UAEMABSTRACTS 1 4 T HA N N U A LI V E E T I N G
warmed on high power for 60-, 75-,9O-, 120-,135-, and 150-sec intervals. Heating was interrupted alter 60 sec for bag turning and vigorous agitation. The fluid was agitated at the end of the heating time. Temperatures were obtained simultaneously after heating with 3 thermometers with a fold technique. Inner fluid temperatures were obtained with an anesthesia probe thermometer. thermometer measurement technique and reliability was dem' onstrated on 3 separate thermometers, with outside and inner fluid temperatures being virtually equal. Experimental trials show that a single liter o{ lactated Ringer's or normal saline with an average starting temperature of 70 F microwaved for 120 sec by the described technique raises the temperature approximately 3l F with a 95% confidence limit of 0.7 E Heating for 135 sec raises the temperature 36 F + 0.7 I from a starting temperature of 69 E The results indicate that a temperature-plemeasured bag of normal saline or lactated Rinser's can be accuratelv and safelv warmed utilizing microwave radiation and applied for use in the hospital.
10231ff1":'#il,i1Tr;il'j"i,:"' Peritoneal Lavage MJ Rubin, MD; WH Blahd, MD; TH Stanisic,MD; HW Meislin, MD / S e c t i o n s o f E m e r g e n c y M e d i c i n e a n d U r o l o g y ,A r i z o n a H e a l t h Sciences Center,Tucson The diagnosis of intraperitoneal extravasation of urine in the multiple trauma patient is o{ten deiayed, resulting in increased morbidity and mortality. To determine whether intraperitoneal extravasation of urine can be detected by peritoneal iavage, an animal study was designed to investigate whether urea nitrogen and creatinine levels in the urine, serum, and lavage fluid would be predictive of urinary extravasation. Seventeen adult mongrel dogs, weighing 2I to 30 kg, were divided into 2 groups. Group I, 6 dogs, served as controls, and had peritoneal lavage (15 mL normal saline/kg) performed using the open technique {direct visualization of the peritoneum). Blood, urine, and lavage urea nitrogen and creatinine, and lavage red cell count were measured. Croup II, ll dogs, had varying amounts of urine (5 mL to 330 mL) instilled into the peritoneal cavity. Group IIa, 9 dogs, had urine instilled under direct visualization through a peritoneal lavage catheter. As bladder dome ruDture is the most common cause of intraperitoneal urine extravaiation, Group IIb, 2 dogs, had bladder dome ruptures performed. The bladders were ruptured via cystoscopy using the resectoscope. Cystograms were performed in the bladder-ruptured dogs to confirm intraperitoneal extravasation of bladder contents. In these animals urine was instilled back into the bladder following bladder rupture. Diagnostic peritoneal lavage was performed 30 to 45 min after the instillation of urine in Group II animals. Results demonstrate urea nitrogen and creatinine can be measured in peritoneal lavage fluid when extravasation of urine is in amounts o{ 15 mL or more, and are not measurable in amounts of 5 mL or less. Four of the iroup II dogs had hemoperitoneum (red ce1l count > 80,000). Measurements of lavage urea nitrogen and creatinine were not a{{ected by the presence of blood in the peritoneum. Detection of peritoneal lavage urea nitrogen and creatinine was significantly diiierent (P < .051 between the Group I (control) and Group II (urinary extravasation) animals by analysis of variance. Results indicate that when
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Iavage urea nitrogen and creatinine exceed serum levels, with or without hemoperitoneum, intraperitoneal extravasation of urine should be strongly suspected. Routine measurement of serum and lavage urea nitrogen and creatinine is use{ul in the early diagnosis o{ intraperitoneal extravasation of urine in trauma patients.
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Emergency Thoracotomy in the Urban Gommunity l{ospital: Gardiac Rhythm as a New Prognosticator?
MW Brautigan, MD, G fieV, DO / Department of Emergency Medicine, Mount Carmel Mercy Hospital, Detroit Several authors have reviewed their experience with emergency thoracotomy in the university hospital setting. We, in an urban community hospital, are seeing increasing numbers of patients who require emergency thoracotomy. In an initial study we compared our experience with that recorded in the university hospital setting by reviewing the charts of 47 patients who underwent emergency thoracotomy in our institution during 19Bl and 1982. In our series, 39 thoractomies (83%) were done for penetrating trauma, of which 29 162%l were for gunshot wounds and 10 (21% ] were for stab wounds. Eight patients i17%) underwent thoracotomy for blunt trauma. A total of 13 patients 127.6%) survived and were drscharged {rom the hospitai. O{ the 13, 8 (17% oI the totai} had no neurological deficit. Our outcome dat^ xe comparable to those o{ univeriity centers in which similar reviews wire undertaken. We think that emergency thoracotomy can and should be done in the community hospital setting as a lifesaving procedure. The decision to pcrform emergency thoracotomy is based on data available in the early assessment o{ the patient. Prognostic {actors include the prchospital evaluation, presenting vital signs, initial neurologic eriamination, type and location oI iDjury, and response to initial therapy. The presenting cardiac rhythm has not been used as a prognostic indicator in patients undergoing emergency thoracotomy. In a second study we performed a retrospective analysis of all patients undergoing emergency thoracotomy from |anuary 7, l99l, through December 3I, 1982. A total of 47 thoracotomies were performed during the 2-year period. Seventeen patients survived beyond the operating room and were admitted to intensive care. Of these. 13 Datients survived hosnitalization and were dischargedhomi. tight patients were neurologically intact. AII 17 survivors presented with sinus rhythms, either sinus tachycardia il6) or normal sinus rhythm il). Five of these 17 patients presented with no blood pressure, and 2 of the 5 were apneic and had fixed and dilated pupils. Thirty patients failed to survive beyond the operating room. Twenty-four nonsurvivors presented with bradyasystolic rhythms, including sinus bradycardia {4), agonal ventricular rhythms (5}, ventricular fibrillation (5), and asystole (10). Six nonsurvivors presented with sinus rhythms, either sinus tachycardia l4l or normal sinus rhythm (2). Four of these patients (2 from each group) suffered severe blunt trauma. The 2 remaining patients died of massive hemorrhage in the operating room. Both patients had gunshot wounds to the aorta. We have found that the presentins cardiac rhythm is the most accurare prognostic indicaior in patients undergoing emergency thoracotomy. Any patient suffering a penetrating iniury who presents in a bradyasystolic rhythm, regardless of vital signs, cannot be expected to survive beyond the operating room. The patients should not undergo emergency thoracotomy.