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Biomedical subjects

S Brotman

Publications and source records attributed to S Brotman.

At least 37 records · Page 2Linked to original sources
PubMed1987

A second-look procedure in major blunt abdominal injuries.

A case is presented in which blunt abdominal trauma ultimately caused necrosis of portions of the small bowel in a patient. The bowel, which had been identified at the first operation as viable, was upon re-exploration 24 hours later, found to be necrotic. Consideration for a "second-look procedure" is made in cases of major blunt small bowel injury with systemic compromise.

Abdominal Injuries↗
PubMed1986

Blunt abdominal trauma in children. Special considerations in evaluation and management.

Blunt abdominal trauma, common in the pediatric patient, often presents diagnostic difficulties. Following proper resuscitation of the patient, the abdomen must be carefully evaluated. Adequate physical examination is often impossible. Computed tomography of the abdomen is preferable in the stable patient, but peritoneal lavage is occasionally useful. Nonoperative therapy is often used in management of solid visceral injuries in children, but this type of therapy necessitates frequent, careful monitoring.

Abdominal Injuries↗
PubMed1986

Massive degloving injury of the trunk.

A case of massive degloving injury of the perineum, thigh, and buttocks is presented. Hemostasis was achieved with a pneumatic anti-shock garment (PASG), followed by direct suturing of bleeding areas. A colostomy was performed. Initial conservative debridement was followed in ten days by multiple skin grafts. The patient was treated with sodium bicarbonate and mannitol to preclude myoglobinuric renal failure. Intravenous hyperalimentation was also utilized.

Accidents, Traffic↗
PubMed1986

Rural interhospital helicopter transport of motor vehicle trauma victims: causes for delays and recommendations.

One hundred twenty-six consecutive ACS Category I motor vehicle trauma patients transported by helicopter from 25 hospitals to a regional trauma center in rural Pennsylvania during a 14-month period were reviewed retrospectively. The overall mortality was 13%. Average round-trip distance was 79 miles. Interventions by the medical flight team (emergency physician/nurse) included endotracheal intubation, tube thoracostomy, and/or central venous access in 42 patients (33%) prior to lift-off. Ground time at the referring facility, from landing to lift-off, when no interventions were required of the flight team, averaged 31.2 minutes (baseline). Ground time when major therapeutic interventions were required (principally airway management), however, averaged 57.4 minutes, an 84% increase over baseline (P less than .01). A major cause of the excessive ground times was the lack of standardized diagnostic workup and stabilization of patients prior to arrival of the flight team. Recommendations for standardized emergency department preparation of trauma victims requiring aeromedical evacuation are made.

Accidents, Traffic↗
PubMed1986

Emergency medicine and surgery resident roles on the trauma team: a difference of opinion.

Although many emergency medicine residency programs are located in major trauma centers, trauma often is managed by a multispecialty team. In order to define the role of the emergency medicine resident at such centers, we sent surveys to the directors of all 64 approved emergency medicine residency programs. Of the 54 programs (84%) responding, 39 (72%) had trauma teams. Trauma team composition varied widely. Only 54% included general surgery staff physicians, and 38% included an anesthesiologist. Ninety percent of the teams included an emergency medicine resident. Overall emergency medicine residents serve as trauma captains 50% of the time and share the role with a general surgery resident 23% of the time. With the exceptions of peritoneal lavage and intubation, resuscitation procedures were shared between the general surgery and emergency medicine residents. Thirty-one percent of the respondents had air ambulances, 70% of which were staffed by emergency physicians. We conclude that emergency medicine residents are active trauma team leaders and providers.

Aircraft↗
PubMed1986

Massive transfusion without major complications after trauma.

A case of massive degloving injury of the trunk, with open pelvic fracture, and evisceration of abdominal contents from blunt trauma is presented. The most significant aspect of this case was the transfusion of 173 units of packed cells and 176 units of fresh frozen plasma in the first thirty hours. The patient ultimately recovered and returned to work.

Abdominal Injuries↗
PubMed1986

High-energy roller injuries to the upper extremity.

Eleven cases of high-energy industrial roller injuries treated between 1980 and 1984 were retrospectively reviewed. The dominant extremity was affected in nine. Six patients sustained fractures and/or dislocations, and three of these patients required fasciotomies for clinical signs of impending compartment syndromes. All fracture/dislocations, with the exception of a scapula fracture, anterior dislocation of a thumb interphalangeal joint, and a fractured coronoid process of the ulna, required open reduction with internal fixation. Three patients required split-thickness skin grafting for extensive skin degloving. Two patients required immediate amputation. Late sequelae included prolonged edema, nutritional depletion, neuroma formation of the superficial branch of the radial nerve, late carpal tunnel syndrome, and partial brachial plexus palsy. Industrial roller injuries continue to be an occupational hazard associated with more severe crushing trauma than the low-energy wringer washer injuries first described by MacCollum (11). Attention must be paid to the treatment of crushed skin, muscle, and nerves, fracture stabilization, nutritional support, and occupational therapy. Concurrent monitoring for signs of a developing compartment syndrome and complications of rhabdomyolysis is essential.

Accidents, Occupational↗
PubMed1984

Intestinal evisceration resulting from a motor vehicle accident.

Presented is the case of a motor vehicle accident (MVA) victim with hypotension and evisceration of small intestine. Vigorous resuscitation in the emergency department was required, after which a portion of small bowel was resected at laparotomy. Evisceration secondary to trauma in an MVA is a rare injury. Significant blood loss occurs. Although abdominal sepsis did not occur in our case, this is a complication for which the patient must be monitored closely.

Abdominal Muscles↗