RESUMO
Presented is a report on the first female hand allotransplantation performed in the USA. The patient sustained a dominant hand amputation at the level of the wrist as a result of a bomb explosion while on active duty in the United States Air Force. A hand allotransplantation was performed at a military treatment facility by a team of physicians composed of representatives from private practice, academia, and military medical institutions.
Assuntos
Transplante de Mão , Feminino , Sobrevivência de Enxerto , Hospitais Militares , Humanos , Pessoa de Meia-Idade , Militares , Texas , Transplante Homólogo , Resultado do Tratamento , Estados Unidos , GuerraAssuntos
Fusão Vertebral , Espondilolistese/cirurgia , Corticosteroides/uso terapêutico , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Humanos , Dor Lombar/etiologia , Coluna Vertebral/cirurgia , Espondilolistese/classificação , Espondilolistese/diagnóstico , Espondilolistese/tratamento farmacológicoAssuntos
Traumatismos Abdominais/diagnóstico , Baço/lesões , Ruptura Esplênica/diagnóstico , Traumatismos Abdominais/terapia , Feminino , Humanos , Masculino , Cavidade Peritoneal , Baço/diagnóstico por imagem , Esplenectomia , Ruptura Esplênica/terapia , Irrigação Terapêutica , Fatores de Tempo , Tomografia Computadorizada por Raios XRESUMO
Although many emergency medicine residency programs are located in major trauma centers, trauma often is managed by a multispecialty team. In order to define the role of the emergency medicine resident at such centers, we sent surveys to the directors of all 64 approved emergency medicine residency programs. Of the 54 programs (84%) responding, 39 (72%) had trauma teams. Trauma team composition varied widely. Only 54% included general surgery staff physicians, and 38% included an anesthesiologist. Ninety percent of the teams included an emergency medicine resident. Overall emergency medicine residents serve as trauma captains 50% of the time and share the role with a general surgery resident 23% of the time. With the exceptions of peritoneal lavage and intubation, resuscitation procedures were shared between the general surgery and emergency medicine residents. Thirty-one percent of the respondents had air ambulances, 70% of which were staffed by emergency physicians. We conclude that emergency medicine residents are active trauma team leaders and providers.
Assuntos
Medicina de Emergência , Cirurgia Geral , Internato e Residência , Equipe de Assistência ao Paciente , Centros de Traumatologia , Aeronaves , Humanos , Relações Interprofissionais , Inquéritos e Questionários , Transporte de Pacientes/métodosRESUMO
Hypothermia is a common complication in fluid resuscitation of the hypovolemic patient. Warm intravenous (IV) fluids have been shown to be a valuable adjunct in volume replacement to prevent this complication. A rapid method of warming IV fluids is the microwave oven. Heating time for liter bags of crystalloid to 39 C was determined to be two minutes at high power, 600 W. Fresh frozen plasma was thawed with five 30-second exposures to microwave radiation. Microwave warming of packed red blood cells (PRBC), 4 C to 37 C, resulted in a 17-fold increase in plasma hemoglobin over that of water bath controls, (P greater than .01). Heating on a warm cycle to room temperature, 21 C, caused an average 26% increase in plasma hemoglobin. Therefore, we do not advocate microwave warming of PRBC because of the possible danger of local overheating, which causes hemolysis. We warm PRBC secondarily by diluting with microwave-warmed, calcium-free crystalloid.
