Search PubMed⌕ Search

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.

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

At least 1,405 records · Page 78Linked to original sources
PubMed2002

Pneumonia in head-injured and severe trauma patients.

Trauma is the leading cause of death in young people. Trauma deaths have a classic trimodal distribution; in late death (3 days to 3 weeks postinjury), infection is the principal cause. Because pneumonia is a major cause of morbidity in trauma patients, early identification of subjects at a high risk of developing nosocomial pneumonia (NP) can reduce morbidity and costs. Methicillin-sensitive Staphylococcus aureus (MSSA) is the predominant pathogen in multiple-trauma patients in coma, and nasal MSSA colonization at time of severe injury may increase the risk of MSSA pneumonia. In the remaining patients, gram-negative bacilli are responsible for the majority of cases. Prolonged mechanical ventilation, continuous enteral feeding, and craniotomy are risk factors for NP in trauma patients. Diagnosis of NP in these patients is difficult because radiographic infiltrates may not highlight any infection. In coma patients, coverage with a beta-lactam active against MSSA is mandatory. Variations in organisms and sensitivities across intensive care units due to differences in demographic characteristics or comorbidities should be considered.

Journal Article↗
PubMed2004

Bilateral traumatic dislocation of testes.

Dislocation of the testis is a rare trauma. Its diagnosis depends on the awareness of the physician of its possible occurrence. It is usually a late finding during treatment of a motorcyclist brought to the emergency room because of multiple trauma injury and is sometimes demonstrated in the computerized tomographic (CT) scanning of the pelvis. We encountered bilateral dislocation of testes in a 40-year-old male due to motorcycle accident. Color Doppler ultrasonography was helpful in locating the dislocated testicle and detecting its blood flow. CT scans are often obtained to evaluate the associated injuries and to examine the area of the dislocated testis to help identify a rupture. Closed reduction is the initial treatment of choice. Immediate surgical intervention should also be performed when closed reduction has failed.

Accidents, Traffic↗
PubMed1980

[Unavoidable thoracotomies in general surgical practice].

The indications, technique and supply of urgent thoracotomies in the general surgical practice are substantiated as based on the results of treatment of 56 patients with severe traumas and acute sequellae of purulent processes of thoracic organs. Major attention is paid to difficulties in diagnosis of the character and size of the injuries of internal organs in patients with multiple traumas.

Adult↗
PubMed1989

Endogenous protein-synthesis efficiency in trauma victims.

Hyperglycemia despite increased glucose oxidation and hypoaminoacidemia despite increased rate of protein breakdown are frequently seen in hypermetabolic and highly catabolic patients with major trauma. The extent of reutilization of endogeneously produced amino acids in the synthesis of new proteins (protein recycling) by the traumatized human is poorly understood. The protein synthesis efficiency was measured in ten multiple trauma patients during the early "flow" phase of injury, and these data were compared with normal and depleted patients. In acute trauma the synthetic efficiency of protein is significantly (P = .01) low (61% +/- 4%) compared with other pathologic states (78% +/- 1%). This suggests that the priority is preferentially set to meet the increased demands of glucose production, and a major portion of the amino acids are utilized for purposes other than synthesis of body proteins. This observation should be taken into account in the early management of acute trauma patients before the body adapts to accept the exogenous supply of amino acids.

Acute-Phase Proteins↗
PubMed2005

[Unilateral dislocations of the thoracic and lumbar spine].

Unilateral dislocation is a trauma typical of the cervical spine. Case reports on unilateral dislocation of the thoracic or lumbar vertebrae can be found in the relevant literature only rarely and they often describe this condition associated with multiple trauma or combined injuries. Although unilateral dislocation is an unstable injury with rotation involved, injury to the spinal cord or spinal nerve roots is not common. Diagnosis is based on radiographic and CT examination. Therapy includes open reduction and instrumented spondylodesis of the injured segment. The cases of two patients with unilateral dislocations in the thoracic and the lumbar spine, respectively, treated at the Department of Spinal Surgery, Motol Teaching Hospital in Prague, are reported here.

