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PubMed2004

Ballistic study of the SAPL GC27 gun: is it really "nonlethal"?

To evaluate the potential dangers of the "nonlethal" 12-gauge single-shot handgun SAPL GC27 with Fun-Tir (FT) and mini-Gomm-Cogne (mGC) ammunition, a ballistic study was performed with both types of ammunition. Nine unembalmed human corpses covered with a cloth sheet were shot through the right and left pectoral regions. With the mGC ammunition, rib fractures were observed when the firing range was less than 2 meters, skin perforation when the range was less than 1.5 meters, with lung injuries at less than 0.2 meter; the heart and the aorta were lacerated at contact range (0 meter). No skin perforation was observed with the FT ammunition, but rib fractures were observed when it was fired at up to 2 meters. Our study shows that the mGC ammunition, shot by the CG27 firearm, can be lethal at contact range and that pellets penetrate the skin at ranges of less than 1 meter. These results led us to conclude that this weapon is too dangerous to be marketed as a "nonlethal" weapon. The term "reduced wounding power weapon" is preferable.

Firearms↗
PubMed2004

Cardiopulmonary resuscitation (CPR) using periodic acceleration (pGz) in an older porcine model of ventricular fibrillation.

Cardiopulmonary resuscitation (CPR) can be achieved by repetitive motion of the body headwards to footwards in the spinal axis, at 2 Hz and +/- 0.6 G in a juvenile pig model of ventricular fibrillation. Return of spontaneous circulation and normal neurological outcome occurred after a total of 22 min of ventricular fibrillation that included a 3-min noninterventional period [Resuscitation 56 (2003) 215; Resuscitation 51 (2001) 55]. Since older pigs have stiffer rib cages than juvenile pigs and their hemodynamic response to various stimuli might differ, this study was carried out to determine whether this method of CPR, termed pGz-CPR, was just as effective in older pigs. pGz-CPR was also compared to chest compression CPR using an automated mechanical device (CONV-CPR). Ventricular fibrillation was instituted in older pigs weighing 23-34 kg and a 3-min noninterventional period was observed, followed by 15 min pGz-CPR in eight pigs or 15 min CONV-CPR in eight pigs. Return of spontaneous circulation (ROSC) occurred after defibrillation in all eight pigs with pGz-CPR and in six of eight pigs with CONV-CPR. Two of eight pigs with CONV-CPR and none of the eight pigs with pGz-CPR had rib fractures. Hemodynamic instability 15 min after ROSC occurred in all animals with CONV-CPR whereas only three of eight pigs with pGz-CPR demonstrated hemodynamic instability (P < 0.05). We conclude that pGz-CPR in older pigs produces similar ROSC reported by other investigators in pigs without the risk of rib fractures. Further, pGz-CPR is associated with a lower incidence of periods of hemodynamic instability following ROSC than CONV-CPR.

Acceleration↗
PubMed2002

[Blood reflux through the catheter when trying catheterization of the subclavian vein is not a reliable sign in case of hemothorax].

A 36-year-old man suffered chest and neurovascular trauma, soft-tissue injury to the left arm, and trauma to facial bones and extremities. He was hemodynamically unstable and responded poorly to blood transfusion and vasoactive medication. Pneumothorax was suspected. When a tube was inserted into the left hemithorax, 1500 mL of blood was drained. A chest film revealed hemothorax and a contusion on the left lung, but no rib fractures. An attempt to catheterize the left subclavian vein yielded reflux, and blood was then transfused. The patient continued to be highly unstable and an additional 1000 mL of blood was drained. Exploratory thoracotomy revealed a ruptured subclavian vein, location of the venous catheter in the pleural cavity, and a fracture of the first left rib. After chest injury leading to hemothorax, reflux upon catheterization of the ipsilateral subclavian vein is not a sure sign of correct tip placement. Additional means for checking placement, such as assessing pressure wave morphology, should be used. A fracture of the first rib, which may not be evident on a chest x-ray, often causes a vascular lesion and thoracic hemorrhage. Incorrect insertion of a subclavian catheter may then follow.

Adult↗
PubMed2000

Nomenclature, classification, and signficance of traumatic extrapleural hematoma.

