Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Multiple Trauma”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 451 records · Page 25Linked to original sources
PubMed2001

[Multiple trauma with craniocerebral trauma. Early definitive surgical management of long bone fractures?].

Head injuries are found in 17.6% of all trauma in-patients and are the most common cause of death after injury (26.6%) in Germany. Main factors for the initial and follow up assessment are the Glasgow Coma Scale (GCS) and pupil reaction. These are of a very predictive value for the outcome and are essential for the emergency crew to choose the adequat trauma hospital. Secondary transport to a higher level trauma center is affected by additional risk factors and a delay in diagnosis resp. treatment. This will increase mortality and must be strictly avoided. Sufficient oxygenation and circulation prevent the patient from secondary brain damage. A low GCS (< or = 8 p.) or specific additional injuries are an indication for immediate intubation. The outcome in patients with a systolic blood pressure below 90 mmHg on arrival is worse: The longer the time of correction the lower the rate of survival. After resuscitation early fracture treatment depends on hemoglobin concentration, hemostasis, oxygenation, body temperature, injury pattern and on the initial cranial CT scan. Cerebral swelling, seen or expected, is a contraindication for definitive fracture stabilization. After resuscitation reassessment should be done including a second CT scan. Cerebral monitoring is best performed by continuous measuring of the intracranial and the arterial pressure. Their difference determines the cerebral perfusion pressure which should be 60 mmHg at least. Intracranial pressure rates below 20 mmHg are favourable. Optimal management within the first days is essential for good outcome.

Adolescent↗
PubMed1989

Blunt arterial injuries associated with multiple trauma.

In this retrospective study, we reviewed the records of 62 patients who were treated at a tertiary care community teaching hospital between 1977 and 1987 for major arterial injury caused by blunt trauma. Nearly half (45%, 28/62) of the injuries were to the thoracic aorta, 24% (15/62) were to arteries of the head and neck, 21% (13/62) were to the arteries of the extremities, and 10% (6/62) were to abdominal arteries. Twenty-eight thoracic aortic transections were repaired, 25 with Dacron grafts and three by primary repair. One patient developed an adventitial hematoma in the thoracic aorta, which was evacuated. Two patients required nephrectomies secondary to renal artery injury. Ten patients with internal carotid artery dissection were successfully treated with anticoagulation therapy. Eight (13%) of the 62 patients died: four from exsanguination, one from cardiac tamponade, one from renal failure, one from pulmonary emboli, and one from cerebral infarction secondary to intracerebral edema. Such injuries are amenable to treatment, with patient and end-organ viability, if recognized and treated promptly by the trauma surgeon.

Abdomen↗
PubMedDate not supplied

Multiple trauma--stabilization and management in pediatric intensive care unit.

Unlike many medical problems which allow us the luxury of casual contemplation or a diligent search for relevant references for assistance, the care of children suffering major trauma does neither. Our only proper response to these young patients is a rapid assessment and treatment, often performed simultaneously, if we are to preserve life and limb. The anxiety this challenge presents us cannot be minimized: the almost unbelievably thin margin for error in injured youngsters, their small total blood volume, the variation in blood pressure, other vital signs and drug dosages with age, and the family's justifiable hope for a complete recovery all account, in part, for this anxiety. It is, however, precisely for these reasons that our preparation and knowledge is critical if the disability and mortality too often associated with childhood trauma are to be circumvented. Neither the price of failure nor the rewards of success can be measured--they're both too high.

Child↗
PubMed1998

[Massive gas embolism following lung inflation for thoracic tomodensitometry in a multiple trauma patient with lung contusions].

We report a case of gas embolism into both right and left circulation in a polytrauma patient with lung contusions, revealed by thoracic CT scan showing the heart and aorta filled with gas. It followed a lung inflation with a O2/N2O mixture for about 30 seconds at a pressure of at least 40 cmH2O in order to obtain apnoea for CT scan and to recruit atelectatic territories. The presumed mechanism was the passage of the O2/N2O mixture during the lung inflation manoeuvre out of disrupted airways into torn pulmonary blood vessels and pushed back into the heart chambers. The patient recovered fully. Lung inflation manoeuvre to obtain a prolonged apnoea during CT scan examinations of thorax is contraindicated in case of thorax trauma, as it carries a risk of gas embolism.

Accidents, Traffic↗
PubMed1992

Acute stabilization of the cervical spine by halo/vest application facilitates evaluation and treatment of multiple trauma patients.

The management of acute cervical spine injuries has traditionally used bed-based skeletal traction until all non-neurologic injuries have been evaluated. This treatment method substantially hinders the ability to transport patients and to perform imaging studies and surgical procedures. In contrast, early application of a halo/vest apparatus provides immediate cervical stabilization and facilitates the diagnostic work-up and treatment of the patients with multiple injuries. The records of all 78 patients admitted from February 1988 through June 1991 who had acute cervical spine fractures, subluxations, or both with a risk of instability were reviewed. All patients were treated with halo/vests and no patient deteriorated neurologically following halo/vest application. Twenty-nine patients (37%) had a total of 55 associated injuries including long bone/pelvic fractures in 17, thoracic injuries in 13, closed head injuries in 11, facial fractures in 6, noncontiguous spinal fractures in 5, and abdominal injuries in 3. The mean injury Severity Score (ISS) was 18 (range, 9-54). While in the halo/vest, 43 patients (55%) had a total of 99 diagnostic studies completed and 46 patients (59%) had a total of 76 surgical procedures performed. There were 35 neurosurgical procedures on 32 patients and 41 non-neurosurgical surgical procedures on 24 patients. Over the past year, 20 of 21 patients (95%) had their halo/vest placed in the emergency department. The data demonstrate that many diagnostic and surgical procedures need to be performed on patients with unstable cervical spine injuries.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Stages of disseminated intravascular coagulation after resuscitation in patients with massive hemorrhage and severe multiple trauma].