Adult↗
PubMed1996

[Traumatic tricuspid insufficiency].

Traumatic tricuspid insufficiency is a rare condition. The diagnosis is difficult because of the slow progression of this pathology and the presence of more clinically acute lesions. Non-penetrating chest trauma is responsible for 90% of cases. Echocardiography is the investigation of choice for assessing the mechanism of the tricuspid regurgitation and for diagnosing associated lesions. It should be performed systematically in patients with multiple trauma. The surgical indications are difficult to determine and depend on the patients' symptoms and the type of anatomical lesions. It should be undertaken before right ventricular myocardial dysfunction. Several techniques may be used from valvuloplasty to valve replacement mainly with bioprostheses in symptomatic patients.

Adult↗
PubMed2006

Ventilator-associated pneumonia leading to acute lung injury after trauma: importance of Haemophilus influenzae.

BACKGROUND: Ventilator-associated pneumonia is a clear risk factor for acute lung injury which has been poorly described in trauma patients. This prospective study was undertaken to estimate the incidence of such ventilator-associated pneumonia leading to acute lung injury, the risk factors, and the associated morbidity and mortality in a group of multiple trauma patients. METHODS: Trauma patients who were mechanically ventilated and survived at least 24 h were included. Ventilator-associated pneumonia was confirmed by a bacterial culture of a blind protected telescoping catheter with at least 10 colony-forming units/ml of at least one pathogen. Episodes of acute lung injury were prospectively recorded. RESULTS: Ventilator-associated pneumonia was documented in 78 patients of the 175 included (44%) and led to the development of ventilator-associated pneumonia acute lung injury in 18 patients (23%). The sole independent risk factor for ventilator-associated pneumonia leading to acute lung injury was the presence of Haemophilus influenzae (hazard ratio, 8.8; 95% confidence interval, 2.7-28.6). Eleven (61%) of the 18 patients with ventilator-associated pneumonia leading to acute lung injury had development of a ventilator-associated pneumonia recurrence, as compared with 20 (33%) of the 60 patients with ventilator-associated pneumonia alone (P = 0.03). Seven (39%) of the 18 trauma patients with ventilator-associated pneumonia leading to acute lung injury died, as compared with 9 (15%) of the 60 trauma patients with ventilator-associated pneumonia alone (P = 0.04). CONCLUSION: Acute lung injury complicated the course of 15% of ventilator-associated pneumonia in trauma patients. H. influenzae seemed to be one of the most frequent bacteria involved and the sole risk factor identified. Occurrence of ventilator-associated pneumonia leading to acute lung injury modified the prognosis of trauma patients.

Adult↗
PubMed2006

Analysis of trauma outcome at a university hospital in Zahedan, Iran using the TRISS method.

OBJECTIVE: To evaluate validity of TRISS (Trauma score and injury severity score) method in trauma outcome analysis and compare trauma care at a university hospital, with the standards reported in the Major Trauma Outcome Study (MTOS). DESIGN: Analytical and descriptive study. SETTING: Khatam-ol-anbia University Hospital in Zahedan, Iran, from March 22, 1997 to March 21, 1998. SUBJECTS: Seven hundred and sixty eight consecutive patients with multiple trauma were included in the study. Survival analysis was completed for all of the patients. RESULTS: The majority of patients were men (82%), and the average age was 23 years. Seven hundred and one patients (91%) sustained blunt trauma, with road traffic accidents being the most common (59%). The predicted mortality was 3.1% and the observed mortality was 8%. The M-statistics was 0.91. CONCLUSION: In developing countries the same as developed countries, the TRISS methodology is an acceptable method for evaluation of the difference between predicted and observed mortality. This study shows that our mortality is significantly more than universal standards and there are weak points in our trauma care system.

