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Preventing hypothermia in trauma patients by microwave warming of IV fluids
Abstracts in this issue were prepared by residents in the University of Arizona Emergency Medicine Residency Program.
ABSTRACTS Harvey W Meislin, MD, FACEP Co-Editor Chief, Section of Emergency Medicine University of Arizona College of Medicine
Vincent J Markovchick, MD, FACEP Co-Editor Emergency Medical Services Denver General Hospital
testicular torsion, intermittent testicular torsion, bell-clapper deformity, scrotom, orchiopexy 4
I n t e r m i t t e n t t e s t i c u l a r torsion Stillwell TJ, Kramer SA Pediatrics 77:908-911 Jun 1986
Acute torsion of the spermatic cord is a uro!ogic emergency. This is the most common cause of acute scrotal pain in prepubertal and adolescent boys. The authors describe poor salvage rates for complete torsion, with up to 90% requiring orchiectomy. There is a previous history of testicular pain and swelling in 30% to 50% of those with acute torsion. The authors define a syndrome of intermittent testicular torsion characterized by acute and i n t e r m i t t e n t sharp testicular pain, separated by asymptomatic periods. Physical examination in these individuals shows horizontal or hypermobile testes, an anteriorly located epidiymus, or a bulkiness of the spermatic cord from partial twisting. Five case histories were discussed. All patients had a history of scrotal pain that had resolved spontaneously. All had at least one positive physical finding. Elective orchiopexy was performed. The most common derangement noted at surgery was testes lacking a normal posterior attachment (bellclapper deformity). Delay between the initial onset of symptoms and orchiopexy probably accounts for the testicular atrophy, fibrosis, and decreased spermatogenesis found in these patients. All remained a s y m p t o m a t i c after orchiopexy. The authors conclude that early intervention will result in improved testicular salvage rates.
Maralee Joseph, MD IV fluids, hypothermia, warming, microwave
Preventing h y p o t h e r m i a in t r a u m a pat i ent s by m i c r o w a v e warmi n g of IV fluids AIdrete JA J Emerg Med 3:435-442
Dec 1985
Hypothermia has long been recognized as detrimental to trauma victims during resuscitation and emergency surgery. The use of blood warming devices has not entirely obviated the problems of metabolic shifts and poorer oxygen delivery to the tissues. This prospective study tested the use of microwave oven (MWO}-warmed crystalloid (to 42 C) in t9 patients undergoing extremity operations and found no significant decrease in body temperature as measured by an
174/1500
esophageal thermometer when compared with the control group, which noted a significant decline. There was less temperature drop from bag to patient with MWO-warmed fluid than if room-temperature fluid was used in conjunction with standard blood warmers. Finally, the author noted that with the use of shorter tubing and faster flow rates (which allowed for less dissipation of heat en route), MWOwarmed fluid s actually reached the patient at a higher temperature than if the warmed fluid was used in conjunction with a blood warmer. Because there was no alteration of the crystalloid's basic properties by the use of MWO, the author concludes that MWO-warmed IV fluids are the most effective and least cumbersome way to prevent hypothermia in trauma victims.
Kenneth Facter, MD tendon lacerations, flexor tendons, tenorrhaphy
T r e a t m e n t of partial flexor t endo n lacerations: The e f f e c t of t e n o r r h a p h y and early p r o t e c t e d mobilization Bishop AT, Cooney WP, Wood MB J Trauma 26:301-312
Apr 1986
The effects of tenorrhaphy using a modified Kessler repair, nonrepair, immobilization, and early protected mobilization in transverse, partial flexor tendon lacerations in dogs were compared using the matched contralateral digit profundus tendon as a control. Ten0rrhaphy was found to have deleterious effects on breaking strength (P < .0005), stiffness (P < .0005), energy absorbed (P < .0005), and excursion (P < .0025), while early protected mobilization had beneficial effects on stiffness (P < .0005), excursion (P < .0025), and to a lesser extent on breaking strength (P < .025). The incidence of adhesions was higher in the immobilized and repaired groups. Tendon rupture was rare and occurred only in the repaired early motion group. Histologic studies and electron microscopy revealed that repair and immobilization increased adhesion formation and disrupted the smooth tendonsurface. These tendons also showed evidence of delayed healing at the laceration site and necrosis of part of the nonlacerated area. The authors conclude that partial flexor tendon lacerations of up to 60% are best treated with early partial mobilization without repair. In the discussion, it was stressed that tendon sheaths should always be repaired if possible, and that tendon lacerations greater than 75% of cross-sectional area probably should be treated as complete lacerations and repaired.
