Biomedical subjects
Publications and source records attributed to Maurizio A Miglietta.
Hepatic artery injuries sustained as a result of blunt abdominal trauma are rare. This case represents the first reported hepatic artery transection and the second hepatic artery injury described in children. Hepatic artery injuries are associated with high mortality, and their management is complex and controversial.
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The efficiencies of the subway system are tempered by the occurrence of accidents, some with devastating injuries. The purpose of this study is to examine our experience with traumatic amputations after subway accidents. A retrospective trauma registry review (1989-2003) of 41 patients who presented to Bellevue Hospital, New York City, with amputations from subway accidents was undertaken to examine the following end points: age, sex, Injury Severity Score, time and mechanism of accident, history of psychiatric disorders and alcohol use, admission vital signs, Glasgow Coma Scale score, amputation type, associated injuries, limb salvage rate, operative procedures, mortality, and disposition. Elevated alcohol levels and prior psychiatric diagnoses were present in 39 per cent and 17 per cent of the patients, respectively. Patients were stable on admission with a mean systolic blood pressure of 114 mmHg, hematocrit of 32, and Glasgow Coma Scale score range of 13 to 15. The most common amputation was below knee, and patients underwent an average of three operative procedures. Limb salvage was attempted in eight patients with no successes. Amputation wound infection rate was 32 per cent and mortality rate was 5 per cent. Victims of subway trauma who arrive at the hospital with devastating amputations have an excellent chance of surviving to discharge.
BACKGROUND: Critically ill nonverbal patients often have limited means of communication through eye-blinking, communication cards, and occasionally writing. We evaluated a novel computer communication device to determine its clinical utility as an alternative form of communication between patients and hospital staff. METHODS: We conducted a prospective pilot study to evaluate a communication system (LifeVoice) for intubated nonverbal trauma patients. Patients and hospital staff completed questionnaires regarding product satisfaction and utility on days 1, 3, and 7. RESULTS: Patients (n = 35) felt the system assisted them in obtaining their needs (>90%). Hospital staff (n = 42) felt the device improved patient care (96%) and comfort (91%). CONCLUSION: The system evaluated offers an effective alternative to traditional means of communication in the intensive care unit. Computer-assisted communication improves patient comfort and allows advanced patient participation in medical care. Further studies will determine whether this modality objectively improves patient care by promoting a higher degree of safety and reducing medical errors.
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Although prehospital trauma guidelines call for spine immobilization for many trauma victims, there is a lack of clarity in medical institutions as to how trauma or emergency medicine physicians should proceed to remove cervical immobilization devices (CIDs) and "clear" the spine. Despite wide variations in physicians' approaches to such matters, however, certain specific aspects of vertebral assessment in such circumstances are well documented. The authors describe and explore several of these issues with respect to initial approach to the immobilized patient, clinical clearance of the spine, radiographic evaluation of the vertebrae in victims of blunt trauma, management of spine tenderness or pain, removal of CIDs, and indications for subspecialty consultation. Critical care physicians should be reminded that the responsibility lies with them for removing CIDs and halting other spine precautions--underlying the importance of careful consultation with radiologists and other specialists.