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 19 recordsLinked to original sources
PubMedDate not supplied

[Repercussions of blood transfusions on postoperative complications in patients with multiple trauma].

Multiple factors connected with the trauma itself or with its therapy may cause post-operative complications in injured patients. In a previous study we have reported on a higher mortality rate in patients that received large quantities of blood. The present report concerns 223 cases of trauma by penetrating and non-penetrating injuries in which the possible influence of blood transfusions on subsequent morbidity was assessed. It was verified that transfused patients exhibited more infections and general complications, as well as a higher mortality rate than controls. A progressive effect related to the number of units of blood administered could be demonstrated. The most unfavorable outcomes correspond to the transfusions of more than 1500 ml of blood.

Abdominal Injuries↗
PubMed1992

[MRSA infections in multiple trauma patients].

Multiple trauma patients requiring prolonged intensive care are at high risk of MRSA infections. Surgical debridement and proper antibiotic prophylaxis combined with isolation of this compromised host from indigenous bacteria are the mainstays of initial therapy to prevent this complication. If this develops postoperatively, the sites of infection vary among the patients, such as urinary tract, surgical wounds, the abdomen, respiratory tract, vascular catheters, etc. Clinical evidence of sepsis suggests that intra-abdominal and respiratory tract infection are major contributors to mortality. In a postoperative multiple trauma patient, with pneumonia, thoracic empyema, intraabdominal abscess, wound infection and sepsis caused by MRSA, surgical drainage of the abscess with systemic infusion of vancomycin was effective and resulted in full recovery.

Adult↗
PubMed1992

Blunt abdominal trauma in cases of multiple trauma evaluated by ultrasonography: a prospective analysis of 291 patients.

Early recognition of blunt abdominal trauma in patients with multiple injuries and in shock is of utmost importance and calls for a rapid screening method. The reliability of diagnostic ultrasonography in detecting hemoperitoneum in patients with multiple trauma was evaluated prospectively. From 1986 to 1990, 291 patients with severe multiple injuries (ISS greater than 20, mean ISS 31.2) were included in the study. Laparotomy was performed on 117 patients (40%). Initial ultrasound (US) findings showed a sensitivity, specificity, and accuracy of 89%, 97%, and 94%, respectively, in detecting intra-abdominal injuries requiring surgical repair. The positive and negative predictive values were 94% and 95%, respectively. A standardized management of frequent repeat US studies can even improve on these numbers. In our department ultrasonography has replaced diagnostic peritoneal lavage (DPL) as the diagnostic study of first choice. Diagnostic peritoneal lavage is reserved for selected cases only.

Abdominal Injuries↗
PubMed1992

[Multiple trauma: definition, shock, multiple organ failure].

Multiple organ failure (MOF) following major trauma occurs in response to perfusion deficits, a persistent inflammatory focus, or a persistent focus of dead and/or injured tissue. Several pathophysiologic aspects are considered relevant to current clinical practice. Their application in settings of trauma and surgical sepsis reduces overall mortality and incidence of multiple organ failure. With regard to the pathophysiologic background (I) microcirculatory resuscitation, (II) source control, and (III) metabolic support appear to be important therapeutic principles. (I) Microcirculatory Resuscitation: Since time is a critical factor in damage control, resuscitation and restoration of microvascular perfusion needs to occur as soon as possible if multiple system organ failure is to be avoided during the later time course. (II) Source control: The best treatment for multiorgan failure appears to be prevention. With early, aggressive control or removal of risk factors for multiple organ failure, namely early surgical intervention for control of hemorrhage, control of potential septic sources, decompression, and early fracture stabilization reductions in the incidence and mortality of MOF have been observed. Metabolic support: Malnutrition appears to be an important cofactor in morbidity and mortality. (III) Metabolic support needs to be started early and prior to the phenomenon of nitrogen retention during the hypermetabolic state of multiple organ failure.

Humans↗
PubMed1989

The frequency and significance of thoracic injuries detected on abdominal CT scans of multiple trauma patients.

Of 174 multiple trauma patients undergoing abdominal CT examination for suspected abdominal trauma, 65 patients had 109 chest injuries detected by abdominal CT, chest film, or both examinations. Forty-one patients had 55 chest injuries at the base of the thorax which were not detected on the initial chest film. The most frequent chest injuries detected only by CT were pneumothroax, fracture (rib, thoracic spine, and sternum), lung contusion, aspiration pneumonia, hemothorax, and post-traumatic atelectasis. Seven patients whose chest injury initially was seen only at abdominal CT required treatment of the injury, suggesting that a variety of chest injuries which may vitally affect patients can be detected early in multiple trauma patients by abdominal CT, and that all abdominal trauma CT scans should be scrutinized for signs of a chest injury.

False Positive Reactions↗
PubMed1991

Fibrinolytic (rt-PA) therapy for superior vena cava thrombosis in a multiple trauma patient.

