Ultrasound-guided radial artery catheterization and the modified Allen's test.

In this case report, ultrasound-guided radial artery catheterization and a modified Allen's test were performed by Emergency Department (ED) physicians to facilitate the management of an intubated, critically injured patient. Ultrasound was demonstrated to be a valuable tool in determining collateral circulation and guiding radial artery cannulation in a patient unable to cooperate with the traditional Allen's test. Ultrasound guidance may reduce the risk of radial artery catheterization in severely injured patients.

Spontaneous hemoperitoneum from a ruptured mesenteric branch arterial aneurysm: report of a case.

We report a case of spontaneous intraperitoneal hemorrhage from a ruptured mesenteric branch artery aneurysm in a patient presenting with syncope. A 54-year-old woman was brought to our emergency department as a medical code, following two syncopal episodes. Computed tomography, carried out to rule out aortic aneurysmal disease, revealed hemoperitoneum without evidence of solid organ injury. Emergency exploratory laparotomy revealed a large jejunal mesenteric hematoma accompanying a ruptured mesenteric branch artery aneurysm with active extravasation. We ligated and excised the lesion and diagnosis was confirmed on final pathologic examination. We report this case because general surgeons should be aware of these vascular lesions and the basic guidelines for treatment.

Postinjury serum secretory phospholipase A2 correlates with hypoxemia and clinical status at 72 hours.

BACKGROUND: Although trauma patients often suffer direct lung damage, an equally destructive mechanism of lung injury involves postinjury systemic inflammation. We postulate that secretory phospholipase A(2) (sPLA(2)) release induced by trauma relates to systemic inflammation that compromises both lung function and clinical status after injury. The objectives of this study were: to relate Injury Severity Score to postinjury sPLA(2); to determine whether circulating sPLA(2) relates to pulmonary oxygenation and compliance; and to determine whether early or persistent increases in sPLA(2) are associated with abnormal chest x-ray at 72 hours after injury. STUDY DESIGN: The prospective cohort study comprised 54 consecutive intensive care admissions in patients with traumatic injury admitted over a 6-month period from November 1, 1996, to May 1, 1997. RESULTS: Postinjury peak sPLA(2) values were associated with increased ISS (r = 0.49, r(2) = 0.24, p < 0.001). Patients with elevated sPLA(2) had poor oxygenation compared with those with normal sPLA(2) levels (Pa0(2)/Fi0(2) ratio 164 +/- 16 versus 260 +/- 26 mmHg [mean +/- SEM], p < 0.01) and also required additional PEEP (5.5 +/- 0.9 versus 2.5 +/- 0.4 cm H(2)O, p = 0.01). Secretory PLA(2) levels in patients with abnormal chest x-ray 72 hours after injury were higher (1.08 +/- 0.2 versus 0.34 +/- 0.1 activity units, p < 0.001) than levels seen in patients with normal x-rays. CONCLUSIONS: Increasing injury magnitude is associated with elevated sPLA(2) levels, and increased sPLA(2) is related to postinjury hypoxemia and clinical status.