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At least 1,153 records · Page 64Linked to original sources
PubMed1994

Elective surgery for blunt cardiac trauma.

The cases of eight patients who underwent elective surgery for blunt cardiac trauma are presented. All but one experienced multiple trauma and the median Injury Severity Score was 26 (range, 18-59). A posttraumatic cardiac defect was diagnosed from 1 day up to 6.5 years (median, 3 weeks) after the accident. These included mitral regurgitation (n = 4), ventricular septal defect (n = 2), atrial septal defect with mitral regurgitation (n = 1), and ventricular aneurysm (n = 1). Elective cardiac surgery was performed from 4 weeks up to 12 years after the traumatic event (median, 18.5 months). A history of blunt chest trauma requires careful clinical follow-up supported by echocardiography in asymptomatic patients. Surgical therapy is performed according to standard techniques and the results are comparable with those of non-trauma surgery.

Adolescent↗
PubMed1994

Age and outcome in pediatric cervical spine injury: 11-year experience.

Age-related outcome in children with cervical spine injury has not been previously reported. We performed a retrospective chart review of all children with cervical spine injury who presented to a children's hospital during an 11-year period; 73 patients were identified. Their mean age was 8.6 years, with bimodal peaks at 2 to 4 and 12 to 15 years. Sixty-seven percent of the injuries were traffic-related, resulting from motor vehicle crashes affecting passengers, pedestrians, or bicyclists. Distraction and subluxation injuries were the most common injuries in children aged eight years or younger, whereas fractures were more common in older children. Younger children sustained more severe injuries than older children, as measured by the Revised Trauma Score, Injury Severity Score, and Trauma Score-Injury Severity Score estimated probability of survival, and were more likely to sustain injuries to higher levels of the cervical spine. Deaths occurred exclusively in children eight years old or younger, but the rate of occurrence of neurologic disability was similar in both groups: 26% in those eight years old and under, and 25% in those more than eight years old. The mortality in younger patients was not caused exclusively by the higher level of cervical injury, but it occurred more often in the presence of head injury and multiple trauma.

Accidents, Traffic↗
PubMed1998

[Must the accident victim be protected from the emergency physician?].

Quality control in preclinical medical care has become a matter of concern in recent years. In order to evaluate the quality of treatment one has to set standards. Most of the current standards were defined by different preclinical care organisations and are also accepted in the unique emergency medical care protocol used in the Federal Republic of Germany. Considering these standards, we retrospectively analyzed the preclinical treatment of all multiple trauma patients admitted to our department between 1985 and 1996. The major issues of this analysis were the diagnoses, the indications for invasive measures and the performance. Regarding the triage, for example, it was noted that 28% of patients who should have been admitted to a level I trauma center considering the severity of their injury were first admitted to a level III hospital and needed to be transferred later. In 7% of patients two additional mistakes and in 4% of patients more than two mistakes in the triage were noted. On the other hand, there are records of patients who were considered to be only slightly injured but received invasive treatment. Preclinical intubation and mechanical ventilation was not performed in 16.5% although the severity of injury clearly demanded it. A thoracic drain tube was not positioned in 38% of patients suffering from severe thoracic trauma (AISThorax > or = 4). Insufficient application of resuscitation volume (< 2500 ml on admission) was evident in 17% of all documented patients. According to our results, the initial evaluation of severity of injury is still a major problem and leads to wrong decisions for treatment. Although the qualification of ambulance physicians has been standardized for some years, there are still clear deficits in the preclinical management of trauma patients that need to be targeted.

Adult↗
PubMedDate not supplied

[Orthopedic treatment of the child with multiple injuries and its current progress].

We regularly use the Elastic Stable Intramedullary Nailing (ESIN) for children over seven years old with shaft limb fractures. This technique is especially adapted to pediatric traumatology, and is to be preferred to rigid osteosynthesis or osteotaxis in closed fractures. We use ESIN as a rule for femoral shaft fractures. Unstable fractures of shaft forearm, tibia and humerus are treated following this technique, as for multiple fractures of the lower limbs. Because of immediate and complete fracture stability. ESIN is especially useful in multiple trauma patients, where nursing facilities and easy transport are helpful. Moreover, re-education can be performed immediately, with a very early walk recovery.

Adolescent↗
PubMed1995

Physiologic state severity classification as an indicator of posttrauma cytokine response.

