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At least 1,135 records · Page 63Linked to original sources
PubMed1993

Thoracic trauma in Nigerians: an eight year experience.

An eight-year combined retrospective and prospective review of thoracic trauma patients managed at the University of Ilorin Teaching Hospital, Ilorin, Nigeria between 1979 and 1986 is presented. Among 239 patients fully reviewed, were 189 (79.1%) males and 50 (20.9%) females. Mean age was 29.4 +/- 14.6 years. Road traffic accidents caused injuries in 72% of patients. The need for non-operative care, limited or extensive operations reflected severity of trauma except that eight severely injured patients were dead on arrival and another 12 were alive on arrival but died during resuscitation. Overall thoracotomy and mortality rates were 5.4% and 15.3% respectively. Unlike experience in developed countries there is a low incidence of penetrating, occupational and heart injuries and a high percentage of fractures of proximal ribs without associated aortic or bronchial ruptures. There is also a high incidence of multiple trauma.

Accidents, Traffic↗
PubMed1997

[Organization, diagnosis and the treatment procedure in chest, abdominal and combined trauma].

Thoracic and associated injuries pose problems demanding enormous interdisciplinary efforts regardless of the improved organizational, diagnostic and treatment potentialities. As shown by the experience of the Emergency Surgery Section at the Pirogov Institute, rendering medical services to patients presenting chest and associated injuries require coordinated integration of specialists from various profiles along with specification of the priorities and hierarchy of the emergency measures undertaken. Over a 12-year period (1985 through 1996), a total of 6983 patients with chest, abdominal and multiple trauma are admitted. They are distributed as follows: chest trauma casualties--3286, abdominal trauma--679, and multiply injured--3018. Chest injuries are divided in close and open injuries--2843 and 444, respectively; the latter include 29 gunshot and 415 penetrating-incise wounds. The abdominal trauma group includes 679 cases, distributed as follows: spleen rupture--341, disruption of liver and mesenterium--151, and lesion to a hollow abdominal organ--187.

Abdominal Injuries↗
PubMed1991

[The polytraumatized child. Pattern of injuries, characteristics of therapeutic management and prognosis].

Accident-related injuries account for a major part of childhood morbidity and mortality. More than 25% of the patients treated at the University Clinic Aachen for severe multiple trauma are below 16 years of age. The younger the children are, the more the pattern of injuries as well as the therapeutic approach differ from the well-known standard in adults. This is due to the anatomic and physiologic differences encountered in children. A reliable and practical triage instrument is needed to overcome the problem of estimating the severity of injuries in a child. The Pediatric Trauma Score seems to fulfill these requirements.

Brain Injuries↗
PubMed1995

[External fixation of the lower limb in children].

18 children (13 boys, 5 girls) with displaced fractures of the femur (13 cases) and tibia (5) after road accidents were treated with Wagner external fixation. 5 fractures were open and 13 closed. 9 also had head injury and were unconscious. In 3 fractures the popliteal artery was torn, requiring arterial reconstruction. 15 were examined an average of 2.3 years after injury and there was full range of motion in 13. In 2 after severe injury, range of motion was 80% of normal. There was refracture after removal of external fixation in 1. We conclude that external fixation is stable and has minimal complications. We recommend it for children with comminuted fractures, multiple trauma and those in intensive care.

Accidents, Traffic↗
PubMedDate not supplied

Oxygen transport and organ dysfunction in the older trauma patient.

