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The role of abdominal CT in the evaluation of stab wounds to the back
ABSTRACTS
sickness score of more than 3, alveolar-arterial 0 2 gradient of more than 10 torr, and radiographic evidence of pulmonary edema. Each subject was given 10 mg of sublingual nifedipine initially and 20 mg of slow-release nifedipine every six hours. Each was allowed to engage in further mountain climbing. Serial examinations, echocardiography, arterial blood gas analysis, and follow-up chest radiographs were performed. No unpleasant side effects from the nifedipine were seen. All symptoms and laboratory parameters of acute m o u n t a i n sickness improved within one hour after nifedipine administration. However, there was a significantly higher continuous wave Doppler calculated mean systolic pulmonary artery pressure in those subjects who developed HAPE (133.7 m m Hg) compared with those who did not develop HAPE (63.9 m m Hg). There was pronounced hypoxic pulmonary hypertension in all climbers. On treatment with nifedipine, pulmonary artery pressure dropped within the range seen in the nonHAPE subjects and remained there. The authors concluded that nifedipine may be an efficacing treatment for HAPE when descent is not possible and oxygen is not available.
had other associated injuries found at surgery that were not seen on CT scan. There were four (2.0%) false-positive CT scans, one suspected retroperitoneal hematoma, one small bowel injury, and two splenic injuries, none of which was found at operation. Of the eight documented diaphragm injuries, only two were identified on CT scan. Statistical analysis revealed a sensitivity of 89%, specificity of 98%, and an accuracy of 97%. It was concluded that double-contrast CT scans of the abdomen are reliable in the evaluation of patients with a stab wound to the back. [Editor's note: Colonic perforations secondary to penetrating injuries to the back are very difficult to diagnose early. Triple-contrast abdominal CT with the addition of rectal administration of contrast m a y increase the possibility of diagnostic accuracy in detecting these injuries on CT scans. Diagnostic peritoneal lavage with a 5,000 to 10,000 RBC threshold is a much more sensitive test in detecting diaphragmatic perforation.]
Harold L Skaggs, Jr, MD CPR, cardiac arrest
Vincent A Marino, MD
wound, stab, retroperitoneal;computed tomography, abdominal
T h e role of a b d o m i n a l C T in t h e e v a l u a t i o n of s t a b w o u n d s t o t h e b a c k Meyer DM, Thai ER, Weigelt JA, et al J Trauma 29:1226-1230
Sep 1989
Penetrating injury to the back has historically been difficult to evaluate as physical examination and diagnostic peritoneal lavage are often not adequate. This prospective study evaluated the utility of abdominal computed tomography (CT) scan in detecting pathology caused by stab wounds to the back. Patients were included in the study if there was no hemodynamic instability or unquestionable signs of injury. Local wound exploration was performed followed by double contrast (IV and oral) abdominal CT scan in all patients with nonsuperficial wounds. Patients with positive CT scan or clinical suspicion of injury underwent laparotomy, while those with a negative CT scan or CT scan that was thought to be positive only for minor injuries were admitted to the hospital for observation. Of the 205 patients included in the study, 13 with a positive CT scan were treated nonoperatively based on the surgeon's low index of suspicion. Thirty of 169 patients (18%) who had a negative scan underwent laparotomy based on the surgeon's suspicion. In this group, the injuries found included diaphragm and liver injuries. None of the remaining 139 patients with negative CT results who were observed developed any problems related to the stab wounds. Sixteen patients had positive CT scan findings that were confirmed at surgery. Of these 16 patients, seven
182/620
Dispatcher-assisted cardiopulmonary r e s u s c i t a t i o n v a l i d a t i o n of e f f i c a c y Kellerman AL, Hackman BB, Somes G Circulation 80:1231-1239 Nov 1989
The national impact of citizen CPR training has been limited by a variety of factors, including time constraints, apathy, and unjustifiable fears of communicable disease. It has been proposed that dispatcher-delivered telephone instruction in CPR increases the rates of bystander CPR in cases of out-of-hospital cardiac arrest. This prospective study investigated the performance of community volunteers to dispatcher-directed CPR instructions in the implementation of CPR on recording manikins. The volunteers were unaware they were going to perform CPR until immediately prior to the test, which was done in a highstress situation. There were three groups of volunteers: group A, no prior CPR training, received telephone instructions; group B, CPR training, received telephone instructions; and group C, previous CPR training, no telephone instructions. Results showed delay in onset of chest compressions in groups A and B of 4.0 minutes, compared with 1.2 minutes in group C. Overall quality of CPR in group A was comparable with that of group C. The performance of group B, which had both previous training and telephone instructions, was superior to that of both groups A and C. It was concluded that telephone CPR instructions can offer a safe, cost-effective means to increase the rate of bystander CPR in communities where few citizens are trained to perform CPR. Telephone instructions also improve the quality of CPR performed by persons with prior CPR training.