A Physiologic State Severity Classification (PSSC) derived from clustering of 17 cardiorespiratory variables was used to predict cytokine response in critically ill posttrauma patients. The PSSC defined physiologic states: A-State (A), normal stress response; B-State (B), metabolic insufficiency; C2-State (C), respiratory insufficiency. Bayesian analysis of these states defined a probability of death (Pdeath). 416 studies from 60 newly studied multiple trauma patients (70% males, Injury Severity Score = 27.5) were analyzed; 45 (75%) had sepsis (s), 28 (47%) had sepsis-adult respiratory distress syndrome (s-ARDS). Of 35 survivors (66% s, 37% s-ARDS, mean Pdeath = .42) 23% were predominantly A, 66% B, and 11% C. Of 25 deaths (88% s, 60% s-ARDS, mean Pdeath = .64) 0% were A, 44% B, and 56% C. PSSC States were correlated with incidence and mean plasma levels (pl) in picograms/mL of cytokines. 23 samples from recovering nonseptic trauma patients were used as controls.

Adolescent↗
PubMed2004

Traumatic injuries of the pelvis and thoracic and lumbar spine: does thin-slice multidetector-row CT increase diagnostic accuracy?

The objective is to evaluate different multidetector-row CT (MDCT) strategies for adequate classification of spinal and pelvic injuries. Seventy intubated patients after multiple trauma underwent conventional radiography (CR) and MDCT. Examinations included the pelvis (P), the lumbar spine (LS) and the thoracic spine (TS). Conventional radiographs, 3-mm (CT5) and 5-mm scans (CT3) and 3-mm and 5-mm scans combined with MPR (CT3R/CT5R) were compared to surgery, autopsy and clinical course. MDCT led to significantly better results than CR (P<0.01). Correlation coefficients were r=1.0 (CT3R), r=0.96 [TS] to r=1.0 [P/LS] (CT5R), r=0.8 [P] to r=1.0 [TS] (CT3), r=0.80 [P] to r=0.86 [TS] (CT5) and r=0.3 [TS] to r=0.69 [P] (CR). Fractures were identified by CT3R in 100% of cases, by CT5R in 95%, by CT3 in 90% [P]-100% [TS], by CT5 in 83.3% [LS]-90% [P] and by CR in 57.1% [TS]-87.2% [P]. Unstable fractures were identified in 100% by CT3R, CT5R and CT3, 85.7% [TS]-100% [P/LS] by CT5 and 57.1% [TS]-80% [P] by CR. Only overlapping thin-slice multiplanar reformation allows for an adequate classification of spinal and pelvic injuries and thus is highly emphasized in patients after severe blunt trauma.

Adult↗
PubMed1992

Palmitic acid kinetics in fasting, traumatized patients.

The contribution of free fatty acid oxidation to the elevation in energy expenditure after trauma has not been well characterized. Six control subjects and six traumatized patients were fasted for 48 hours and given a primed continuous infusion of (1-14C)palmitate to measure plasma palmitate and total free fatty acid kinetics. Traumatized patients had greater urinary nitrogen losses (20.8 vs. 9.3 g N per day) and a significantly greater ratio of measured to predicted resting energy expenditure (+36% vs. -6%) compared with controls. Individual and total plasma free fatty acid concentrations were similar for the two groups. The turnover and oxidation of plasma palmitate and total free fatty acids were not changed by multiple trauma. These results demonstrated that plasma free fatty acids and palmitate do not contribute to increased energy expenditure following trauma.

Adult↗
PubMed1998

Ascaris lumbricoides: a case report.

This is a case presentation of a multiple trauma patient who was infested with Ascaris lumbricoides, a roundworm. The infestation was undiagnosed until after extubation. Intraoperative anesthesia was uneventful and the patient was discharged 7 days after admission.

Adult↗
PubMed1995

[Bilateral bronchial rupture: problems of respiratory management].

The authors report the case of bilateral bronchial rupture in a 39-year-old multiple trauma patient. During the thoracotomy for right main bronchus repair, a partial left bronchial rupture was recognized because of severe hypoxaemia after left selective intubation.

Adult↗
PubMed1997

Validation of an outcome prediction model for critically ill trauma patients without head injury.

