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.

SourceResearch connectionFrom yearThrough year

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

At least 901 records · Page 50Linked to original sources

PubMedDate not supplied

Head trauma. Perioperative nursing implications.

1. The highest mortality rate in the adult trauma patient population is among those presenting with acute head trauma and associated multiple trauma. 2. Motor vehicle crashes are the leading cause of head trauma, with alcohol being a primary associated factor. The other major mechanisms of head trauma are falls and assaults. 3. Secondary brain injury is a result of brain swelling and intracranial hemorrhage causing hypoxia and ischemia of the brain tissue. 4. The goals of surgical intervention are to evacuate intracranial hematoma and prevent increases in intracranial pressure.

Craniocerebral Trauma↗

PubMed1991

Heparin, deep venous thrombosis, and trauma patients.

One hundred consecutive patients with multiple trauma, who were admitted to a level I trauma center with an injury severity score of 10 or greater, were studied prospectively. A duplex scan was used to evaluate each patient initially and at set intervals during the hospitalization for the presence of deep vein thrombosis (DVT). The prophylactic regimen for DVT in this study was 5,000 U of subcutaneous heparin every 12 hours. This was used in 50 patients at the discretion of the attending physician, while the remaining 50 patients received no DVT prophylaxis. Fourteen of 50 patients (28%) who were receiving heparin developed DVT, while only 1 patient (2%) of the 50 who did not receive heparin developed DVT. The use of heparin did not provide any significant protection in the susceptible trauma patient. It is believed that those patients with minimal lower extremity injuries, lower injury severity scores, and a shorter period of immobilization do not require any form of DVT prophylaxis. However, those patients at increased risk for DVT are better served with either increased doses of heparin or alternative forms of DVT prophylaxis.

Adolescent↗

PubMed2000

[Prevention of venous thromboembolism in polytraumatized patients. Epidemiology and importance].

OBJECTIVE: Unfractionated heparin, low-molecular-weight heparin (LMWH), mechanical compression, and vena cava filters are part of a large panel of chemical or physical methods proposed to trauma patients as prophylaxis against venous thromboembolism. This prophylactic strategy is based on a 1961 autopsy survey showing a 16.6% rate of pulmonary embolism in this population. The objective of this study was to assess the incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE) in multiple trauma patients. METHODS: A Medline and Current Contents search was conducted for prospective studies including trauma patients with ISS > 9 whose incidence of DVT and PE was evaluated by contrast venography and/or duplex scan and by ventilation/perfusion lung scan and/or pulmonary angiography and/or autopsy, respectively. RESULTS: Twelve studies met the selection criteria for DVT. Among the global population of 2,374 trauma patients (14% of all admissions) 47% suffered lower limb injury and 17% had severe head injury. Overall incidence of DVT was about 20%. It was about 38% in patients without prophylaxis (range 2 to 61.5%) and about 13% in patients with prophylaxis (range 0.8 to 37%). Similar variations were observed for proximal DVT. In comparative studies (unfractionated heparin versus LMWH or versus mechanical compression devices), the incidence of thromboembolic events varied from 3.2 to 44% in patients given unfractionated heparin, 0.8 to 31% in those given LMWH, and 3.1% to 12% with mechanical compression. Thirteen studies met the selection criteria for PE and included an overall population of 4,245 trauma patients where the diagnosis of PE was suspected only if the patient had clinical signs. The incidence of PE and fatal PE was about 1.4% and 0.3% respectively. Only one study systematically studied the presence of PE and showed an incidence of 18.7% for PE in a population of 32 patients. DISCUSSION: The current literature reports wide variability in methodology, characteristics of the study population and prophylaxis. These differences explain the wide variability from one study to another in the risk factors for venous thrombosis identified by univariate and multivariate analysis. CONCLUSION: Current methodological imperfections make it impossible to correctly assess the incidence of DVT and PE in the multiple trauma population. Studies with a rigorous methodology using a precise stratification of the trauma injuries are required to determine the real risk for DVT/PE in trauma patients and to assess the impact of early systematic prophylaxis.

Adolescent↗

PubMed1993

[Polytrauma: comparison of the hospital course after air- (with emergency physician) versus ground transport (without emergency physician)].