BACKGROUND: Extrapleural hematoma has been found mostly in single case reports as diagnoses with different names. Although huge extrapleural hematoma can cause ventilatory and circulatory disturbances and even death, it has received almost no attention in the literature. Certain basic and modern facts need to be clarified regarding the definition, classification, and significance of extrapleural hematoma in the practice of chest trauma. METHODS: A 10-year retrospective study was undertaken to analyze the incidence, diagnosis, management, morbidity, and mortality of patients with chest trauma and a documented extrapleural hematoma. RESULTS: The incidence of traumatic extrapleural hematoma was 34 of 477, 7.1%. The incidence of thoracic lesions was 86 of 34 = 2.5 lesions per patient, whereas the incidence of extrathoracic lesions was 30 of 34 = 0.9 lesions per patient. Associated rib fractures were found in 30 of 34, 88.2%. More than half of the patients had an associated hemothorax. A thoracotomy was used successfully to remove a huge hematoma in one patient. CONCLUSION: Extrapleural hematoma has been found to be more common than previously reported. Nomenclature and classification are suggested. One of the common injuries to the chest, particularly rib fracture, hemothorax, lung contusion, or pneumothorax might provide the surgeon with a reliable clinical clue that the patient is at inordinate risk to have associated extrapleural hematoma. A formal or mini-thoracotomy is the recommended procedure in cases of huge hematomas.

Adult↗
PubMed2004

Thoracoabdominal injuries in the elderly: 25 years of experience.

BACKGROUND: The present study was conducted to determine the clinical characteristics and outcome of hospitalized elderly patients with thoracic and thoracoabdominal injuries. METHOD: This is a longitudinal, nonblinded study using established standard of care of patients with penetrating and blunt chest trauma. From April 1972 to August 1997, 5,702 patients were hospitalized for chest injuries. Out of these patients, 171 (3%) were aged 65 or above. Of these patients, 96 (56%) had blunt trauma (group 1)--motor vehicle accident in 83 (86%) and falls in 13 (14%). The remaining 75 (44%) patients had penetrating injuries (group 2)--gunshot wounds in 47 (63%) and stab wounds in 28 (37%). RESULTS: Of the blunt trauma patients, 45% (43/96), and 15% (11/75) of the penetrating trauma patients were managed by observation alone; the remainder required surgical procedures. The overall mortality was 10% (17/171), of which mortality among penetrating and blunt trauma to the chest were 12% (9/75) and 8% (8/96), respectively. Of eight deaths due to blunt trauma, six had multiple (four or more) rib fractures. There were no deaths among the 54 patients who were simply observed, and none of them required surgery at a later date. Complication rate among the survivors was 12.3%, with only 0.4% being infectious. CONCLUSIONS: Mortality was highest among the elderly with penetrating chest trauma. Mortality was high because of cardiac and great vessel injuries in group 2, whereas multiple rib fractures and brain injuries were the higher cause of mortality in group-1 patients. Infectious complications were low among the survivors.

Abdominal Injuries↗
PubMed1986

Conservative therapy for missed esophageal perforation after blunt trauma.

An 80-year-old man was treated, non-operatively, for a distal esophageal perforation, diagnosed nine days after blunt thoracic trauma. Emergency department diagnosis was impeded by absence of mediastinal air; right chest-wall emphysema was thought to result from associated rib fractures. Conservative therapy consisting of nasogastric suction, intravenous antibiotics, right-chest tube drainage of a large communicating empyema cavity, temporary nasotracheal intubation with ventilatory support, total parenteral nutrition, and, finally, nasoduodenal intubation for elemental feeding were employed. This mode of therapy may be best in comparable elderly patients with esophageal perforation that is overlooked during the initial 24 hours after injury. Possibly, routine barium swallow in all patients with chest-wall emphysema and rib fractures would circumvent missed esophageal rupture after blunt trauma.

Aged↗
PubMed1990

Thoracic trauma in children: an indicator of increased mortality.

This study was undertaken to assess the significance of thoracic trauma as a marker of morbidity and mortality in children. During a 34-month period, 2,086 children younger than 15 years old were consecutively admitted to a Level I pediatric trauma center with blunt or penetrating trauma. For each child we prospectively recorded Trauma Score (TS), Injury Severity Score, (ISS), medical, and etiologic data. One hundred four children (4.4%) presented with thoracic trauma. The most common mechanisms of injury were pedestrian injury (36%), motor vehicle crashes (32%), and armed assault (12%). The most common injuries were pulmonary contusion (48%), pneumothorax, hemothorax, or pneumohemothorax (39%), and rib fractures (32%). Multisystem injury was present in 82% of the children. The mean TS and ISS were 11 and 27, respectively, significantly worse than scores for children without thoracic injury (15 and 7; P less than .0001). Seventy-one percent of the children were admitted to the intensive care unit, where they stayed an average of 6 days; 20% required surgery. The mortality rate was 26%. Injuries to the heart or great vessels had the highest mortality rate (75%), followed by hemothorax (53%), lung laceration (43%), and rib fracture (42%). Mortality for children with isolated chest injury was 5%, compared with rates of 20% for abdominal and chest trauma, 35% for head and chest trauma, and 39% for trauma to the head, chest, and abdomen. Less than 5% of the admissions to a pediatric trauma center incurred thoracic injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Traffic↗
PubMed1988

Nonpenetrating subclavian artery trauma.