OBJECTIVES: To determine baseline values of cardiac index (CI) and oxygen transport variables in patients with multiple trauma within 24 hours of admission to a level I trauma center. METHOD: This project was part of a larger study comparing methods of measuring oxygen consumption (VO2) in 38 severely injured patients. Measurements of CI, oxygen delivery (DO2), and VO2 were performed every 6 hours for 24 hours. Patients were monitored for multiple organ dysfunction syndrome. RESULTS: The mean age was 59 (+/- 17) years, with 74% (n = 28) of patients 50 years or older. Patients 65 years or older had significantly lower levels of CI, DO2, and VO2. Initial age-related differences in CI (P < .001) persisted at each time period (P < .0136). Younger patients generated a higher DO2 at each time period (P < .0005). Even though there were persistent age-related differences in VO2 over time (P < .0001), no interaction between age and time was found. Survivors had lower scores for multiple organ dysfunction syndrome than did nonsurvivors (P < .0001), all of whom were 50 years or older. Mortality was 21%. CONCLUSIONS: All patients were hypermetabolic, but older patients were much less so. Younger patients progressively had increased CI and DO2 levels, whereas older patients started with low levels that remained so. Patients in each age group appeared to lock into a level of VO2 that did not change over time. These findings underscore the vulnerability of older patients to poor outcomes. As the magnitude of the postinjury response is partly age-dependent, future research should differentiate patient characteristics associated with positive outcomes among elderly trauma patients.

Adult↗
PubMed1993

Fatalities in the war in Croatia, 1991 and 1992. Underlying and external causes of death.

OBJECTIVE: To show the underlying and external causes of death and selected characteristics of those killed in the war in Croatia between March 1991 and December 1992. DESIGN: Analysis of 4339 fatalities recorded on two national mortality statistics documents that specified war operations as the cause of death: a demography mortality statistical form and a death certificate. MAIN OUTCOME MEASURES: The frequency of clinical causes of death and their association with methods of wounding, length of survival, and attendant diagnoses. RESULTS: Half of those killed were men aged 21 to 35 years. Among women killed, the majority were aged 61 to 75 years. Skull fracture with intracranial injuries was the leading cause of death (28.9%), followed by multiple traumas and injuries of unspecified site (17.9%), and thoracic wounds with lung and heart injuries (17.6%). The most common methods of wounding were bombs and fragments of other explosive devices involving 1907 persons (43.9%), followed by deaths from bullet wounds (33.0%). More than 50% of those killed had sustained multiple injuries. In 78.6% of the cases, death immediately followed the wounding.

Adult↗
PubMed1990

Adult assault as a mechanism of burn injury.

Assault by burning is an often unappreciated cause of burn injury. One hundred forty-eight of 3678 adults admitted to a major burn center with acute burn injuries sustained their burns as a result of an assault by another adult. High-risk groups included blacks and alcohol abusers. Patients were extremely reductant to describe the cause of their injury and to identify their assailant. In contrast to child abuse, very few cases go to court due to the patient's failure to press charges. There was no typical burn pattern, although the injury often did not coincide with the initial medical history. The presence of multiple trauma, occurring in 16% of these patients, must be excluded in the assaulted patient.

Adolescent↗
PubMed1989

[Plate osteosynthesis in humeral shaft fractures. Indications and results].

Non operative management of humeral shaft fractures is well recognized as the standard of care for uncomplicated injuries. Operative treatment of humeral fractures may be performed when limited indications are present as in patients with multiple trauma including ipsilateral forearm injuries, arterial injury or primary radial nerve palsy. 18 patients with humeral shaft fractures underwent open reduction and internal fixation (ORIF) using the AO plating technique at the Kantonsspital Chur from 1980 to 1986. Follow-up was available for 17 patients of whom 16 suffered from multiple injury trauma. The broad DC plate combined with lag screws was used in most cases. Two brachial artery transections were repaired at the time of primary osteosynthesis by the same surgeons with full functional recovery. Concomitant nerve injuries were repaired primarily in one case and postprimarily in 3 more cases. The overall result was excellent in 9 patients, good in 5 patients, fair in 2 patients and poor in one patient with complete brachial plexus injury. Bone healing was uneventful in all 17 patients. No infection and no delayed union or pseudarthrosis has been observed.

Adult↗
PubMed2003

[Hb 1.1 g/dl: successful treatment of a polytraumatized patient in hemorrhagic shock].

