Cushman et al identified physiologic findings associated with mortality in patients with trauma to the iliac vessels. This can help identify patients who are at risk for irreversible shock and who may require more aggressive therapy to correct physiologic abnormalities. The authors are from Emory University in Atlanta.


Physiologic parameters:

(1) body temperature and hypothermia

(2) pH

(3) base deficit


Findings in body temperature associated with poor outcome:

(1) initial temperature in OR < 34°C

(2) fall in temperature during laparotomy

(3) final temperature in OR < 35°C



• Handling the fall in temperature is difficult. In the discussion in page 1036 the temperature of nonsurvivors fell < 35°C, which would trigger the third finding. In addition, the parameters to judge a falling temperature are not specified.

• In survivors the body temperature increased by the time surgery was complete.


Findings in pH values:

(1) initial pH < 7.0

(2) persistent pH approximating 7.2 during laparotomy for abdominal vascular injury


Base deficit:

(1) initial base deficit approximating –20

(2) persistent base deficit approximating –10 in the operating room


The presence of 2 or more of these findings should prompt:

(1) discontinuation of a laparotomy once hemorrhage has been controlled

(2) complex surgical repairs should be deferred

(3) taking steps to reverse the abnormal physiologic finding


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