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Biomedical subjects

G A Timberlake

Publications and source records attributed to G A Timberlake.

At least 37 records · Page 2Linked to original sources
PubMed1993

Safety belt use and hospital charge differences among motor vehicle crash victims.

Trauma remains a leading cause of death and disability in America, and motor vehicle crashes (MVC) are the most common cause of serious injury in West Virginia. In this study, we examined the role of seat belt use or non-use in the death, disability, and hospital charges of 500 patients admitted after MVC to a rural Level 1 trauma center in 1990. Eighty percent of the patients who required hospitalization did not use seat belts. The unbelted patients had a 34% higher injury severity score, a 97% increase in the need for extended care after discharge from the hospital, and a 186% increase in hospital charges compared to belted patients. Our study concluded that seat belt use among motor vehicle crash victims reduced their hospital costs, and improved their outcome as compared to those patients not wearing seatbelts.

Accidents, Traffic↗
PubMed1992

Development and organization for casualty management on a 1,000-bed hospital ship in the Persian Gulf.

A 1,000-bed hospital ship designed for trauma patients was deployed to the Middle East with the objectives of preparing for large numbers of casualties resulting from Operation Desert Storm from conventional, chemical, and biological weapons. Plans for receipt and decontamination of casualties, triage, and optimal utilization of the 1,000-bed facility were developed. Mass casualty drills were conducted, involving all aspects of patient care from the flight deck to the wards. Trauma and critical care registries were developed to collect casualty data that could then be analyzed for specific military purposes and compared with current civilian registries. Attempts were made to identify the advances in shock resuscitation, systems management, and operative treatment from the civilian community that could be applied to care of combat casualties. Difficulties with accomplishing these objectives included limited trauma experience and supplies and poorly defined medical regulating and evacuation policies. The development of these programs, as well as the unique difficulties encountered, are discussed.

Disaster Planning↗
PubMed1992

Giant, benign, mucinous cystadenoma of the ovary: case study and literature review.

Benign, mucinous cystadenomas account for 15 per cent of all ovarian neoplasms. Of these, the giant variant occurs rarely. A morbidly obese, 52-year-old, white woman was seen for acute abdominal pain and diagnosed using computerized tomography as having a giant, benign, mucinous cystadenoma. At laparotomy, 21-kg cystic mass attached to the right ovary was removed. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. In such patients, special consideration must be given to hemodynamic and ventilatory monitoring and intraoperative fluid management. Recognition and subsequent surgical management of this and other large abdominal masses can be optimized by thoughtful, preoperative evaluation and careful planning of the operative approach.

Cystadenoma↗
PubMed1992

Pancreatic pseudocyst: diagnosis and management.

Diagnosis and management of pseudocysts of the pancreas often present difficult clinical problems. We reviewed our 18 patients with pancreatic pseudocysts treated between January 1985 and October 1989 to identify criteria for operative and nonoperative management based on size of the lesion on computerized tomography. Diagnostic modalities, etiology, management, and concurrent medical problems were also evaluated. Alcohol (72%) was the most common etiologic agent. Hypertension (39%), peptic ulcer disease (28%), and chronic obstructive pulmonary disease (22%) were the most common associated medical problems. CT scan was the most frequently used (100%) and most accurate (100%) preoperative diagnostic tool. Preoperative ERCP modified the treatment plan in only one patient. All pseudocysts smaller than 3 cm on CT scan were managed nonoperatively, without recurrence (mean follow-up of 3 months). The most commonly performed surgical procedure was cystogastrostomy. External drainage procedures had a higher complication rate (100% vs 14%) and higher recurrence rate (33% vs 0%) than internal drainage procedures. Attempted percutaneous drainage in one patient resulted in recurrence. Pancreatic pseudocysts less than 3 cm in diameter can be safely managed nonoperatively. CT scan remains the diagnostic tool of choice. Preoperative ERCP evaluation is of limited utility and needs further evaluation. Internal drainage procedures provide the best surgical results.

Adult↗
PubMed1990

Penetrating injuries of the abdominal aorta.

The charts of 56 consecutive patients with penetrating injuries to the abdominal aorta were reviewed in an attempt to identify prognostic factors. Mechanism of injury was gunshot wound (GSW), 82 per cent (.22 cal: 15.2%; greater than .38 cal: 84.8%); shotgun wound (SGW), 5 per cent; and stab wound (SW), 13 per cent. Overall mortality was 73 per cent, with GSW 78 per cent (.22 cal: 0%; greater than .38 cal: 92%), 67 per cent with SGW, and 43 per cent with SW. Average initial systolic blood pressure (ISBP) was 53 (0-130); 87 (0-120) in survivors; and 40 (0-130) in nonsurvivors (NS). Eighteen patients (32%) had no ISBP, with one survivor. Thirty (54%) patients had ISBP less than 70, with three survivors. Six Emergency Department (ED) thoracotomies were performed, with five patients surviving to reach the operating room (OR), and none surviving long-term. Ten patients died in the ED, 18 during surgical intervention, six within 24 hr, and seven greater than 24 hr postop. Average time from injury to OR was 75 minutes, with 122 minutes in survivors, and 53 minutes in nonsurvivors (P less than 0.05); 49 minutes in those dying in the OR; and 58 minutes in those surviving the OR but dying postop (NS). At surgery, six patients had thoracotomy before celiotomy for control of the thoracic aorta, with three surviving the OR and two surviving long-term. Survivors had 2.53 associated injuries; nonsurvivors had 2.89 (NS). No significant difference was noted in number or location of associated injuries between survivors and nonsurvivors.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗
PubMed1989