We report on the successful treatment of a seriously traumatized patient (injury severity score=59) who presented with exsanguinating hemorrhage in the emergency room. Preclinical and emergency room management included "small volume" hypertonic resuscitation as well as massive transfusion, C-clamp stabilization of a pelvic ring instability, and attachment of external fixators to multiple bone fractures. During the intensive care period,we started enteral immunonutrition immediately after an abdominal compartment syndrome was removed by laparotomy and a jejunal catheter had been inserted. Multiple fractures were stabilized rapidly and the soft tissue wounds were covered by split skin grafts. Additionally, we provided sufficient analgesia with few side effects using an epidural catheter for continuous application of local anesthetics. In summary, an effective synthesis of up-to-date strategies for preclinical, emergency room, and intensive care management prevented multiple organ failure and achieved survival with good quality of life after a "fatal" multiple trauma.

Adult↗
PubMed2004

[Diagnosis and immediate therapeutic management of limb injuries. A systematic review of the literature].

OBJECTIVE: Limb injuries are often underestimated in the diagnostic procedures initiated in the resuscitation room. Missed diagnosis is therefore a frequent consequence in this issue. A systematic analysis of evidence-based procedures was therefore investigated in this paper. METHODS: Clinical trials were systematically collected (Medline, Cochrane and hand searches) and classified into evidence levels (1 to 5 according to the Oxford system). RESULTS: Following admission of a multiple trauma patient vital functions have to be established in first priority. After stabilization a systematic clinical investigation and consecutive specific radiological procedures should rule out extremity injuries. These are the only evidence-based criteria leading to a complete detection of all limb injuries. All other aspects are only based on clinical experience or the opinion of expert committees. CONCLUSION: The quality of shock room management is mostly dependent on the experience of the " trauma team" (and especially of the trauma leader). Guidelines and specific trauma algorithms can provide a helpful instrument in this issue.

Arm Injuries↗
PubMed2001

Whole-body computed tomography in polytrauma: techniques and management.

An interdisciplinary team should be involved in the diagnosis and management of severely injured patients. The adoption of criteria for starting treatment for multiple trauma avoids underestimation of seriousness of injury. These criteria are established by the circumstances of the accident, the patterns of trauma, and the vital findings. Basic diagnosis comprises a limited number of plain films in the trauma room, including supine chest, lateral cervical spine, and pelvis, and ultrasound of abdomen, pleura, and pericardium. Organ diagnosis using CT is complementary and depends on the clinical findings and findings from the basic investigations. We recommend spiral CT (skull base 2/2/4 mm, cerebrum 8/8/8 mm native) and after intravenous contrast medium thoracic (5/7.5/5 mm) and abdominal CT (8/12/8 mm). Image reconstruction of bony structures can be added. The CT and the trauma center should be in close proximity; time-consuming transfers must be avoided. If this is not possible, a CT can be integrated in the trauma room. Our hospital trauma registry contains over 2200 entries. A quality committee has been established and external quality control is implemented.

Humans↗
PubMed1991

The epidemiology of pediatric trauma.

Trauma is the leading cause of death in children. Children in the toddler and preschool age groups are more prone to falls, poisonings, and foreign body aspirations, whereas school-age children are more likely to be involved in pedestrian and bicycle accidents. In all age groups, males are more likely to receive injuries than females. Major mechanisms of injury include motor-vehicle--occupant and -pedestrian accidents, bicycle accidents, and falls. Most injuries are blunt in nature and occur to the central nervous system, musculoskeletal system, and thoracic-abdominal area. Head injuries account for most of the injuries and fatalities in pediatric multiple trauma patients.

Adolescent↗
PubMed2004

Thoracolumbar fractures in patients with multiple injuries: diagnosis and treatment-a review of 147 cases.

