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Biomedical subjects

D D Trunkey

Publications and source records attributed to D D Trunkey.

At least 163 records · Page 9Linked to original sources
PubMed1975

Renal trauma and retroperitoneal hematomas-indications for exploration.

One hundred nineteen patients with renal trauma documented at laparotomy or by an abnormal excretory urogram were followed up sufficiently to allow assessment of their postinjury course. One-fourth of these patients had a laparotomy and Gerota's fascia was opened; one-fourth had a laparotomy and Gerota's fascia was not opened; and one-half had no laparotomy. Gerota's fascia was opened only after vascular control of the renal pedicle was obtained. Nonetheless, the loss of renal tissue in this group was high. Twenty-three of 34 patients (68%) required nephrectomy or partial nephrectomy, indicating the severity of their renal injuries. The loss of renal tissue was low in the two groups in which Gerota's fascia was not opened. Six of 85 patients (7%) developed complications eventually requiring nephrectomy or partial nephrectomy; an additional three patients (4%) demonstrated loss of renal tissue on followup urograms, the loss being minimal in all three cases. The relatively low morbidity in these 85 patients indicates that their original renal injuries were, for the most part, less serious than the injuries in the group in which Gerota's fascia was opened. This low morbidity also indicates that retroperitoneal hematomas in the area of the kidney which are nonexpanding, contained, and nonpulsatile need not be routinely explored.

Adolescent↗
PubMed1974

Extravascular lung water following hemorrhagic shock in the baboon: Comparison between resuscitation with Ringer's lactate and Plasmanate.

Baboons were subjected to deep hemorrhagic shock by using a membrane potential of -65 mv as an endpoint. They were then resuscitated with either Plasmanate plus their shed blood or Ringer's lactate plus their shed blood. As compared with their own preshock values, the Plasmanate-resuscitated animals accumulated more extravascular lung water than the Ringer's lactate-resuscitated animals. Another group of baboons resuscitated from deep shock demonstrated significant extravasation of albumin on postmortem analysis of lung composition. This increased tendency for extravasation of albumin after shock partially explains why resuscitation with Plasmanate gave no protection against the formation of pulmonary edema. The authors believe that Plasmanate, and probably other colloidal solutions, should be used sparingly in the initial treatment of deep hemorrhagic shock.

Albumins↗
PubMedDate not supplied

Outcome of hospitalized injured patients after institution of a trauma system in an urban area.

OBJECTIVE: To determine if risk of death for hospitalized injured patients changes when an urban trauma system is implemented. DESIGN: An analysis of the risk of death in hospitalized injured patients in 1984 and 1985 (pretrauma system), 1986 and 1987 (early trauma system), and 1990 and 1991 (established trauma system) using hospital discharge abstract data. SETTING: A total of 18 acute care hospitals in the four-county area encompassing Portland, Ore. PATIENTS: A cohort of 70,350 hospitalized patients with at least one discharge diagnosis indicating injury. MAIN OUTCOME MEASURE: Death during hospitalization. RESULTS: After the trauma system was established, 77% of patients in the region with an Injury Severity Score (ISS) of 16 or greater were admitted to level I trauma centers. More than 72% of patients with an ISS less than 16 were hospitalized in nontrauma centers. Risk of death for injured patients hospitalized at level I trauma centers declined after the trauma system was established (odds ratio, 0.65; 95% confidence interval, 0.51 to 0.81). Patients who died in trauma centers after institution of the trauma system were younger and had more severe injuries, and the majority died within 1 day of admission, whereas patients who died in nontrauma centers died a median of 5 days after admission. CONCLUSION: Establishment of a trauma system shifted the more seriously injured patients to level I trauma centers, where there was a significant reduction in the adjusted death rate.

Adolescent↗