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Juan A Asensio

Publications and source records attributed to Juan A Asensio.

At least 19 recordsLinked to original sources
PubMed2006

Femoral vessel injuries: analysis of factors predictive of outcomes.

BACKGROUND: Femoral vessel injuries are the most common vascular injuries treated in a Level I trauma center. No studies have identified risk factors for survival and complications. STUDY DESIGN: We performed a retrospective, 132-month study that included univariate and multivariate analyses. RESULTS: We studied 204 patients with 298 vessel injuries: 204 were arterial, 94 were venous. Mean age (+/- SD) was 29+/-13 years and mean Injury Severity Score (+/- SD) was 17+/-8. There were 176 (86%) penetrating injuries and 28 (14%) blunt injuries. Arterial repairs included: reverse saphenous vein graft bypass, 108 (53%); primary repair, 53 (26%); PTFE, 21 (10.2%); ligation, 13 (6.4%); and vein patch, 9 (4.4%). Venous repairs included: ligation, 49 (52%); primary repair, 41 (44%); and bypass, 4 (4%). Fasciotomies included: calf, 56 (27%); thigh, 25 (12%); traumatic amputations, 6 (3%); and delayed amputations, 0. Overall survival rate was 91% (186 of 204), and adjusted survival was 95% (excluding emergency department thoracotomy deaths). There were 1 or more complications in 47 (23%), including wound infection, 31 (15%); venous thrombosis, 6 (3%); bleeding, 5 (2.5%); ARDS, 4 (2%); and arterial thrombosis, 1 (0.5%). Predictors of mortality were age>45 years, Injury Severity Score>25, common femoral artery injury, associated venous and abdominal injury, hypotension, hypothermia, and acidosis; coagulopathy in the operating room and the need for PTFE repair also predicted outcomes. Predictors of postoperative complications were intraoperative hypotension, arterial intimal injury, bony fracture, and thoracic injury. CONCLUSIONS: Although survival and limb salvage rates are high for femoral vessel injuries, these injuries incur high complication rates. Independent predictors for mortality are: Injury Severity Score > 25, Glasgow Coma Scale 28, presence of coagulopathy in the operating room, presence of two or more vascular signs, and age > 45 years.

Adult↗
PubMed2005

[Technology of the future applied to the present: Life Support for Trauma and Transport (LSTAT)].

One of the most recent innovations coalescing computer technology and medical care is the development of integrated medical component technology coupled with a computer system. One such example is the patient transport system known as the Life Support for Trauma and Transport (LSTAT). LSTAT is a self-contained stretcher-based intensive care unit designed by the United States Army to provide care for critically injured patients during transport and in remote settings where resources are limited. It contains conventional medical equipment that has been reduced in size and integrated into a single platform. This article presents the latest technology applied to the field of medicine, which should not be limited to patients injured during warfare but should also be used to assist the injured civilian population who need transport from remote settings to urban trauma centers.

Beds↗
PubMed2005

Traumatic ureteral injuries: a single institution experience validating the American Association for the Surgery of Trauma-Organ Injury Scale grading scale.

PURPOSE: Ureteral injuries are uncommon and challenging. In this study we report our institutional experience with ureteral injuries. We evaluated the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) for ureteral injuries as a predictor of outcomes for complexity of repair, morbidity, mortality and associated injuries. MATERIALS AND METHODS: We performed a retrospective, 120-month study (January 1992 to December 2002) at an urban, level I trauma center. RESULTS: In the 57 patients mean hospital Admission blood pressure +/- SD was 115 +/- 25 mm Hg, mean Revised Trauma Score was 7.38 +/- 0.84 and mean Injury Severity Score was 15 +/- 1.15. The mechanism of injury was penetrating in 55 cases (96.5%), including gunshot wound in 52 (54.5%) and stab wound in 2 (5.5%), and in blunt 2 of motor vehicle accidents (3.5%). The anatomical location was the left side in 33 cases (58%), right side in 23 (40%) and bilateral in 1 (2%). The distribution of injuries was proximal in 15 cases (26%), mid in 21 (37%) and distal in 21 (37%). Associated injuries were present in 56 patients (98%). An intraoperative diagnosis was made in 44 cases (77%). Of the patients 50 (88%) required complex repairs or an adjunct procedure, including a double pigtail stent in 33 (58%), ureteroureterostomy in 20 (35%), ureteroneocystostomy with a psoas hitch in 10 (18%), external diversion in 9 (16%), suprapubic cystostomy in 8 (14%), nephrostomy in 2 (3.5%), nephrectomy in 2 (3.5%) and ligation in 2 (3.5%). Injury grade was I to V in 5 (8%), 8 (13%), 13 (22.8%), 18 (31.6%) and 13 (22.8%) cases, respectively. Overall 51 patients (89%) survived. No deaths were related to ureteral injury. Renal salvage was achieved in 49 of the 51 surviving patients (96%). CONCLUSIONS: Ureteral injuries are uncommon. The complexity of repair and number of associated injuries increase with AAST-OIS injury grade. Mortality increases with AAST-OIS injury grade but it is not related to the ureteral injury. Excellent results can be achieved with complex techniques of primary repair, leading to renal salvage.

