[Rapid progress of a severe brain stem syndrome with flaccidity of nape, of neck in two cranial injuries; immediate surgery; complete cure without sequelae].
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Brain Diseases↗
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Transient systolic hypotension. A serious problem in the management of head injury.
OBJECTIVE: To determine the frequency and clinical impact of transient systolic hypotension (systolic blood pressure < 100 mm Hg) in patients with severe anatomic head injury. DESIGN: Retrospective case-control study. SETTING: Urban level 1 trauma center. PATIENTS: Consecutive trauma patients admitted to the intensive care unit (ICU) with severe anatomic head injury, defined as Head and Neck Abbreviated Injury Scale Score of 4 or higher. One thousand thirteen trauma patients were admitted to the ICU during the study period, 157 of whom met inclusion criteria. MAIN OUTCOME MEASURES: Acute mortality, defined as death during initial ICU admission, and functional status of ICU survivors, assessed as level of function sufficient for discharge to home. RESULTS: One hundred fifty-seven patients with severe head injury had a total of 831 episodes of systolic hypotension. Fifty-five percent of the patients suffered at least one event. Patients were grouped by total number of low systolic blood pressure events and by average number of events per ICU day. The total number of hypotensive events was associated with increased mortality rates and decreased rate of discharge to home. Average daily frequency of events was associated with increased mortality rates. After stratification by admission Glasgow Coma Scale score, the effects were most dramatic in patients with an initial Glasgow Coma Scale score higher than 8. CONCLUSIONS: Transient hypotension is common in the ICU and is associated with increased acute mortality and decreased functional status in patients with head injury. The impact of this secondary insult is greatest in patients with less severe primary injury. Strict avoidance of hypotension through enhanced monitoring and active treatment appears to be important, especially in patients with higher presenting Glasgow Coma Scale scores.
Brain Injuries↗
Percutaneous versus Conventional Tracheostomy in Burned Patients with Inhalation Injury.
The aim of the study was to compare conventional tracheostomy with percutaneous dilatational tracheostomy in patients with inhalation burn injury. A total of 37 patients with severe burn injuries and associated inhalation injury, underwent percutaneous tracheostomy in our burn unit and were retrospectively compared with 22 patients who underwent conventional surgical tracheostomy. In the first group, 25 of 37 patients and in the second group 17 of 22 patients presented with partial or full-thickness burn injuries (or both) in the neck region. The cost of the procedure, operating time, complications, and incidence of pulmonary infection were recorded. There were no significant perioperative complications in the percutaneous tracheostomy group, and no patient required surgical revision or conversion to surgical tracheostomy. In the conventional tracheostomy group, 2 patients developed tracheal stenosis, 1 had a tracheoesophageal fistula, and 10 had stomal infections. The average procedure time in the first group was 9 minutes, and in the second group it was 22 minutes. The cost of the bedside percutaneous tracheostomy was one-fifth the cost of a conventional tracheostomy. The incidence of pulmonary sepsis was 45% after percutaneous tracheostomy compared to 68% after conventional tracheostomy. With the percutaneous technique, spontaneous closure of the stoma occurred within 1 to 3 days after removal of the tracheostomy tube, whereas with the conventional technique it was within 5 to 7 days. Percutaneous tracheostomy is associated with a lower complication rate and can be safely performed at the bedside. Moreover, it is faster and can be done at a lower cost than conventional open tracheostomy.
Adolescent↗
Treatment of scattered glass foreign bodies in both the superficial and deep neck: a case report.
There have not been any reports about scattered glass foreign bodies in the neck, while injuries of the head and neck region as a result of traffic accidents have been frequently reported. We report the case of a 17-year-old male injured in a traffic accident, with scattered glass foreign bodies in both the superficial and deep neck. A CT scan indicated the existence of numerous glass foreign bodies in the various layers of the neck. Most of the foreign bodies were very fine or sand-like. The wounded skin was keloidal and expected to lead to remarkable facial edema of the left side. The foreign bodies and cervical keloidal lesions with small pieces of glass were carefully removed, and then reconstruction was conducted in stages using tissue expanders. The facial edema was reversed and the aesthetic reconstruction satisfied the patient.
Accidents, Traffic↗
Battered women: a medical problem requiring detection.
A one month study of the surgical and psychiatric service of a university hospital emergency room identified thirty-seven women coming for treatment as a result of physical abuse. Thirty-three of the thirty-seven women presented at the surgical services are represented 3.8 per cent of surgical admissions in the emergency room. These women came from all ages, social and ethnic groups. They usually presented with contusions or other injuries to the head and neck. The majority would not accept psychiatric treatment but were willing to discuss the problem with the emergency room physician if encouraged. The preventive implications of these findings for the nonpsychiatric physician are discussed.
Adolescent↗
Multivascular trauma on an adolescent. Perioperative management.
