Post-traumatic fluid loss

Abstracts the incident and detail one person to the nearest telephone; another message to go by arc and keep one copy to go with the injured person when the ambulance arrives. Watch out for high tension lines, turn off the damaged car’s engine, post flagmen with reflective wear (newspaper, white shirts etc.). Leave the injured person in his car unless there is a smell of petrol or smoke and clear his airway. If the damaged person must be removed, slip the seat as far back as possible and use 3 people to move him so that the relationship of the spine is not altered. Having moved him off the road roll the victim on to his side. use a aatz to keeo his iaw onen then clear his mouth. ‘If breathing has stopped &mouth-to-mouth resuscitation until skilled rescuers arrive. The value of cardiac massaee - bv- unskilled oersons is of dubious value. PACY, H. (1973). ’ First aid for drivers ‘. J. Am. med. Ass.. 223, 1151. Old Bailey bomb explosion The explosion occurred so close to a hospital that had prepared and rehearsed a scheme for dealing with large numbers of casualties that patients began to arrive without any warning of what might be expected. The authors have some useful comments to make on the management of this state of affairs. CARO, D., and IRVING, M. (1973), ‘ The Old Bailey bomb explosion ‘, Loncel, 1, 1433. Battle casualty care

This paper is an account of theexperiences of the Unit Medical Officer to 40 Commando, Royal Marines, during a three-month period in 1972, during which 2 deaths were sustained and 17 other gunshot wounds and 22 blast injuries were treated in hospital. The paper outlined the type of injuries, the treatment given and the problems of battle casualty management in a ditiicult urban environment. GOODMAN,H. P. (1972), ‘ Casualty care in Northern Ireland ‘, JI R. nav. med. Serv., 59, 24. The battered child

A panel of experts in Chicago called together by Medical News discussed this problem in all its aspects. Although only a fraction of the cases come to official attention, it was estimated that there were 60,808 in the United States. No one can predict when child abuse is likely to happen and prevention by taking the child away from its home may inflict further psychological damage. Without positive preventive measures probably more than half of the patients seen by doctors as a result of abusive trauma will be dead or have permanent brain damage within a year. The conditions can be accurately identified by the X-ray finding of multiple injuries in several stages of healing. Throughout the United States doctors enjoy virtually absolute legal immunity from liability for a false. report of child abuse. The panel thought that at least some abusive patents can be rehabilitated. Some

87 are psychotics or alcoholics, but the experts were impressed by the impulsiveness of the act and found that frequently there was no evidence of gross psychopathology. The young accident officer faced with this problem is advised to admit the child without disclosing to the parents what he thinks caused the injuries, and leave tackling the parents until the aetiology is clear beyond doubt, then call in the experts. CHRISTIAN, J. (1972), ‘ Medical progress has had little effect on an ancient childhood syndrome ‘, J. Am. I led. Ass., 222, 1605. Tomorrow’s bedpans A report of a recent meeting at Guy’s Hospital to advise those who have to decide on- equipment for new or renovated hospitals. Of the disposable, only the totally destructible self-supporting type is acceptable, but only if the drains are suitable for the destructor. D.H.S.S. Engineering Division Study Group No. 9 gives advice upon suitable drainage. There is little to choose between conventional bedpans with a washerdisinfector and the totally disposable type. Washers that do not disinfect should not be used in paediatric, obstetric, gynaecological, psychiatric, and infectious disease units. Polypropylene bedpans do not readily conduct heat, and bacteria are not always killed in disinfectors. All systems sometimes break down, and no ward should be without its sloe-hoooer. bedpan ‘, Br. ~Eorroat~~ (1974), ‘ Tomorrow’s med. J., lt 298. Respiratory

intensive care

An account of the work of the respiratory intensive care unit at the Glasgow Royal Infirmary (8 beds) upon 2800 patients. The reduction in mortality justified this approach to patient care, but there was a disturbing increase in the incidence of self poisonings which begins to rival that of road accidents. The continued importance of infection as a life-threatening complication is also emphasized. Y&S. R. K. B., C&PBELL, D., REID, J. M., and TELFER, A. B. M. (1974), ‘ Respiratory intensive care: A lo-year survey ‘, Br. med. J., 1,307.

