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Biomedical subjects

K Solheim

Publications and source records attributed to K Solheim.

At least 55 records · Page 3Linked to original sources
PubMed1992

[Multiple injuries in pregnant women].

It is relatively uncommon for pregnant women to suffer multiple injuries. In such a situation, however, two lives are at stake. The survival of the foetus depends on the mother's condition with regard to respiratory passage, oxygenation, and hypovolemia. This last condition implies that the blood is shunted away from the uteroplacental circulation, thus endangering the foetus. The principles of treatment are the ones described in this series of articles, and furthermore, in addition to concern for the foetus. Blows against the abdomen can cause abruption of the placenta, which is a frequent cause of death of the foetus after closed trauma, and can occur up to 48 hours after the accident. This necessitates monitoring of the foetus during this period.

Accidents, Traffic↗
PubMed1992

[Multiple injuries in children].

Multiple injuries do not occur very often in children, but are important because children's general reaction to trauma is different from that of adults. This is due to the anatomic and physiological differences between children and adults, and because some injuries in children differ considerably from similar injuries in adults. It is important to know these facts, even if the methods used for resuscitation and immediate follow-up are much the same in children as in adults. A special type of injury that is seen with increasing frequency comprises the bizarre injuries caused by child abuse.

Age Factors↗
PubMed1992

[Abdominal injuries].

20% of patients with multiple injuries have abdominal injuries. Patients with massive symptoms and signs indicating abdominal injury should receive high priority in the treatment of the multiple injury patient, second only to injuries to airways and thorax. The unstable critically ill patient must undergo laparotomy without further investigation. In a patient in extremis, however, left emergency thoracotomy and clamping of the descending aorta should be performed prior to the laparotomy. Extensive abdominal haemorrhage should be treated first with a tamponade to control the bleeding, after which the patient should receive further transfusions and treatment to correct acidosis. It is then possible to proceed with further necessary surgical repair. In many patients with multiple injuries, however, the problem is to diagnose the abdominal injury. Peritoneal lavage is a sensitive but unspecific method of diagnosis, and the discovery of blood in the lavage fluid is not an absolute indication for laparotomy. Sometimes injuries to parenchymatous organs may be treated without operation. This necessitates good clinical judgment, available adequate diagnostic imaging techniques and repeated examinations by an experienced surgeon.

Abdominal Injuries↗
PubMed1992

[Trauma severity grading and quality control].

The effect of trauma may be graded by the extent of anatomical injury caused or functional derangement created. The anatomical scoring is useful in determining the trauma load in a hospital and for comparisons between hospitals. It correlates well with the need for resources. Functional scoring may be used to follow the effect of treatment of the individual patient. A combined evaluation of both anatomical injuries, physiological derangements and patient's age is necessary for individual prognostics and is used in evaluation of trauma care. The most widely used system of anatomical scoring is Injury Severity Score based on the Abbreviated Injury Scale. Trauma Score is a widely disseminated functional scoring system. These two may be combined into the TRISS method for assessing probability of survival. Under conditions of war, patients are divided into groups which either have to be operated, which can wait or which have to wait. War wounds are graded according to the extent of soft tissue damage, involvement of deeper structures and whether the wound contains foreign bodies.

Abbreviated Injury Scale↗
PubMed1992

[Multiple injuries and quality control].

A prospective registration was carried out of all patients with multiple injuries who were admitted to hospital in 1990 during the first 24 hours after the accident. The total number was 441, and included 47 patients with penetrating injuries. Such patients constituted 5% of a total of 9,000 admitted patients, and 19% of a total of 2,266 injured persons. The injuries were scored using the Trauma Score and Injury Severity Score and the probability for survival was calculated by the TRISS method. 148 patients were seriously injured, having an Injury Severity Score 16 or more. Traffic accidents were more common, and were the cause of injury in more than 50% of the patients. 15% of the patients with such injuries were under the influence of alcohol and 5% were drug abusers. The percentage under the influence of alcohol was three times as high, however, among patients injured by violence. Median ISS was 26 for the whole series, and 41 for the 41 patients who died. Mortality was significantly higher in patients older than 54 years of age than among younger patients. No patients were reduced to a vegetative state, but 13% of the surviving patients were considerably disabled. Among the 41 patients who died the main cause of death was haemorrhage in 17, and airway obstruction in five. Estimation of probability of survival showed that the mortality in this series compared well with the mortality in larger series of injured persons in America. None the less, improvement is still feasible.

