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Biomedical subjects

K L Mattox

Publications and source records attributed to K L Mattox.

At least 37 records · Page 2Linked to original sources
PubMed1998

Remote clinical assessment for acute trauma: an initial experience.

Optimal care of the injured patient requires an organized approach, dedicated resources and clinical expertise. Victims of major trauma, however, frequently present to rural and suburban hospitals regardless of whether a dedicated trauma system in place. Immediate consultation by a trauma expert could potentially expedite effective evaluation and management of trauma victims, reducing the occurrence of unnecessary transport and leading to efficient stabilization and transport when needed. Remote assessment of trauma patients must be assesses for feasibility, safety and efficacy before widespread implementation. This project represents the initial steps towards the development of a functional telemedicine system for trauma care.

Acute Disease↗
PubMed1997

Acute management of complex cardiac injuries.

BACKGROUND: Injury to the heart has been studied extensively. However, a small group of patients with injuries to the coronary arteries or intracardiac structures may require a different operative approach. METHODS: Retrospective review of a cardiovascular injury database. RESULTS: Over a 20-year period, 711 cardiac injuries were treated. The mean age of the victims was 31.1 (90% men). Causes were primarily stab wounds (54%) and gunshot wounds (42%). Cardiac chambers injured included the right ventricle (40%), left ventricle (40%), right atrium (24%), and left atrium (3%). The overall mortality was 47%. Sixty complex injuries occurred. Of 21 left anterior descending coronary artery injuries (76.2% mortality), two patients presented with sufficient signs of life to warrant emergent coronary artery bypass (mortality 50%). There were seven circumflex/obtuse marginal coronary artery injuries, all treated with ligation (mortality 71.4%). Eight right/posterior descending coronary artery injuries (mortality 62.5%) were seen, and all but one were treated with ligation. The one patient not treated with ligation underwent coronary bypass and died. Delayed mitral valve replacement was performed for two valvular injuries (mitral). There were a total of 14 intracardiac fistulas (mortality 35.7%). All six of the surviving patients with ventricular septal defect required reoperation. CONCLUSION: The mortality for complex injuries (coronary, septal, valvular) was 53%. This group was a specific population that self-selected by surviving to operation. Acute operations for complex injuries (beyond cardiorrhaphy) were primarily heroic life-saving efforts. Reoperation for cardiac injuries was most common for septal or valvular injuries. Only 2% of all survivors required reoperation to correct a residual defect.

Acute Disease↗
PubMed1997

Subclavian artery obstruction by tube thoracostomy.

A case of subclavian artery obstruction by tube thoracostomy for penetrating trauma is presented. The obstruction was not physiologically significant; however, it did impede the assessment of the subclavian artery for potential injury using emergency center arteriography. The difficulty was easily corrected with repositioning of the chest tube. This previously undescribed complication of tube thoracostomy is presented with its clinical implications.

Adult↗
PubMed1997

Newer diagnostic measures and emergency management.

Evolving technology provides new diagnostic and emergency management options for the surgeon caring for patients with thoracic trauma. Abdominal ultrasound performed by surgeons in the emergency department makes pericardiocentesis and subxyphoid pericardiotomy obsolete. Transesophageal echocardiography supplements aortography in the diagnosis of thoracic aortic injury. New terminologies replace the overused term myocardial contusion. Pulmonary tractotomy is an innovative approach to through-and-through pulmonary penetrating injuries. Centrifugal pumps add new options to thoracic great-vessel injury management. Endovascular stented grafts will be added to the armentarium of the thoracic surgeon for injured vessels.

Diagnostic Imaging↗
PubMed1997

Prolonged abdominal packing for trauma is associated with increased morbidity and mortality.

Abdominal packing and planned reoperation is a lifesaving technique for temporary control of hemorrhage in severely injured patients. Morbidity and mortality in this group of patients, however, remain significant. It is unclear whether the duration of packing impacts upon outcome. The purpose of this study is to evaluate the abscess, sepsis, and mortality rates associated with duration of abdominal packing. The records of 35 patients treated with abdominal packing between July 1994 and December 1995 who survived to reoperation were retrospectively reviewed. Evaluation included age; sex; mechanism; injuries; Abdominal Trauma Index; duration of packing; survival; and presence of abscess, sepsis or other infections. Patients packed for a total of 72 hours or less had lower abscess, sepsis, and mortality rates than those packed for more than 72 hours. The differences in abscess rate and mortality were statistically significant (P < 0.05). The Abdominal Trauma Index and mechanism of injury were similar for the two groups. Based on these results, we conclude that although abdominal packing is a useful technique in the severely injured patient, it is associated with greater morbidity and mortality when the duration of packing exceeds 72 hours.