We analyzed the influence of initial intensive care at the accident site performed by an emergency physician and followed by helicopter transport on the course during hospital stay in patients with multiple trauma. We therefore compared the dates of 107 patients transported by the swiss air rescue (REGA) and an emergency physician with 131 patients transported by an ambulance and paramedic staff. By similar case material the REGA-patients showed a higher injury severity grade. Mortality of the REGA-patients was significantly higher (21%) than of the ambulance-patients (10%), but length of stay was significantly shorter and morbidity identical. We suspect, that the higher mortality of the REGA-patients is explained by the large number of surgically nontreatable severe traumas. None of the REGA-patients arrived at hospital with circulatory insufficiency whereas 4 of the ambulance-patients were in state of shock. We assume that first of all primary treatment of the scene of injury by an emergency physician and eventually also transport by helicopter have a positive effect on the course of patients with multiple trauma during hospital stay.

Adult↗

PubMed1998

[Attempted suicide--a challenge for the trauma surgeon?].

The data from 767 patients after a suicide attempt or suicide were analyzed retrospectively. Skeletal damage was present in 52% of the patients. This was also the highest percentage in the breakdown of the injury patterns, followed by damage of the central nervous system (26.6%). Injuries to parenchymatous organs (20.1%) took third place. Extensive soft tissue injuries were diagnosed in 18.1% and relevant vascular lesions in 16% of suicide cases. At the same time, the high percentage of multiple trauma patients (22.9%) reflects the severity and the extent of injuries suffered in the application of "violent methods". Injuries of suicide cases involving violence often resemble those of serious road traffic accidents. In contrast to unselected patients, the injury pattern of suicide cases with multiple trauma is dominated by jumps from a great height and being run over by a train. However, when unusual suicide techniques are used, the surgeon's experience may soon become insufficient. To our knowledge, special traumatology wards provide the best available diagnosis and emergency care for these patients unless they have suffered purely trivial injuries.

Adolescent↗

PubMed1986

Enteral versus parenteral nutritional support following laparotomy for trauma: a randomized prospective trial.

Although enteral nutrition is considered more 'physiologic' than parenteral nutrition, there is greater published experience with parenteral nutrition in trauma patients. To compare the efficacy of these two techniques, we prospectively randomized multiple trauma patients during their admission laparotomy to receive either central venous parenteral nutritional (TPN: n = 23) or enteral nutrition by jejunostomy (Jej: n = 23). Nutritional support began on the first postoperative day; the study period continued a maximum of 14 days. There were no significant differences between the two groups in age, sex, injury severity, estimated caloric needs (3,322 TPN; 3,114 Jej), hours to achieve full prescription (77 PTN; 79 Jej), or the number of days on nutritional support (22 TPN; 25 Jej). Average daily caloric intakes, nitrogen balance results, and complication rates were also comparable. These results suggest that early postoperative jejunostomy feeding is a safe and efficacious choice for multiple trauma patients undergoing laparotomy.

Adult↗

PubMedDate not supplied

[Kidney traumatism in general surgery (65 cases)].

From September 1989 to September 1994, 65 patients, 15 females and 50 males, with a mean age of 32 +/- 14 years were admitted in the emergency unit for renal trauma. In 38.5% of cases multiple trauma was present. Lesional mechanism was most frequently contusions (49.2%) and deceleration injuries (43.1%). Gross hematuria or microscopic hematuria were presents in 72.3% of cases. The sensibility of systematic abdominal echography was 100% in case of perirenal hematoma and 65% in case of parenchymatous lesions. Only 23 patients were operated (35.3%) because of low blood pressure. None secondary operation was necessary in abstention group. Global mortality was 7.7%. Postoperative morbidity was 20% and specific morbidity in abstention group was 10.7%.

Accidents, Occupational↗

PubMed2002

Systemic and pulmonary effector cell function after injury.

OBJECTIVE: Traumatic injury initiates a complex inflammatory response that is associated with end-organ dysfunction, immunosuppression, and the development of nosocomial infection. We hypothesize that the lungs of injured patients experience a unique inflammatory response to traumatic injury in which the ability of alveolar effector cells to respond to a bacterial challenge is impaired. DESIGN: Prospective, longitudinal comparative study. SETTING: The surgical intensive care unit of an ACS level I trauma center. PATIENTS: Forty consecutive multiple trauma patients requiring mechanical ventilation. MEASUREMENT: Blood and bronchoalveolar lavage fluid were collected on admission, 24, and 48 hrs postinjury. Interleukin (IL)-6, IL-8, and IL-10 were measured in each sample initially and after lipopolysaccharide stimulation by using an ex vivo model of whole blood and bronchoalveolar lavage fluid cellular contents. Five patients who underwent elective surgery formed a control group. MAIN RESULTS: Systemic and alveolar levels of IL-6, IL-8, and IL-10 increase dramatically after severe injury. Levels of IL-6 and IL-8 in trauma bronchoalveolar lavage fluid are significantly greater than those of the systemic circulation. Whereas whole blood up-regulates production of IL-6 and IL-8 in response to lipopolysaccharide, bronchoalveolar lavage fluid cellular contents do not. In contrast, bronchoalveolar lavage fluid and whole blood from injured patients contain similar amounts of IL-10 and both up-regulate IL-10 production in response to lipopolysaccharide. CONCLUSION: The lungs of injured patients experience a profound proinflammatory response to injury more severe than that of the systemic circulation. Within this setting, the ability of alveolar effector cells to respond to a bacterial challenge is diminished compared with that of systemic cells. As such, alveolar effector cell function after injury seems to be impaired, possibly explaining the high frequency of pulmonary infection among these patients.