Shock Post-traumatic

fluid loss

The ability to withstand the fluid loss produced by limb ischaemia in a thermoneutral environment was studied in the rabbit during the first three weeks of life. The difficulties of defining and comparing acute injuries are discussed, and it is concluded that the fluid loss from the circulation is best expressed as a fraction of the plasma volume or total body water. The body composition (water content, etc.) varies with age and when this was taken into account, the I-2day-old rabbit was more resistant to this form of

Injury:

88

fluid loss than older animals. The significance of these observations is discussed. LITTLE,R. A. (1972), ‘ Resistance to post-traumatic fluid loss at different ages ‘, Br. J. exp. Path., 53, 341. Restoring

renal function

in shock

Comparison of the effects of two different solutions in the treatment of haemorrhagic shock was done in A balanced salt solution experimental animals. (Ringer lactate) with red cell replacement proved to be better than a colloid solution in restoring kidney tubular function. SIEGAL, D. C., COCKIN, A., GEOCARIS, T., and Moss, G. S. (1973) ‘ Effects of saline and colloid resuscitation on renal function ‘, Ann. Surg., 177, 51. Electrolyte oedema

replacement

and pulmonary

In experimental animals a standard degree of shock was produced by bleeding. On replacement by electrolyte solution pulmonary oedema occurred in proportion to the amounts infused. It was greater with colloid solution. SCHLOERB, P.

R., HUNT, P. T., PLUMMER,J. A., and CAGE, G. K. (1972), ‘ Pulmonary edema after replacement of blood loss by electrolyte solutions ‘, Surgery Gynec. Obstet., 135, 893. Melposition

of catheters

Nearly one-third of 73 catheters that were judged by the usual signs to be in an innominate vein or the superior vena cava were shown by X-rays to be in tributary veins or in the right atrium. Radiographic confirmation is recommended in all cases. JOHNSTON,A. 0. B.. and CLARK, R. G. (1972). ‘ Malpositioning of central venous catheters ‘, Lancer, 2, 1395. Saline

and pulmonary

oedema

Electron microscopic study of the lungs of baboons after haemorrhagic shock and after shock treated by saline infusion. In the shocked animals there was demonstrable interstitial sodium; in the saline treated ones this had disappeared and the lung tissue was almost indistinguishable from normal. The authors conclude that it will be necessary to look elsewhere for the cause of post-resuscitative pulmonary insufficiency. Moss, G. S., DAS GUPTA, T. K., NEWWN, B., and NYHUS, L. M. (1973), ‘ The effect of saline solution resuscitation on pulmonary sodium and water distribution ‘, Surgery Gynec. Obstet., 136, 934.

the British

low. A quick return toward normal occurred if the hypotension was relieved at 1 hour but only a slow return resulted if hypotension had been maintained for 3 hours. The effects of ischaemia or the presence of a myocardial depressant factor are subjects of speculation. HEIMBACH,D. M., FISHER, W. D., HUTTON, L. MCARDLE, C. S., and LEDINGHAM,I. McA. (1973). ‘ Myocardial blood flow and metabolism during and after hemorrhagic shock in the dog ‘, Surgery Gynec. Obsret.. 137, 243.

Hand Injuries Nerve

function

oxygen

After a period of hypotension in experimental dogs, induced by the standard method of withdrawing blood, the effects on myocardial oxygen consumption were studied. During the shock phase this value was

in the hand

Denervated skin does not shrivel when the hand is immersed in water for half an hour, but this property is restored by reinnervation. O’RIAM, S. (1973), ‘ New and simple test for nerve function in the hand’, Br. med. J., 3, 615. lschaemic

contracture

of the hand

This paper emphasizes the importance of early diagnosis and management of impending ischaemic contractures of the hand. It does not deal with the treatment of late established ischaemic contractures or cases of Volkmann’s ischaemic forearm contracture. The diagnostic triad of’ pain, paralysis, and increase in pain on passive stretch of the involved surgical intrinsic muscles ’ calls for immediate decompression of the unyielding interosseous compartments. The authors have found that ischaemic contractures of the hand may occur as a complication of some of the compression syndromes seen following coma induced by drug overdosage. SPINNER,M., AIACHE, A., SILVER,L., and BARSKY. A. J. (1972), ‘ Impending ischaemic contracture of the hand: Early diagnosis and management ‘, Plastic reconstr. Surg., SO, 341. Suture

materials

An extremely useful critical review of the suture materials currently available. It is too detailed and compressed in style to reproduce as an abstract. There is an excellent list of the recent relevant literature and the paper deserves careful study in the original text, especially by those. called upon to teach surgical techniques. FORREST~R, J. C. (1972). ’ Suture materials and their use ‘, Br. J. Hosp. Med., 8, 578. Amputated

Blood loss and myocardial consumption

Journal of Accident Surgery Vol. ~/NO. 1

finger

replacement

Reattachment of a finger amputated in the proximal third has been done before with varying degrees of success. Corry from Harvard has produced a particularly fine result using a microvascular technique to restore the vascular channels. The operation was performed four hours after the accident. The bone