Adult↗
PubMed2005

Lessons learned in the management of thirteen celiac axis injuries.

OBJECTIVES: Celiac axis injuries are rare. The purposes of this study were to (1) review institutional experience, (2) determine additive effect on death of associated vessel injuries, and (3) correlate mortality rates with the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) for abdominal vascular injury. METHODS: This was a retrospective, 132-month study (January 1992 to December 2002) of patients with celiac axis injuries. RESULTS: Thirteen patients were included in the study. Mean revised trauma score was 5.35+/-2.63; mean injury severity score was 25+/-12. The mechanism was penetrating in 12 (92%) and blunt in 1 (8%); 3 of 13 had Emergency Department thoracotomy (100% mortality rate). Treatment included ligation in 11 and primary repair in 1; 1 exsanguinated. Overall survival was 5 of 13 (38%). Adjusted survival excluding patients who had Emergency Department thoracotomy was 5 of 10 patients (50%). Those surviving with isolated injuries included 57% of patients. Mortality rate versus AAST-OIS was grade III, 43% (3 of 7 patients); grade IV, 50% (1 of 2 patients); and grade V, 100% (4 of 4 patients). CONCLUSIONS: Celiac axis injuries are rare. Patients with isolated injuries have better survival rates. Mortality rate correlates well with AAST-OIS for abdominal vascular injury.

Celiac Artery↗
PubMed2005

Functional outcome after blunt and penetrating carotid artery injuries: analysis of the National Trauma Data Bank.

BACKGROUND: We analyzed the functional outcome at discharge among a cohort of patients suffering traumatic carotid arterial injury (CAI) and compared them with matched controls. METHODS: CAI were identified by International Classification of Diseases-9 codes from the National Trauma Data Bank. Control groups were matched by age, mechanism, head Abbreviated Injury Scale score, Injury Severity Score, base deficit, and admission Glasgow Coma Scale score. Outcome was assessed using the functional independence measure (FIM) score for feeding, locomotion, and expression. FIM scores for each category ranged from 1 (full assistance required) to 4 (fully independent), with a maximum total FIM score of 12 representing full independence. RESULTS: There were 967 CAI identified among 474,024 patients for an overall incidence of 0.2%. The mechanism of injury was blunt in 570 (59%) and penetrating in 397 (41%) patients. Seventy-eight percent of penetrating CAI patients were fully independent for locomotion at discharge (FIM = 4) compared with only 37% of blunt patients (p < 0.01). Compared with the control group of similarly injured patients without carotid injury (n = 14,119), the blunt CAI group demonstrated more severe functional disability (FIM < or = 2) at discharge for feeding, expression, and locomotion. Fifty-five percent of blunt control patients were discharged fully independent (FIM total = 12) compared with only 33% of blunt CAI (odds ratio= 2.5; p < 0.01). The penetrating CAI group showed no significant difference in severe disability for feeding, expression, or locomotion compared with controls. However, 80% of penetrating control patients were discharged fully independent (FIM total = 12) compared with only 67% of patients with penetrating CAI (odds ratio = 2.0; p = 0.01). CONCLUSION: Blunt CAI is associated with more severe functional disability at discharge than penetrating CAI. Even when compared with a similarly injured control group, blunt CAI results in significant additional severe functional disabilities in feeding, expression, and locomotion.

Adolescent↗
PubMed2004

Has evolution in awareness of guidelines for institution of damage control improved outcome in the management of the posttraumatic open abdomen?

