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D D Trunkey

Publications and source records attributed to D D Trunkey.

At least 19 recordsLinked to original sources
PubMed1992

A decision analysis of traumatic splenic injuries.

We created a decision analysis model of the nonsurgical management of traumatic splenic injuries to clarify the risk of hospital survival, overwhelming postsplenectomy infection (OPSI) deaths, and transfusion-related deaths. We reviewed 72 cases of splenic injury at our institution to identify our transfusion requirements for successful observation (0.5 units), observation failure (1.0 units), and surgical splenic management (1.6 units). Using our model and baseline probabilities determined from the literature, we compared the nonsurgical management of splenic injuries with immediate laparotomy and found an increase in hospital survival with observation, but an over two-fold increase in the risk of transfusion-related death. The OPSI deaths were not markedly different between the two strategies. Overall, we found decision analysis useful in identifying important variables such as the probability of nontherapeutic laparotomy death or missed injury, and in clarifying the risk of the nonsurgical management of splenic injuries with regard to transfusion-related deaths and OPSI deaths.

Blood Transfusion↗
PubMed1992

Blunt cardiac injury.

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Abbreviated Injury Scale↗
PubMed1992

Chronic hyperdynamic sepsis in the rat. II. Characterization of liver and muscle energy metabolism.

Sepsis was induced in male rats by injections of live Escherichia coli No. 4 (or E. coli No. 3) and Bacteroides fragilis organisms into a preformed subcutaneous abscess. Body weight, food and water intake, and cardiac output were measured daily. After 1, 2, or 3 weeks, animals were sacrificed, and blood, liver, and muscle were collected for measurements of plasma glucose and carnitine, mitochondrial respiratory activity, mitochondrial cytochrome concentrations, and tissue adenine nucleotides. Compared with sham controls, no significant differences were found in state 3 respiratory activities of liver mitochondria isolated from rats with moderate (no weight loss, cardiac output increased to 150% of control) or severe (0.5% weight loss/day, cardiac output increased to 200% of control) sepsis at any time. After 1 week of severe, but not moderate, sepsis, pyruvate-supported respiration in muscle mitochondria was significantly decreased, while branched-chain ketoacid and beta-hydroxybutyrate-supported respiration remained unchanged. After 2 weeks of severe, but not moderate, sepsis, beta-hydroxybutyrate and branched-chain ketoacid oxidation increased severalfold; pyruvate utilization remained depressed. Severe or moderate sepsis did not uncouple mitochondrial respiration at any time. Total muscle carnitine concentration was significantly decreased after long-term but not short-term severe sepsis. Severe short-term sepsis caused a significant increase in liver short-chain acyl and total carnitines. Muscle energy charge was unaltered by either moderate or severe sepsis. These results represent the first demonstration of sepsis-induced fuel shifts at the mitochondrial level in muscle: Severe hyperdynamic sepsis is characterized by the reduced ability of muscle mitochondria to utilize pyruvate with a simultaneous increase in branched-chain ketoacid and ketone body utilization. These changes were not observed in liver mitochondria.

Adenine Nucleotides↗
PubMed1990

Nonoperative management of abdominal trauma.

In an effort to reduce the rate of nontherapeutic celiotomy yet avoid the possibility of missed injuries, surgeons are evaluating protocols for nonoperative management of abdominal trauma. Discussion of this controversial issue includes specific approaches to the diagnosis and management of splenic injury, gunshot wounds, and stab wounds.

Abdominal Injuries↗
PubMed1990

Priorities in trauma management.

The overriding concern in trauma care is not only to minimize mortality, but to maintain a functional human being. Treatment should first be directed to preserve the brain and the cardiopulmonary viscera.

Emergencies↗
PubMed1990

Samuel D. Gross: pioneer academic trauma surgeon of 19th century America.

