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R R Ivatury

Publications and source records attributed to R R Ivatury.

88 records · Page 5Linked to original sources
PubMed1986

Emergency department thoracotomy for penetrating injuries: predictive value of patient classification.

In 18 months, 44 patients underwent thoracotomy in an emergency department (ED) for penetrating thoracic injuries. Of 14 patients resuscitated, seven (50%) survived, and all were neurologically intact. Patients were classified according to the quality of signs of life in transit or upon arrival at the ED. Identical survival rates of 29% were noted for patients in Group I (profound shock) and in Group II (agonal), with survival at 14% for individuals in Group III ("dead" on arrival). There were no survivors among patients in Group IV ("dead" on the scene), and ED thoracotomy, in the authors' opinion, is fruitless in this group. In Groups I, II, and III, total salvage from cardiac injuries was six of 24 patients (25%), and for those with non-cardiac injuries, it was one of 11 (9%). The rate of survival from cardiac stab wounds in Groups I, II, and III, was five of 16 (31%) and one of eight (13%) for gunshot wounds. Five of the seven survivors (71%) arrived at the ED by rapid transport without the benefit of any pre-hospital life support. Patient classification appears to be a valuable tool in evaluating the benefit of ED thoracotomy. The neurological status of all survivors and pertinent transportation data should be included in all future studies of ED thoracotomy. "Scoop and run" in the urban setting with rapid transport capability may be superior to pre-hospital stabilization of victims of penetrating thoracic trauma.

Adolescent↗
PubMed1986

Liver packing for uncontrolled hemorrhage: a reappraisal.

The efficacy of liver packing for uncontrolled hemorrhage was assessed in 345 patients with hepatic injuries divided into two groups: Group I (1977-1980; n = 177), when packing was not used and Group II (1981-1985; n = 168) when the technique was employed. Despite similar clinical details, mortality from bleeding was unchanged (19.2% and 19.4% overall, and 63.7% and 61.7% for Grade IV, V, VI liver injuries). Packing was used in 14 patients who were in clinical coagulopathy after debridement-resection of the injured liver: eight patients (57%) expired from continued bleeding; five of the six survivors (83.3%) developed intra-abdominal abscesses despite early removal of the pack. The incidence of sepsis was significantly (p less than 0.002) increased as compared to that of 15 similar patients who had debridement-resection without packing. Liver packing, in our experience, has not altered the mortality from major hepatic trauma and appeared to increase the incidence of abdominal sepsis.

Bandages↗
PubMed1985

Penetrating duodenal injuries. Analysis of 100 consecutive cases.

One hundred consecutive patients with penetrating duodenal injuries were reviewed retrospectively to analyze the results of various methods of treatment. The severity of the abdominal injury was quantified by the Penetrating Abdominal Trauma Index (PATI). The overall mortality was 25%. Sixteen per cent of the deaths were related to extensive associated organ injury, eight per cent to sepsis, and one per cent to concurrent head trauma. Duodenal fistulas occurred in four per cent and were associated with mortality in two per cent. The complications of duodenal fistula, abdominal sepsis, and mortality from sepsis were significantly higher in those patients treated by repair and decompressive enterostomy with or without a serosal patch than in those with repair or resection. The severity of duodenal and associated organ injuries, as well as the clinical status, were similar in both groups. It is concluded that the majority of duodenal injuries from penetrating trauma may be treated effectively by primary repair, and that the use of decompressive enterostomy or serosal patch appears to contribute to an increased morbidity rate.

Abdomen↗
PubMed1985

Cimetidine and hepatic blood flow in polytrauma patients.

Recent reports suggest that cimetidine acutely reduces liver blood flow in normal healthy subjects. To determine whether this finding is applicable to critically ill patients, we studied nine polytrauma patients admitted to a surgical ICU. All patients were being monitored with pulmonary artery catheters; all were stable with normal liver function. Liver blood flow was estimated by indocyanine green clearance, before and after administration of a single dose of 600 mg cimetidine. Hemodynamic variables were measured at the same times. Cimetidine did not significantly alter either hepatic blood flow or cardiovascular status in these critically ill patients.

