Salvage splenic function after traumatic injury.
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Adult↗
Biomedical subjects
R F Sing
Publications and source records attributed to R F Sing.
Neurogenic pulmonary edema.
Neurogenic pulmonary edema is a potential complication of severe central nervous system insult. In the patient described, neurogenic pulmonary edema resulted from gunshot injuries to the head. Aggressive supportive care and intravenous administration of dopamine successfully resolved this pulmonary complication. Although such treatment is crucial in patients with possibly reversible central nervous system injury, the patient described had irreversible brain injury. The authors discuss current theories of the pathogenesis as well as diagnosis and treatment options.
Adult↗
A new perspective on stress ulcer prophylaxis.
Gastric acid suppression by use of either antacids or histamine H2-receptor antagonist therapy is the mainstay of stress ulcer prophylaxis. Available evidence indicating an antimicrobial role for gastric acid calls for the reevaluation of gastric acid suppression. A pH of greater than 4.0 leads to bacterial overgrowth and colonization of the upper gastrointestinal tract which has been associated with nosocomial pneumonia, bacterial translocation from the gut, systemic sepsis, and multiple-organ failure. The availability of alternative therapy should discourage the routine use of acid-suppression therapy in the critically ill patient.
Antacids↗
Cholecystocolic fistula: an unusual presentation and diagnosis by endoscopic retrograde cholangiopancreatography.
This report describes a patient with a cholecystocolic fistula whose presentation was unusual because it lacked the signs and symptoms that suggest biliary disease (abdominal pain, food intolerance, and belching) and because the fistula was not visualized on barium enema but was apparent on endoscopic retrograde cholangiopancreatography after incidental pneumobilia discovered on ultrasound directed our attention to the biliary tree. A previous Billroth II with vagotomy may have predisposed to the development of the fistula.
Aged↗
Shoulder injuries in the javelin thrower.
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Athletic Injuries↗
Balloon catheter tamponade of exsanguinating facial hemorrhage: a case report.
A 42-year-old man sustained a gunshot wound to the frontal process of the left maxilla just lateral to the nasal bone medial to the maxilla that caused profuse hemorrhage. Anterior and posterior nasal packing along with packing of the gunshot wound with Vaseline gauze did not control the hemorrhage. A 28 French (30-cc balloon) Foley catheter was placed directly into the wound, and bleeding stopped immediately upon inflation of the balloon with 30 cc of sterile water. Arteriography identified bleeding from an anterior branch of the maxillary artery that was successfully embolized.
Adult↗
A case series analysis of mass casualty incidents.
INTRODUCTION: Mass casualty incidents (MCIs) are infrequent but potentially overwhelming events that can stress the capabilities of even the most organized emergency medical services (EMS) system. The Maryland EMS system has been identified as a pioneer and leader in the field of prehospital emergency care and, as with many states, Maryland's regional preparation for MCIs has been integrated into its overall EMS systems planning. OBJECTIVE: To determine how successful this integration has been by examining a three-year history of response to MCIs in Maryland. METHODS: A three-year case series of MCIs in Maryland was obtained from a Nexis national news publications search. These MCIs were cross-referenced with U.S. postal ZIP codes and the U.S. Census Bureau's ZIP code files. They were then mapped and summary statistics were prepared for analysis. Data obtained through the Maryland Health Services Cost Review Commission for all severely injured patients discharged from Maryland hospitals were obtained over the same three-year period for comparison. RESULTS: Eight MCIs occurred over a three-year period, resulting in a total of 203 injuries. An average of 25.4 +/- 10.7 injuries occurred per MCI. A total of 158 (77.8%) of injuries necessitated ambulance transportation. An average of 3.1 +/- 1.1 hospitals were involved per MCI. CONCLUSIONS: The Maryland EMS system was effective in responding to MCIs ranging in size from 10 to nearly 40 injuries. Analyzing MCIs that reoccur on a year-to-year basis should figure into the planning process for EMS systems.
Catchment Area, Health↗
Predicting survival in pediatric trauma patients receiving cardiopulmonary resuscitation in the prehospital setting.
OBJECTIVES: To determine survival in pediatric trauma patients receiving cardiopulmonary resuscitation (CPR) in the prehospital setting and to identify subgroups of patients who may have increased survival rates. METHODS: Records were obtained from the National Pediatric Trauma Registry on all pediatric trauma patients (age <19 years) over an 82-month period who received CPR at the scene of the injury. Data were recorded as to type of injury, need for additional CPR at the receiving hospital, and intubation in the field. Patient outcome was defined as: dead on arrival, dead at trauma center discharge, or alive at trauma center discharge. Univariate and logistic regression analyses were performed to identify statistical differences in survivors compared with nonsurvivors. RESULTS: Seven hundred twenty-nine patients were identified. The median age was 7.0 years, with a mean of 7.9 years; 62% were male, 37% were female, and 1% had no gender recorded. Age and gender distributions were not statistically different for the three outcomes. Eighty-seven patients (12%) were dead on arrival and an additional 458 (63%) were dead at trauma center discharge, while 184 (25%) were alive at trauma center discharge. Motor vehicle crashes accounted for 27% of admissions, and pedestrians struck by vehicle accounted for 23%. Intentional violence accounted for 18% of the accrued patients. Predictors of death in the patients who were alive at admission were penetrating injury (p = 0.001) and requirement of additional CPR at the trauma center (p = 0.001). Prehospital intubation was associated with decreased survival. Of the 641 patients who arrived at the hospital alive, 29% lived to trauma center discharge, but of the 534/641 who received prehospital intubation, only 19% lived. The mean Functional Independence Measure (FIM) scores were 38.9 (range 18 to 126). CONCLUSIONS: Survival of pediatric trauma patients after receiving CPR in the prehospital setting is significantly higher than expected in adult patients. Penetrating trauma, the need for additional CPR at the trauma center, and prehospital intubation are all predictors of a worse outcome.
Adolescent↗