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PubMed1998

Priorities in the multiple trauma patient.

The primary goal in caring for the traumatized patient is to provide effective resuscitative interventions while minimizing the time from injury to definitive care. The emergency physician is often called on to provide initial stabilization and resuscitation, which is done most effectively if one is well versed in trauma care and has an organized approach to the multiply injured patient. This article discusses several current controversies in the emergency care of trauma patients.

Humans↗
PubMedDate not supplied

[Bilateral axillary brachial plexus block guided by multiple nerve stimulation and ultrasound in a multiple trauma patient].

We present the case of a woman with multiple wounds and injuries after attempted suicide by jumping from a high place. She had multiple craniofacial injuries and fractures of both forearms requiring emergency osteosynthesis. The neurosurgeons requested that a level of consciousness be maintained for frequent assessment; therefore it was decided to provide a bilateral axillary brachial plexus block. The procedure was carried out with the aid of a nerve stimulator to locate a triple response in the left arm (radial, medial and musculocutaneous nerves) and with both ultrasound and double nerve stimulation in the right arm (medial and radial nerves). Surgery proceeded without adverse events. The location of nerves or nerve roots with both ultrasound and stimulators was highly useful in this patient in need of bilateral brachial plexus blockade. This combination, and ultrasound in particular, might be the technique of choice because it offers an image in real time and assessment of the least amount of anesthetic that seems to be needed for achieving a block.

Adult↗
PubMed2002

Burns with multiple trauma.

The purpose of this study was to determine the incidence, mechanisms, and outcomes of management in patients with multisystem trauma and associated burn injury. A retrospective review was performed of patients admitted with combined burns and trauma from 1990 through 1999. Mechanism of injury, extent of burns, associated injuries, Injury Severity Score (ISS), and patient outcomes were identified. There were 2,845 burn and 19,418 trauma admissions. Fifty-six patients (2.0% and 0.29% respectively) had combined burns and trauma. Mean ISS was 21.7 and average percentage total body surface area was 16.2. Associated injuries included fractures in 32, complex soft-tissue injury in 20, head injury in 11, and abdominal trauma in seven. Mechanism of injury was industrial in 19, motor vehicle accident in 16, house fire in 13, high voltage in six, and other in three. Skin grafting was required in 33 of 56 patients (59%). Six of 56 patients died. Mean ISS was 19.0 in survivors compared with 46.2 in nonsurvivors. The combination of burns with multiple system trauma is uncommon. Fractures are the most frequent associated injury, and the majority of patients will require skin grafting in their burn treatment. Outcomes with appropriate management are favorable and are primarily dependent on the degree of associated trauma.

Adolescent↗