Adult↗
PubMed1985

The morbidity of injuries of the extra-hepatic biliary system.

Blunt and penetrating injuries of the extrahepatic biliary system are rare and appear to be increasing in frequency. The severe morbidity associated with these lesions is related to incomplete efforts at diagnosis and errors in therapeutic decisions. The morbidity may be minimized by a high index of suspicion and awareness of these lesions; complete exploration of all hematomas around the bile ducts to reduce the incidence of overlooked injuries; meticulous repair of tangential injuries; and primary biliary-enteric diversion for complete transection of the ducts. A knowledge of the various options in operative management is crucial since unexpected injuries are not uncommon.

Adolescent↗
PubMed1985

Treatment of penetrating duodenal injuries: primary repair vs. repair with decompressive enterostomy/serosal patch.

We analyzed 60 patients with penetrating duodenal injuries (1972-1983) treated by two operative techniques: primary repair or anastomosis after debridement, and repair with decompressive enterostomy with or without serosal patch of jejunum. The two treatment groups were comparable in terms of severity of duodenal and associated injuries and clinical status of the patients. Morbidity was significantly higher (p less than 0.001) in the enterostomy/patch group and mortality was limited to that group. Our data suggest that debridement and primary repair of duodenal wounds is the treatment of choice and that the addition of decompressive enterostomy and/or serosal patch does not improve results and may contribute to morbidity and mortality.

Adolescent↗
PubMed1984

Post-traumatic thoracobiliary fistula.

Post-traumatic thoracobiliary fistulas are preventable complications of thoracoabdominal trauma. Once established, prompt diagnosis and early surgical intervention with chest drainage after decortication, suture repair of the diaphragmatic lacerations, and extraperitoneal liver drainage are crucial in the management of this complication.

Abdominal Injuries↗
PubMed1984

Aggressive definitive management of penetrating colon injuries: 136 cases with 3.7 per cent mortality.

One hundred thirty six patients with penetrating colon injuries (gunshot wounds, 95; stab wounds, 41) were retrospectively analyzed. A scoring system, the Penetrating Abdominal Trauma Index (P.A.T.I.), was employed to quantitatively assess the severity of injuries in each patient. Of 67 patients with right colon injuries, 48 (72%) were treated definitively by primary repair (32) and by resection and ileocolic anastomosis (16), with minimal morbidity. In 69 patients with left colon injuries, 47 (68%) were treated by colostomy (28) and by exteriorized repair (19). Overall, exteriorized repair was successful in 74% of patients. All five mortalities (3.7%) were related to associated injuries. It is concluded that the majority of the right colon injuries can be treated definitively. Exteriorized repair should be the preferred method whenever colostomy is considered, except in severe left colon injuries requiring resection.

Adolescent↗
PubMed1984

Omental evisceration through an abdominal stab wound: is exploratory laparotomy mandatory?

The authors reviewed and analysed the records of 75 patients with omental and bowel evisceration as a result of abdominal stab wounds to discover whether omental prolapse makes laparotomy mandatory. Major intraabdominal injuries were found in 82.7% of the total group, 82.9% in those with omental protrusion and 82.5% in patients with bowel prolapse. The nature of the injuries and the incidence of multiple organ trauma were similar in the two groups. Negative laparotomy did not cause important morbidity. The authors conclude that omental herniation after stab wounds of the abdomen should routinely prompt exploratory celiotomy.

Abdominal Injuries↗
PubMed1983

Penetrating injuries of the neck: criteria for exploration.

One hundred thirty-six patients with penetrating injuries of the neck over a 4-year period were studied prospectively. Seventy-two patients (52.9%) had no major physical signs on admission, 56 were observed without complications, and 16 had a negative exploration. Injuries below the level of the cricoid cartilage were associated with a very high mortality (12.12%). We recommend a policy of selective conservatism in the management of penetrating neck injuries.

Brachial Plexus↗
PubMed1983

Emergency room thoracotomy for penetrating cardiac injuries.

