Effect of alcohol on the lactate/pyruvate ratio of recently injured adults.

Objective: To compare the ability of plasma (lactate) and the plasma lactate/pyruvate (L/P) ratio to predict shock-related outcome after injury and also to examine the influence of plasma ethanol on any relationships found.

Design: Prospective observational study.

Setting: Emergency departments in the UK and the Republic of South Africa.

Effect of alcohol intoxication on hemodynamic physiology and outcome in patients with traumatic cardiac tamponade.

Background: Alcohol intoxication has a detrimental effect on hypovolemic shock. Our aim, was to study its effects on "pure" cardiac tamponade (i.e.

Evaluation of a small trauma team for major resuscitation.

There has been a great improvement in the early management of trauma patients, encapsulated by ATLS. Initial in-hospital management of significant trauma is undertaken by a trauma team, the number and content of which varies. No study has demonstrated that large trauma teams per se improve patient survival, compared to smaller teams working in the same tertiary referral centre environment.

Conservative management of abdominal injuries: audit of criteria for discharge.

This prospective study was conducted to audit the discharge criteria of patients admitted for the conservative management of abdominal trauma. A total of 184 patients who were admitted to Groote Schuur Hospital (GSH) with penetrating or blunt abdominal injuries and who were conservatively managed according to the GSH protocol were assessed. The study concluded that patients with abdominal trauma who do not require emergency laparotomy can be safely discharged after a period of conservative management provided they are pain-free, hungry and passing flatus.

Injured pedestrians in Cape Town--the role of alcohol.

Objective: To establish a profile of injured adult pedestrians and attempt to define the role which alcohol plays in this regard.

Design: Prospective survey of injured pedestrians who presented consecutively over 9 weeks to Groote Schuur Hospital. Data on fatally injured pedestrians were retrospectively collected from the State Mortuary.

Operative strategies in pancreatic trauma.

Pancreatic injuries are relatively uncommon and the choice of an appropriate operative procedure can be difficult. Operations for pancreatic trauma from January 1990 to June 1993 have been reviewed. Fifty-one patients were studied; 13 had blunt trauma, 17 gunshot wounds and 21 stab wounds.

Is there a place for radionuclide bone scintigraphy in the management of radiograph-negative scaphoid trauma?

Objective: To evaluate the role of radionuclide bone scanning in patients with suspected scaphoid trauma, particularly in those with negative radiographs.

Design: Prospective. Radionuclide scans and carpal bone radiography were performed on all participants in the early post-injury period.

Involuntary defaecation in acutely injured patients: a useful clinical sign.

The phenomenon of involuntary defaecation following acute, severe injuries has never been documented before, but has been noted by those who work in major trauma units. The exact cause of the phenomenon is unknown. We prospectively noted 14 patients who involuntarily defaecated in a 3-month period and analysed their clinical findings retrospectively.

Patients who reattend after head injury: a high risk group.

Objective: To assess risk factors for important neurosurgical effects in patients who reattend after head injury.

Design: Retrospective study.

Subjects: 606 patients who reattended a trauma unit after minor head injury.

Immediate and delayed contact hypersensitivity to verbena plants.

Plants from the Verbenaceae family may cause contact dermatitis of unknown nature. This report describes 2 cases of allergic reactions to the Verbena species. A teenage boy developed an anaphylactic allergic response following contact with the leaves of Verbena hybrida.

The suction test for oesophageal placement of the endotracheal tube using an oesophageal detector device: caution is required with inexperienced operators.

A modified oesophageal detector device made from simple universally available components was tested in a cadaver model using relatively inexperienced nurse volunteers as operators. In all but two of 71 tests the correct location of an endotracheal tube was identified in under 10 s. The errors were the result of inadequate attention to seating the device in the endotracheal tube connector.

Closed traumatic forequarter amputation without fracture. A case report.

Closed forequarter amputation (scapulothoracic dissociation) is a rare, easily missed, life-threatening injury. The diagnosis should be suspected in patients with a pulseless, flail limb, supraclavicular haematoma, lateral scapular displacement and clavicular disruption. Early surgery is essential to control haemorrhage and completion of the amputation with attention to closure of the resulting defect is often required.

The use of midazolam in trauma resuscitation.

Experience with the use of midazolam in the resuscitation of severely injured patients is described. All 33 patients included in the study were given midazolam to allow endotracheal intubation and/or positive pressure ventilation in the resuscitation room, prior to transfer to the operating theatre or intensive care unit. Those with possible head injury were subjected to computed tomography of the head once stabilized.

Traumatic rhabdomyolysis from severe beating--experience of volume diuresis in 200 patients.

Fluid loading with balanced salt solution (BSS) was carried out in 200 patients with extensive soft tissue injuries from severe beatings. Urinary volume and dipstick specific gravity testing were used to monitor renal function with administration of furosemide for persistent oliguria. Acute intrinsic renal failure (AIRF) occurred in 21 patients (10.

Lipohaemarthrosis in knee trauma: an experience of 907 cases.

The role of the horizontal beam lateral radiograph in the investigation of knee trauma was assessed by retrospective analysis of 907 cases presenting to a tertiary trauma unit. For each case the presence of a visible lipohaemarthrosis on the horizontal beam radiograph was correlated with the presence of an intra-articular fracture. Visible lipohaemarthrosis is a very specific sign of an intra-articular fracture (88.

Preventable mortality following sharp penetrating chest trauma.

We examined the determinants of outcome following sharp penetrating chest trauma (SPCT) in Cape Town, South Africa. During a 6-month period, 248 nonsurvivors (comprising 231 prehospital and 17 in-hospital deaths) and 474 survivors admitted to the Groote Schuur Hospital Trauma Unit were located. Most (77%) of the deaths resulted from cardiac or great vessel injuries.

Traumatic haemothorax--experience of a protocol for rapid turnover in 1,845 cases.

Incomplete or prolonged drainage of the pleural cavity for haemothorax may lead to the development of empyema, with long-term morbidity. Using a protocol based on vigorous physiotherapy and early withdrawal of the thoracostomy tube (average drainage time 27.1 hours), hospital stay in 1,845 patients with traumatic haemothorax was 48 hours or less in 81.