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At least 433 records · Page 24Linked to original sources
PubMed1993

Priorities in the management of multiple trauma: intracranial versus intra-abdominal injury.

UNLABELLED: Setting priorities in the management of patients with suspected injuries to both the head and the abdomen is difficult and depends on the likelihood of different injuries. Eight hundred trauma patients were retrospectively reviewed to determine the likelihood of a surgically correctable cerebral injury. All 800 patients, at the time of initial evaluation, were thought to have potentially correctable injuries to both the head and the abdomen. Of these, 52 had a head injury requiring craniotomy; 40 required a therapeutic celiotomy. Only three patients required both craniotomy and therapeutic celiotomy. There were more cases of delay in therapeutic celiotomy because of negative results of computed tomographic (CT) scanning of the head (13 cases) than there were delays in craniotomy because of nontherapeutic celiotomy (four cases). Need for craniotomy, based on emergency department evaluation, was indicated by the presence of lateralizing neurologic signs. Low Glasgow Coma Scale score, anisocoria, fixed/dilated pupils, loss of consciousness, facial or scalp injuries, and age were of no independent value in predicting the need for craniotomy. CONCLUSIONS: Patients with surgically correctable injuries of both the head and the abdomen are rare. In stable patients with altered mental status and potential injuries to both the head and the abdomen, the abdomen is best evaluated first by diagnostic paracentesis. If paracentesis does not return gross blood, CT scanning of the head should be done.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗
PubMed2003

Quality of multiple trauma care in 33 German and Swiss trauma centers during a 5-year period: regular versus on-call service.

BACKGROUND: The purpose of this study was to evaluate process and outcome quality of severely injured patients admitted during on-call (OC) versus regular trauma service (RS). METHODS: This was a prospective and multicentric analysis of the Trauma Registry of the German Trauma Society. Patients were evaluated if directly admitted from the scene of accident with an Injury Severity Score of > 15 and if alive on arrival at the emergency department. RESULTS: Seventy percent of patients were admitted during OC; these patients were significantly younger. Blunt trauma predominated, with a 95% incidence. Falls from great heights were significantly more frequent during RS, whereas motor vehicle crashes predominated during OC. No differences were found for emergency department management (e.g., time to abdominal ultrasound, chest radiograph, or cranial computed tomography). However, time to admission to the intensive care unit was substantially longer during RS. No significant differences were found for outcome parameters such as length of intensive care unit stay, hospitalization time, incidence of organ failure, or mortality. CONCLUSION: This study demonstrates a constant quality of care provided 24 hours per day, 7 days per week in the participating hospitals. Differences within individual trauma centers were not compared and need to be assessed by internal quality management.

Germany↗
PubMedDate not supplied

[Early morphological changes of the respiratory system after blunt multiple trauma].

Pronounced changes with a specific development sequence were detected on the basis of microscopy and morphometry examinations of peculiarities of structural changes in the respiratory system in death soon after mechanical trauma concomitant with head injuries. It was demonstrated the way the severity of histomorphologic changes occurring in the lungs influence the survival time of victims after trauma (time prescription).

Erythrocyte Aggregation↗
PubMed1990

Care of the multiple trauma victim. The first hour.

Trauma is a devastating event that affects all ages. Trauma can be fatal, disabling, or disfiguring. Public awareness, education, and legislation can affect the trauma statistics of the future. Health professionals such as nurses are working toward these goals, but government and community support is also needed. If 24 per cent of trauma deaths can be prevented when appropriate medical and nursing care is provided within the first hour after injury, then health professionals and hospitals, as well as communities, are obligated to provide a system that makes "appropriate" care available. Appropriate care involves a team approach including prehospital personnel, nurses, physicians, and ancillary services, all trained in performing primary and secondary assessments. Appropriate care also includes immediate treatment of life-threatening injuries and shock during the first hour. Nurses are key members in this team approach. By utilizing assessment skills, nursing diagnosis, interventions, and constant evaluation, the trauma nurse will contribute to the decrease in preventable deaths during the first hour.

Burns↗
PubMed1992

[Clinical impact of rib fractures in single and multiple trauma].

In a retrospective study we evaluated the data regarding 126 patients (96 male/30 female) hospitalized with rib fractures between 1986 and 1989. Fifty percent of the subjects had been in a traffic accident. Eighty-five percent of the patients had 2-7 broken ribs. Sixty-two patients suffered from multiple injuries, 40% were men aged less than 40 years. Fifty-six patients were treated by pleural drainage either for hemato- and/or pneumothorax or to prevent intrapleural tension during surgical intervention under endotracheal anesthesia. Thirty-two patients underwent mechanical ventilation for between 1 and 52 days (mean 10 days). In five cases a flail chest was stabilized by ribosteosynthesis to avoid prolonged artificial ventilation. Pain relief by continuous peridural Carbostesin (bupivacaine) administration was given to 31 patients. There was a positive correlation between the incidence of pneumo- and hematothorax and the number of broken ribs. A significant association was found between multiple-injured patients died in hospital; six of them had multiple injuries. The recovery of 44 patients was interrupted by complications, predominantly of pulmonary origin (68%). The pattern and severity of concomitant injuries and interference of complications influenced the length of the hospital stay; pulmonary complications doubled it.

Adolescent↗
PubMed1999

[Temporary balloon occlusion as therapy of uncontrollable arterial hemorrhage in multiple trauma patients].

PURPOSE: Presentation of temporary balloon occlusion as an interventional radiological method for managing hemorrhage in multiply injured patients with uncontrollable loss of blood. METHOD: Temporary, non-selective arterial occlusion by introduction of a balloon catheter contralaterally to the source of bleeding has been performed since 1992 on 7 patients with multiple injuries, hemorrhagic shock requiring reanimation, and angiographic demonstration of an arterial hemorrhage in the supply region of the internal iliac artery with complex pelvic fracture. In each case a PTA balloon catheter was introduced transfemorally, non-selectively positioned proximal to the bleeding source, and left in place for 24-48 h under manometric control. Control angiographies were performed prior to catheter removal. RESULTS: The bleeding was stopped immediately in all 7 patients. The hemodynamic stability made transport and thus further surgical management and/or a short-term treatment in the intensive-care station possible. Control angiographies confirmed that the bleeding had stopped in all patients. CONCLUSIONS: We recommend temporary balloon occlusion as a rapid and effective method for the management of bleeding in otherwise uncontrollable traumatic hemorrhages in the supply region of the internal iliac artery.

Adult↗
PubMedDate not supplied

Emergency nursing management of the multiple trauma patient.

This case study reinforces key principles in caring for multiply injured trauma victims. The Primary Survey is a tool developed to allow those caring for trauma patients to prioritize injuries. Those injuries identified in the Primary Survey will be the most life threatening.

Adult↗