Changes in blood coagulation and fibrinolysis were followed up in 255 patients of intensive care wards during 5 days after effective treatment of grave and terminal stages of traumatic hemorrhagic shock. Four stages in the development of disseminated intravascular coagulation (DIC) were distinguished. Special attention is paid to the time course of the third stage with repeated hypercoagulation, suppressed fibrinolysis, and microthrombolysis in organs and tissues leading to multiple organ failure. The fourth stage of DIC is described, when involvement of the organs and generalized inflammation or sepsis is associated with remote (on days 3-5 and later) hemorrhages. These hemorrhages are apparently caused by disorders in fibrin production but not by acute fibrinolysis and consumption coagulopathy, as during the second stage of DIC.

Blood Coagulation Tests↗
PubMedDate not supplied

Nursing management of hypothermia in the multiple-trauma patient.

Hypothermia is a common complication occurring in seriously injured patients. Emergency department and prehospital protocols governing the care of trauma patients should include the assessment of core temperature and the management of hypothermia so that it does not go unrecognized and untreated.

Body Temperature↗
PubMed1996

[Resuscitation in multiple trauma].

We report on a case of successful outpatient cardiopulmonary resuscitation of cardiac arrest after blunt multisystem injury. The literature is discussed and prognostic indicators are described.

Accidents, Traffic↗
PubMed1992

[The effect of first aid and care times on the clinical course and treatment results in multiple trauma. Initial interim results of an interdisciplinary trauma registry in the St. Gallen district hospital].

QUESTION: To date little is known about the influence of variable rescue (i.e. transportation/preclinical care) and clinical care times on the clinical progress and outcome of patients suffering injuries ranging from average to severe. Having examined this question within the framework of an ongoing study of trauma, we present the first provisional results and compare them with existing documentation. METHOD: Since 15 June 1990, all cases of multiple injury have been recorded in a trauma register. The present interim investigation of 143 patients covers a period of 13.5 months. We have recorded the rescue and clinical care times and compared them with survival, disability, complications and length of stay in hospital or intensive care unit. RESULTS: 106 (74%) of the total of 143 patients were operated on an average of 5.5 hours after the accident. In cases of intracranial or intraabdominal bleeding, there was an average time lag of 220 minutes after the accident before the patient could undergo surgery. Overall, 70% of the total rescue time was spent on medical attention and waiting time in the emergency unit. The secondary transfer rate is 46%. In the case of 4 patients, it is possible that the delays involved contributed appreciably to mortality (19%. i.e. 4/21). Generally, however, no coherent and conclusive correlation could be established between prolonged rescue and clinical care times and a worsened outcome. False negative results cannot be totally excluded, since the classification of the individual degree of injury by means of ISS and TRISS is unreliable, the variable quality of medical care prior to arrival at our emergency unit has not been taken into account, and the case figures are low (possibly of a large-scale beta error). CONCLUSIONS: The database for the assessment of standard times is still inadequate. For a reliable analysis, a total number of at least 500 patients is necessary (beta error acceptable). Our own data and the meagre results of other studies support the supposition that it is not the absolute time-lapse which has prognostic significance but the qualified medical assistance provided within a critical, individual, but extremely variable time-span. The increased employment of highly qualified emergency staff and a more efficient "triage", in the sense of a clearly directed trauma regionalization, could thus lead to optimization of trauma care.

Adolescent↗
PubMed1992

[Diagnosis-related groups and injuries. Is multiple trauma underrated?].

A consecutive registration of all trauma patients admitted to the Department of Surgery, total 868, was made in 1989. Such patients constituted 20% of all surgical patients. The aim was to study the relation between the Norwegian Diagnosis-related group (DRG) cost weights and severity of injury and use of resources. The DRG system correlated reasonably well with the Injury Severity Score and use of resources, except in the case of serious multi-trauma, which seemed to be under-rated.

Adolescent↗
PubMed1992

[Judgement of prognosis in multiple trauma of patients with blunt abdominal injuries based on different useful trauma scores].

The use of trauma indices for characterisation of polytraumatized patients concerning prognoses is being discussed for nearly 30 years. In the seventies a couple of trauma indices were developed. Some of them are in use all over the world. In the Department for Trauma surgery in the General Hospital of Salzburg three of the common trauma scores were analysed and compared with one another: Injury Severity Score (Baker), Polytraumascore of the University Clinic of Hannover, Trauma index (Schreinlechner and Eber). As a rule most studies presently published are based on the Injury Severity Score. In a retrospective analysis of 62 polytraumatized patients we could show that the Trauma index of Schreinlechner and Eber is more practicable for classification of polytrauma because it shows a good correlation of score, fatality and prognoses.

Abdominal Injuries↗