Diagnostic pneumoperitoneum in the pediatric patient with a unilateral inguinal hernia.

Controversy continues among surgeons over the management of pediatric patients with unilateral groin hernias. Currently, advocated treatment modalities include repair of only the clinically apparent side, exploration of the contralateral side when the ipsilateral hernia is repaired, or performance of contrast herniography before surgery. Another technique for consideration--diagnostic intraoperative pneumoperitoneum--is a simple, quick, safe, and highly accurate means of detecting a clinically inapparent contralateral inguinal hernia during the initial surgery. This technique, the results of its use, and a review of the literature are included.

Adolescent↗
PubMed1989

Primary repair vs. colostomy for the treatment of penetrating colon injuries.

The charts of 81 consecutive patients with penetrating colonic trauma were reviewed. Sixty-five patients were considered for evaluation. Penetrating abdominal trauma index, associated injuries, length of operative procedure, wounding agent, length of hospital stay, method of treatment, and septic complications were evaluated. Twenty-eight patients were treated with colostomy at the site of injury: five with diverting colostomy proximal to repair, 30 with primary repair (either single or multiple injuries), and two with exteriorization and early drop back. Overall septic morbidity was 15 of 65 (23 percent) patients. No statistically significant difference was found in morbidity between colostomy, 9 of 33 (27 percent), and primary repair, 6 of 30 (20 percent). The two patients with exteriorized repairs had no morbidity. No deaths were reported among the 65 patients studied. Thirty-two of the 33 (97 percent) colostomies were later closed with morbidity in 7 of 32 (22 percent). The mean length of stay for primary repair patients was 10.3 +/- 2.8 days and for colostomy patients, 25.7 +/- 3.8 days, counting days for both initial and colostomy closure admissions (P less than .05). Colostomy was not mandated by anatomic location or number of colonic injuries, circumference of colonic wall involved, presence of fecal contamination, or involvement of mesenteric blood supply. This study indicates that primary repair does not carry an increased risk of septic complications and saves the patient the significant risk and increased hospital stay of colostomy closure. Prospective studies addressing this area are indicated.

Adult↗
PubMed1989

Transtracheal needle catheter ventilation in complete airway obstruction: an animal model.

Transtracheal needle catheter ventilation (TNCV) may be used as an alternative airway when contraindications to endotracheal intubation exist. A feline model tested the efficacy of low-flow oxygen delivery, and initial data were gathered to define proper catheter calibers to effect adequate oxygenation and ventilation. Cats were anesthetized, trachea intubated, and ventilated for 30 minutes with a pressure-regulated ventilator. Arterial and venous pressures were monitored, and a chest tube was inserted to measure intrathoracic pressures. Arterial blood gas analysis was performed every five minutes during the baseline period. The endotracheal tube was then removed, the trachea cross-clamped, and TNCV instituted. Oxygen flow rates of 1, 3, and 5 L/min were varied with catheter sizes of 14, 16, and 18 g. Data demonstrated that TNCV provided adequate oxygenation and ventilation with flow rates of 3 and 5 L/min with the 14- and 16-g catheters. Satisfactory oxygenation could be obtained with these flow rates with the 18-g catheter, but ventilation was inadequate. Ventilation was unsatisfactory with the 1 L/min flow rate in all catheter sizes. These preliminary data indicate that a minimum catheter:trachea cross-sectional area ratio of 0.03 may be required to obtain oxygenation and ventilation with low-flow oxygen rates of 3 to 5 L/min in cats.

Airway Obstruction↗
PubMed1989

High cost of trauma care in the elderly.

Trauma in the elderly is a significant public health problem in terms of morbidity, mortality, and expenditure of health care resources. We compared injury severity score, length of stay, hospital charges, and mortality rate in a group of 60 elderly patients and a group of 60 younger patients admitted to our hospital. The older group had an average hospital stay that was more than four days longer, at an average hospital charge of $15,769.55, and their mortality rate was 15% versus 0% among the younger group. Despite early and aggressive care, the elderly continue to pose an important problem for trauma centers in terms of both length of stay and cost.