The results of emergency room thoracotomy (ERT) and cardiorrhaphy for 91 patients with penetrating cardiac injuries admitted in extremis to Lincoln Medical and Mental Health Center from 1963 to 1981 are reviewed to determine criteria for selection of patients for this procedure. Four groups were defined based on the severity of the effects of their injuries. The survival rates were 32.1 and 33.3%, respectively, for Group I ('fatal') and Group II ('agonal') patients. There were no survivors in Group IV ('D.O.A.') patients for whom ERT is a fruitless procedure. Survival in Group III ('profound shock') patients was only 40%, which might have been improved if ERT had been performed without delay. We conclude that ERT is essential for patients with 'fatal' and 'agonal' wounds and advise prompt ERT for patients in 'profound shock' who do not respond immediately to rapid volume infusion.

Adolescent↗
PubMed1982

Penetrating gluteal injuries.

A review of 60 patients admitted with penetrating gluteal trauma during a 4-year period supports the concept that these wounds constitute a distinct group of injuries with a potential for serious, or even lethal, damage to a spectrum of organ systems. A plan of evaluation and management is presented. A high index of suspicion, repeated careful evaluation, and aggressive operative management of these injuries are mandatory to achieve a low morbidity and mortality.

Adolescent↗
PubMed1981

Emergency room thoracotomy for the resuscitation of patients with "fatal" penetrating injuries of the heart.

A total of 75 patients with penetrating cardiac injuries were treated at Lincoln Medical and Mental Health Center from January, 1974, to November, 1980. Twenty-two patients (29.3%) were unconscious on arrival and had no detectable vital signs, cardiac activity, or spontaneous respirations. Their last physical movement was observed in the ambulance. Immediate resuscitation of these patients employing intercostal or sternal splitting incisions in the emergency room revealed arrested hearts and permitted relief of tamponade, finger occlusion of the cardiac wound or wounds, and temporary suturing of the defect. Restoration of cardiac function was accomplished in 16 patients (72.7%). After transfer to the operating room for more definitive cardiorrhaphy and repair of other major wounds, 8 patients (36.4%) recovered without objective neurological disability. Our experience clearly supports the value of immediate emergency room thoracotomy in this group of patients.

Adolescent↗
PubMedDate not supplied

Management of penetrating laryngotracheal injuries.

BACKGROUND: Penetrating laryngotracheal injuries are uncommon; however, these injuries are associated with significant morbidity and mortality. In an attempt to define the management of penetrating laryngotracheal injuries, we reviewed our experience with these injuries. METHODS: We retrospectively analyzed the records of all patients admitted to a Level I trauma center who required operative management for penetrating laryngotracheal injuries. During the period of this study all patients with penetrating neck injuries were managed according to a protocol of selective exploration. RESULTS: Of fifty-seven patients with penetrating laryngotracheal injury 32 patients sustained gunshot wounds and 25 had stab wounds. The injuries were to the larynx in 24 (42%) and trachea in 33 (58%). Forty-six (81%) had isolated airway injuries and 11 (19%) had combined airway and digestive-tract injuries. Emergent airway management in 32 (56%) patients included: tracheostomy (15), endotracheal intubation (14), and cricothyroidotomy (3). Respiratory distress and subcutaneous crepitus were the commonest clinical findings. Diagnostic evaluation included: laryngoscopy/ tracheoscopy (17), esophagoscopy (12), contrast esophagography (9), angiography (8), and bronchoscopy (3). Repair of laryngotracheal and esophageal injury was performed in the majority of patients. Selected patients with milder laryngotracheal injury did not have tracheostomy performed, with no increase in morbidity or mortality. There were 2 (3.5%) early deaths from associated major vascular injury. CONCLUSION: Mortality can be minimized by aggressive airway control. Endotracheal intubation can be accomplished safely in selected patients with penetrating laryngotracheal injuries. Digestive-tract injuries can often clinically occult and contribute significantly to morbidity and mortality; therefore, early evaluation of the esophagus is vital. Simple repair of laryngotracheal and digestive-tract injuries can be performed safely with good results. In patients with minor injuries, tracheostomy does not appear to be mandatory.

Adolescent↗