An adult multiple trauma patient (head injury with coma, blunt chest trauma, bone and pelvis fractures) developed superior vena cava thrombosis which extended to the right atrium as a complication of central venous catheterism. Since a four day heparin therapy was unsuccessful, the patient was treated with recombinant tissue-type plasminogen activator (rt-PA), 100 mg over three hours. Thrombolysis with rt-PA was not associated with cutaneous or internal bleeding and was partially effective (improvement of the clinical picture, disappearance of the right atrium thrombus, superior vena cava still occluded). Although our patient could have benefited from an additional administration of rt-PA, we did not start a second course because the risk of major hemorrhage increases over 100 mg. For its relative clot-selectivity rt-PA could be indicated when fibrinolytic treatment is required in multiple trauma patient, but safe and more efficacious regimens have still to be defined.

Adult↗
PubMed1990

[Diagnostic problems of multiple trauma and technical means].

Multiple trauma requires immediate and combined resuscitation and surgery. For resuscitation, the neurological condition must be assessed prior to any sedation, as well as the respiratory and hemodynamic condition, in order to carry out first aid (tubing, ventilation, infusion...). The surgeon who is present must contribute in the quick clinical assessment of the lesions, perform temporary hemostasis as well as hemostatic and anti-infectious dressing, find out associated vascular complications and possible injuries to the spine and cord. Various blood samples must be taken before setting up the venous pathways (peripheral and central), and the various parameters will be followed up. Thoracic aspiration will sometimes be essential for better ventilation. Radiographs of the chest and of the pelvis will be taken with the injured person on the stretcher, without displacing him/her. The rest of the assessment will be performed only when the person with multiple trauma has been resuscitated and is hemodynamically stable, and it will include various radiographs, ultrasound and CT studies, and even angiograms, of the skeleton and of the cranial contents, of the thorax and of the abdomen. However, all these explorations are somewhat time-consuming, and involve a risk of neurological, hemodynamic or ventilatory aggravation. Therefore they must be organized into a hierarchy, and only those that are essential will be performed to avoid delaying the treatment. Neither must the effectiveness of resuscitation be too reassuring, as the morbidity of the lesions increases with the number of units of transfused blood. The vital prognosis is often worsened when a lesion is not recognized or when complications occur.

Brain↗
PubMed2026

Online-delivered eye movement desensitization and reprocessing treatment for adults with post-traumatic stress disorder due to multiple traumas: a non-concurrent multiple baseline design.

Background: No controlled studies incorporating randomization have been conducted to investigate the effectiveness of online eye movement desensitization and reprocessing (EMDR) treatment, despite its use in clinical practice.Objective: This study evaluated the effect of online EMDR treatment in adults aged 18-65 years with post-traumatic stress disorder (PTSD) resulting from multiple traumas.Method: A multiple baseline single-case experimental design (n = 21) was employed. Participants were patients with PTSD due to multiple traumas, recruited from a mental healthcare institution in the Netherlands. They were randomly assigned to baseline phases of 2, 3.5, or 5.5 weeks. After this, participants received 10 weekly online EMDR sessions. The primary outcome was the total score on an adapted version of the PTSD Checklist for DSM-5 (PCL-5), which was administered twice a week during baseline and intervention phases, and once 12 weeks after the end of the intervention phase. We performed visual analysis and calculated the improvement rate difference (IRD) for each individual separately to determine whether online EMDR was effective. We also performed a paired t-test and calculated Cohen's d for pretreatment and post-treatment comparisons, and pretreatment versus follow-up to evaluate effects at the group level.Results: Visual analysis and IRD scores showed that the treatment was effective for 15 participants, with effect sizes ranging from small to very large. The mean scores on the PCL-5 at group level decreased significantly over time between pretreatment and post-treatment (Mdiff = 23.6, Cohen's d = 1.34, 95% CI 0.74-1.93), as well as between pretreatment and follow-up (Mdiff = 27.2, Cohen's d = 1.62, 95% CI 0.95-2.27).Conclusion: Most participants showed a reduction in symptoms following the start of the online EMDR. Furthermore, at the group level there was a significant and clinically relevant reduction in symptoms over time. This provides preliminary evidence for the effectiveness of online EMDR treatment.

Humans↗
PubMed1992

Diagnosis and treatment of retroperitoneal hematoma in multiple trauma patients.

From 1984 to 1991 20 multiple trauma patients with pelvic fractures and retroperitoneal bleeding from pelvic vessels underwent angiographic localization and embolization of massively bleeding arterial vessels. Nine patients survived (multiple trauma index grade III, Hanover polytrauma index), three patients with very severe injuries died immediately (multiple trauma index grade IV). After successful control of bleeding by embolization, three other patients died from severe brain injuries and five patients from septic multiorgan failure. The interval to definite localization and treatment of the bleeding source was three times shorter in the group of survivors, and the amount of transfusions needed was less by a factor of three. This underlines the importance of early angiography in multiple trauma patients with pelvic fractures and persisting hemorrhage. Embolization has proven to be effective in the treatment of such injuries.

