Biomedical subjects

W R Olsen

Publications and source records attributed to W R Olsen.

At least 19 recordsLinked to original sources

PubMed1990

Selective monitoring of patients with suspected blunt cardiac injury.

Blunt chest trauma can result in cardiac injury with consequent dysrhythmias, valve malfunction, or frank rupture. Typically, patients with blunt chest trauma and suspected cardiac injury have required cardiac monitoring for 48 to 72 hours. Predicting which patients with blunt chest trauma are not at risk for cardiac complications would obviate many patient-hours of monitoring in the intensive care unit. This series examines the sensitivity of two-dimensional surface echocardiography in predicting cardiac complications. Over a 24-month period, 115 patients were admitted with blunt chest trauma and prospectively evaluated for cardiac injury with admission electrocardiograms, serial creatine kinase isoenzyme studies, and two-dimensional echocardiography. Thirty-one patients (27%) had abnormal two-dimensional echocardiograms. In 8 (25.8%) of these patients, cardiac complications requiring treatment developed. Eighty-four patients (73%) had normal two-dimensional echocardiograms, and a cardiac complication requiring treatment developed in only 1 (1.2%) of them. Of the 9 patients who required treatment of cardiac complications, 3 had normal admission electrocardiograms and only 1 had elevated levels of the myocardial-specific isoenzymes of creatine kinase. We believe two-dimensional echocardiography is a sensitive test for evaluating cardiac injury resulting from blunt chest trauma and is helpful in selecting those patients who require monitoring in the intensive care unit.

Adult↗

PubMed1982

Late complications of central liver injuries.

Twenty-one patients developed complications of central liver injuries requiring reoperation 1 week to several years after the initial injury. Seven patients were from a series of 320 acute liver injuries treated by us, and 14 were referred to us when their complications became evident. Eleven patients had hepatic abscesses, six had sterile hematomas, and four had hemobilia and its sequelae. Seven patients had asymptomatic vascular disruptions detected with angiography. Two patients developed biliary calculi secondary to hemobilia. Treatment was individualized and ranged from hepatostomy to extended hepatic resection. There were four deaths, three of which were related to the liver injury. Iatrogenic factors were responsible for 62% of these complications. The creation of a central hepatic cavity by superficial suturing or by packing was the most frequent cause, but inadequate resection, failure to provide posterior drainage, and hepatic artery ligation were implicated as well. Late complications of central liver injuries should be infrequent, often are preventable, are not subtle, and respond well to established modes of therapy.

Adolescent↗

PubMed1978

Non-mechanical hemorrhage in severe liver injury.

Coagulopathy, or non-mechanical hemorrhage, complicated the operative course of 17 of 33 (51.5%) patients suffering severe liver trauma. The highest incidence of non-mechanical hemorrhage (66.7%) occurred in patients undergoing anatomic lobectomy. Serial hemostatic parameters were assessed and thrombocytopenia was the most striking abnormality in patients with non-mechanical hemorrhage. The degree of thrombocytopenia was directly correlated with the number of blood transfusions administered. The mean operative blood transfusion requirement was significantly greater in patients with non-mechanical hemorrhage, 25.1 +/- 2.87 (S.E.M.) units, than in those without, 12.2 +/- 1.83 units (p < 0.001). The bulk of this transfusion was given before the onset of clinically overt coagulopathy. Massive transfusion of stored blood was felt to be the most important factor in causing non-mechanical hemorrhage. Convincing evidence for disseminated intravascular coagulation was lacking, and abnormal fibrinolysis was infrequent and mild when observed. Although uneventful in most, in six patients non-mechanical hemorrhage resulted in excessive blood transfusion, unnecessary operation or death. Infusions of platelet concentrate, fresh frozen plasma, and fresh blood were used to successfully treat most cases of non-mechanical hemorrhage. In all cases, these components were not started until non-mechanical hemorrhage was clinically apparent. The value of prophylactic use of blood components is stressed. Because of troublesome side effects associated with the use of prothrombin complex concentrates, these agents are contraindicated in patients with severe liver injury. After receiving concentrates, one patient developed severe hypotension leading to ventricular fibrillation, two developed transient thrombocytopenia and two others demonstrated multiple pulmonary microthrombi at autopsy, a finding not observed in autopsied patients not receiving the concentrates.

Adolescent↗

PubMed1977

A second look at delayed splenic rupture.

From 1968 to 1976, 314 patients were treated by splenectomy for blunt splenic injuries. Three hundred four of these were operated on within 24 hours. All had typical splenic lacerations with intraperitoneal bleeding from the time of injury. This was true also of seven of the ten operated on after 24 hours. In only three of this late group was the evidence in favor of possible delayed rupture of a subcapsular hematoma. These data support our conclusion that delayed rupture is an unusual sequel to blunt splenic trauma, and that most patients thought to have delayed rupture of the spleen have, instead, delayed recognition of splenic rupture.

Accidents, Traffic↗

PubMed1975