Adult↗
PubMed1987

Complement-mediated neutrophil activation in sepsis- and trauma-related adult respiratory distress syndrome. Clarification with radioaerosol lung scans.

Complement-mediated neutrophil activation (CMNA) has been proposed as an important pathogenic mechanism causing acute microvascular lung injury in the adult respiratory distress syndrome (ARDS). To clarify the relationship between CMNA and evolving lung injury, we studied 26 patients with multiple trauma and sepsis within 24 hours of risk establishment for ARDS. Pulmonary alveolar-capillary permeability (PACP) was quantified as the clearance rate of a particulate radioaerosol. Seventeen patients (65%) had increased PACP (six developed ARDS) while nine (35%) had normal PACP (none developed ARDS; clearance rates of 3.4%/min and 1.5%/min, respectively). These patients, regardless of evidence of early lung injury, had elevated plasma C3adesArg levels and neutrophil chemotactic desensitization to C5a/C5adesArg. Plasma C3adesArg levels correlated weakly, but significantly, with PACP. Thus, CMNA may be a necessary, but not a sufficient, pathogenic mechanism in the evolution of ARDS.

Adult↗
PubMed1989

Hypokalaemia in severe head trauma.

Forty-six consecutive patients with severe isolated head trauma (GCS less than or equal to 7) had significant hypokalaemia averaging 3.1 +/- 0.4 (S.D.) mmol/litre upon admission to the emergency room. This electrolyte imbalance occurred within hours of the trauma and resolved under treatment within the first day. There was no correlation between serum potassium and pH, glucose, urine electrolytes, patient age or sex, admission Glasgow Coma Score or the Glasgow Outcome Score. Sixteen patients with multiple trauma but without head trauma had an average serum potassium of 3.5 +/- 1.1 mmolar. Mechanisms of serum potassium level control and their correlation with brain trauma are addressed in a search for an explanation of this phenomenon. We believe that the most appropriate explanation for this hypokalaemia is the large catecholamine discharge that is known to accompany severe head trauma, with resultant beta 2-adrenergic stimulation of the Na+ -K+ pump. The formation of a prospective on-going study to clarify the basic mechanism of hypokalaemia in severe head trauma is presented.

Adolescent↗
PubMed1983

Blunt traumatic rupture of the main pulmonary vessels.

This report described a patient who, though exhibiting no physical signs of chest trauma, had fatal blunt traumatic rupture of the main pulmonary blood vessels, unaccompanied by bronchial injury. A high index of suspicion for such intrathoracic injury should prompt a chest x-ray film in any case of multiple trauma.

Accidents, Traffic↗
PubMed2006

Classification and management of chest trauma.

OBJECTIVE: To classify the predominant pattern of injuries following blunt and penetrating chest trauma and to assess the adequacy of treatment strategies, complications and mortality associated with such injuries. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Surgical Unit I, Holy Family Hospital, Rawalpindi, from December 2000 to December 2003. PATIENTS AND METHODS: One hundred consecutive patients with thoracic trauma either blunt or penetrating, admitted in the ward were evaluated. Their injuries were classified, treatment strategies outlined and complications and mortality were documented on a specially-designed proforma. RESULTS: Out of the 100 patients presenting in emergency, 44% presented with blunt and 56% with penetrating trauma. Pneumothorax was detected in 39% of the patients, hemopneumothorax in 29%, hemothorax in 12%, flail chest in 9 %. Two had involvement of the heart and major vessels, 4 % had injury to the diaphragm and 5 % had multiple trauma. During treatment, 3% of all the patients were managed conservatively, 83% of patients required chest intubations, 6% needed ventilatory support and 8 % required thoracotomy. Complications were experienced in 28% of the patients of which 9% had pneumonias, 14% empyema and 5 % suffered from wound infections. The overall mortality was 7 %. CONCLUSION: This series showed the pattern of injuries following blunt and penetrating chest trauma. Furthermore, it was found that chest intubation and simple resuscitation was adequate for majority of the cases.