BACKGROUND: The Acute Physiology and Chronic Health Evaluation (APACHE) II system is inaccurate in predicting the risk of death in trauma patients, especially those without head injury. Using multivariate analysis of the APACHE II system in a development set, a new predictive equation was modeled. The four variables that were independently associated with mortality were PaO2/FiO2 ratio, mean arterial pressure, temperature, and the need for inotropic support. This model was tested prospectively in an independent validation set of 300 patients. METHODS: Risk of death was calculated using the APACHE II system with the diagnostic category of multiple trauma and weighting for operative intervention as required. The new model was similarly assessed using the four predictor variables and their beta-coefficients for each mechanism of injury and the entire group. The predicted risk of death derived by both models was compared with the observed mortality rate. Discrimination was calculated using a 2 x 2 decision matrix with a decision threshold of r = 0.5 and receiver operating characteristic curves. Calibration was assessed graphically and by statistical correlation. RESULTS: The observed mortality rate was 28.3% and the predicted mortality risk was 27.4% for the model and 6.26% for APACHE II. The sensitivity and specificity of the model were 58.8 and 90.7%, and the sensitivity and specificity of APACHE II were 1.2 and 100%. The areas under the receiver operating characteristic curves were 0.84 and 0.78 for the model and the APACHE II system, respectively. Calibration of the model was superior within all deciles of risk (model, R2 = 0.93, p < 0.001; APACHE II, R2 = 0.82, p = 0.02). CONCLUSION: The model accurately predicted the risk of death for the entire group. It is superior to the APACHE II system and is the highest reported sensitivity for 24-hour intensive care unit predictive models that have been applied to the critically injured.

APACHE↗
PubMed1993

Severe blunt trauma of the liver: study of mortality factors.

One hundred three victims of blunt trauma of the liver with serious hepatic lesions (classes III through V of Moore's classification) were seen over a period of 18 years, the total duration of this retrospective study being divided in two: 1973-1981 and 1982-1990. During the first period, indications for hepatic resection were extensive (56% of all surgical procedures), and overall perioperative mortality was 24%. Preference was shown for conservative treatment during the second period (71% of patients) and there was an increase in perioperative mortality to 34%. This increase was not attributable to the decrease in the number of excisions but rather to an increase in the severity of hepatic lesions between the two periods (the rate of class V lesions rising from 17% to 26% of cases) and the rate of multiple trauma (rising from 41% to 95%), with mortality linked to the presence of extra-abdominal lesions rising from 20% to 50% of all deaths. These results may bring into question the validity of conservative treatment for liver trauma at the present time.

Adolescent↗
PubMed1997

[Selenium deficiency favors the appearance of heart failure after multiple injury].

A 47-year-old multiple trauma patient, experiencing a C. Difficile colitis with diarrhoea, developed diffuse oedema with peritoneal and pleural effusion due to global heart failure. Selenium deficiency, reported in trauma patients, may explain the occurrence of cardiomyopathy. The role of selenium in cardiac dysfunction and the various situations inducing a selenium deficiency are discussed.

Clostridioides difficile↗
PubMed1998

[Comparison of severe multiple injuries in childhood and adulthood].

Multiple injuries in children are responsible for a great part of childhood mortality. Remaining handicaps after injuries have a social and economic significance. In this study, the characteristics of polytrauma in childhood are evaluated by comparison with severely injured adults. The two groups of multiple trauma patients (117 children between 3 and 15 years of age and 1159 adults between 16 and 59) were equal in the overall severity of all injuries. Children were mainly hurt as pedestrians, whereas adults had an accident more often as car passengers. The most frequently injured region were in both groups fractures of the extremities. The greatest injury severity represented head injuries in each group. Complications were seen more often in adult patients. Multiple organ failure and isolated liver failure were exclusively seen in the adult group, pneumonia and lung failure occurred significantly more often. The duration of artificial ventilation and the duration of hospital stay were prolonged in the adult group. In summary, children with multiple injuries have a lower mortality rate than adults. The main cause of death are cerebral injuries. Remaining handicaps in surviving children are most often caused by fractures of the lower extremities.

Adolescent↗
PubMed1999

Helical CT in emergency radiology.

Today, a wide range of traumatic and nontraumatic emergency conditions are quickly and accurately diagnosed with helical computed tomography (CT). Many traditional emergency imaging procedures have been replaced with newer helical CT techniques that can be performed in less time and with greater accuracy, less patient discomfort, and decreased cost. The speed of helical technology permits CT examination of seriously ill patients in the emergency department, as well as patients who might not have been taken to CT previously because of the length of the examinations of the past. Also, helical technology permits multiple, sequential CT scans to be quickly obtained in the same patient, a great advance for the multiple-trauma patient. Higher quality CT examinations result from decreased respiratory misregistration, enhanced intravenous contrast material opacification of vascular structures and parenchymal organs, greater flexibility in image reconstruction, and improved multiplanar and three-dimensional reformations. This report summarizes the role and recommended protocols for the helical CT diagnosis of thoracic aortic trauma; aortic dissection; pulmonary embolism; acute conditions of the neck soft tissues; abdominal trauma; urinary tract stones; appendicitis; diverticulitis; abdominal aortic aneurysm; fractures of the face, spine, and extremities; and acute stroke.

