Biomedical subjects
S Van Duzer-Moore
Publications and source records attributed to S Van Duzer-Moore.
Cimetidine for the prophylaxis of potential gastric acid aspiration pneumonitis in trauma patients.
Acute trauma victims are at high risk for gastric aspiration during urgent anesthesia. The morbidity of this complication is well known and is directly related to the acidity of the gastric contents. A pH less than 2.5 is associated with a marked increase in pulmonary sequelae. Cimetidine has been effective in the treatment of peptic ulcer disease because of its ability to elevate gastric pH. This was a prospective randomized study of administering a single dose of cimetidine (300 mg IV) to trauma patients in the Emergency Department. Fifty patients were studied and 39 (78%) had an initial gastric aspirate pH less than 2.5. The gastric pH remained in this critical range over the ensuing 4 hours in 19 (90%) of the 21 patients not receiving cimetidine. In contrast, only two (11%) of the 18 patients given cimetidine were observed to have gastric pH levels less than 3.0, 1 hour after administration. This protective effect was maintained over the subsequent 3 hours of observation. These preliminary findings warrant further clinical trial of cimetidine for the prophylaxis against aspiration pneumonitis in patients at high risk for this complication.
Mandatory laparotomy for gunshot wounds penetrating the abdomen.
A 4 year experience with 245 patients with isolated lower thoracic or anterior abdominal gunshot wounds was reviewed. Twenty-three (16 percent) of the 144 abdominal injuries were clinically superficial and all were managed successfully nonoperatively. Of the remaining 121 patients, 115 were confirmed to have peritoneal violation at laparotomy and 111 (96 percent) of these had significant visceral injuries. Of the 101 patients with lower chest wounds, 47 had peritoneal violation and 45 (96 percent) had intraabdominal injuries. Twenty-six (17 percent) of the 156 patients with intraperitoneal trauma had unimpressive physical signs on admission. these findings support a policy of routine exploration for gunshot wounds violating the peritoneum. When depth of penetration is uncertain, diagnostic peritoneal lavage should be used. Only those patients with unequivocally superficial injuries warrant observation.
The evolution of abdominal stab wound management.
The results of the selective management of 300 abdominal stab wound victims have been reviewed for a 5-year period. Initially the need for laparotomy was evaluated by sinography, later physical examination, and most recently by local wound exploration combined with peritoneal lavage. The use of sinography resulted in an unnecessary laparotomy rate of 38%. Exploration based upon physical findings eventuated in 36% unnecessary laparotomies, of which 79% were negative, 17% morbidity, and no mortality. Local wound exploration followed by peritoneal lavage when peritoneal violation was suspected resulted in 8% unnecessary laparotomies of which half were negative, 9% morbidity, and no mortality. Based on this experience we have adopted the following approach to abdominal stab wounds. Patients with unexplained blood loss or overt signs of visceral injury undergo prompt exploration. In all other cass with intact peritoneum are discharged from the Emergency Department. If peritoneal violation is evident peri toneal lavage is performed. If the lavage is positive laparotomy is undertaken, and if negative the patient is hospitalized for an additional 24 hours of observation.