Adolescent↗
PubMedDate not supplied

Intramedullary osteosynthesis with Grosse-Kempf nailing for the treatment of distal fractures of the femur.

The authors report the results they obtained in a homogeneous series of fractures of the distal third of the femur treated by Grosse-Kempf nailing. Of the 67 fractures (58 closed, 9 exposed) treated with closed surgery (except for 1 case treated by nailing 35 days after trauma) non-union was never observed. The two cases of delay in consolidation (one related to an infection) did not require a change in method. Bone grafting was never necessary. Only in 3 cases (2 with multiple trauma, 1 treated by open reduction) was moderate reduction in range of movement of the knee observed.

Adolescent↗
PubMed1997

The role of ultrasonography and inferior vena cava filter placement in high-risk trauma patients.

Undetected lower-extremity deep-vein thrombosis (LEDVT) in the trauma patient can lead to significant morbidity and mortality. The purpose of this study was to: 1) evaluate the role of ultrasonography in the early detection of LEDVT in high-risk trauma patients; 2) identify prognostic indicators that predict LEDVT; and 3) evaluate the efficacy of selected inferior vena cava (IVC) filter placement in the prevention of pulmonary emboli. From October 1993 through December 1994, all adult multiple-trauma patients admitted to the Trauma Service who required prolonged bed rest (>3 days) or sustained a lower-extremity, pelvic, or spinal fracture with paralysis were prospectively studied with serial physical examinations and lower-extremity venous ultrasounds within 72 hours of admission and then weekly until discharge. Two hundred twenty-eight patients were entered into the study. Thirty-nine patients (17%) developed ultrasound evidence of LEDVT; of these, only seven (18%) were evident on physical examination. This allowed 32 patients (82%) with unsuspected LEDVT to receive earlier definitive therapy. Multivariate logistic regression analysis of LEDVT with various predictors found age, hospital length of stay, and lower-extremity trauma to be significant predictors of LEDVT (P < 0.05). Twenty-nine patients (74%) had immediate IVC filter placement upon ultrasound identification of proximal LEDVT. None of these patients developed pulmonary emboli. Ten patients (26%) with a LEDVT were treated with systemic anticoagulation alone. One of these patients sustained a fatal pulmonary embolus. In a historic control group of 234 high-risk trauma patients admitted in the 14 months prior to implementing screening ultrasounds, six patients sustained pulmonary emboli (P < 0.05). Screening ultrasounds combined with selective placement of IVC filters play an important role in reducing the morbidity and mortality associated with LEDVT in high-risk trauma patients.

Adult↗
PubMed2008

Sensory filtering phenomenology in PTSD.

Disrupted sensory filtering, or problems with suppressing irrelevant environmental sensory stimuli, has been reported in individuals with posttraumatic stress disorder (PTSD). However, the relationship of sensory filtering deficits to specific PTSD symptoms versus an association with general trauma exposure is unclear. These relationships were examined by administering self-report measures of trauma exposure, PTSD, and sensory gating phenomenology to undergraduate participants with PTSD (n=32), with trauma history but without PTSD (n=144), and with minimal trauma history (n=153). Subjects with PTSD reported greater filtering disruption than individuals in the trauma only and low trauma groups, who did not differ. Individuals endorsing reexperiencing and numbing symptoms, and females endorsing hypervigilance, reported disrupted sensory filtering phenomenology. These results suggest that impaired filtering differentiates between individuals with PTSD symptoms and asymptomatic individuals exposed to multiple traumas and low-trauma controls.

Acoustic Stimulation↗
PubMed2006

Building a trauma center and system in Tuscany, Italy.