Penetrating vascular injury, in particular at the neck, is a life-threatening trauma not only of the nature and the anatomic proximity of cardiovascular, aerodigestive, glandular and neurologic system but also of the development of early and late complications. The following case report describes our experience with a penetrating wound patient, who was admitted to our emergencies twelve hours after the accident. The only demonstrable objective signs included a large hematoma at the right-side of the neck and distended mediastinum on the chest X-ray. As the patient was cardiovascularly unstable he was immediately transported to the theater without any angiography. The mandatory operative exploration was initially unsuccessful and a median sternotomy with a standard cardiopulmonary bypass and deep hypothermia circulatory arrest was established to restore all the vascular lesions. Actually, the patient was in critical condition with a rupture of the right internal jugular vein, a large pseudoaneurysm of the innominate artery and an avulsion of the ascending aorta with the suspicion of a cardiac tamponade. The postoperative period lasted two full months, while complications appeared. The substantial message from this multivascular trauma is the early diagnosis of the life-threatening complications as exsanguinations, ventricular fibrillation and the ability to minimize postoperative complications, which will impair the normal functional life of the patient.
Adolescent↗
All-terrain vehicle-related deaths--West Virginia, 1985-1997.
From 1985 through 1997, the U.S. Consumer Product Safety Commission (CPSC) identified 113 deaths associated with all-terrain vehicles (ATVs) in West Virginia. This report summarizes data from the CPSC ATV-related death database and on-site and/or follow-up telephone investigations; findings indicate that approximately two thirds of deaths were caused by injury to the head or neck. Consistent use of helmets by riders can substantially reduce ATV-related deaths.
Accidents↗
[Isolated bilateral traumatic paralysis of the accessory nerve (spinal nerve)].
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Accessory Nerve Injuries↗
Penetrating neck trauma with tracheal and oesophageal injuries.
Failure to recognize early that penetrating neck wounds include the cervical oesophagus greatly increases morbidity and mortality. From an analysis of experience over 5 years (1978-1983) it emerges that, while tracheal wounds are usually recognized early, cervical oesophageal injuries are not. It is empyema which complicates such oesophageal injury and which prompts referral to a Department of Thoracic Surgery, the patients by this time being mortally ill, with septicaemia and malnutrition. Neck penetration is usually left-sided, the injuring agent usually a knife, driven downwards and medially by a right-handed assailant. Empyema is usually right-sided. Early recognition and prompt referral are associated with a low morbidity and low mortality. Late recognition and late referral carry a high morbidity rate, prolonged convalescence in those who survive, and a mortality rate of nearly 25 per cent.
Adolescent↗
Dynamic hip screw in the management of reverse obliquity intertrochanteric neck of femur fractures [Injury 36 (2005) 105-109].
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Bone Screws↗
Neurosurgical intervention in penetrating spinal trauma with associated visceral injury.
Associated injuries to the neck, chest, or abdomen are found in approximately one-quarter of all civilians with penetrating spinal cord or cauda equina injuries. While the value of and indications for general surgical exploration and repair of these injuries are fairly self-evident, the value of neurosurgical intervention in terms of neurological outcome and infection prophylaxis remains the subject of debate. To study this issue, 160 civilian patients with penetrating spinal injuries and neurological deficits were retrospectively reviewed. Associated injuries of the esophagus, trachea, bronchi, or bowel were seen in 107 individuals (67%); 33 (31%) of these patients had abdominal injuries, 25 (23%) had neck injuries, 23 (21%) had thoracic injuries, and 26 (24%) had injuries occurring at multiple sites. Of these 107 patients, 67 (63%) had complete neurological injuries and the remaining 40 (37%) demonstrated incomplete deficits. All 107 patients underwent surgical exploration and repair of their visceral injuries; in 19 of them a neurosurgical procedure was also performed for decompression of the neural elements and/or debridement of the wound. Regardless of the presence of associated visceral injuries, the mechanism of injury, and the extent of the neurological deficit, no statistically significant difference in neurological outcome was found in patients with or without neurosurgical intervention. Complications associated with neurological injury were reported in 17 (11%) of the total group of 160 patients. Four (21%) of the 19 patients who had neurosurgical intervention suffered a related complication, compared to only six (7%) of the 88 patients who were managed conservatively (p less than 0.05). Within the limitations of a retrospective review, the results of this study do not clearly support the value of routine neurosurgical intervention as an adjunct to general surgical repair in cases of spinal injury associated with penetrating visceral trauma.
Adolescent↗
INCIDENCE AND SOURCE OF CASUALTY WOUND INFECTIONS.
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Arm Injuries↗
A survey of injuries sustained in the game of touch.