Nonpenetrating injury to the subclavian vessels is uncommon. During a 6-year period we have treated 167 patients with injuries to the subclavian and superior mediastinal arteries. Fifteen of these injuries (9%) occurred after blunt trauma. In 10 patients the proximal segment (first and second parts) of the artery was involved. No patient had an isolated injury; the most frequent associated injuries were rib fractures (n = 11), with the first rib being involved in four of these. Total brachial plexus disruption was found in nine patients. All patients with distal artery involvement had a clavicular fracture. All had an absent radial pulse and eight had critical ischemia of the hand. Four patients were treated nonoperatively and the remainder were treated along standard lines. Brachial plexus reconstruction was not feasible in any patient. Within 2 weeks of operation, one patient died as a result of head injuries and one required amputation because of sepsis. During a 12-month period, five regained full function, one additional patient requested above-elbow amputation after 6 months, and seven had a flail anesthetic limb. Twelve of these patients were involved in automobile accidents, eight of whom were wearing lap-shoulder harness seat belts with a loose-fitting shoulder strap component that created a characteristic abrasion pattern on the torso and chest. We conclude that the torsionshearing motion allowed by this situation contributed significantly to the pattern of injury and a plea is made for correctly fitted restraining devices.

Adult↗
PubMed1997

[Ultrasound diagnosis of rib and sternum fractures].

PURPOSE: Lesions of the thoracic skeleton can sometimes be a problem in radiological diagnosis. Aim of the study was to investigate the value of ultrasound in the diagnosis of thoracic trauma in clinical practice. METHOD: Patients with thoracic trauma and suspected rib or sternal fracture were entered in the study. The results of the thoracic x-ray including a special target film and thoracic sonography were compared. RESULTS: 103 patients took part in the study (32 women, 71 men, average age 54.3 years). In x-ray the diagnosis of rib fracture was certain in 27 patients (30%). In US 56 patients (58%) had definitive signs of rib fracture. Because of multiple fractures in the same patients the total number of radiologically found rib fractures was 49, whereas 101 fractures could be detected by sonography. Also minimal pleural effusions could be found in 31 patients (32%) sonographically, only 18 of them were seen in x-ray. Larger effusions in six patients (6%) with serial rib fractures and haematothorax could all be diagnosed in x-ray and also US. The seven patients with suspected sternum fracture showed clear fracture signs in x-ray as well as US. CONCLUSIONS: Rib fractures could be found about twice as often US than x-ray. There was no difference in the diagnosis of sternal fracture. Detection of fluids (local haematoma and pleural effusion) is better via US than by x-ray. Therapeutical consequences may follow a quick bed-side diagnosis by US in a patient who needs intensive care. Other aspects after detection of a rib fracture US apart from thoracic contusion are psychological effects for the patients (usually they can cope better with their pain), the importance in the interpretation of the duration of incapacity to work and the additional information provided by expert opinions.

Female↗
PubMed2005

Thoracic Injury Investigation using PMHS in Frontal Airbag Out-of-Position Situations.

Many studies have reported multiple rib fractures sustained by an Out-of-Position (OOP) driver subjected to a frontal airbag deployment, but the injury mechanisms and thresholds remain unclear. Two successive phases occur during the bag deployment: punch-out loading of the thorax, followed by a membrane effect (Horsch et al. 1990). The aim of this study was to investigate the thoracic injuries generated by each phase separately. Tests of nine post-mortem human surrogates (PMHS) were carried out on a static test bench using a driver side airbag module described by Petit et al. (2003). The steering wheel was replaced by a plate in order to increase the loading generated by the airbag. Three loading configurations were performed: membrane only, punch-out only, and both types combined. The membrane-only tests were performed with the thorax initially positioned at 13, 78 and 128 mm from the plate in order to vary the load magnitude. The punch-out and the combined tests were performed with the thorax initially 8 mm from the module. Accelerometers and angular rate sensors were fixed on the sternum and on the first, fourth, and eighth thoracic vertebrae of the PMHS. Ribs 2 to 6 were instrumented with strain gauges. The reaction force of the bag on the plate was measured using four 2-axis load cells. Results show that both pure punch-out and pure membrane loading can result in thoracic injuries. However, the rib fracture locations seemed to differ from one type of loading to the other. Moreover, for the same initial distance between the airbag module and the thorax, the injuries were more severe in the combined effect tests than in the pure punch-out or pure membrane. The nine PMHS tests formed a matrix allowing validation of a finite element model and further analysis of thoracic injury mechanisms and thresholds.

