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Background: Tachycardia is believed to be closely associated with hypotension and is often listed as an important sign in the initial diagnosis of hemorrhagic shock, but the correlation between heart rate and hypotension remains unproved., Study Design: Data were collected from all trauma patients, 16 to 49 years old, presenting to our university-based trauma center between July 1988 and January 1997. Moribund patients with a systolic blood pressure < or =50 or heart rate < or = 40 and patients with significant head or spinal cord injuries were excluded. Tachycardia was defined as a heart rate >or= 90 and hypotension as a systolic blood pressure < 90., Results: Hypotension was present in 489 of the 14,325 admitted patients that met the entry criteria. Of the hypotensive patients, 35% (169) were not tachycardic. Tachycardia was present in 39% of patients with systolic blood pressure 120 mmHg. Hypotensive patients with tachycardia had a higher mortality (15%) compared with hypotensive patients who were not tachycardic (2%, P = 0.003). Logistic regression analysis revealed tachycardia to be independently associated with hypotension (p = 0.0004), but receiver operating curve analysis demonstrated that the sensitivity and specificity of heart rate for predicting hypotension is poor., Conclusions: Tachycardia is not a reliable sign of hypotension after trauma. Although tachycardia was independently associated with hypotension, its sensitivity and specificity limit its usefulness in the initial evaluation of trauma victims. Absence of tachycardia should not reassure the clinician about the absence of significant blood loss after trauma. Patients who are both hypotensive and tachycardic have an associated increased mortality and warrant careful evaluation.

Background: There are indications that methamphetamine production and illicit use are increasing. We investigated the epidemiology of methamphetamine use in trauma patients in an area of heavy methamphetamine prevalence., Study Design: This was a retrospective population-based review. We reviewed toxicology and alcohol test results in trauma patients admitted to the University of California, Davis, between 1989 and 1994 to the only trauma center serving a population of 1.1 million., Results: Positive methamphetamine rates nearly doubled between 1989 (7.4%) and 1994 (13.4%), compared with a minimal increase in cocaine rates (5.8% to 6.2%) and a decrease in blood alcohol rates (43% to 35%). Methamphetamine-positive patients were most likely to be Caucasian or Hispanic; cocaine-positive patients were most likely to be African American. Methamphetamine-positive patients were most commonly injured in motor vehicle collisions or motorcycle collisions; cocaine-positive patients were most commonly injured by assaults, gunshot wounds, or stab wounds. Cocaine positivity and alcohol positivity predicted a decreased need for emergency surgery and cocaine positivity predicted a decreased need for admission to the ICU., Conclusions: Methamphetamine use in trauma patients increased markedly in our region between 1989 and 1994, alcohol rates decreased, and cocaine rates remained unchanged. Methamphetamine-positive patients had mechanisms of injury similar to those of alcohol-positive patients, so injury prevention strategies for methamphetamine should be patterned after strategies designed for alcohol.

Background: Jehovah's Witnesses can create perplexing treatment problems by their refusal of blood transfusions. This dilemma is especially difficult for the trauma surgeon faced with critically low hemoglobin levels or life-threatening blood loss in an injured Jehovah's Witness., Study Design: Retrospective review of the records of 58 Jehovah's Witnesses admitted to a single trauma center between July 1992 and June 1995., Results: There were 53 blunt and 5 penetrating injuries. Four patients (7 percent) received blood transfusions; one received banked blood and three received autotransfusions. Two patients were sedated and paralyzed to optimize oxygen utilization; one patient received erythropoietin. Eighteen patients had a general anesthetic and underwent an operative procedure; one underwent controlled hypotensive anesthesia with normovolemic hemodilution. The records of 21 patients (36 percent) included documentation of absolute refusal of blood or blood products; the exact status of consent for blood transfusion was not documented in the records of 33 patients (57 percent). One death and six complications occurred, none of which were attributed to acute blood loss or anemia. Treatment options and special techniques for the severely anemic patient refusing blood transfusions are discussed., Conclusions: Documentation of religious status and beliefs about blood transfusion, as well as knowledge of special treatment options available for anemic Jehovah's Witnesses, is necessary to provide quality care to this unique trauma population.