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Biomedical subjects

J J Colella

Publications and source records attributed to J J Colella.

8 recordsLinked to original sources
PubMed1996

Early tracheostomy in trauma patients.

A retrospective analysis of 118 trauma patients who underwent tracheostomy for airway and pulmonary management was undertaken. Timing of the procedure was defined as early (0-3 days), intermediate (4-7 days), and late (> 7 days). Head injury patients received tracheostomy early (p < 0.00003). Aspiration evaluated by modified bedside aspiration test was a frequent occurrence in all three groups with no difference in incidence (p < 0.34). Pneumonia was less frequent in the early group compared with the intermediate and late groups (p < 0.0034). The incidence of pneumonia in the early group was not different from that observed in early extubated patients (n = 282; p < 0.23). Our study suggests that early tracheostomy may decrease pulmonary septic complications in trauma patients. Although no change in length of stay can be attributed to the early performance of tracheostomy, preventing pneumonia in the intensive care unit setting with its resulting high expense is beneficial.

Adult↗
PubMed1996

Blunt carotid injury: reassessing the role of anticoagulation.

Twenty patients with blunt mechanism injuries to the internal carotid artery were treated over a 10-year period. The purpose of this review is to assess the necessity and timing of anticoagulation as a primary therapeutic modality in patients with this injury. Sixteen patients (80%) survived, the majority with normal neurologic function. Twelve patients with either unilateral or bilateral carotid mural injury were anticoagulated. Ten survived with normal neurologic function. Five patients in the heparin anticoagulant group had a significant delay in the initiation of anticoagulation. All recovered without deficits. Two patients were treated with aspirin alone and recovered without deficits. Two patients received no treatment; one survived without deficits, and the nonsurvivor succumbed to a severe head injury. Therefore, a total of nine patients were either not treated with heparin or had a significant delay in the initiation of heparin. Eight of nine (88%) in this group recovered without deficit. A delay in the initiation of heparin therapy, no therapy, or the institution of antiplatelet therapy may all be appropriate in the initial management of mural injuries of the internal carotid artery.

Adult↗
PubMed1990

Traumatic rupture of the aorta--critical decisions for trauma surgeons.

The diagnosis and initial stabilization of patients with traumatic rupture of the aorta (TRA) is performed by trauma surgeons. The resuscitations of 54 TRA patients at a Level I trauma center are reviewed. Although the survival of patients who underwent attempted repair was good (75%), 21/27 (78%) deaths occurred during phases of treatment controlled by a trauma surgeon. The techniques and sequencing of resuscitation can affect outcome. Pneumatic antishock garments were not beneficial in the prehospital setting for patients with TRA. In fact, PASG were on and inflated in all patients who presented in cardiac arrest. Awake, unanesthetized intubation caused fatal aortic rupture in three patients. Pharmacologic control of blood pressure during intubation is necessary. The amount of fluid, blood transfusion, and changes in blood pressure secondary to therapy did not statistically affect outcome. The average time from arrival in the ER to angiogram was 64.7 minutes. The average time ER to operating room was 159.7 minutes. Seven cases of TRA had delayed diagnosis usually for a misinterpreted CXR (5/7). Delay in diagnosis did not directly contribute to any deaths. Associated abdominal injuries are a common cause of preventable deaths. Fourteen patients with combined abdominal injuries and TRA were identified. Four of six deaths occurred with potentially reparable injuries. Operative and diagnostic sequences must be adjusted to allow rapid control of all potentially fatal injuries.

Adolescent↗
PubMed1975

Indwelling arterial catheters as a source of nosocomial bacteremia. An outbreak caused by Flavobacterium Species.

Between mid-May and mid-October, 1973, 49 blood cultures from 14 patients in an intensive care unit were positive for flavobacterium species, Group II-b. We conducted an investigation to determine how patients were being infected with this unusual organism. Comparison of the 14 infected patients with 37 controls associated indwelling arterial catheters with subsequent flavobacterium bacteremia (p = 0.005). Risk of infection was greatest during the period in which blood gas determinations were done most frequently (the first three days of catheterization) and in which infected patients had more blood gas determinations than control patients with arterial catheters (p less than 0.05). Flavobacterium species was cultured from in-use arterial catheters, from stopcocks, and from ice in the intensive-care unit's ice machine; the catheters were probably contaminated by syringes that were cooled in ice before being used to obtain arterial specimens for blood gas determination. This outbreak calls attention to arterial monitoring systems as a potential source of nosocomial infection.

Arteries↗
PubMedDate not supplied

Use of Doppler ultrasound in performing percutaneous cannulation of the radial artery.

Doppler ultrasound has been used extensively in assessing adequacy of circulation. We have found it to be convenient in the identification of blood flow, particularly in hypotensive states where percutaneous radial artery cannulation of the vessel is tedious and difficult to perform. The technique is simple, atraumatic, and usually successful.

Arteries↗