Subject(s)
Aminoimidazole Carboxamide/analogs & derivatives , Ribonucleosides/therapeutic use , Sepsis/drug therapy , Shock, Hemorrhagic/drug therapy , Adenosine/pharmacology , Aminoimidazole Carboxamide/therapeutic use , Animals , Hemodynamics/drug effects , Humans , Microcirculation/drug effects , Swine , Wounds and Injuries/drug therapySubject(s)
Cyanides/poisoning , Organ Transplantation , Tissue Donors , Adult , Brain Death , Female , Heart Transplantation , Humans , Kidney Transplantation , Liver Transplantation , Male , Middle Aged , SuicideABSTRACT
Demand for viable human organs for transplantation continues to exceed the supply. To expand supply, the criteria for identification and management of suitable donors must continue to evolve. Poisoned patients are often excluded as potential organ donors due to perceived risks of transmittable agents and/or physiologically compromised organs. In this report, a patient succumbed after an intentional ingestion of cyanide and multiple pharmaceuticals. Donor organ viability was determined by lack of significant injury beyond the central nervous system. Following standard procurement procedures, the heart, liver, corneas, 16 skin grafts and 16 bone grafts were deemed suitable and successfully transplanted. All organ recipients were doing well eight months post transplantation. The focus of procurement personnel should be on tissue injury and not on the mere presence of clinical effect of a toxic agent. With the paucity of organs available, poison centers need to be cognizant of this dilemma when faced with a toxicologically compromised potential organ donor.
Subject(s)
Corneal Transplantation , Cyanides/poisoning , Heart Transplantation , Liver Transplantation , Adult , Bone Transplantation , Female , Humans , Male , Poison Control Centers , Pregnancy , Skin Transplantation , Tissue SurvivalABSTRACT
The immediate transfusion of uncrossmatched type O blood in the initial resuscitation of the trauma victim remains controversial. To examine difficulties in crossmatching blood for later transfusions after use of uncrossmatched type O blood, we undertook a prospective 23-month study at a level I trauma center. One hundred thirty-five severely injured patients received uncrossmatched type O blood during the study period. Sixty-one patients (45%) died and 76 patients (56%) underwent emergent operation. There were no major transfusion reactions. Six patients had blood antigen-antibodies present on admission, and such antibodies developed in three patients during hospitalization. We conclude that uncrossmatched type O blood may be used safely in the exsanguinating patient, but blood antigen-antibodies, which may complicate later crossmatching, can develop after its use.
Subject(s)
ABO Blood-Group System/immunology , Blood Group Incompatibility/immunology , Blood Grouping and Crossmatching , Isoantibodies/analysis , Adult , Aged , Emergencies , Female , Humans , Male , Prospective Studies , Wounds and Injuries/therapyABSTRACT
Testing for the presence of the human immunodeficiency virus (HIV) remains one of the most controversial issues of this decade. Among persons diagnosed to be HIV positive, social ostracism and exaggerated atypical behavior are common. The resulting impact on the delivery of healthcare services to the seropositive patient has raised many ethical and professional dilemmas. Discussion of HIV testing and the subsequent effects of seropositivity on the delivery of healthcare will be emphasized.
Subject(s)
Critical Care , Emergency Medical Services , HIV Infections/diagnosis , HIV-1 , Mass Screening/methods , Risk Assessment , Attitude of Health Personnel , Attitude to Health , Codes of Ethics , Federal Government , HIV Infections/nursing , HIV Infections/prevention & control , Humans , Mass Screening/standards , Voluntary ProgramsABSTRACT
The critical care nurse has tremendous opportunities in clinical research projects. Until now, position descriptions that incorporated research into practice were scarce. This manuscript describes how to develop a trauma research nurse (TRN) position at your institution.
Subject(s)
Critical Care , Job Description , Multiple Trauma/nursing , Nurse Clinicians , Personnel Management , Research Design , Career Choice , HumansABSTRACT
Because many nursing interventions require mobilization of the patient, cervical spine film interpretation should be a necessary tool of the critical care nurse. This article provides the fundamentals necessary for initial interpretation of the cervical spine, plus a review of the common radiographic views of the cervical spine, abnormalities, and a systematic approach to the interpretation of these studies.
Subject(s)
Cervical Vertebrae/diagnostic imaging , Critical Care , Multiple Trauma/diagnostic imaging , Humans , Multiple Trauma/nursing , RadiographyABSTRACT
Aortic injury following deceleration is an uncommon clinical entity in the pediatric population. Flexibility of the thoracic cage and marked tissue elasticity have been hypothesized as critical factors. Unfortunately, the scarcity of this phenomenon can lead to a lowered suspicion. We describe a case of blunt aortic injury following deceleration to raise the index of suspicion for this injury in the pediatric population.
Subject(s)
Accidents, Traffic , Aorta, Thoracic/injuries , Wounds, Nonpenetrating/diagnosis , Aorta, Thoracic/diagnostic imaging , Child , Deceleration , Female , Humans , Radiography , Wounds, Nonpenetrating/diagnostic imaging , Wounds, Nonpenetrating/etiologyABSTRACT
Myocardial contusion after chest trauma remains one of the major complexities of trauma care today. Diagnostic methods such as 12-lead electrocardiography and echocardiography, as well as activity of the biochemical marker creatine kinase and the MB subfraction, have not been shown to be sensitive or specific indicators. We report a case of an intraoperatively proved myocardial contusion without creatinine kinase or creatine kinase MB elevation.
Subject(s)
Clinical Enzyme Tests , Contusions/diagnosis , Creatine Kinase/blood , Heart Injuries/diagnosis , Adult , Echocardiography , Electrocardiography , False Negative Reactions , Humans , Isoenzymes , MaleABSTRACT
The Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS) are objective means of assessing injury. Accepted methodology involves retrospective scoring of injury based on discharge diagnoses. Recently, early clinical scoring, supplemented by review at discharge, has been introduced. A prospective study was instituted to compare these methodologies. Four hundred sixty consecutive victims of blunt trauma were scored using both clinical and retrospective methodologies by independent, blinded observers. Of these, 333 patients had a change in ISS, 174 with a change of greater than four points. The population mean ISS remained unchanged; however, paired values were significantly different (p less than .03). We conclude that either methodology is applicable for studies of large populations of trauma victims. When accurate individual AIS or ISS scoring is required, the clinical method combined with discharge review is most appropriate.
Subject(s)
Severity of Illness Index , Wounds and Injuries/classification , Accidents, Traffic , Adult , Humans , Intensive Care Units , Male , Outcome and Process Assessment, Health Care , Prognosis , Wounds and Injuries/diagnosis , Wounds, Nonpenetrating/classification , Wounds, Nonpenetrating/diagnosisABSTRACT
Abdominal trauma should always be suspected with major pelvic fractures until proven otherwise. Thorough assessment and diagnostic evaluation will determine whether surgical management is necessary. Nursing care continues to the postinjury period, which needs close observation because further complications are common.
Subject(s)
Abdominal Injuries/nursing , Fractures, Bone/complications , Pelvic Bones/injuries , Abdominal Injuries/diagnosis , Abdominal Injuries/etiology , Humans , Nursing Assessment , Postoperative CareSubject(s)
Thoracic Injuries/diagnosis , Adolescent , Adult , Child , Child, Preschool , Humans , Infant , Thoracic Injuries/classificationABSTRACT
Intravascular foreign body emboli, although first reported in 1834, are rare sequelae of penetrating injuries. We report a case of missile embolus to the pulmonary artery after penetrating injury to the left iliac vein and artery. A review of the literature and discussion of appropriate management are presented.