HYPOTHESIS: Awareness of guidelines for damage control can improve patient outcomes after postraumatic open abdomen. DESIGN: Retrospective (November 1992 to December 1998), prospective (January 1999 to July 2001), 104-month study. SETTING: Los Angeles County and University of Southern California Medical Center, Los Angeles. PATIENTS: All patients undergoing damage control resulting in posttraumatic open abdomen. MAIN OUTCOME MEASURES: The main outcome measure was survival. Data were also collected on surgical findings and indications for damage control, including organs injured, intraoperative estimated blood loss, and intraoperative fluids, blood, and blood products administered. Postoperative complications, length of time patients had an open abdomen, and surgical intensive care unit and hospital length of stay were also recorded. RESULTS: No difference in mortality existed between patients admitted before awareness of guidelines (group 1; 21 [24%] of 86 patients died) and patients who underwent damage control following these suggested guidelines (group 2; 13 [24%] of 53 patients died) (P =.85). Of the 139 patients, 100 had penetrating injuries and 39 had blunt injuries. Estimated blood loss was 4764 +/- 5349 mL. Mean intraoperative fluid replacement was 22 034 mL. One hundred one patients (73%) experienced 228 complications, for a mean of 2.26 complications per patient. Group 1 patients spent a longer time in the operating room (mean, 4.09 +/- 1.99 hours; range, 0.4-9.5 hours) vs group 2 patients (mean, 2.34 +/- 1.50 hours; range, 0.3-6.2 hours; P<.001). The surgical intensive care unit length of stay was 23.5 +/- 18.3 days vs 8.7 +/- 14.9 days (P<.001), and the hospital length of stay was 37.4 +/- 27.5 days vs 12.4 +/- 21.0 days (P<.001) in survivors and nonsurvivors, respectively. CONCLUSIONS: We recommend close monitoring of intraoperative outcome predictors as validated within our guidelines and recommend following our model for early institution of damage control.

Abdominal Injuries↗
PubMed2004

Thyroid storm induced by strangulation.

Thyroid storm most often occurs in patients with known thyrotoxicosis. This report discusses a severe case of thyroid storm developing as a direct result of strangulation in a patient without a preexisting history of thyroid disease. Classification and treatment of this entity are discussed.

Adult↗
PubMed2003

Analysis of 185 iliac vessel injuries: risk factors and predictors of outcome.

HYPOTHESIS: Iliac vascular injuries incur high mortality. DESIGN: Retrospective 100-month study (January 1, 1992, through April 30, 2000). PATIENTS: One hundred forty-eight patients with 185 iliac vessel injuries. OUTCOME MEASURES: Survival and mortality, analyzed by univariate and logistic regression. RESULTS: Admission mean +/- SD systolic blood pressure was 81 +/- 42 mm Hg, mean Revised Trauma Score was 6.0 +/- 2.8, and mean Injury Severity Score was 20.0 +/- 9.5. The mechanism of injury was penetrating in 140 patients (95%) and blunt in 8 (5%). The mean estimated blood loss was 6246 +/- 6174 mL. Of the 185 injured vessels, 71 (99%) of 72 iliac arteries were repaired, 101 (89%) of 113 iliac veins were ligated, and 12 (11%) of 113 iliac veins were repaired. Overall survival was 51% (76/148). Mortality was 82% (49/72) in patients with exsanguination. Survival by vessel: iliac artery, 57% (20/35); iliac vein, 55% (42/76); and iliac artery and vein, 38% (14/37). Significant predictors of outcome were thoracotomy in the emergency department, associated aortic injury, inferior vena cava injuries, iliac artery and vein injury, intraoperative arrhythmia, and intraoperative coagulopathy. On logistic regression, independent risk factors for survival were absence of thoracotomy in the emergency department, surgical management, and arrhythmia. Mortality by grade on the Organ Injury Scale of the American Association for the Surgery of Trauma (AAST-OIS) was as follows: grade III, 35% (33/95); grade IV, 71% (24/34); and grade V, 79% (15/19). CONCLUSIONS: Mortality remains high. Associated vessel injuries and intraoperative complications predict mortality. AAST-OIS grade for abdominal vascular injuries correlates well with mortality.

Adolescent↗
PubMed2003

Pancreaticoduodenectomy: a rare procedure for the management of complex pancreaticoduodenal injuries.