Three hundred and forty-five Touch football players were retrospectively surveyed to determine the nature and incidence of injuries sustained over a one year period. The definition of injury was that it prevented playing or training for at least one week. A total of 177 injuries were sustained by 117 players who participated in a total of 1043 hours of playing and training each week. The injury rate was 4.85/1000 hours of playing or training which was less than in other football codes. This rate was significantly more (p < 0.05) among males and no relationship was evident based on representative or training status. 71% of injuries were to the lower limb. 23% of all injuries involved the ankle. Less than 3% of injuries affected the head or neck. 54% of injuries were considered mild in that they only prevented playing or training for less than two weeks. Only 17% of injuries were stated to have been caused by contact with another player. This study found that the injury rate in Touch was much less than in other football codes.
Adolescent↗
Neck sprain after motor vehicle accidents in drivers and passengers.
Neck sprain is a general term denoting a soft tissue injury of the neck, which seldom causes major disability but is considered a modern epidemic. The purpose of the present study was to determine the prevalence of sprain of the neck injury due to motor vehicle accidents (MVAs) in both drivers and passengers. In addition, the degree of seat belt wearing in both driver and passenger was analysed. A second aim was to identify groups at risk by analysing the age and gender distribution of patients with neck sprain. The results of this population-based study revealed a sharp increase in neck sprain from 1989 through 1995, whereas a more or less stable pattern was found for seat belt use. The sharp increase was found to be attributable to outpatients. Finally, we found a driver predominance as well as a female predominance; groups at risk were the 20- to 24-year-olds for drivers and 15- to 19-year-olds for passengers.
Accidents, Traffic↗
Delayed radiation-induced bulbar palsy.
We report a man with a slowly progressive bulbar palsy 14 years after radiation therapy for nasopharyngeal carcinoma. Electromyography demonstrated prominent myokymic and neuromyotonic discharges in muscles innervated by the lower cranial nerves. Late effects of radiation therapy can occur in the cranial nerve musculature that are similar to well-recognized syndromes affecting the brachial plexus and spinal cord.
Adult↗
[Animal bite injuries in the head and neck area and their care].
Animal bites in the head and neck vary in severity. Surgical treatment depends on the size, extent and site of the wound. Straightforward injuries need only to be cleaned and disinfected or may require simple surgery. Extensive, complex bites must be treated by the techniques of plastic-reconstructive surgery. Good cosmetic results can only be achieved in this way. Lacerations should be treated immediately. Bites with loss of tissue can be treated immediately by flaps, skin or composite grafts or revascularised flaps. Usually however, the wound is covered by gauze impregnated with ointment or artificial skin. Two to three weeks after granulation the lesion is reconstructed. An anti-tetanus injection must be given for every animal bite. Simple bites do not require antibiotics, but extensive wounds do. The indication for rabies vaccination is described and questions concerning the treatment of injuries caused by rabid or suspected-rabid animals are clearly explained.
Adult↗
Carotid and vertebral artery injury following severe head or cervical spine trauma.
In order to determine the frequency of neck vessel injuries, Doppler investigations were performed in 60 patients following either severe head injury (n = 29), cervical spine injury (n = 26), or combined head and cervical spine injury (n = 5). The majority of patients were referred to our hospital for early rehabilitation; before admission Doppler investigations had been performed in only 2 patients. Clinically, 3 patients sustained severe cerebral ischemia due to neck vessel trauma: 1 patient with left-sided ICA dissection after head trauma revealed Doppler abnormalities only in the early phase of the disease; the second patient demonstrated persistent Doppler abnormalities due to traumatic right-sided ICA and VA occlusion. The third patient sustained a fatal vertebral and basilar artery thrombosis following cervical spine injury. In 57 patients without clinical signs suspicious of neck vessel trauma, sonography revealed abnormalities in 3 patients (11%) with severe head injury and in 6 patients (20%) with cervical spine or combined head and spine injury, in both groups mainly related to the vertebrobasilar system. Neck vessel injury is probably an underdiagnosed complication of severe head or cervical spine trauma. Although interpretation of Doppler findings may be difficult, particularly in the vertebrobasilar system, Doppler investigations can be recommended as a screening method to exclude neck vessel injuries.
Adolescent↗
Severe laryngeal injury caused by blunt trauma to the neck: a case report.
Acute blunt laryngeal trauma can be a life-threatening event and often poses a difficult airway management problem. Patients may be unable to supply important anemnestic facts because of aphonia or intubation as a result of their injury. Therefore the immediate recognition and appropriate initial assessment and treatment are vital for a successful outcome. The first step is assuring an appropriate airway, either by careful intubation or temporary tracheotomy. An assessment of potential vascular and oesophageal injuries must be undertaken. The use of computerized tomography (CT) with contrast material is especially useful in identifying and localizing the damage caused by blunt neck injuries. Laryngeal fractures, air in the soft tissues and the extravasation of contrast material in the neck are all helpful in assessing the injuries before surgical intervention. Immediate initial surgery is aimed at stabilizing the cartilaginous framework and repairing the mucosa. We present a case of severe laryngeal injury caused by blunt trauma to the neck; our evaluation, treatment and the outcome.
Accidents, Occupational↗