Abdominal Injuries↗
PubMed1996

Missed injuries in abdominal trauma.

Injuries missed at initial diagnoses or operations have the potential to cause disastrous complications in abdominal trauma patients. The aim of this retrospective study is to assess the causes and the outcomes of missed abdominal injuries. Twelve patients (2%) with missed injuries were identified among 607 abdominal trauma patients operated on from 1985 to 1993. Ten patients were male and two were female. The modes of the trauma were ten blunt injuries (83%) and two stab penetrating injuries (17%). Five cases had delayed operations because of clinical errors in the initial diagnosis. Their causative factors were obscured trauma history (two cases), radiologic misinterpretation (two cases), no reliable radiologic finding (one case), and admission to inappropriate department (one case). Missed injured organs were spleen (two cases), liver (one case), diaphragm (one case), and rectum (one case). Median delayed time was 7 days (3 to 96 days). Another seven cases of injuries were missed at the time of initial operation because of incomplete exploration. Their causative factors were surgical inexperience (two cases), severe peritoneal adhesions (one case), neglected exploration of retroperitoneal hematoma (two cases), underestimated mesocolic vascular injury (one case), and early contraction of the perforating wound with intraoperative hypotension (one case). Missed injured organs were stomach (two cases), duodenum (one case), rectum (one case), pancreas (one case), urinary bladder (one case), and rectosigmoid mesocolon (one case). Median time interval between initial and second operation was 9 days (4 to 32 days). Two patients died of complications directly related to their missed injuries. Major complication and mortality rates of missed injuries were 83 and 17%, respectively. These were significantly higher compared with those (39 and 6.3%, respectively) of detected abdominal injuries. We conclude that missed abdominal injuries can cause high mortality and morbidity, and, therefore, a systematic approach, including careful history taking, complete diagnostic procedure, complete surgical explorations, and early reoperation are mandatory for patients with multiple trauma.

Abdominal Injuries↗
PubMed1987

[The polytraumatized patient. One year's documentation with special reference to the prognostic significance of individual immune status (cell-mediated immunity)].

Fifty-four patients with multiple trauma have been investigated in a prospective one-year documentation. The following features were documented and evaluated: circumstances of the accident, condition on admission, course under special consideration of the cell-mediated immunity with Merieux multitest, course after indoor treatment.

Adult↗
PubMed1992

Clonidine in the treatment of alcohol withdrawal in the intensive care unit.

We present two cases of patients with a past history of alcohol abuse admitted to the Intensive Care Unit (ICU) for treatment of respiratory problems, after multiple trauma and after sub-total colectomy, respectively. In both patients, features of alcohol withdrawal were prominent after sedation had been discontinued. Both were treated successfully with an infusion of clonidine.

Acute Disease↗
PubMed1994

Urinary free cortisol values in children under stress.

Children with adrenocortical insufficiency are commonly instructed to increase their baseline glucocorticoid replacement doses by three to five times during periods of stress such as surgery or febrille illness. We conducted this to determine whether these recommendations reflect the actual change in urinary free cortisol (UFC) output during stress. The 24-hour UFC excretion was determined in 78 children who were admitted to a general pediatric department or intensive care unit with temperature > 38.7 degrees C, after major surgery, or during status epilepticus; we reevaluated 43 of the patients 2 weeks after recovery. In addition, the 24-hour UFC levels were determined in 127 healthy children aged 1.8 to 17 years. The UFC level positively correlated with age (r = 0.254; p < 0.001). The amount of UFC per gram of creatinine was inversely correlated with age (r = 0.255; p < 0.001). The amount of UFC per surface area was independent of age. The mean change in the level of UFC per square meter surface area was highest among children who had cardiothoracic surgery and those with multiple trauma. The increase in UFC level during bacterial infection was significantly greater than that during viral infection. The current recommendation to increase the dose to three to five times the baseline glucocorticoid dose during times of stress may underestimate the changes in UFC found in some patients with major surgery, trauma, or certain serious bacterial infections. Production rate studies are needed to prove this point.

Abdomen, Acute↗