Adult↗

PubMed2005

Stent-graft treatment of complete acute aortic transection complicated by intussusception and pseudo-coartaction.

Aim of the study was to validate the use of endoluminal stent-graft treatment as an alternative to conventional surgery in patients affected by blunt chest trauma and aortic disruption with multiple associated lesions. We report the case of a young female admitted with diagnosis of descending thoracic aortic transection and multiple traumas following a car accident. Spiral computed tomography revealed circular disruption of thoracic aorta immediately after isthmus region with intussusception of leaflets and pseudo-coartation. Doppler analysis showed a 70 mmHg transaortic gradient. The hemodynamic evaluation confirmed the existence of severe transaortic gradient. A Gore-TAG endoprosthesis (26 x 100 mm) was selected. Intraoper-ative transesophageal echocardiography assessment was performed to monitoring the entire procedure. The final arteriogram showed an optimal sealing at proximal and distal site without endoleak with complete readjustment of intimal leaflets to the aortic wall and disappearance of transaortic gradient related to the pseudo-coartation. No complication was observed in the early postoperative and patient was discharged one month later once complete rehabilitation of associated lesion was obtained. Computed tomography scan performed before discharge revealed persistency of patent lumen of aorta with fibrosis of readjusted circumferential intimal flap. In conclusion endovascular repair of complete aortic transection may result safe and effective particularly in patients with extensive associated injuries. Indeed the severity of coexisting non-aortic lesions could be adversely affected by conventional surgery in consideration of high surgical morbidity due to open thoracotomy. Stent-graft repair allows the patient to timely undergo medical or surgical management of associated lesions and a prompt rehabilitation with shorter hospital stay.

Accidents, Traffic↗

PubMed2003

Changes in cholesterol and its precursors during the first days after major trauma.

BACKGROUND: The causes of hypocholesterolemia in the critically ill, including major trauma patients, have not yet been fully elucidated. OBJECTIVE: We tested the hypothesis that hypocholesterolemia is caused by decreased production of cholesterol precursors. DESIGN: Serum concentrations of squalene, lanosterol, and lathosterol were measured on admission, and then at 24 and 48 hours after injury using gas chromatography coupled with mass spectrometry. Serum concentrations of total low-density and high-density lipoprotein cholesterol were measured on admission and every day in the first week after injury. RESULTS: 83 consecutive patients with multiple trauma were examined. Significant drops in concentrations of lanosterol and lathosterol were found in the patients in comparison with the control group. The most profound drop was in lathosterol. CONCLUSION: Decreased synthesis of cholesterol precursors is the major cause of hypocholesterolemia in patients with multiple trauma. Lathosterol concentration is proposed as a marker of cholesterol synthesis.

Adolescent↗

PubMed2003

Blunt liver injuries in polytrauma: results from a cohort study with the regular use of whole-body helical computed tomography.

The estimated prevalence of liver injury in patients with blunt multiple trauma ranges from 1% to 8%. The objective of this study was to investigate the profile of accompanying liver injury in a cohort of polytraumatized patients who had regularly undergone contrast-enhanced, whole-body helical computed tomography (CT). We enrolled consecutive patients admitted between September 1997 and January 2001 to a level I trauma center. Clinical baseline data were compiled as part of a nationwide trauma registry. Morphologic features were evaluated descriptively, whereas prognostic variables were assessed by logistic regression analysis. We identified 218 patients [149 men, mean age 35 +/- 18 years, mean injury severity score (ISS) 35 +/- 10], 55 of whom had sustained blunt liver trauma [25.2%, 95% confidence interval (CI) 19.6-31.5%]. The prevalence of Moore III to V lesions was 10.1%. There were 99 parenchymal contusions, 15 capsular tears, and 2 liver fractures. Surgery was required in 15 patients and was best predicted by the classification of the American Association for the Surgery of Trauma [odds ratio (OR) 3.91, 95% CI 1.59-9.61]. The mortality rate was 0.0035/person/day. Patients requiring surgical repair had fourfold increased relative odds of case fatality (OR 4.50, 95% CI 1.01-19.96). Sevenfold increased relative odds were observed if liver laceration was considered the leading injury (OR 7.17, 95% CI 1.17-43.97). The prevalence of liver lacerations among multiple-trauma patients is likely to be underestimated and must be determined by the independent application of reference standards, such as helical CT. High-grade hepatic injuries and the need for surgical repair are associated with poorer survival prognosis.