It is appropriate on the 50th anniversary of the American Association for the Surgery of Trauma to recall the most influential trauma surgeon in 19th century America: Samuel D. Gross. Gross was an innovative surgeon whose 50-year career as a surgeon caring for injured patients encompassed orthopedics, thoracic surgery, abdominal surgery, and ophthalmology. The dominant influence of Gross over contemporary surgical doctrine was a consequence of his prolific scholarship which included six superbly written texts that passed through a combined total of 15 editions. Gross was a teacher, occupying for 42 years Chairs of Surgery at three medical schools. Gross wore the mantle of political leadership, founding medical societies that continue today as forums for the presentation and review of new treatments for injured patients. Modern academic trauma surgeons could do no better than to emulate the career of Samuel David Gross, the Patriarch of American trauma surgeons.

General Surgery↗
PubMed1990

The treatment of sepsis and other complications in the trauma patient.

Immediate complications of trauma and shock include right heart failure, acute respiratory distress syndrome, coagulopathy, brain edema, small bowel dysfunction, renal failure, and immune dysfunction. Nosocomial infections are also common in trauma patients. These infections are the combined result of a compromised host defense and various iatrogenic risk factors, including the use of percutaneous drainage tubes, malnutrition, the injudicious use of prophylactic antibiotics, and treatment staff hygiene. The use of prophylactic antibiotics appears to be unwarranted in head, maxillofacial, and neck injuries and is debatable in chest and soft-tissue wounds, fractures, and injuries of the peritoneal cavity. The use of antibiotics in small bowel and colon injuries is justified. Antibiotics are necessary in crush or avulsive injuries. Combination antibiotic therapy often results in multiple complications that may compound the patient's problems. Therefore, a single antibiotic with minimal side effects is the therapy of choice in the surgical intensive care unit.

Animals↗
PubMed1988

Trauma systems. Current status--future challenges.

The national status of regional trauma system development was evaluated by a survey sent to all state emergency medical services directors and state chairpersons of the American College of Surgeons Committee on Trauma. Eight essential components of a regional trauma system based on criteria set forth by the American College of Surgeons were listed. Only two states were found to have all components and statewide coverage. Nineteen states and the District of Columbia lacked one or more components of a regional trauma system. The remaining 29 states had yet to initiate the process of trauma center designation. In response to these shortcomings, an attempt was made to define the barriers to trauma system implementation and a step-by-step process was outlined for the development, management, and analysis of a comprehensive system of trauma care.

Economics, Hospital↗
PubMed1988

A time for decisions.

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Emergency Medical Services↗
PubMed1988

CT scanning in acute abdominal injuries.

Computed tomography has become an important adjunct in the evaluation of the patient with blunt abdominal trauma. It provides quantitative information about hemoperitoneum as well as qualitative information about the source of hemoperitoneum. CT scanning also evaluates the retroperitoneal organs and retroperitoneal hematoma more accurately than any other available imaging technique. Like any other diagnostic tool, the CT scan must not be overused or abused. This technique should be applied only to stable patients and only in institutions with up-to-date equipment, a committed radiology and surgery staff, and appropriate monitoring equipment in the CT suite. If proper technique is used, then high-quality scans can be obtained which, if interpreted by experienced personnel in the light of the clinical findings, can improve our management of selected trauma patients.

Abdominal Injuries↗
PubMed1988

Variables affecting outcome in blunt chest trauma: flail chest vs. pulmonary contusion.

We reviewed 144 consecutive patients with flail chest and/or pulmonary contusion between 1979 and 1984. The purpose was to analyze the factors adversely affecting morbidity and mortality. There were 97 males and 47 females, with an average age of 40 years +/- 18 S.D. (range, 2-83). Seventy-five per cent of the injuries were caused by motor vehicle accidents, with the remainder due to falls (17%), cardiopulmonary resuscitation (4%), altercations (2%), or falling objects (2%). The Injury Severity Score (ISS) averaged 32 +/- 14 S.D. in all survivors versus 60 +/- 14 S.D. in those who died. Eighty-three patients (58%) required mechanical ventilation. Thirty-six patients died (25%). Isolated pulmonary contusion or flail chest had a mortality of 16% each. However, the mortality more than doubled when there was a combined pulmonary contusion and flail chest (42%). More than half of all deaths were directly attributed to central nervous system injuries with another third due to massive hemorrhage. Factors that were associated with a higher morbidity and mortality included severe associated thoracic injuries, a high ISS, the presence of shock, falls from heights, and the combination of pulmonary contusion and flail chest.

Adolescent↗