth guard material compared with heat cured silicone rubber "Molloplast-B" as a commercial product used to fabricate mouth guards. The tests chosen were those that measured tensile strength, elongation percent modulus of elasticity, energy absorption, tear strength, surface hardness and abrasion resistance of both materials as they were considered the properties of greatest importance to the function of a mouth protector. The appropriate standardized test procedures, which were established by the American Society for Testing and Materials [ASTM] were followed in this study. From the results of this study it was concluded that, the photopolymerized urethane diacrylate Lite Line showed higher mean value of tensile strength, elastic modulus and surface hardness with the lowest percent of elongation. Lite Line had better shock absorbing properties compared to Molloplast-B, so maximum protection can be achieved by the use of Lite Line for fabrication of mouth guards. There were no significant differences between the Lite Line and Molloplast-B in the tear strength values. Surface roughness mean values showed significant differences between the two tested materials before and after abrasion resistance test. Molloplast-B appeared with smoother surface than Lite Line following abrasion test as shown in SEM photomicrographs. In general, the physicomechanical properties of the tested materials were within the accepted range of variation for a mouth guard material

Ruptura espontánea del hígado en el embarazo : a propósito de un caso / Spontaneous rupture of liver in pregnancy : apropos of a case

Se aporta un nuevo caso de ruptura espontánea de hígado en el embarazo a la casuística nacional. Se destaca su asociación a la preeclampsia o a la eclampsia, 12 y 50 por ciento respectivamente. Se analiza su relación con la anemia hemolítica microangiopática y trombocitopenia (HELLP syndrome). Se explica su fisiopatología con la aparición de hemorragia intraparenquimatosa con formación de hematoma subcapsular que por aumento de la presión provoca ruptura secundaria con hemoperitoneo. Se realza la velocidad de instauración de shock hipovolémico que genera alta incidencia de mortalidad materna y fetal: 24 por ciento y 7.7 a 60 por ciento respectivamente. Se insiste en la importancia de su reconocimiento temprano y de efectuar tratamiento quirúrgico precoz combinado: césarea con extracción fetal y gestos sobre el hígado para detener la hemorragia.

Central lesion abolishes the beneficial effect of hypertonic saline on circulatory shock produced by compound 48/80 in rats

The purpose of the presente study was to examine the protective action of a 7.5% hypertonic NaCl solution (HS) on the ciruclatory shock produced by compound 48/80 (48/80) in rats and to determine the effect of the AV3V lesion on the protective action of HS. Intravenous injection of 48/80 into sham-operated rats resulted in an innediate drop of mean arterial pressure (In sham-operated rats, intravenous inection of HS prevented the drop of MAP produced by 48/80, but HS was ineffective in AV3V-lesioned rats. These results show that HS had a protective action on the circularory shock produced by 48/80 and that the AV3V region plaus an important role in this protective action

Participacion de la enfermera en el manejo de pacientes con monitoreo hemodinamico, orientado hacia el estado hipovolemico durante el post-operatoio inmediato de revascularizacion coronaria / Nurse participation in the management of patients with hemodynamic monitoring oriented to hypovolemic status during coronary revascularization inmediate to the postoperative period

Este trabajo establece la forma como la enfermera puede determinar el estado hipovolemico del paciente durante las 6 primeras horas del periodo postoperatorio de revascularizacion coronaria, analizando los datos obtenidos en los controles hemodinamicos. El marco teorico se refiere a la fisiologia del sistema cardiovascular, a los parametros establecidos para evaluarla, a la fisiopatologia y el tratamiento de la enfermedad coronaria y describe el impacto de los procedimientos intraoperatorios como condicionantes del estado hemodinamico del paciente durante el postoperatorio y el protocolo de manejo postquirurgico y finalmente discute la intervencion de enfermeria en termino del manejo de cateteres de Swan-Ganz, la medicion del gasto urinario, el control de la presion arterial, el balance de liquidos el control de los pulsos perifericos y la observacion de las caracteristicas de la piel como indicadores del estado de shock del paciente. Por ultimo describe la metodologia empleada en el estudio..