Injury 144 INJURY: THE BRITISH JOURNAL OF ACCIDENT SURGERY Oct. 1971

ABSTRACTS

S H O C K

Acidaemia in Shock A study is presented of acid/base levels and other

factors in shock. COLLINS, J. A., SIMMONS, R. L., JAMES, P. M.,

BREDENBERG) C. E., ANDERSON, R. W., and H'EISTER- KAMP) C. A. (1970), ' The Acid-Base Status of seriously Wounded Combat Casualties. I. Before Treatment ', Ann. Surg., 171, 595.

Cardiac Output after Trauma Cardiac output was estimated in a series of patients

with acute trauma. Peripheral resistance, central blood-volume, etc., were calculated. The authors refer to haemorrhagic shock and traumatic shock as different entities.

A reaction to trauma without blood-loss was recog- nized and in this state there was increased cardiac output, reduced peripheral resistance, and tachy- cardia. The response to trauma with blood-loss was the commonly accepted syndrome of reduced cardiac output, low central blood-volume, etc.

SHOEMAKER, W. C., LIM, L., BOYD, D. R., CORLEY, R. S., REINHARD, J. M., DREILING, D. A., and KARK, A. E. (1971), 'The Sequential Hemodynamic Events after Trauma to the Unanaesthetised Patient ' , Surgery Gynec. Obstet., 132, 651.

Keeping Control of Fluid Input in Treating Shock The relative value of blood-volume estimation and

of central venous pressure estimation in diagnosing shock and in controlling therapy was studied in a series. (Only a few cases, however, were of uncompli- cated hypovolaemia.) Low values of one or other or both of these investigations correlated well with the initial clinical judgement. They did not afford a certain safeguard, however, against overtransfusion in ill patients. The response of the central venous pressure to treatment seemed to be of greater signifi- cance than isolated readings in estimating the neces- sary quantity of fluid replacement.

WILSON, R. F., SARVER, E., and BIRKS, R. (1971), 'Central Venous Pressure and Blood Volume Determinations in Clinical Shock ', Surgery Gynec. Obstet., 132, 631.

Experimental Shock An investigation into the discrepancies which are

found in the extracellular fluid volume assessments by the radiosodium and radiosulphate methods. Possible explanations are offered.

GILDER, H., CORTESE, A. F., LOEHR, W. J., MOORE, H. V., and DE LEON, V. (1970), ' Dilution in Studies in Experimental Haemorrhagic and Endotoxic Space in Shocked Dogs ', Ann. Surg., 171, 42.

O R G A N I Z A T I O N T O P I C S AND A C C I D E N T P R E V E N T I O N

Tractor Accidents The reports on which the figures and conclusions

are based are principally the fatal accidents reports submitted by the Ministry of Agriculture, Fisheries and Food.

Tractor accidents account for about 40 per cent of all fatal accidents in agriculture, and of these about 75 per cent are due to overturning. On the other hand, for non-fatal accidents, tractors are responsible for only 7 per cent of the total in agriculture of which only one-tenth is due to overturning.

A factor to observe is the low percentage incidence of tractor accidents (about 0-1) whether expressed as a proportion of tractor population or as a proportion of labour force, the probability of achieving a signifi- cant reduction in the accident incidence being low.

With the legal requirements for safety frames, tractor overturning fatalities should soon be excep- tional. The greatest risk to farm workers seems to be in Devon and Cornwall when working on or adjacent to steep slopes.

MARPLES, V. (1971), ' A n Analysis of Tractor Accidents in England and Wales, 1967-69 ', Occup. Saf. Hlth, July, 1971.

Tranquillizers and Road Accidents

A timely reminder that physicians who prescribe tranquillizers (as well as certain other drugs) have a responsibility to the patient and the public to point out the dangers that may accompany their use. An accident is reported in which sensitivity to a tran- quillizer resulted in the patient losing control of a car. Tranquillizers also increase the effect of taking alcohol and may cause an accident in this way. Drowsiness from taking tranquillizers, certain antihistamines, barbiturates, and depressant drugs may also cause car accidents.

WELLS, R. L. (1971), 'Tranquillizers and the Automobile ', J. Am. med. Ass., 215, 705.

Injury from Steering Wheels

Closed rupture of intestine is rare among car passengers and most likely to affect the driver. Two patients suffered closed rupture of intestine as a result of impact against steering wheels of supposedly safe design. The wheels were buckled by the force of impact and in each case there was a sharp, chisel- like stump of one of the spokes. Neither driver wore a seat belt. One had well marked bruising in the pattern of his clothing; the other's belly wall was unmarked.

GISSANE, W., and BULL, J. (1971), ' Lessons from Two Steering Wheels ', Br. med. J., 1,270.