Abdominal Abscess↗
PubMed1996

Penetrating thoracic vascular injuries.

1. Known injuries to the ascending aorta and arch are exposed by median sternotomy. Known injuries to the descending thoracic aorta can be exposed through a posterolateral thoracotomy. These injuries are more commonly diagnosed through emergent exploration by means of anterolateral thoracotomies. 2. Preoperative arteriography is extremely useful in managing penetrating injuries to the thoracic outlet, as it allows the choice of appropriate incisions for exposure and control. 3. Innominate artery, right common carotid or subclavian artery, as well as left intrathoracic common carotid artery injuries are best managed via median sternotomy with appropriate extension. 4. Left subclavian arteries are managed with high left anterolateral thoracotomy for proximal control combined with supraclavicular incision. 5. Distal subclavian arteries are managed with proximal control by a supraclavicular incision and distal control by an infraclavicular incision. 6. The bypass principle is useful for managing innominate or left carotid artery injuries. Ligation with brachiocephalic bypass can be a simple solution to a complex problem. 7. Soft grafts, fine sutures, and minimal mobilization are the techniques of choice. 8. Adjuncts such as Fogarty balloon catheters, Foley catheters, autotransfusion, shunts, and pulmonary tractotomy can be useful in managing these injuries. 9. Documentation of the preoperative neurovascular status of the patient should be performed, as well as discussion with the patient and the family, if available, of the potential outcome with appropriate documentation in the chart. 10. Rehabilitation services should be involved as appropriate to care for these patients. 11. Ligation is always an option to save the patient's life.

Blood Vessel Prosthesis↗
PubMed1996

Duration of antibiotic treatment in surgical infections of the abdomen. Penetrating abdominal trauma.

Infection is a major cause of morbidity and mortality following penetrating abdominal trauma. Antibiotics are routinely used although their effectiveness has never been evaluated in a placebo-controlled randomised trial, and they have never been shown to reduce the incidence of post injury intra-abdominal, as opposed to wound, infections. The available evidence indicates that a single preoperative dose of an appropriate antibiotic is adequate prophylaxis for penetrating abdominal injuries. Postoperative antibiotics should be reserved for "late" (> 12 hours) operations for enteric perforations. The optimal duration of treatment under these circumstances is not well established. Fever and leucocytosis are poor indicators of the need for continued postoperative administration in the severely traumatised patient.

Abdominal Injuries↗
PubMed1995

Predictors of amputation for popliteal artery injuries.

BACKGROUND: Popliteal artery injuries continue to result in limb loss. This study identifies risk factors that predict amputation. METHODS: Over a 5-year period, a retrospective chart review was conducted of 80 consecutive patients with 81 popliteal artery injuries. RESULTS: The overall amputation rate was 16.5%. Blunt trauma carried a higher rate of amputation (47%) than penetrating injuries (6.2%); P < 0.0001). Associated fractures had a higher amputation rate, regardless of mechanism (odds ratio +2.7, 95% confidence limits 1.2 to 6.2). Fasciotomy at the time of operation was associated with reduced amputation rate. CONCLUSIONS: Blunt injuries and associated fractures carry an increased risk for amputation. Compartmental pressures should be appropriately monitored postoperatively. Fasciotomy at the time of vascular repair may be considered even without evidence of compartment syndrome.

Adolescent↗
PubMed1995

Planned reoperation for severe trauma.

OBJECTIVE: The authors review the physiologic basis, indications, techniques, and results of the planned reoperation approach to severe trauma. SUMMARY BACKGROUND DATA: Multivisceral trauma and exsanguinating hemorrhage lead to hypothermia, coagulopathy, and acidosis. Formal resections and reconstructions in these unstable patients often result in irreversible physiologic insult. A new surgical strategy addresses these physiologic concerns by staged control and repair of the injuries. METHOD: The authors review the literature. RESULTS: Indications for planned reoperation include avoidance of irreversible physiologic insult and inability to obtain direct hemostasis or formal abdominal closure. The three phases of the strategy include initial control, stabilization, and delayed reconstruction. Various techniques are used to obtain rapid temporary control of bleeding and hollow visceral spillage. Hypothermia, coagulopathy, and the abdominal compartment syndrome are major postoperative concerns. Definitive repair of the injuries is undertaken after stabilization. CONCLUSION: Planned reoperation offers a simple and effective alternative to the traditional surgical management of complex or multiple injuries in critically wounded patients.