Adult↗
PubMed1992

[Initial evaluation and treatment, selection by priority].

Mortality from severe multitrauma is 25-30%. Haemorrhage is the cause of one third of the deaths, either directly or indirectly as the cause of organ failure. Many trauma victims will not present alarming symptoms shortly after the accident. When high energy trauma is suspected the patient should be admitted to a resource hospital with the relevant expertise for systematic evaluation. Control over the airways and venous access should be obtained within minutes, and it should be established whether the patient is bleeding so much as to warrant emergency operation. The diagnostic work-up should have been completed within two to three hours. All severely injured patients should be treated initially at the same location, following the same routines. Due to risk of overlooking injuries, patients should not be sorted by surgical specialty in the field. Obstructed airways are more acutely life-threatening than inadequate respiration, which is more serious than decreased circulation, which is again more dangerous than impaired consciousness. In general, thoracic injuries take priority over abdominal, cerebral and orthopaedic injuries, in that order.

Emergency Medical Services↗
PubMed1992

[Multiple injuries and quality control].

A prospective registration was carried out of all patients with multiple injuries who were admitted to hospital in 1990 during the first 24 hours after the accident. The total number was 441, and included 47 patients with penetrating injuries. Such patients constituted 5 per cent of a total of 9,000 admitted patients, and 19 per cent of a total of 2,266 injured persons. The injuries were scored using the Trauma Score and Injury Severity Score (ISS) and the probability for survival was calculated by the TRISS method. 148 patients were seriously injured, having an Injury Severity Score 16 or more. Traffic accidents were most common, and were the cause of injury in more than 50 per cent of the patients. 15 per cent of the patients with such injuries were under the influence of alcohol and 5 per cent were drug abusers. The percentage under the influence of alcohol was three times as high, however, among patients injured by violence. Median ISS was 26 for the whole series, and 41 for the 41 patients who died. Mortality was significantly higher in patients older than 54 years of age than among younger patients. No patients were reduced to a vegetative state, but 13 per cent of the surviving patients were considerably disabled. Among the 41 patients who died the main cause of death was haemorrhage in 17, and airway obstruction in five. Estimation of probability of survival showed that the mortality in this series compared well with the mortality in larger series of injured persons in America. None the less, improvement is still feasible.

Adolescent↗
PubMed1991

[Waiting lists].

Explore the source record for details and available documents.

Humans↗
PubMed1991

[Angiosarcoma of the colon].

Angiosarcoma is a rare tumour, particularly angiosarcoma in the colon. We report such a case, and demonstrate the need to use other methods to supplement the ordinary morphological examination of the tumour in order to verify the correct diagnosis. This is important, in order to plan the correct treatment and follow-up of the patient.

Aged↗
PubMed1991

[Diaphragmatic injuries].

Diaphragmatic injuries are serious, since they can lead to herniation of abdominal organs into the thorax. The injury is simple to treat when diagnosed early. The operation can then be performed with direct suturing. Concomitant injuries are common, however, and complicate diagnosis and treatment in an acute situation. During the period 1980-90, 30 patients with diaphragmatic injuries where treated in Ullevål hospital, 18 after closed and 12 after penetrating trauma. 28 of the 30 patients also had associated injuries. In four patients the diagnosis was initially missed. The majority of the patients were treated by laparotomy. Four patients died during the primary admission to the hospital, one of them suddenly in delirium tremens, two from massive bleeding from a pelvic fracture and one from septicemia and multiorgan failure. One patient died four years later from pneumococcal septicemia. No patient died because of the diaphragmatic injury, and traumatic diaphragmatic hernia due to earlier injuries was not registered during the study period.

Abdominal Injuries↗