Adult↗

PubMed1998

The role of a nurse in early trauma management.

Optimal care of the patient with multiple trauma injuries requires an enormous amount of effort which begins with planning and preparation of system development in which personnel are educated and trained. Guidelines must include all aspects of the patient's care and the team must be drilled well. Protocols for management should be customized to suit the facilities available and the needs of the patient. The Primary Survey provides basic data essential when life is threatened. The Secondary Survey provides detailed assessment of the various organ systems. Inclusion of Psycho-Social aspects achieves a holistic approach to the victims of Trauma.

Cardiopulmonary Resuscitation↗

PubMed1989

[Humoral and cellular changes of non-specific immune response following severe trauma].

The influence of trauma and hemorrhagic shock on the non-specific immune system has been pointed out in various experimental studies. Other investigations have also been able to find a relationship between these changes and a higher incidence of post-traumatic complications in the form of organ failure. Our aim was to demonstrate the potential changes in the cellular defense system in a clinical study on multiple trauma patients. The polymorphonuclear leukocytes (PMNL) are the main representative of the mobile, non-specific immune system. Our study revealed a significant deterioration of PMNL function after trauma. The metabolic activity and phagocytic function were mainly affected by a decrease in the concentration of so-called "opsonins." The opsonins are important for the identification and engulfment of debris (necrosis, fat emboli and thrombi) and bacterial substances (endotoxin). Next to the opsonin level, a change in the receptor configuration is important for phagocytosis. However, we could not find any substantial evidence of surface receptor alteration. The reticuloendothelial cells (RES), a stationary phagocytic system, also showed a significant reduction in clearance function in these polytraumatized patients. Similar to PMNL, these disturbances were based on the reduction of the opsonine concentration. We were able to demonstrate a significant disturbance in immune function in multiple trauma patients with post-traumatic complications compared to patients with a normal clinical course after injury. Disturbances in the PMNL function (seen after 4 days) were found to appear after the RES disturbances. Systemic interaction between these two phagocytic systems cannot be excluded and further investigation is therefore required.

Adolescent↗

PubMed1993

Trauma and multiple sclerosis: a population-based cohort study from Olmsted County, Minnesota.

Utilizing the Olmsted County, Minnesota, population-based records-linkage resource at Mayo Clinic, we identified an incidence and a prevalence cohort with multiple sclerosis (MS), a head injury cohort, and a lumbar disk surgery cohort to evaluate the association between mechanical trauma and MS onset or exacerbation. The MS cohorts consisted of 225 incidence cases (1905 to 1991) and 164 prevalence cases (December 1, 1991) of definite MS in the population of Olmsted County. We assessed the effect of mechanical trauma in the form of spinal injury or extremity fracture with regard to precipitation of MS or exacerbation of an existing neurologic deficit. Fifty-four episodes of trauma, as defined, occurred among 39 MS prevalence cases; most occurred 10 years or more after the onset of disease and were associated with existing MS-related disability. We compared the final disability status of the groups with and without trauma. We found no correlation between the occurrence of peripheral fractures and the onset of MS, exacerbation of MS, or final disability due to MS in the prevalence cohort. In a cohort of 819 head injury cases from the Olmsted County population, none developed MS within 6 months of the trauma. In a lumber disk surgery cohort of 942 local residents, there were five with MS, but onset of MS had preceded the spinal surgery in four of the five. Thus, we found no association of head injury and spinal disk surgery with onset of MS.

Cohort Studies↗

PubMed1998

Clinical and pathophysiological significance of severe neurotrauma in polytraumatized patients.

INTRODUCTION: Traumatic brain injury (TBI) is present in up to two-thirds of multiply injured patients. The degree of TBI influenced the mortality and morbidity of multiple trauma significantly. RESULTS: Important prognostic predictors are: injury severity score (ISS); Glasgow coma score [(GCS), motor score]; pupil size and reactivity; coma grade and duration; age; morphological primary brain lesion; and pathophysiological changes leading to secondary brain damage. The time course of brain edema, raised intracranial pressure and, especially, pathophysiology of disturbed cerebral blood flow and metabolism characterizes early and late periods of ischemic vulnerability. CONCLUSION: These should be taken into consideration when planning operative procedures in multiple-trauma patients. Avoidance of secondary ischemic brain damage by reducing the number of systemic insults (hypovolemia, hypotension, hypoxia) will improve prognosis of critically ill polytraumatized patients with head injury.