Annals of Emergency Medicine
Katherine Hurlbut, MD 15:12 December 1986
ABSTRACTS Harvey W Meislin, MD, FACEP Co-Editor Chief, Section of Emergency Medicine University of Arizona College of Medicine
Vincent J Markovchick, MD, FACEP Co-Editor Emergency Medical Services Denver General Hospital
testicular torsion, intermittent testicular torsion, bell-clapper deformity, scrotom, orchiopexy 4
I n t e r m i t t e n t t e s t i c u l a r torsion Stillwell TJ, Kramer SA Pediatrics 77:908-911 Jun 1986
Acute torsion of the spermatic cord is a uro!ogic emergency. This is the most common cause of acute scrotal pain in prepubertal and adolescent boys. The authors describe poor salvage rates for complete torsion, with up to 90% requiring orchiectomy. There is a previous history of testicular pain and swelling in 30% to 50% of those with acute torsion. The authors define a syndrome of intermittent testicular torsion characterized by acute and i n t e r m i t t e n t sharp testicular pain, separated by asymptomatic periods. Physical examination in these individuals shows horizontal or hypermobile testes, an anteriorly located epidiymus, or a bulkiness of the spermatic cord from partial twisting. Five case histories were discussed. All patients had a history of scrotal pain that had resolved spontaneously. All had at least one positive physical finding. Elective orchiopexy was performed. The most common derangement noted at surgery was testes lacking a normal posterior attachment (bellclapper deformity). Delay between the initial onset of symptoms and orchiopexy probably accounts for the testicular atrophy, fibrosis, and decreased spermatogenesis found in these patients. All remained a s y m p t o m a t i c after orchiopexy. The authors conclude that early intervention will result in improved testicular salvage rates.
Maralee Joseph, MD IV fluids, hypothermia, warming, microwave
Preventing h y p o t h e r m i a in t r a u m a pat i ent s by m i c r o w a v e warmi n g of IV fluids AIdrete JA J Emerg Med 3:435-442
Dec 1985
Hypothermia has long been recognized as detrimental to trauma victims during resuscitation and emergency surgery. The use of blood warming devices has not entirely obviated the problems of metabolic shifts and poorer oxygen delivery to the tissues. This prospective study tested the use of microwave oven (MWO}-warmed crystalloid (to 42 C) in t9 patients undergoing extremity operations and found no significant decrease in body temperature as measured by an
174/1500
esophageal thermometer when compared with the control group, which noted a significant decline. There was less temperature drop from bag to patient with MWO-warmed fluid than if room-temperature fluid was used in conjunction with standard blood warmers. Finally, the author noted that with the use of shorter tubing and faster flow rates (which allowed for less dissipation of heat en route), MWOwarmed fluid s actually reached the patient at a higher temperature than if the warmed fluid was used in conjunction with a blood warmer. Because there was no alteration of the crystalloid's basic properties by the use of MWO, the author concludes that MWO-warmed IV fluids are the most effective and least cumbersome way to prevent hypothermia in trauma victims.
Kenneth Facter, MD tendon lacerations, flexor tendons, tenorrhaphy
T r e a t m e n t of partial flexor t endo n lacerations: The e f f e c t of t e n o r r h a p h y and early p r o t e c t e d mobilization Bishop AT, Cooney WP, Wood MB J Trauma 26:301-312
Apr 1986
The effects of tenorrhaphy using a modified Kessler repair, nonrepair, immobilization, and early protected mobilization in transverse, partial flexor tendon lacerations in dogs were compared using the matched contralateral digit profundus tendon as a control. Ten0rrhaphy was found to have deleterious effects on breaking strength (P < .0005), stiffness (P < .0005), energy absorbed (P < .0005), and excursion (P < .0025), while early protected mobilization had beneficial effects on stiffness (P < .0005), excursion (P < .0025), and to a lesser extent on breaking strength (P < .025). The incidence of adhesions was higher in the immobilized and repaired groups. Tendon rupture was rare and occurred only in the repaired early motion group. Histologic studies and electron microscopy revealed that repair and immobilization increased adhesion formation and disrupted the smooth tendonsurface. These tendons also showed evidence of delayed healing at the laceration site and necrosis of part of the nonlacerated area. The authors conclude that partial flexor tendon lacerations of up to 60% are best treated with early partial mobilization without repair. In the discussion, it was stressed that tendon sheaths should always be repaired if possible, and that tendon lacerations greater than 75% of cross-sectional area probably should be treated as complete lacerations and repaired.
Annals of Emergency Medicine
Katherine Hurlbut, MD 15:12 December 1986