Abdominal Injuries↗
PubMed1995

Double jeopardy: thoracoabdominal injuries requiring surgical intervention in both chest and abdomen.

The critical decisions in patients with thoracoabdominal trauma are establishing the need to explore either or both cavities and determining appropriate sequencing. The causes and patterns of management difficulties were analyzed in 82 consecutive patients with penetrating thoracoabdominal injuries. Nine thoracotomies (11%) and 16 laparotomies (22%) were negative, with the major causes being misleading chest tube outputs, bullet trajectories, and abdominal tenderness. Inappropriate sequencing occurred in 19 patients (23%), and 15% required reoperation within 24 hours. Pitfalls and misjudgements in management of penetrating thoracoabdominal injuries occur in distinct patterns. The unreliability of chest tube output and abdominal examination must be kept in mind, and intraoperative clues of ongoing hemorrhage outside the operative field must be sought.

Abdominal Injuries↗
PubMed1994

Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries.

BACKGROUND: Fluid resuscitation may be detrimental when given before bleeding is controlled in patients with trauma. The purpose of this study was to determine the effects of delaying fluid resuscitation until the time of operative intervention in hypotensive patients with penetrating injuries to the torso. METHODS: We conducted a prospective trial comparing immediate and delayed fluid resuscitation in 598 adults with penetrating torso injuries who presented with a pre-hospital systolic blood pressure of < or = 90 mm Hg. The study setting was a city with a single centralized system of pre-hospital emergency care and a single receiving facility for patients with major trauma. Patients assigned to the immediate-resuscitation group received standard fluid resuscitation before they reached the hospital and in the trauma center, and those assigned to the delayed-resuscitation group received intravenous cannulation but no fluid resuscitation until they reached the operating room. RESULTS: Among the 289 patients who received delayed fluid resuscitation, 203 (70 percent) survived and were discharged from the hospital, as compared with 193 of the 309 patients (62 percent) who received immediate fluid resuscitation (P = 0.04). The mean estimated intraoperative blood loss was similar in the two groups. Among the 238 patients in the delayed-resuscitation group who survived to the postoperative period, 55 (23 percent) had one or more complications (adult respiratory distress syndrome, sepsis syndrome, acute renal failure, coagulopathy, wound infection, and pneumonia), as compared with 69 of the 227 patients (30 percent) in the immediate-resuscitation group (P = 0.08). The duration of hospitalization was shorter in the delayed-resuscitation group. CONCLUSIONS: For hypotensive patients with penetrating torso injuries, delay of aggressive fluid resuscitation until operative intervention improves the outcome.

Abdominal Injuries↗
PubMed1994

Transcervical gunshot injuries.

Gunshot injuries across the cervical midline are not addressed in existing trauma algorithms. A retrospective study of 41 patients with transcervical gunshot wounds was undertaken to delineate injury patterns and management principles. Thirty-four of the 41 patients (83%) sustained 52 injuries to major cervical structures. Vascular (22 injuries) and upper airway (13 injuries) structures were most commonly involved. This resulted in presentation with life-threatening problems in 16 patients (39%). The in-hospital mortality was 10%. In 30 of the 36 neck explorations (83%), the findings were positive for injuries to cervical structures. Sixteen bilateral explorations were performed; in each case, cervical injury was observed on at least one side of the neck. These results indicate that transcervical injuries are excellent markers of associated visceral injury. Therefore, a policy of mandatory neck exploration and a particularly "low threshold" for bilateral exploration are the key to managing these injuries.

Adolescent↗
PubMed1994

Delayed tension pneumopericardium after thoracotomy for penetrating chest trauma.

Tension pneumopericardium is a rare entity typically described in premature infants requiring positive-pressure ventilation. However, recent reports suggest an increase in its occurrence in adults. A case of delayed postoperative tension pneumopericardium in an adult patient is presented with a review of the history, pathophysiology, presentation, and treatment of this entity.

Adult↗