thromboplastin and Wounds--Gunshot

Tissue thromboplastin probably plays an important role in the development of post-traumatic pulmonary microembolism. Infusion of purified human tissue thromboplastin in animals resulted in an intravascular coagulation and respiratory insufficiency. This could be inhibited by previous infusion of phospholipase C (PLC) from Bacillus cereus. We have studied the effects of PLC infusion on the course of post-traumatic pulmonary microembolism, induced by a high-energy (c. 700 J) missile trauma to the hind legs of pigs. The trauma resulted in a major muscular injury and an indirect femoral fracture. Untreated pigs developed intrapulmonary microemboli. The degree of microembolism in the lungs was measured quantitatively by external detection over the right lung of radiolabeled platelets and fibrin. Infusion of 80 micrograms PLC/kg/hour resulted in an accumulation of blood PLC associated with toxic reaction leading to increasing tachycardia and circulatory collapse after 10 hours. PLC infusion of 20 micrograms/kg/hour did not inhibit the pulmonary microembolism. A PLC-dose in between, viz. 40-50 micrograms/kg/hour, proved to efficiently inhibit most of the microembolism during the infusion period. Cessation of PLC infusion after 24 hours was accompanied by a later increase in pulmonary trapping of platelets and fibrin and decreases in paO2. Concomitantly there were opacities seen on chest X-rays. The results show that tissue thromboplastin is an important etiologic factor in post-traumatic pulmonary microembolism and that inhibition with phospholipase C can be of value in the prophylaxis of the syndrome.

Topics: Animals; Hindlimb; Pulmonary Embolism; Swine; Thromboplastin; Type C Phospholipases; Wounds, Gunshot

Utilizing a disposable unit, intraoperative autotranfusion was employed during surgery in 53 patients admitted to the Bexar County Teaching Hospital at the University of Texas Health Science Center at San Antonio. During the two-year period of study, 26 patients underwent surgery for major traumatic injuries, 8 for ruptured ectopic pregnancy and 19 for miscellaneous emergency or elective conditions. The indication for intraoperative autotransfusion was an anticipated blood loss of 1,000 ml or more. Contraindications for its use were colon injury or localized infection. Over 325 units of blood were salvaged and returned directly to these patients during surgery. One death related to the use of the autotransfusor unit was due to massive air embolism. Twenty other deaths were associated with severe injuries and irreversible shock requiring greater than 3,600 ml of both autologous and homologous blood. Eight of these patients demonstrated severe pancoagulopathies. In the remaining patients, clotting factors and plasma or urine hemoglobin levels were transiently abnormal. However, there were no clinically apparent bleeding defects or renal problems detected. Postoperative blood cultures were consistently negative. It is concluded that intraoperative autotransfusion, when properly employed, is a safe, practical and technically feasible procedure.

Topics: Abdominal Injuries; Adult; Blood Cell Count; Blood Coagulation Disorders; Blood Platelets; Blood Transfusion, Autologous; Blood Volume; Disposable Equipment; Emergencies; Female; Humans; Male; Pregnancy; Pregnancy, Ectopic; Prothrombin Time; Rupture, Spontaneous; Surgical Procedures, Operative; Thoracic Injuries; Thromboplastin; Time Factors; Wounds and Injuries; Wounds, Gunshot

Topics: Blood Coagulation Tests; Blood Transfusion; Brain; Brain Injuries; Debridement; Disseminated Intravascular Coagulation; Heparin; Humans; Male; Middle Aged; Thromboplastin; Wounds, Gunshot