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R P Carraway

Publications and source records attributed to R P Carraway.

14 recordsLinked to original sources
PubMed1997

Blunt intrapericardial rupture of the pulmonary artery in a surviving patient.

Blunt chest trauma can produce a number of potentially lethal injuries, including pulmonary artery rupture. Survivors of pulmonary artery injuries are rare. Most previously reported surviving patients presented with hemothorax from a hilar injury. We report a patient who survived a blunt rupture of the intrapericardial portion of the pulmonary artery and thus presented with pericardial tamponade. The interventions that led to her survival are discussed.

Accidents, Traffic↗
PubMed1990

Is diagnostic peritoneal lavage for blunt trauma obsolete?

Diagnostic peritoneal lavage was 97 percent accurate, with a 2 percent false positive rate and a 1 percent false negative rate in this series of 414 patients. The ease, safety, and accuracy of diagnostic peritoneal lavage justify its continued use in evaluating these patients. Recent studies show computerized tomography (CT) can be highly accurate in detecting intra-abdominal injuries after blunt trauma. We reviewed our experience with diagnostic peritoneal lavage (DPL) to evaluate whether the accuracy, safety, speed, and cost justified its continued use. Four hundred fifteen DPLs were performed on 414 patients from February 1, 1983, through December 31, 1987. All DPLs were done by the open technique. The lavage was considered grossly positive if 10 cc gross blood were aspirated. If there were greater than 100,000 red blood cells (RBC)/mm3, greater than 500 white blood cells (WBC)/mm3, elevated amylase or bilirubin, or bacteria or vegetable fibers the lavage was microscopically positive. There were no cases with elevated bilirubin, amylase, or presence of bacteria. All four cases with "rare vegetable fibers" were false positive. Six DPLs were for penetrating trauma to the lower chest or back. There were 291 negative lavages, including five false negatives (1%), and 124 positive DPLs, including seven false positives (2%), resulting in a crude accuracy of 97 percent. Three of the five false negative lavages had a ruptured diaphragm as the only intra-abdominal injury. There was one minor complication. DPL was usually performed in the trauma resuscitation room during the secondary survey. At our institution, the total fees for DPL are +185 less than the fees for CT. DPL is accurate, rapid, safe, and avoids the disruption of patient care that results in the radiology suite. DPL remains our procedure of choice for evaluating blunt abdominal trauma in the adult.

Abdominal Injuries↗
PubMed1989

Ultrarapid diagnostic peritoneal lavage.

Diagnostic peritoneal lavage is an important adjunct in the evaluation of blunt trauma. The open technique has proven to be safer, though more time consuming, than the closed percutaneous technique. A significant time-consuming aspect of the procedure is the infusion and drainage of the peritoneal lavage fluid. With the use of cystoscopy irrigation tubing, infusion time for one liter of Ringer's lactate averaged 2.9 minutes compared to 14.4 minutes when using IV fluid tubing. Similarly, effusion time was 2.3 times rather than 9.8 minutes. These differences are significant at the 0.0001 level. The average time saved was 19 minutes, allowing more rapid assessment and treatment of these critically injured patients.

Abdominal Injuries↗
PubMed1988

Diagnostic peritoneal lavage in blunt trauma.

We reviewed the records of 274 trauma patients who had 275 diagnostic peritoneal lavages from Feb 1, 1983 through Jan 31, 1986. Lavage was done in 271 of 560 (48%) cases of blunt trauma and three of 245 (1%) penetrating injuries (gunshot wounds to the chest). The open lavage technique was used, and results were considered grossly positive if there was 10 ml of gross blood. Results were considered microscopically positive if there were more than 100,000 RBCs or 500 WBCs/cu mm, an elevated amylase or bilirubin value, or bacteria or vegetable fibers. Lavage was negative in 193 cases, including false-negative results (1%), and positive in 78, with three false-positive results (3.8%). Open peritoneal lavage is safe, rapid, readily available, and accurate in the evaluation of blunt abdominal trauma.

Child↗
PubMed1988

Pulmonary artery disruption from blunt thoracic trauma.

Blunt chest trauma occurs in up to 50 per cent of all fatal motor vehicle accidents and is the primary cause of death in 12-25 per cent; yet only 15 per cent of patients with chest trauma arriving alive to the emergency department require early thoracotomy. Pulmonary artery disruption from blunt trauma is extremely rare. Two patients both women, older and obese with multiple rib fractures and little pulmonary parenchymal damage are reported. Neither had injury to the aorta, heart or intra-abdominal organs. One patient survived after lateral repair of the left main pulmonary artery and the other exsanguinated from a laceration of the right main pulmonary artery. Intrapericardial exposure of the proximal pulmonary arteries may be necessary for control of hemorrhage. Trauma surgeons should be familiar with this technique. Indications for immediate thoracotomy should include: massive hemothorax (greater than 1000 ml), continued bleeding greater than 300 ml in the first hour, bleeding greater than 200 ml/hr for 5 hours, or increasing hemothorax in spite of tube thoracostomy. Close adherence to these guidelines would have allowed both patients to be explored earlier.

Accidents, Traffic↗
PubMed1985

Proper management of renal artery injury from blunt trauma.

Blunt trauma to renal arteries often receives suboptimal management because of delayed diagnosis, incomplete preoperative evaluation, associated injuries, or unknown functional capacity of the contralateral kidney. We propose a rational treatment plan from an analysis of our three cases and a review of 118 cases. Two thirds of the patients were male, and left-sided injuries predominated over right 42.9% to 30.6%. In 20 cases the insult was bilateral. Associated injuries occurred in 72%, averaging 1.6 injuries per case, of which one half were intra-abdominal. Flank and/or abdominal pain was present in 73% of cases, tenderness in 65%, and gross or microscopic hematuria in 74%. Repairs were attempted on 38 renal arteries. "Successful" repairs were accomplished in 16 arteries, while repairs failed in 22. Subsequent hypertension developed in 32% of successes. Repair should be attempted in stable patients with unilateral injury of less than four hours' duration, bilateral injuries of less than 20 hours' duration, or injuries with nonocclusion on arteriogram.

Adolescent↗
PubMed1984

Life Saver: a complete team approach incorporated into a hospital-based program.

Both military and civilian settings have shown that a team approach through an excellent prehospital Emergency Medical Services system, an organized regional communication system, access to rapid air evacuation with a "complete" medical team on board, and dedicated trauma resources allows a critically ill or injured patient optimal chances for survival. The Life Saver airborne emergency service, operated by Carraway Methodist Medical Center in Birmingham, Alabama, is a "complete team" concept with a well trained emergency physician and a critical care flight nurse aboard every flight. The physician upgrades the level of care at the scene of an accident, lessens the referring physician's anxiety, maintains an intensive care unit environment during transport and intervenes if a life threatening emergency occurs, which cannot be predicted prior to lift-off. This report describes the development, operations, and results in the aeromedical transport of 1047 patients from January 2, 1981 to December 31, 1982. Trauma transports accounted for 47.5%, nonsurgical problems 47.8% and nontraumatic surgical patients representing the remaining 4.7%. The in-flight mortality was 0%. This type service is not appropriate for all hospitals to provide, but should be considered by major trauma and cardiac referral centers.

Adolescent↗