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Article
April 17, 1967

Closed Visceral Injuries of Abdomen and Thorax

Author Affiliations

From the departments of surgery, Western Reserve University School of Medicine, Cleveland, and the Cleveland Metropolitan General Hospital. Dr. Haiderer was Junior Research Fellow of the Heart Association of Northwestern Ohio, Inc., at the time this study was completed.

JAMA. 1967;200(3):231-235. doi:10.1001/jama.1967.03120160097015
Abstract

When a wound penetrates the abdomen or thorax the presence of internal visceral injury must be assumed. On the other hand, "closed" visceral injuries of the abdomen and thorax constitute special problems because the clinical manifestations may be unimpressive early in the postinjury period, as has been emphasized by Simeone.1 Later, when symptoms develop, a severe physiological derangement may already exist and may compromise the results of therapy.

It is the purpose of this presentation (1) to emphasize the importance of precise physiological assessment in preparation of the patient before major surgery required as a result of trauma, (2) to define the frequency of this clinical problem in a general hospital, and (3) to cite specific cases as illustrations of principles in management.

Initial Therapy and Assessment  In a military evacuation system this function is carried out continuously in a triage area. Blood volume replacement is initially started with

References
1.
Simeone, F.A.:  Blunt Trauma to the Abdomen ,  Lancet 80:1-15 ( (Jan) ) 1960.
2.
Moore, F.D.:  The Metabolic Response of the Surgical patient , Philadelphia: W. B. Saunders, Co., 1959.
3.
Clowes, G.H.A., Jr.; Del Guercio, L.Z.; and Barwinsky, J.:  The Cardiac Output in Response to Surgical Trauma: A Comparison Between Patients Who Survived and Those Who Died ,  Arch Surg 81:212-222 ( (Aug) ) 1960.Crossref
4.
Barratt-Boyes, B.G., and Wood, E.H.:  Hemodynamic Response of Healthy Subjects to Exercise in the Supine Position While Breathing Oxygen ,  J Appl Physiol 11:129-135 ( (July) ) 1957.
5.
Boyd, A.E., et al:  Estimation of Cardiac Output Soon After Intracardiac Surgery With Cardiopulmonary Bypass ,  Ann Surg 150:613-620 ( (Oct) ) 1959.Crossref
6.
Wilson, J.N.:  The Management of Acute Circulatory Failure ,  Surg Clin N Amer 43:469-495 ( (April) ) 1963.
7.
Spencer, F.C., et al:  Assisted Circulation for Cardiac Failure Following Intracardiac Surgery With Cardiopulmonary Bypass ,  J Thorac Cardiov Surg 49:56-73 ( (Jan) ) 1965.
8.
McLean, L.D.:  Blood Volume Versus Central Venous Pressure in Shock ,  Surg Gynec Obstet 118:594-595 ( (March) ) 1964.
9.
Thung, N., et al:  The Cost of Respiratory Effort in Postoperative Cardiac Patients ,  Circulation 28:552 ( (Oct) ) 1963.Crossref
10.
Wiggers, C.J.:  Dynamics of Ventricular Contraction Under Abnormal Conditions ,  Circulation 5:321-348 ( (March) ) 1952.Crossref
11.
Connolly, J.E., et al:  Acidosis as a Cause of Renal Shutdown During Extracorporeal Circulation: Its Correction by the Use of Tham ,  J Thorac Cardiovasc Surg 46:680-687 ( (Nov) ) 1963.
12.
Lyons, J.H., and Moore, F.D.:  Posttraumatic Allalosis: Incidence and Pathophysiology of Alkalosis in Surgery ,  Surgery 60:93-106 ( (July) ) 1966.
13.
Sampson, P.C., discussion of Halter, B.L.:  Nonpenetrating Trauma to the Heart ,  Amer J Surg 90:237-240 ( (Aug) ) 1955.Crossref
14.
Williams, R.D., and Zollinger, R.M.:  Diagnostic and Prognostic Factors in Abdominal Trauma ,  Amer J Surg 97:575 ( (April) ) 1959.Crossref
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