Initial resuscitation volume in uncontrolled hemorrhage: effects on organ function.

Conventional resuscitation of hypovolemia due to hemorrhage has consisted of aggressive fluid administration. Recent studies have suggested that surgical control of bleeding before fluid resuscitation might improve early survival. The effects of limited resuscitation on organ function have not been assessed in these studies. We developed a model of moderate intraperitoneal hemorrhage designed to evaluate long-term end-organ function after various resuscitation protocols. Male Sprague-Dawley rats underwent ketamine anesthesia, followed by placement of femoral artery and vein lines. Intraperitoneal hemorrhage was induced by division of distal branches of the ileocolic artery and vein. After 5 minutes of bleeding, the animals were randomized to one of three resuscitation groups: Group 1 received no fluid resuscitation before surgical control of the hemorrhage; Group 2 received 0.5 mL of lactated Ringer's solution (LR) every 5 minutes for a mean arterial pressure (MAP) of less than 80 mm Hg; Group 3 received 2.0 mL of LR every 5 minutes for a MAP of less than 80 mm Hg. In all three groups, after 20 minutes, the bleeding was surgically controlled. All rats were then resuscitated with LR to a MAP of 80 mm Hg. The intravascular lines were removed, and the rats were allowed to recover from anesthesia and were returned to animal holding. On the 7th day, survivors were sacrificed, and their blood was assayed for hematocrit and serum levels of bilirubin, alanine aminotransferase, urea nitrogen, and creatinine. Kidneys, lungs, and liver were harvested for microscopic examination. Survival was lower in Group 2 than in the other groups (90%, 60%, and 100%, respectively; P = 0.04), but all deaths occurred within 3 hours of hemorrhage and were due to either hypovolemia or anesthetic complications. No histologic abnormalities were identified in the livers of the animals that survived, but pulmonary atelectasis and mild-to-moderate renal tubular necrosis were identified uniformly. No histologic differences could be discerned between the groups. Hematocrit and indices of liver and renal function were similar in all groups, and no animal developed organ dysfunction. In this model of moderate uncontrolled intraperitoneal hemorrhage, the volume of fluid resuscitation, or the absence of resuscitation, had an inconsistent effect of 7-day survival and did not influence function or histologic appearance of the liver, lungs, or kidneys 7 days after hemorrhage.

A 15 year retrospective review of homicide in the elderly.

With constant improvements in socioeconomic conditions, the people of most industrialized nations are living longer. Most elderly individuals lead productive lives within the community. Unfortunately, when elderly individuals suffer from a debilitating disease or injury, society seems ill-equipped to care for them. The frailty and social isolation that comes with illness or advanced age renders the elderly more vulnerable to crime. This study examines the circumstances that surround homicides of those 65 years of age or older which occurred in Jefferson County, Alabama over a 15 year span. We conducted a retrospective study of all decedents brought to the Jefferson County Coroner/Medical Examiner Office during the 15 years from 1981-1995. A computer search identified 150 homicide victims who were 65 years or older. In these 150 cases the causes of death were as follows: gunshot wound 50%, blunt force injuries 19%, knife wounds 14%, and asphyxiation 10%. Younger homicide victims were much less likely to be killed as the result of a direct physical assault; blunt force injuries and asphyxiation combined caused death in only 7% of the younger population. Robbery was the most common motive for death in the elderly population, which accounted for 37% of cases. The most common location for homicides in the elderly population was in their own residence, which accounted for 71% of cases. Four elderly homicide victims were shot by the police. Three elderly decedents died as a result of abuse.