The reliability of excretory urography as a screening examination for blunt renal trauma.

A prospective study was designed to evaluate the reliability of excretory urography (EU) in excluding renal damage in patients with blunt abdominal trauma, using contrast-enhanced computed tomography (CECT) as the "gold standard" of diagnostic studies. Sixty patients with indications for genitourinary evaluation and with normal EU underwent CECT. Five renal injuries were demonstrated by CECT in patients with negative EU: one contusion, one subcapsular hematoma, two perirenal hematomas, and one renal laceration. All of these lesions resolved with conservative patient management. Thus, the CECT findings did not alter treatment in these five patients.

Comparison of superior vena caval and inferior vena caval access using a radioisotope technique during normal perfusion and cardiopulmonary resuscitation.

Recent studies of thoracic pressure changes during external cardiopulmonary resuscitation (CPR) suggest that there may be a significant difference in the rate of delivery of intravenous drugs when they are administered through the extrathoracic inferior vena cava (IVC) rather than the intrathoracic superior vena cava (SVC). Comparison of delivery of a radionuclide given using superior and inferior vena caval access sites was made during normal blood flow and during CPR. Mean times from injection to peak emission count in each ventricle were determined. There were no significant differences between mean peak times for SVC or IVC routes during normal flow or CPR. When peak times were corrected for variations in cardiac output, there were no significant differences between IVC and SVC peak times during normal flow. During CPR, however, mean left ventricular peak time, when corrected for cardiac output, was significantly shorter (P less than .05) when the SVC route was used. The mean time for the counts to reach half the ventricular peak was statistically shorter (P less than .05) in both ventricles with the SVC route during the low flow of CPR. This suggests that during CPR, increased drug dispersion may occur when drugs are infused by the IVC route and thus may modify the anticipated effect of the drug bolus. These results suggest that during CPR, both the cardiac output and the choice of venous access are important variables for drug delivery.

Central versus peripheral intravenous routes in cardiopulmonary resuscitation.

The central venous (CV) and peripheral venous (PV) routes of drug administration are generally considered to be equally effective during cardiopulmonary resuscitation (CPR). This canine study compared simulated drug delivery via CV and PV routes during CPR. The CV group dogs had a CV catheter placed via the external jugular vein, and the PV group dogs had a PV catheter placed in the distal forelimb. Thirty seconds after the induction of cardiac arrest with KCl, CPR was begun with a gas-powered chest compressor with ventilations after every fifth compression. Sixty seconds later, a 0.5 ml bolus of technetium 99m-labeled serum albumin was given. Time activity curves were obtained over the right and left ventricles. The mean time for the counts to rise to half the left ventricular peak (T1/2LV) was significantly less for the CV group than for the PV group (P less than 0.05), averaging 11 and 84 seconds, respectively. The time to left ventricular peak (TLV) was also statistically shorter for the CV group than the PV group, averaging 118 versus 258 seconds, respectively. This study demonstrates that central venous administration is more rapid than peripheral venous administration during CPR and supports the preferential use of the central venous route for drug administration clinically.

Peripheral versus central venous delivery of medications during CPR.

Traditionally drug delivery during cardiopulmonary resuscitation (CPR) has been considered to be equally effective when given through the peripheral venous and central venous routes. Recently, however, these routes of drug administration have undergone reevaluation. During normal flow drug delivery appears to be equally efficient by the peripheral venous and central venous routes. During CPR, however, drug administration by way of the supradiaphragmatic central circulation appears to result in significantly more rapid drug delivery to the central arterial circulation. Data regarding the effect of route of administration on quantitative peak levels are mixed. Changes in cardiac output and the mechanics of blood flow during CPR are thought to be responsible for these route-dependent rates of drug delivery.

Male sexual assault.

Reported cases of sexual assault in the United States increased 21% from 1974 to 1978. Recent literature discusses the medical, legal, and psychological management of the female sexual assault victim, but little has been written regarding appropriate management of male sexual assault. Twenty-nine male sexual assault victims were examined at University Hospital from 1976 to 1980. This study reviews evidence of genital and extragenital trauma and the percentage of those requiring gonorrhea prophylaxis. It further studies the background and characteristics of the sexual assault victim, characterization of the assailant, as well as the details and time of the assault. Information concerning male sexual assault and the unique problems associated with this group is scarce. This study is intended to aid in the development of an effective protocol in dealing with this group of patients and to sensitize physicians to this group of patients.