ABSTRACT
Blunt chest trauma represents a spectrum of injuries to the heart and aorta that vary markedly in character and severity. The setting, signs, and symptoms of chest trauma are often nonspecific, which represents a challenge to emergency providers. Individuals with suspected blunt chest trauma who have only mild or no symptoms, a normal electrocardiogram (ECG), and are hemodynamically stable typically have a benign course and rarely require further diagnostic testing or long periods of close observation. Individuals with pain, ECG abnormalities, or hemodynamic instability may require rapid evaluation of the heart by echocardiography and the great vessels by advanced imaging.
Subject(s)
Heart Injuries , Wounds, Nonpenetrating , Aorta/injuries , Aortic Rupture/diagnosis , Aortic Rupture/etiology , Aortic Rupture/therapy , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/therapy , Commotio Cordis/diagnosis , Commotio Cordis/etiology , Commotio Cordis/therapy , Contusions/diagnosis , Contusions/etiology , Contusions/therapy , Echocardiography , Electrocardiography , Heart Injuries/complications , Heart Injuries/diagnosis , Heart Injuries/therapy , Heart Valves/injuries , Humans , Myocardial Infarction/diagnosis , Myocardial Infarction/etiology , Myocardial Infarction/therapy , Wounds, Nonpenetrating/complications , Wounds, Nonpenetrating/diagnosis , Wounds, Nonpenetrating/therapySubject(s)
Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/drug therapy , Mycobacterium Infections, Nontuberculous/diagnosis , Mycobacterium marinum/isolation & purification , Skin Diseases, Bacterial/diagnosis , Aged , Anti-Bacterial Agents/therapeutic use , Antirheumatic Agents/adverse effects , Arthritis, Rheumatoid/complications , Arthritis, Rheumatoid/immunology , Biopsy, Needle , Exanthema/diagnosis , Exanthema/drug therapy , Exanthema/immunology , Fisheries , Follow-Up Studies , Humans , Immunocompromised Host , Immunohistochemistry , Male , Mycobacterium Infections, Nontuberculous/drug therapy , Mycobacterium Infections, Nontuberculous/immunology , Risk Assessment , Severity of Illness Index , Skin Diseases, Bacterial/drug therapy , Skin Diseases, Bacterial/immunologySubject(s)
Aneurysm, False/diagnosis , Aneurysm, False/etiology , Foreign Bodies/complications , Substance Abuse, Intravenous/complications , Aneurysm, False/pathology , Aneurysm, False/surgery , Anti-Bacterial Agents/therapeutic use , Endocarditis, Bacterial/drug therapy , HIV Infections/complications , Hepatitis C/complications , Humans , Male , Middle Aged , Nafcillin/therapeutic use , NeedlesABSTRACT
OBJECTIVES: This study was designed to evaluate the consequences of ultrafiltration (UF) and standard intravenous diuretic (furosemide) therapy on glomerular filtration rate (GFR) and renal plasma flow in patients with acute decompensated heart failure. BACKGROUND: It has been hypothesized that treatment with diuretics may worsen renal function as the result of systemic neurohormonal activation and direct renal vascular effects. UF also removes fluid, but its actions on intrarenal hemodynamics, and therefore renal function, are unknown. METHODS: Patients hospitalized for acute decompensated heart failure with an ejection fraction less than 40% and two or more signs of hypervolemia were randomized to receive UF or intravenous diuretics. Urine output, GFR (as measured by iothalamate), and renal plasma flow (as measured by para-aminohippurate) were assessed before fluid removal and after 48 hours. RESULTS: Nineteen patients (59 +/- 16 years, 68% were male) were randomized to receive UF (n = 9) or intravenous diuretics (n = 10). The change in GFR (-3.4 +/- 7.7 mL/min vs. -3.6 +/- 11.5 mL/min; P = .966), renal plasma flow (26.6 +/- 62.7 mL/min vs. 16.1 +/- 42.0 mL/min; P = .669), and filtration fraction (-6.9 +/- 13.6 mL/min vs. -3.9 +/- 13.6 mL/min; P = .644) after treatment were not significantly different between the UF and furosemide treatment groups, respectively. There was no significant difference in net 48-hour fluid removal between the groups (-3211 +/- 2345 mL for UF and -2725 +/- 2330 mL for furosemide, P = .682). UF removed 3666 +/- 2402 mL. Urine output during 48 hours was significantly greater in the furosemide group (5786 +/- 2587 mL) compared with the UF group (2286 +/- 915 mL, P < .001). CONCLUSIONS: During a 48-hour period, UF did not cause any significant differences in renal hemodynamics compared with the standard treatment of intravenous diuretics.
