The role of the pneumatic antishock garment in penetrating cardiac wounds

Article Abstract:

Chest wounds that penetrate the heart are associated with a high death rate (60 to 80 percent), especially if the patient is without pulse and measurable blood pressure at the scene of the injury. Death is usually due to exsanguination (life-threatening loss of blood) into the chest cavity. These penetrating cardiac injuries often are the result of stab wounds or gunshots, and occur frequently in large cities. Various procedures are performed by paramedics before the patient arrives at the hospital. Some of these interventions, such as the application of the pneumatic antishock garment (PASG), are controversial. This garment is quickly placed on a patient in shock; it contains compartments that can be inflated to prevent pooling of blood in the extremities. Several studies have associated its use with decreased survival of patients with penetrating chest injuries. A review was undertaken of urban patients who received a gunshot or stab wound to the heart over a 6.5 year period to determine the impact of the PASG on survival. There were 70 patients with penetrating cardiac wounds (31 gunshot and 39 stab wounds). The average revised trauma score (calculated from the information in the patient's prehospital records) was 2.8. There were 32 patients (46 percent) who suffered cardiac tamponade (pathologic compression of the heart due to accumulation of excess fluid in the sac containing the heart). The overall survival rate was 21 percent. Factors negatively influencing survival were the presence of cardiac tamponade and a higher revised trauma score. Fifty patients required intubation, and 44 patients required the PASG; both procedures are used only in the most severely injured patients. Use of the PASG was associated with a 700 percent lower rate of survival; this detrimental effect was seen across all groups of trauma scores. It is concluded that survival is associated with various anatomic and physiologic factors, and the use of the PASG appears to have a detrimental effect. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Research, Injuries, Equipment and supplies, Heart, Traumatology, Emergency medicine, Traumatic shock

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Hypoxic events in the surgical intensive care unit

Article Abstract:

The serious consequences of hypoxia, the inadequate oxygenation of body tissues, are well known. Brain hypoxia for only four minutes causes irreversible damage, and suboptimal peripheral oxygenation is a factor in multisystem organ failure. The definitive method of evaluating oxygenation is arterial blood gas analysis; this method is expensive, invasive (blood samples must be taken), and is performed intermittently. Newer methods of continuous oxygen monitoring allow early identification of low oxygenation. A review was undertaken to evaluate these continuous monitoring methods, and to outline the causes and significance of acute hypoxic events. Three months of surveillance revealed that of 241 surgical intensive care unit patients, 51 (21 percent) experienced 100 hypoxic events. Of these 51 patients, 29 (57 percent) had sustained acute trauma and 22 patients were recovering from surgery. There were 39 incidents that occurred in patients who were not intubated; 46 patients experienced hypoxic events during mechanical ventilation, and 15 patients experienced a hypoxic event during spontaneous breathing with an artificial airway. Two-thirds of these hypoxic events were due to mechanical problems that were easily corrected. Low oxygen levels in the blood were identified by pulse oximetry in 59 incidents; pulse oximetry measures functional arterial hemoglobin saturation. It is concluded that hypoxia in the surgical intensive care unit is common, and continuous oxygen monitoring using new techniques permits early identification and can limit adverse outcomes. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Diagnosis, Measurement, Prevention, Physiological aspects, Oxygen, Hypoxia, Anoxia, Oxygen in the body, Oximetry, Blood chemical analysis, blood

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The role of chronic alcohol abuse in the development of acute respiratory distress syndrome in adults

Article Abstract:

A history of regular alcohol abuse may increase the risk of acute respiratory distress syndrome (ARDS) in people with critical illnesses. ARDS is the accumulation of fluid in and around the lungs, often causing patients to require artificial respiration. Researchers analyzed alcohol abuse and the outcomes of 351 patients in intensive care units who had significant risk factors for ARDS. These risk factors included blood infection, multiple blood transfusions, trauma to the torso, aspiration of stomach contents, several fractures, and pancreatitis. Among the patients, 34% had a history of alcohol abuse. ARDS occurred in 43% of the patients with a history of alcohol abuse and 22% of the patients without such a history. Among the patients with ARDS, the death rate was 65% for those who had chronically abused alcohol and 36% for those who had not.

Complications and side effects, Risk factors, Alcoholism, Acute respiratory distress syndrome, Adult respiratory distress syndrome, Alcoholic myopathy

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