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At least 1,117 records · Page 62Linked to original sources
PubMed1999

The "seat belt mark" sign: a call for increased vigilance among physicians treating victims of motor vehicle accidents.

The use of seat belts is shown to cause a specific pattern of internal injuries. Skin bruise corresponding to the site of the seat belt is known as the "seat belt mark" (SBM) sign and is associated with a high incidence of significant organ injuries. No study has yet defined the exact incidence of injuries requiring intervention at the presence of this sign. The objective of this study was to find the incidence of surgically correctable injuries in belted car occupants with a SBM sign and to define strategies of early detection and treatment of such injuries. The prospective study included consecutive patients involved in road traffic accidents who were admitted at an academic Level I trauma center. Of 650 car occupants, 410 (63%) were restrained and 77 (12%) had a SBM across the abdomen, chest or neck. The injuries of these 77 patients were compared with the injuries of belted patients without an SBM sign. Of patients with SBMs, 9 per cent had neck bruises, 32 per cent had chest bruises, 40 per cent had abdominal bruises, and 19 per cent had bruises in multiple sites. No significant neck injuries were detected. Three patients were found to have myocardial contusion, and 10 patients had intra-abdominal injuries (predominantly bowel and mesenteric lacerations) requiring laparotomy. There was a near 4-fold increase in thoracic trauma (22.5% versus 6%; P=0.01) and a near 8-fold increase in intra-abdominal trauma (23% versus 3%; P < 0.0001) between the groups of patients with and without SBMs. The presence of the SBM sign should alert the physician to the high likelihood of specific internal injuries. Routine laparotomy or mandatory evaluation by specific diagnostic tests is not justified; rather, a high index of suspicion with a low threshold for appropriate diagnostic evaluation and/or surgical exploration should be maintained for the optimal management of such patients.

Abdominal Injuries↗
PubMed1996

The pathology of hanging deaths in Western Australia.

We present here the results of a prospective study of the pathology of 233 fatalities due to hanging in Western Australia (WA). The deaths occurred during the 5 year period 1988-92. Post mortem examination of these cases was undertaken according to a standardised protocol by forensic pathologists of this office. Post mortem findings of a further 37 cases examined by medical practitioners in rural WA are also reviewed, making a useful comparison. Petechial hemorrhages, as a hallmark of asphyxiation, were present in 113 of the 233 cases (48%). An observable ligature mark to the skin of the neck was seen in 230 cases (99%). Injury to the tissues of the neck was identified in 122 cases (52%), more commonly with complete suspension of the body (62%) than incomplete suspension (46%). Neck injury was essentially equally prevalent with a slip-knot (58%) or a fixed knot (60%). Other fresh injuries besides the neck injury were present on the deceased's body in 80 cases (34%). In the 37 non-metropolitan cases, an observable ligature mark to the skin of the neck was recorded in 30 (81%). Petechial hemorrhages were described in 3 cases (8%). Internal neck injury was apparently observed in 10 cases (27%), although precise detail adequately identifying the site of injury was given in only 2 cases (5%).

Adolescent↗
PubMed1998

Blunt vascular injuries of the head and neck: is heparinization necessary?

BACKGROUND: Blunt vascular injuries to the head and neck (BHVI) represent some of the most devastating and morbid injuries seen by a trauma surgeon. This series reviewed the experience of a single institution to determine if diagnostic and therapeutic guidelines can be established for these uncommon injuries. In particular, the utility of anticoagulation in the treatment of these injuries is examined. METHODS: The institutional trauma registry of a single state-designated Level I trauma center was examined for patients with BHVI. Patients were identified and their charts reviewed individually with regard to multiple data points including the type of injury, its presentation, the treatment of the injury, and the functional outcome of the patient. RESULTS: Twenty-nine BHVI in 23 patients were reviewed from 1989 to 1997. No mortalities were noted. Among the injuries noted were 14 internal carotid artery dissections and 8 carotid artery tears. Thirteen patients had accompanying closed head injuries. Ten patients were diagnosed after an abnormal neurologic examination, and eight others were diagnosed after having carotid canal fractures. Heparin was started within 48 hours of injury in 4 patients (17%) and was used in a total of 12 patients (52%). No patient worsened neurologically after diagnosis independent of the use of heparin. Thirteen patients (57%) had no or minimal deficits upon discharge. CONCLUSION: BHVI represent a serious cause of morbidity in the patient with multiple injuries. Patients with closed head injuries and carotid canal fractures appear most at risk. A multicenter, randomized trial involving antiplatelet therapy, full systemic anticoagulation, or observation with a long-term functional assessment is indicated to determine the optimal management of these injuries.

Adolescent↗
PubMed1977

Bladder rehabilitation in patients with old spinal cord injuries with bladder neck incision and external sphincterotomy.

Seventy-five patients with neurogenic bladders underwent bladder neck incision and/or external sphincterotomy to establish effective vesical emptying and reverse progressive hydronephrosis. A second operation to achieve these goals was necessary in 11 cases. The over-all success rate of these procedures in improving urinary tract stability was 94 per cent. Complications were infrequent, with hemorrhage and impaired penile erection being the principal problems. Eradication of established urinary tract infections was poor. However, infection-related morbidity was improved.

Adolescent↗
PubMed1994

Neck strain in car occupants: injury status after 6 months and crash-related factors.