Adolescent↗
PubMed1992

Platelet activation during acute phase after multiple trauma.

The acute phase after multiple trauma is associated with both thrombotic phenomena and a bleeding diathesis. To evaluate the activation of platelets, beta-thromboglobulin (BTG) in plasma and serum and thromboxane B2 (TxB2) in serum were measured in 14 patients with multiple trauma. BTG in plasma was significantly increased on days 1, 2 and 10 to 14 after the trauma. The highest median value 90 micrograms/l was measured on day 1. BTG in serum was significantly reduced 1 to 7 days after the trauma (median levels 4450-9100 micrograms/l). TxB2 was significantly reduced (median levels 18-97 ng/l) on days 1 to 14. The increased plasma levels of BTG is due to the posttraumatic activation of platelets in vivo. The reduced levels of serum BTG and TxB2 reflect the deficient functional capacity of circulating platelets to respond to extreme stress. Therefore, platelet count alone may correlate poorly with the haemostatic potential and may underestimate the need of platelet transfusions.

Acute-Phase Reaction↗
PubMedDate not supplied

Orthopaedic treatment of paediatric multiple trauma patients. A new technique.

In multiple trauma, skeletal injuries are generally responsible for long hospital stays, with concomitant nursing inconveniences and for most of the sequelae. A new operating technique has been perfected, especially adapted to paediatric traumatology: stable elastic rodding, precise and less aggressive technique. It avoids plastering and traction systems, and rapidly restores sufficient independence for a return to school. It is especially useful in multiple trauma patients, where nursing facilities and easy transport may be very helpful. The hospital regularly uses this technique for patients over six years old with femur fractures, tibia fractures associated with a contralateral lower limb injury, and forearm fractures where conservative treatment has failed.

Child↗
PubMed1989

The septic multiple-trauma patient.

Sepsis in the multiple trauma patient is being seen with increased frequency now that more of these patients are surviving the initial period. Traumatic destruction of tissue barriers, the placement of various tubes and drains, and surgical repair with debridement all provide conduits for colonization and infection with pathogens. Many components of the host immune system also become altered after trauma and surgery, predisposing this population to infectious complications. The site of infection can be cryptic in the moribund trauma patient; locating it may require many special diagnostic procedures. Continuing close surveillance is important to prevent or to identify infections at the earliest possible time. The liberal use of antibiotics should be discouraged so that development of resistant organisms and superinfection is kept to a minimum. Handwashing between patient contacts may be the most important prophylaxis against the spread of pathogens within a trauma unit.

Bacterial Infections↗
PubMed1988

The septic multiple-trauma patient.

Sepsis in the multiple trauma patient is being seen with increased frequency now that more of these patients are surviving the initial period. Traumatic destruction of tissue barriers, the placement of various tubes and drains, and surgical repair with debridement all provide conduits for colonization and infection with pathogens. Many components of the host immune system also become altered after trauma and surgery, predisposing this population to infectious complications. The site of infection can be cryptic in the moribund trauma patient; locating it may require many special diagnostic procedures. Continuing close surveillance is important to prevent or to identify infections at the earliest possible time. The liberal use of antibiotics should be discouraged so that development of resistant organisms and superinfection is kept to a minimum. Handwashing between patient contacts may be the most important prophylaxis against the spread of pathogens within a trauma unit.

Bacterial Infections↗
PubMed1990

[Mortality rate in multiple trauma and prospects of its reduction].

In all the 1746 patients, who died from trauma, the multiple and associated injuries were revealed. Multiple wounds of a head and thoracicoabdominal trauma, shock, blood loss, combination of two and more severe injuries were the leading cause of death. The aid to the patients with polytrauma at all the stages of treatment should be given with maximal promptitude, admission to the multiprofile hospitals is expedient.

Abdominal Injuries↗
PubMed1989

Multiple trauma and the burn patient.

Multiple trauma greatly complicates the care of the burn patient, whereas a burn often complicates the diagnosis and treatment of the trauma patient. One hundred seventy-six of 3,550 consecutive acute burn admissions received nonburn trauma. The majority of injuries were sustained in motor vehicle accidents (70), escaping fire (32), electrical burns with falls (24), scald burns associated with assault (22), and explosions (18). Eighty patients received orthopedic injuries, including major (47), minor (25), and multiple (28) fractures, 10 dislocations, and 4 open joints. Soft-tissue injury occurred in 91 patients, head injury in 30, thoracic trauma in 27, and abdominal injury in 15. Unstable orthopedic injuries were major contributors to morbidity. Early internal and external fixation permitted optimal mobilization and wound care. Awareness of the potential for multiple injuries and the team approach to these injuries are the most important factors in appropriate care.

Adolescent↗