BACKGROUND: The initial evaluation and treatment of patients with multiple injuries are challenging. However, little is known about thoracolumbar fractures in patients with multiple injuries. We aimed to determine the incidence of missed injuries of the thoracolumbar spine in patients with multiple injuries, to examine the reasons for the delay in diagnosis, and to study the selection of treatment options in the management and timing of surgical intervention. METHODS: One hundred forty-seven consecutive patients with acute thoracolumbar fractures and multiple trauma at the authors' hospital between 1988 and 1997 were retrospectively reviewed. The incidence of missed injuries of the thoracolumbar spine and the reasons for the delay in diagnosis were determined. All these patients were observed for a minimum of 3 years after surgery, except four who died during their hospital stay. RESULTS: Delayed diagnosis of thoracolumbar fractures was made in 28 patients (19%). There was an increased incidence of pulmonary complications (p < 0.01) and increased length of hospital stay (p < 0.05) in patients treated nonoperatively compared with patients treated operatively. Although no significant differences in the recovery rate of neurologic function (p > 0.05) were noted between the groups, the surgical patients had highly significantly less pain compared with the nonoperative patients (p < 0.01). The relationship between the timing of thoracolumbar surgery and complications failed to show statistical significance (p > 0.05). Neither the severity of injury nor the timing of surgery had any significant effect on the recovery rate (p > 0.05). CONCLUSION: Patients with blunt trauma caused by high-energy impact injuries are much more likely to have thoracolumbar fractures even if injuries elsewhere have been noted. Further radiographic studies of the thoracolumbar spine should be performed if there is any question related to a thorough and systematic examination. Choice of treatment options of thoracolumbar fractures in patients with multiple injuries is not different from that in patients with no associated injuries to other systems. Appropriate timing of thoracolumbar fracture fixation in patients with multiple injuries should not be dependent on a rigid protocol.

Adolescent↗
PubMedDate not supplied

The use of manual edema mobilization for the reduction of persistent edema in the upper limb.

Management of persistent edema with the common treatment methods reported in the literature is not always successful. Manual edema mobilization (MEM) is a relatively new treatment regimen derived from established European and Australian lymphedema reduction regimens. It includes the use of exercises, light skin-tractioning massage techniques following the lymphatic pathways, and the use of low-compression garments. The typical patient who may benefit from the use of MEM has a presumed healthy lymphatic system, is an active participant, and performs some of the techniques independently between therapy sessions. This case report describes the use of MEM on a patient with multiple trauma, which resulted in a significant reduction--78%--of the persistent edema in the affected upper limb. A theoretic rationale is offered for each MEM technique.

Adult↗
PubMed2003

[Cost analysis of acute therapy of polytrauma patients].

The rising costs of the Swiss health care system are currently a source of discussion. Precise facts about the treatment costs in Switzerland are not available. The aim of this paper is to assess the price of the acute therapy of multiple trauma patients at the University Hospital of Zurich. We analysed the exact treatment costs of 16 patients with an average Injury Severity Score (ISS) of 33.9. All these cases had a private or a supplementary insurance coverage, were foreigners or were otherwise invoiced according to the so-called hospital tariff (Spitalleistungskatalog/SLK). We developed a concept to measure the expenditure not covered by the insurance of those with a basic insurance, who entail the largest percent of all hospitalized patients. The average amount invoiced was 128,135 Swiss Francs (31,266-310,358 CHF). After subtracting the profit, gained on cases charged according to the SLK, the remaining deficit per ordinary insured was 42-65% or 33,703-138,829 CHF The range of this amount depends on the insurance status of the afflicted person. If hospitals are required to work with a balanced budget, then these losses can no longer be neglected. New forms of invoicing multiply trauma patients must be found in Switzerland.

Adolescent↗
PubMed1988

Candida septicaemia and abscess formation following multiple injuries with blunt rupture of the stomach.

A case of multiple injuries including blunt rupture of the stomach is reported. It demonstrates that Candida needs to be considered as a possible cause of continued sepsis following a ruptured viscus in the presence of multiple trauma. Surgical drainage is required in this situation, in the same way that abscesses caused by more conventional organisms require aggressive surgical treatment.

Abscess↗
PubMed2000

[CT imaging of pelvic injuries in polytrauma patients].

CT has become a major tool in the management of multiple trauma. Concerning pelvic trauma, visceral and bone injuries can be detected. We review here the different pelvic injuries focusing on CT diagnostic approach.

Fractures, Bone↗
PubMed1992

Transmylohyoid oroendotracheal intubation: a novel method.

Anesthetic management of patients with multiple trauma of the face or those undergoing multiple facial osteotomies is problematic perioperatively, because anesthetists and surgeons fight for the same space. A novel method is demonstrated with use of a nylon flexometallic tube carried across the mylohyoid muscle (floor of the mouth).

Humans↗