PubMed · 7064063
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L H Pitts, N Martin. 1982. Head injuries.. https://doi.org/10.1016/s0039-6109(16)42633-2
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Facial trauma is frequent and mainly caused by motor vehicle accidents. Due to this main etiologic factor, trauma to the facial skeleton is often associated with serious injuries, commonly involving the brain, chest or abdomen. As a consequence, the initial clinical management of these patients includes control of hemorrhage and immediate assessment of life-threatening injuries, including the maintenance of the airways. Patients presenting with facial trauma are initially evaluated with a systematic clinical examination because many fractures can be accurately diagnosed by inspection and palpation alone. In these cases plain film radiographs serve only for confirmation and documentation of the diagnosis. In many other cases accompanying and extensive soft tissue swelling may clinically obscure fractures. A complete and accurate evaluation of these patients requires additional radiological imaging methods. A series of plain films may be generally sufficient but in most of the cases they can be regarded as initial screening methods for more thorough diagnosis with computed tomography (CT). In trauma patients CT is the imaging method of choice because it shows more fracture lines and displaced fragments than any other imaging modality. CT delineates soft tissue and bony structures and can localize and even characterize foreign bodies. A complete and accurate characterization of the fracture type and potentially associated complications in mandatory for the appropriate treatment and can only be achieved by careful radiological (CT) evaluation.
Brain death occurred in a 47-year-old head trauma patient following 5 days of intensive care. The procedure for multiple organ procurement was initiated. Irreversible cardiac arrest had occurred during the period in the surgical intensive therapy unit. External cardiac massage and mechanical ventilation were maintained until in situ cooling of the kidneys was achieved. The patient was taken to the operating room for nephrectomy. Both kidneys were transplanted with a favorable outcome. Procurement of kidneys from non-heart-beating donors could increase the number of available grafts for transplantation.