Brain Edema↗

PubMed1994

Immediate internal fixation for open fractures of the long bones of the upper and lower extremities.

Immediate open reduction with internal fixation was performed on 66 open fractures (54 patients) of the long bones in the upper or lower extremity, including one clavicle. Using the classification system of Gustilo, there were 13 (20%) type I, 30 (45%) type II, 11 (16%) type IIIA, six (9%) type IIIB, and six (9%) type IIIC soft tissue injuries. Thirty-two patients had associated major multiple trauma. Eighty-eight percent of the patients had good functional results using a modification of Katenjian's criteria. There were three late deep infections (4.5%), all at the sites of type III fractures. The nonunions occurred in four open fractures (6.1%). We conclude that, if a complete and timely debridement can be accomplished, immediate internal fixation of open fractures allows for improvement in ultimate function and a decrease in mortality in patients with multiple trauma. This procedure should be performed in selected patients who have type III open fractures, with careful attention to the general status of the patient and the severity of the soft tissue wound at the fracture site.

Adolescent↗

PubMed2001

[Congenital diaphragmatic hernia in a polytrauma patient].

A case of congenital, bilateral, diaphragmatic hernia in a patient with multiple trauma after a motor accident is presented. No anamnestic information was available because of the need for intubation at the accident site. After the insertion of bilateral chest tubes because of left sided pneumothorax and right sided haematopneumothorax a mediastinal mass became apparent. A CT scan revealed a bilateral diaphragmatic hernia. Problems and therapy of this condition as well as differentiation between congenital and traumatic hernias are discussed in this case report. A mediastinal mass of unknown origin in multiple trauma patients suggests the presence of traumatic diaphragmatic hernia. Diagnostic signs suggesting congenital hernia as compared to acute traumatic hernia are: unilateral or bilateral localisation in the dorsal muscular part of the diaphragm and non-suspicious appearance of parenchymal abdominal organs in relation to the size of the hernia. Diaphragmatic hernias reduce the vital and functional residual capacity of the lungs, possibly leading to respiratory complications and infections.

Aged↗

PubMed1999

Minimal invasive treatment of proximal femur fractures with the long gamma nail: indication, technique, results.

BACKGROUND: The surgical treatment of complex unstable proximal femur fractures from the trochanteric region to the middle shaft area is difficult and often highly invasive, especially in older patients with osteoporotic bones. METHODS: In 1993, we began to treat all unstable proximal femur fractures from the trochanteric region to the middle third of the shaft with the long gamma nail (LGN) and allowed the patients immediate full weightbearing after surgery. Perioperative, postoperative, and follow-up data were analyzed. RESULTS: During a 3-year period, we treated 37 patients with unstable proximal femur fractures with the LGN. Five of the patients had sustained pathological fractures, and four patients had sustained multiple trauma. The 37 operations were performed by 22 different surgeons with varying degrees of experience. The LGN implantations through maximal 40-mm skin incisions were performed in a mean skin-to-skin operation time of 125 minutes (range, 65-200 minutes) without any further complications. Thirty-one of the 37 patients were allowed immediate full weightbearing after the second postoperative day. The six patients who were not allowed full weightbearing were the ones who had multiple trauma (4) and those who were unable to walk before surgery (2). Three postoperative complications were as follows: one deep infection 4 months after surgery, one superficial infection 3 weeks after surgery, and one deep vein thrombosis 2 weeks after discharge. All three complications occurred in the group of patients who had sustained only one trauma. All traumatic fractures (n = 32) healed without any bone grafting, which means a union rate of 100%. Although immediate full weightbearing was allowed, there were no implant dislocations, implant failures, or other problems. The 30-day mortality was 0%. The follow-up examinations after a mean time of 6 months were very satisfying. All traumatic fractures were healed. The patients had symmetrical functional findings to the opposite side or before surgery, respectively, except for two patients with a leg shortening of 2 cm, two patients with an external malrotation of 10 degrees, and one patient with a hip extension deficit of 10 degrees after a pathological fracture. CONCLUSION: The LGN is, after appropriate introduction and training, a safe and easy implant for the treatment of complex proximal femur fractures from the trochanteric region to the middle shaft area. The minimal invasive technique with low risks and minimal complications and the possibility of immediate full weightbearing sets a new standard, especially for older patients with osteoporotic bones.

Adolescent↗