BACKGROUND: Growing evidence supports the premise that adult trauma centers lower the risk of death for severely injured patients. The same principles have been applied to the pediatric population and mounting research suggests that, as in the adult population, gravely injured children have better outcomes at pediatric trauma centers where personnel trained and experienced in the specific needs and unique physiology of injured children provide care. As in the United States, acute traumatic injury represents an important public healthcare concern to the Tuscan regional government whose goal is to maximize clinical outcomes within available resources. In order to address this problem, the Tuscan regional government has created a new and innovative collaboration between the Meyer Pediatric Hospital/University of Florence School of Medicine and the Children's Hospital Boston/Harvard Medical School to build a pediatric trauma center and regional pediatric trauma referral system. GOALS AND OBJECTIVES: This long-term international initiative will seek to develop a demonstration model for pediatric trauma care that may later be replicated elsewhere. The initial goals of the project will focus on expanding the role of the pediatricians working in the emergency department to include the acute care of medical, surgical, orthopedic and multiple trauma patients. This new configuration will closely resemble the single provider model of emergency medical care commonly utilized in the United States. During this transition period to a more broadly trained emergency physician, a multi-disciplinary trauma team will be created and pediatric trauma clinical practice guidelines will be introduced into the emergency department and inpatient care units. Systems measurements will be achieved through a comprehensive quality improvement and risk management program. Ultimately, all Tuscan regional pediatric major trauma will be consolidated at the Meyer Pediatric Hospital in Florence.

Boston↗
PubMed1999

Trauma in the elderly: a new epidemic?

Australia's population is ageing. Statistics predict that by the year 2021, 17.8% of our population will be over the age of 65 years. These statistics are reflected in most Western nations. The elderly represent an increasing proportion of emergency department patients. They are generally more acute on presentation, they get admitted more frequently, and account for an increasing proportion of admissions to intensive care units. The elderly trauma patient will increasingly consume more resources than patients from any other age group. There are significant differences in physiology and response to trauma between the elderly patient and the young. Airway compromises, a decrease in lung compliance, a change in cardiovascular haemostasis and the prevalence of pre-existing disease all contribute to increase morbidity and mortality in a patient with an already limited physiological reserve. Many studies demonstrate an increased mortality in hospitalized elderly trauma patients. For those who die from traumatic insult, death is mainly due to multiorgan system failure. The long-term functional outcome of the elderly trauma patient has been investigated by a number of authors. One study showed that only 8% of survivors returned to independent living 1 year post-polytrauma. Another more encouraging study showed that 89% of survivors of blunt multiple trauma after 38 months were independent and living at home. Ethical issues have been raised regarding the appropriateness of care for the severely injured elderly patient given today's ever-shrinking hospital finances and bed shortages. Today's environment is very challenging as frequently, the clinician is forced to make an economic decision on who will take the last critical care bed, which is a far from optimal situation.

Age Factors↗
PubMed2000

Posttraumatic stress disorder: the burden to the individual and to society.

BACKGROUND: Little is known about the total population prevalence and societal costs of posttraumatic stress disorder (PTSD); this report reviews relevant literature on these topics. METHOD: A literature search of computerized databases for published reports on trauma and PTSD was conducted. This literature was reviewed to find data on general population exposure to trauma, conditional risk of PTSD among those exposed to trauma both in focused samples of trauma victims and in general population samples, and the adverse consequences of PTSD. RESULTS: PTSD was found to be a commonly occurring disorder that often has a duration of many years and is frequently associated with exposure to multiple traumas. The impairment associated with PTSD in U.S. samples, where the majority of research on these consequences has been carried out, is comparable to, or greater than, that of other seriously impairing mental disorders. Risk of suicide attempts is particularly high among people with PTSD. Available evidence suggests that the prevalence of PTSD and the adverse emotional and psychological consequences of PTSD are much greater in the many countries around the world that are in the midst of armed conflicts involving political, racial, or ethnic violence. CONCLUSION: PTSD is a highly prevalent and impairing condition. Only a minority of people with PTSD obtain treatment. Early and aggressive outreach to treat people with PTSD could help reduce the enormous societal costs of this disorder.

Comorbidity↗