BACKGROUND: Pancreaticoduodenectomy (Whipple's procedure) is a formidable procedure when undertaken for severe pancreaticoduodenal injury. The purposes of this study were to review our experience with this procedure for trauma; to classify injury grades for both pancreatic and duodenal injuries in patients undergoing pancreaticoduodenectomy according to the American Association for the Surgery of Trauma-Organ Injury Scale for pancreatic and duodenal injury; and to validate existing indications for performance of this procedure. STUDY DESIGN: We performed a retrospective 126-month study (May 1992 to December 2002) of all patients admitted with proven complex pancreaticoduodenal injuries requiring pancreaticoduodenectomy. RESULTS: Eighteen patients were included; mean age was 32 +/- 12 years (SD), mean Revised Trauma Score was 6.84 +/- 2.13 (SD), and mean Injury Severity Score was 27 +/- 8 (SD). There were 17 penetrating injuries (94%) and 1 blunt injury (6%). One of 18 patients had an emergency department thoracotomy and died (100% mortality); 5 of the remaining 17 patients required operating room thoracotomies, and only 1 survived (80% mortality). There was 1 AAST-OIS pancreas grade IV injury, and there were 17 pancreas grade V injuries and 18 AAST-OIS duodenum grade V injuries. Indications for pancreaticoduodenectomy were: massive uncontrollable retropancreatic hemorrhage, 13 patients (72%); massive unreconstructable injury to the head of the pancreas/main pancreatic duct and intrapancreatic portion/distal common bile duct, 18 patients (100%); and massive unreconstructable injury, 18 patients (100%). Mean estimated blood loss was 6,888 +/- 7,866 mL, and overall survival was 67% (12 of 18 patients). CONCLUSIONS: Complex pancreaticoduodenal injuries requiring pancreaticoduodenectomy (Whipple's procedure) are uncommon but highly lethal; virtually all are classified as AAST-OIS grade V for both pancreas and duodenum. Current indications for performance of pancreaticoduodenectomy are valid and should be strictly applied during procedure selection.

Adult↗
PubMed2003

The vasculopathic patient: uncommon surgical emergencies.

Recognition of the patient who has an emergent vascular disorder and the early initiation of simple management steps in the ED can significantly impact patient outcome. The vasculopathic patient presents with significant comorbid conditions and a small window of opportunity to alter the prognosis favorably. The critical role of the EP lies in prompt use of this opportunity and appropriate direction of further care.

Axillary Vein↗
PubMed2003

Surgical management and strategies in the treatment of hypothermia and cold injury.

Increased participation in outdoor activities and the epidemic of homelessness have caused the incidence of cold injuries in the civilian population to rise dramatically over the last 20 years. Knowledge of the treatment is crucial for emergency physicians in rural and urban areas. Recent developments have significantly advanced the understanding of the pathophysiology of hypothermic and frostbite injuries. Together with improved rewarming techniques and use of radiological assessment of tissue viability, future advancements should allow for a more aggressive and active approach to the management of these injuries.

Energy Transfer↗
PubMed2003

Necrotizing soft-tissue infections.

It has been more than 130 years since NSTIs were first described. Despite the development of various classification systems and progress in surgical management, these infections continue to have high mortality and pose enormous diagnostic and therapeutic challenges. For optimal outcome, treatment involves rapid institution of appropriate antibiotic coverage and early wide surgical debridement. Recovery requires aggressive resuscitation, postoperative nutritional support and wound care that is similar to the care of burn patients in many respects. The entire therapeutic process requires a well-prepared and coordinated team of health care professionals including EPs, general, orthopedic, and other specialist surgeons, infectious disease consultants, specially trained nursing staff, and physical therapists.

Humans↗
PubMed2003

Operative management and outcomes in 103 AAST-OIS grades IV and V complex hepatic injuries: trauma surgeons still need to operate, but angioembolization helps.

BACKGROUND: American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) grades IV and V complex hepatic injuries are highly lethal. Our objectives were to review experience and identify predictors of outcome and to evaluate the role of angioembolization in decreasing mortality. METHODS: This was a retrospective 8-year study of all patients sustaining AAST-OIS grades IV and V hepatic injuries managed operatively. Statistical analysis was performed using univariate and multivariate logistic regression. The main outcome measure was survival. RESULTS: The study included 103 patients, with a mean Revised Trauma Score of 5.61 +/- 2.55 and a mean Injury Severity Score of 33 +/- 9.5. Mechanism of injury was penetrating in 80 (79%) and blunt in 23 (21%). Emergency department thoracotomy was performed in 21 (25%). AAST grade IV injuries occurred in 51 (47%) and grade V injuries occurred in 52 (53%). Mean estimated blood loss was 9,414 mL. Overall survival was 43%. Adjusted overall survival rate after emergency department thoracotomy patients were excluded was 58%. Results stratified to AAST-OIS injury grade were as follows: grade IV, 32 of 51 (63%); grade V, 12 of 52 (23%); grade IV versus grade V (p < 0.001) odds ratio, 2.06; 95% confidence interval, 2.72 (1.40-3.04). Logistic regression analysis identified as independent predictors of outcome Revised Trauma Score (adjusted p < 0.0002), angioembolization (adjusted p < 0.0177), direct approach to hepatic veins (adjusted p < 0.0096), and packing (adjusted p < 0.0013). CONCLUSION: Improvements in mortality can be achieved with an appropriate operative approach. Angioembolization as an adjunct procedure decreases mortality in AAST-OIS grades IV and V hepatic injuries.

Embolization, Therapeutic↗