Adult↗
PubMed1989

Penetrating thoracic aortic injuries: rare but potentially salvageable sequelae of urban warfare.

Penetrating injuries of the thoracic aorta are rare and often fatal. Victims of such wounds rarely survive to reach the emergency department. Those patients who do arrive will display one of two symptom complexes--either continuing hemorrhage or seeming hemodynamic stability with a widened mediastinum on chest roentgenography. As the results of our study of six such patients show, at least 50% of those who arrive with any signs of life may be salvaged by aggressive surgical management.

Adolescent↗
PubMed1989

Massive retroperitoneal hemorrhage from an asymptomatic adrenal cortical adenoma. Report of a case.

A 52-year-old man was admitted to the General Surgical Service, with acute onset of left back and flank pain. Two weeks prior to admission he had been subjected to a 3G to 4G acceleration in an ejection seat training simulator. On the day of admission, he had performed a 100 yard swim in flight gear following a seven foot jump into water. He denied any injury during the above exercises or any other trauma. A falling hematocrit was demonstrated by serial determinations and a computerized tomography scan revealed a left retroperitoneal hematoma with normal bilateral renal function and no obvious renal injury. Continued hemorrhage resulted in laparotomy, which showed an 11 cm left adrenal tumor with massive hemorrhage into the retroperitoneum. Histologically the tumor was a benign non-functioning adrenal cortical adenoma.

Adenoma↗
PubMed1989

Trauma in pregnancy. A 10-year perspective.

Trauma is the most common cause of nonobstetric death in pregnant women. Fortunately, the incidence of trauma in the pregnant population is low, and individual surgeons are unlikely to see many cases in their practice. This report reviews the Charity Hospital of Louisiana at New Orleans experience with trauma in pregnancy over a recent 10-year period. Our results, with an 8 per cent incidence of maternal death and 28 per cent incidence of fetal death, support the concept of an aggressive approach to resuscitation and evaluation of traumatized pregnant women to achieve optimal results.

Adolescent↗
PubMed1989

Penetrating injury to the carotid artery. A reappraisal of management.

Penetrating trauma remains the most common cause of cervical carotid artery injury. Controversy persists regarding proper management of these injuries, especially in the presence of a neurologic deficit. Recent experience with 24 patients over a 5-year period is reviewed. In patients with preoperative neurologic deficits, neither repair nor ligation of the injured vessel altered outcome. Outcome correlated only with preoperative neurologic status. All patients without preoperative neurologic deficits should have repair attempted when technically feasible. Although controversial, this study supports carotid artery repair except in comatose patients who have profound neurologic deficits.

Adult↗
PubMed1988

Thromboembolism as a complication of myocardial contusion: a new capricious syndrome.

Myocardial contusion is becoming more frequently recognized as a concomitant of blunt chest and abdominal trauma. Thromboembolism is an infrequent, but serious, complication of myocardial contusion and management is controversial. We report a case and review the literature of thromboembolism complicating blunt heart injury, and suggest a protocol to prevent this complication.

Adolescent↗
PubMed1988

Impotence following pelvic fracture.

A group of 42 men (mean age, 26.7 years) with pelvic fractures as the result of motor vehicle accidents were evaluated for impotence 48 hours after injury. Hormone levels were normal in all patients tested. One half (21/42) of the patients had abnormal penile:brachial arterial ratios. Of this group, 13/21 had abnormal bulbocavernosus reflex (BCR): four patients were paraplegic and nine had urethral injuries. Followup of available patients to 20 months reflects persistent impotence in those who experienced vasculogenic trauma. Only 2/21 patients with normal tests (vascular, hormonal, neurologic) complain of impotence (followup at 23 months); one of these patients is in litigation.

Adolescent↗
PubMed1988

Autotransfusion of blood contaminated by enteric contents: a potentially life-saving measure in the massively hemorrhaging trauma patient?

The role of autotransfusion of shed blood is well established in thoracic, abdominal, vascular, and orthopedic elective surgery. When hollow viscera or infected organs are uninvolved, autotransfusion is also well accepted in trauma surgery. Less clear is whether shed blood from an injury violating hollow organs in the abdomen can be used safely in the trauma patient. We retrospectively identified 11 patients with penetrating thoracoabdominal trauma who had received enteric contaminated shed blood, processed by the Haemonetics Cell Saver, and reviewed their records for infectious morbidity or mortality. All patients received parenteral broad-spectrum antibiotics. Three patients developed infectious wound complications, one probably nosocomial from the intensive care unit. No patient developed intra-abdominal sepsis and no deaths were reported. Based on the results of this preliminary result, it may be appropriate to use autotransfusion of shed blood in trauma patients with gastrointestinal injuries, if banked blood is not readily available and the patients receive perioperative broad-spectrum antibiotics.

Abdominal Injuries↗