Annalsof EmergencyMedicine
Robert S Van Hare, MD 19:5 May 1990
sickness score of more than 3, alveolar-arterial 0 2 gradient of more than 10 torr, and radiographic evidence of pulmonary edema. Each subject was given 10 mg of sublingual nifedipine initially and 20 mg of slow-release nifedipine every six hours. Each was allowed to engage in further mountain climbing. Serial examinations, echocardiography, arterial blood gas analysis, and follow-up chest radiographs were performed. No unpleasant side effects from the nifedipine were seen. All symptoms and laboratory parameters of acute m o u n t a i n sickness improved within one hour after nifedipine administration. However, there was a significantly higher continuous wave Doppler calculated mean systolic pulmonary artery pressure in those subjects who developed HAPE (133.7 m m Hg) compared with those who did not develop HAPE (63.9 m m Hg). There was pronounced hypoxic pulmonary hypertension in all climbers. On treatment with nifedipine, pulmonary artery pressure dropped within the range seen in the nonHAPE subjects and remained there. The authors concluded that nifedipine may be an efficacing treatment for HAPE when descent is not possible and oxygen is not available.
had other associated injuries found at surgery that were not seen on CT scan. There were four (2.0%) false-positive CT scans, one suspected retroperitoneal hematoma, one small bowel injury, and two splenic injuries, none of which was found at operation. Of the eight documented diaphragm injuries, only two were identified on CT scan. Statistical analysis revealed a sensitivity of 89%, specificity of 98%, and an accuracy of 97%. It was concluded that double-contrast CT scans of the abdomen are reliable in the evaluation of patients with a stab wound to the back. [Editor's note: Colonic perforations secondary to penetrating injuries to the back are very difficult to diagnose early. Triple-contrast abdominal CT with the addition of rectal administration of contrast m a y increase the possibility of diagnostic accuracy in detecting these injuries on CT scans. Diagnostic peritoneal lavage with a 5,000 to 10,000 RBC threshold is a much more sensitive test in detecting diaphragmatic perforation.]
Harold L Skaggs, Jr, MD CPR, cardiac arrest
Vincent A Marino, MD
wound, stab, retroperitoneal;computed tomography, abdominal
T h e role of a b d o m i n a l C T in t h e e v a l u a t i o n of s t a b w o u n d s t o t h e b a c k Meyer DM, Thai ER, Weigelt JA, et al J Trauma 29:1226-1230
Sep 1989
Penetrating injury to the back has historically been difficult to evaluate as physical examination and diagnostic peritoneal lavage are often not adequate. This prospective study evaluated the utility of abdominal computed tomography (CT) scan in detecting pathology caused by stab wounds to the back. Patients were included in the study if there was no hemodynamic instability or unquestionable signs of injury. Local wound exploration was performed followed by double contrast (IV and oral) abdominal CT scan in all patients with nonsuperficial wounds. Patients with positive CT scan or clinical suspicion of injury underwent laparotomy, while those with a negative CT scan or CT scan that was thought to be positive only for minor injuries were admitted to the hospital for observation. Of the 205 patients included in the study, 13 with a positive CT scan were treated nonoperatively based on the surgeon's low index of suspicion. Thirty of 169 patients (18%) who had a negative scan underwent laparotomy based on the surgeon's suspicion. In this group, the injuries found included diaphragm and liver injuries. None of the remaining 139 patients with negative CT results who were observed developed any problems related to the stab wounds. Sixteen patients had positive CT scan findings that were confirmed at surgery. Of these 16 patients, seven
182/620
Dispatcher-assisted cardiopulmonary r e s u s c i t a t i o n v a l i d a t i o n of e f f i c a c y Kellerman AL, Hackman BB, Somes G Circulation 80:1231-1239 Nov 1989
The national impact of citizen CPR training has been limited by a variety of factors, including time constraints, apathy, and unjustifiable fears of communicable disease. It has been proposed that dispatcher-delivered telephone instruction in CPR increases the rates of bystander CPR in cases of out-of-hospital cardiac arrest. This prospective study investigated the performance of community volunteers to dispatcher-directed CPR instructions in the implementation of CPR on recording manikins. The volunteers were unaware they were going to perform CPR until immediately prior to the test, which was done in a highstress situation. There were three groups of volunteers: group A, no prior CPR training, received telephone instructions; group B, CPR training, received telephone instructions; and group C, previous CPR training, no telephone instructions. Results showed delay in onset of chest compressions in groups A and B of 4.0 minutes, compared with 1.2 minutes in group C. Overall quality of CPR in group A was comparable with that of group C. The performance of group B, which had both previous training and telephone instructions, was superior to that of both groups A and C. It was concluded that telephone CPR instructions can offer a safe, cost-effective means to increase the rate of bystander CPR in communities where few citizens are trained to perform CPR. Telephone instructions also improve the quality of CPR performed by persons with prior CPR training.
Annalsof EmergencyMedicine
Robert S Van Hare, MD 19:5 May 1990