Journal Article↗
PubMed1977

Influence of post mortem changes on experimental safety belt injuries.

Belt protected car occupants involved on head-on collisions do not seem to suffer as severe injuries as unembalmed cadavers subjected to comparable simulated head-on collisions. Therefore it has been questioned if cadavers constitute adequate test specimens for study of thoracic tolerances. This investigation compares injuries in safety belt wearing living and dead pigs which have been subjected to simulated head-on collisions on an acceleration tract. Tests were performed on all 20 pigs (10 living and 10 dead). The arterial side of the circulatory system of the dead pigs was infused. The force in the safety belts, the intraaortic pressure, the impact velocity and the deceleration of the sled were recorded. The tests were high speed filmed. Post mortem examination of the pigs revealed differences in injury severity. Dead pigs more easily suffered rib fractures. Deformation of the rib cage due to stripping of the periosteum and laceration of surrounding tissue occurred mainly in the dead pigs. Laceration of intrathoracic blood vessels was seen in dead pigs while isolated heart lesions were seen only in living animals. The main cause of these differences in tolerance level seems to be post mortem changes of the mechanical properties of the different tissues. The results are valid for pigs but indicate that great care has to be exercised when results obtained from cadaver experiments are evaluated concerning thoracic tolerance.

Acceleration↗
PubMedDate not supplied

[Cortisone-induced osteoporosis: from physiopathology to treatment].

Corticosteroid-induced osteoporosis, the principal cause of "secondary" osteoporosis, is usually observed in patients under prolonged systemic corticosteroid therapy and results from the multiple effects exerted by these drugs on bone cell metabolism. Corticosteroids reduce the intestinal absorption of calcium and its tubular reabsorption, thereby negativating the calcium balance and inducing a parathyroid reaction. This reaction is responsible for an increase in bone cell remodelling, but the main manifestation of the direct effect of corticosteroids on bone is osteoblast depression, so that there is disparity between bone resorption and formation, which in turn is responsible for bone tissue deficit. Sex hormone deficiency (due to menopause or treatment) and lack of physical activities (due to the causal disease or to iatrogenic myopathy) amplify bone rarefaction. By quantifying the bone loss, modern densitometry methods provide an early risk evaluation. Osteoporosis of varying intensity exposes some 20% of patients to fractures, vertebral collapse and rib fractures. Preventive measures are always recommended, including minimal effective dose corticosteroid therapy, sodium-free diet, calcium and vitamin D supplement, sex hormone replacement and pursuance of physical activities. Once the stage of fractures by osteoporosis has been reached, the "curative" treatment aims at reducing the incidence of new fractures, either by slowing down osteoclast resorption, or by restoring the bone tissue reserve through stimulation of the osteoblasts. The usefulness of these therapeutic measures in the preventive treatment of corticosteroid-induced osteoporosis remains controverted.

Adrenal Cortex Hormones↗
PubMed2003

Management of osteoporosis in women aged 50 and older with osteoporosis-related fractures in a managed care population.

This study describes the pattern of evaluation and management of osteoporosis in women aged 50 and older following an osteoporosis-related fracture, conducted as a retrospective cohort study using the administrative claims database of a managed care organization. Subjects were women, aged 50 years and older, with at least one osteoporosis-related fracture in the years 1996-1998 who were continuously enrolled in the system's health plan for at least 6 months prior to and post-fracture. Bone mineral density (BMD) testing, diagnosis of osteoporosis, and treatment with any Food and Drug Administration-approved medication for osteoporosis were identified using CPT, ICD-9, and National Drug Codes for the 6-month post-fracture period. There were 658 women with an osteoporosis-related fracture: 189 (29%) hip fractures, 226 (34%) wrist fractures, 127 (19%) vertebral fractures, and 116 (18%) rib fractures. In the post-fracture period, 46 (7%) underwent BMD testing, 153 (23%) had a diagnosis of osteoporosis, and 220 (31%) were treated with a medication approved for the prevention or treatment of osteoporosis. Of the 220 women with medication claims, 124 (56%) were for estrogen, and 96 (44%) were for other antiresorptive agents. Of the 507 women who did not have medication claims during the 6 months prior to the fracture, only 17% had new fills after the fracture. Management of osteoporosis in women aged 50 and older with fractures was inadequate, despite the high risk of subsequent fractures and recommendations that osteoporosis be the presumptive diagnosis. Significant opportunity exists for improvement in assuring post-fracture followup care.

Aged↗