Treating Mandible Fractures

The three main tenets in treating a mandible (jawbone) fracture are reduction, rigid fixation, and avoiding infection. Reduction is placing the bony segments
Continue reading "May 29, 2007"

Diagnosing Mandible Fractures

The mandible (jawbone) is not infrequently fractured in trauma to the lower face. However, even severe injury may not be immediately apparent in the
Continue reading "May 28, 2007"

Iliac Aneurysms

Aneurysms are outpouchings along a weakened section of the wall of an artery. They can occur in many different arteries. One artery where they can occur
Continue reading "May 24, 2007"

Liver Injury Scale – Part 3

Severe liver injuries are described as follows:

Grade V – parenchymal disruption involving > 75% of a hepatic lobe or more than three Couinaud’s segments in a single lobe OR a juxtahepatic vein injury (a vena cava or portal vein injury).

Grade VI – hepatic avulsion (liver displaced from its vascular attachments).


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Liver Injury Scale – Part 2

More severe blunt liver injuries are characterized as:

Grade III – a subcapsular (just below the surface) hematoma that is greater than 50% of the surface area or is expanding (growing larger) OR a ruptured subcapsular hematoma that is actively bleeding OR an intraparenchymal hematoma that is > 10 cm or is expanding OR a laceration that is > 3 cm in depth.

Grade IV – a ruptured intraparenchymal hematoma with active bleeding OR a parenchymal disruption involving 25-75% of a hepatic (liver) lobe or more than three Couinaud’s segments in a single lobe.

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Liver Injury Scale – Part 1

The liver is a large organ located on the right side of the abdominal cavity. It is commonly injured in blunt trauma, particularly in patients who are riding a bicycle and struck by an SUV. To describe the severity of blunt injury to the liver, trauma surgeons have devised the following scale (last revised in 1994):

Grade I – A non-expanding subcapsular (just under the liver surface) hematoma that is < 10 cm of the liver surface OR a capsular tear that is not bleeding and that is less than 1 cm deep into the liver parenchyma (tissue).

Grade II – A non-expanding subcapsular hematoma (collection of blood) that is 10-50% of the liver surface OR a non-expanding intraparenchymal hematoma OR an actively bleeding capsular tear < 10 cm in length that is 1-3 cm into the liver tissue.


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Hetastarch – Part 3

Dosing of hetastarch is usually 500 mL to 1000 mL of the 6% solution with the total daily dosing not to exceed 1500 mL. In hemorrhagic shock the rate of administration (20 mL/Kg/hr) is generally more rapid than in sepsis or burns.

The use of hetastarch usually causes an increase in amylase to twice the normal value in the setting of a normal serum lipase.


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Hetastarch – Part 2

The most common indication for use of hetastarch (hydroxyethyl starch) is as volume-expanding fluid in sepsis, systemic inflammatory response syndrome (SIRS), hemorrhage, and burns. It causes an osmotic diuresis (makes the kidneys produce urine) after administration so an increased urine output should not be taken that adequate fluid resuscitation has occurred.

Hetastarch is eliminated through both the kidneys and the liver. In patients with renal (kidney) impairment, repeated doses of hetastarch should be avoided as total body accumulation will occur causing volume overload. In these patients, alternate fluids to be considered include hypertonic saline and crystalloid.


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Hetastarch – Part 1

The are several different solutions that surgeons and physicians use when volume resuscitation is needed. One commonly used solution is hydroxyethyl starch, also known as hetastarch.

Hetastarch is a synthetic molecule that is similar in structure to glycogen and that is formulated as a 6% solution in physiologic saline solution (0.9% NaCl.) It is considered a colloid solution and expands the intravascular volume to a greater degree than the amount of solution infused.


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Peptic Ulcer Disease – Part 9

Type 4 gastric ulcers are the least commonly occurring type and comprise about 5% of all gastric ulcers. They occur on the lesser curve of the stomach close to the gastroesophageal junction. They are associated with normal acid secretion so vagotomy is not generally performed. If possible, the ulcer is removed with a wedge resection.


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