In this study, 29 individuals who sustained a neck strain as a result of a car crash were drawn from a group of physiotherapy and general practices and were followed up after 6 months. The aim was to examine relationships between the state of the neck injury at the time of follow up and crash-related factors, notably crash severity and occupant awareness. Crash severity was assessed by measurement of damage to the involved vehicles, while 6-month injury status was established through physical examinations and interviews. No statistically significant associations between crash severity and 6-month injury status were found, but subjects who were unaware of the impending collision had a greatly increased likelihood of experiencing persisting symptoms of and/or signs of neck strain, compared with those who were aware (odds ratio = 15.0; 95 per cent confidence limits: 1.8, 178). While the role of crash severity in the production and duration of neck strains remains unclear, awareness appears to have a strong protective influence and may prove to be a useful prognostic indicator in clinical settings.

Accidents, Traffic↗
PubMedDate not supplied

Occurrence, duration and prognosis of unexpected accessory nerve paresis in radical neck dissection.

Injuries to the spinal accessory nerve in connection with radical neck dissection occur frequently, despite the preservation of the nerve. Although the surgeon was unaware of any serious lesion of the accessory nerve, a trapezius paresis of varying degree was observed in about 60% of the patients during convalescence. The shoulder function improved in most patients, but major paresis with loss of essential rotary and supportive functions of the trapezius muscle persisted in 17% of the patients operated on. No further improvement was seen 18 months after the surgical trauma.

Accessory Nerve Injuries↗
PubMed1998

War injuries to the head and neck.

During the 1991-1992 war in Croatia, 7,043 wounded persons were treated at Dr Josip Bencević General Hospital in Slavonski Brod. Among them, 728 (580 soldiers and 148 civilians) had war injuries to the head and neck and were admitted to the Department of Otorhinolaryngology and Cervicofacial Surgery. There were 541 (74.3%) patients with head injuries, 117 (16.0%) with neck injuries, and 70 (9.6%) with a combination of head and neck injuries. The wounds were mostly inflicted by shell and bomb fragments (542 wounds, or 74.5%). War injuries of the facial bones were preliminarily or definitively treated. Preliminary treatment was used for the wounds with multifragmentary fractures and extensive soft-tissue defects. Definitive treatment was used in lesions of cervical structures. Immediate exploration of the neck was performed on 84 patients with penetrating neck wounds. Exploration was positive in 49 patients. Concerning long-term complications, two cases of partial paralysis of the cranial plexus and one case each of quadriplegia, hemiplegia, and glottic paralysis were recorded. To our knowledge, primary closure of war wounds to the head and neck (supported by antibiotic therapy) and reconstruction of extensive laryngotracheal injuries with the medial layer of the cervical deep fascia were used for the first time as war surgery procedures.

Blast Injuries↗
PubMed2004

Cervical impalement injury.

Impacted injuries of the head and neck are uncommon. Associated injuries can be present and can be a serious problem. We present an unusual clinical case and discuss the management of this complex injury. Head and neck injuries deserve special attention because of their enormous functional and esthetic significance. Contusion, abrasion, retained foreign bodies, laceration, and avulsion are some of the most frequent injuries. Impalement injuries are not so common. These lesions combine aspects of blunt and penetrating trauma and usually result from penetration by a large, rigid, blunt-tipped object that traverses a certain body area in a through-and-through fashion and often remains in situ at the time of presentation. There have been many case reports describing these injuries in the trunk and extremities; however, cases of head and neck impalement are still lacking in number. A case of an unusual cervical impalement is presented, together with a discussion of the management of this complex injury.

Adolescent↗
PubMed1997

Endotracheal intubation in the field improves survival in patients with severe head injury. Trauma Research and Education Foundation of San Diego.

OBJECTIVE: To measure the effect of prehospital endotracheal intubation on outcome in patients with severe head injury and the percentage of these patients intubated in the field under existing protocol. DESIGN: Retrospective case-control study. SETTING: Countywide urban trauma system. PATIENTS: Trauma patients with blunt injury and scene Glasgow Coma Score of 8 or less, transported by ground ambulance with advanced life support capabilities from January 1, 1991, to December 31, 1995. Severe head injury was defined as head or neck Abbreviated Injury Scale score of 4 or greater. Isolated severe head injury was defined as head or neck Abbreviated Injury Scale score of 4 or greater with no other Abbreviated Injury Scale component greater than 3. One thousand ninety-two patients met initial criteria; of these, 671 had severe head injury, and 351 had isolated severe head injury. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Mortality and functional status sufficient for discharge to home. RESULTS: Field intubation was associated with significant decreases in mortality from 36% to 26% in the full study group, from 57% to 36% in patients with severe head injury, and from 50% to 23% in patients with isolated severe head injury. Rate of discharge to home was unaffected by field intubation. Between 50% and 60% of study patients were intubated under current paramedic protocol, compared with intubation rates of 85% to 92% for similar patients transported by aeromedical teams operating under expanded indications for intubation. CONCLUSIONS: Prehospital endotracheal intubation was associated with improved survival in patients with blunt injury and scene Glasgow Coma Score of 8 or less, especially those with severe head injury by anatomic criteria. Broadening indications for intubation by paramedical personnel has great potential to improve outcome in patients with severe head injury.

Adult↗