Fine bore silicone catheters for peripheral intravenous nutrition in adults.

Abstract

bone injury.Most cardiac abnormalities after crushing injury occur from blunt trauma after road traffic accidents, where deceleration causes damage to the anterior right ventricle.Electrocardiograms and cardiac enzyme activity are not sensitive indicators of this injury, but radionuclide scanning or echocardio- graphy show abnormalities of right ventricular function.'`Ourpatients had acute strain of the right heart because of severe pressure overload which occurs in asphyxiation or with a major pulmonary embolus.One patient only was haemodynamically compromised and required inotropic support.Acute right heart strain may have occurred for several reasons.External compression, especially of the abdomen, causes increased filling of the right heart.Thoracic compression produces a rise in intrathoracic pressure and pulmonary artery pressure, which would rise further from an increase in pulmonary vascular resistance secondary to hypoxia.The possibility of a pulmonary fat embolus from a crushing injury could not be excluded.4Finally, direct cardiac trauma and contusion of the septum and right ventricle was a possibility, supported by pericardial effusions in two patients and transient conduction abnormalities in two.'3 The electrocardiographic and echocardio- graphic appearances improved in all six patients, and possibly no long term cardiac damage occurred.We did not test cardiac function, however, and the abnormal right ventricular function may interfere with exercise and normal activity in these young men.We thank the following anaesthetists for their support of these patients: Drs S P Gerrish, P A Wilkinson, T