摘要:

Cervical spine cord injuries continue to be a major cause of death and disability for trauma victims. Motor vehicle trauma results in 500 to 650 quadriplegic patients per year. Most of the patients are cared for at Level I trauma centers which may not have a dedicated rehabilitation facility. Long-term rehabilitation, nursing care, and financial support remain difficult areas in the overall management of these injuries.Seventy-one cervical spine fracture patients were admitted to this medical center over a 2-year period. Twenty-two patients had a neurologic injury, 15 quadriplegic patients, and seven with incomplete deficits. Vehicular trauma was the etiology in 14 injuries; gunshot wounds in five; falls in three. Twelve of these 22 patients had associated injuries, including chest and abdominal trauma. Prolonged stays in the intensive care unit were common (avg.=13.5 days). Bronchoscopy (8/22 patients) and aggressive pulmonary care were constantly needed. Six patients died in the intensive care unit. The average hospital stay of the survivors was 45 days.Three of the 16 surviving patients were ventilator dependent at the time of discharge. Ten patients were discharged to a rehabilitation center, one to a nursing home, and five went home (one on a ventilator).The total hospital charges were 1,250,000. No financial resources were available for five of the 16 surviving patients. Four patients had resources which covered less than 50% of the total charges. Average hospital charges for survivors were 50,370. Maximum reimbursement using all outlier days under DRG 5 would be 12,385. The financial support of initial hospitalization, rehabilitation, and nursing care for these quadriplegic patients is a serious national health care issue.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

When used appropriately on superficial or moderate-depth partial-thickness burns, Biobrane significantly decreased total healing time to complete reepithelialization, reduced pain, and was associated with decreased nursing time and costs when compared to 1% silver sulfadiazine cream. Care must be used in selecting wounds for Biobrane therapy. They must be fresh, noninfected, and free of eschar and debris with a moist, sensate surface that demonstrates capillary blanching and refill. Wounds must be inspected regularly for nonadherence and signs of infection. Early fluid accumulation requires prompt aspiration. Biobrane should be removed if fluid reaccumulates or the Biobrane becomes nonadherent at any time after 48 hours. When used appropriately, Biobrane offers significant advantages over conventional therapy of acute partial-thickness burns.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Modern methods of open fracture management, skeletal fixation, and soft-tissue and bone reconstruction have dramatically improved the potential for limb salvage. The absence of adequate objective parameters on which to base the decision for salvage results in delayed amputations in many cases. The present study was undertaken to review the medical and economic impact of delayed versus primary amputations following severe open fractures of the tibia.From January 1980 to August 1986, 263 patients with grade III open tibia fractures were treated at a major trauma center: 43 ultimately had amputations. This group included 38 males and five females with an average age of 31 years (range, 15-73). All patients were taken to the operating suite for consideration of limb salvage procedures including debridement, fasciotomy, revascularization, or rigid fixation. The standard subjective criteria including color, consistency, bleeding, and contractility were used to determine muscle viability at the time of debridement. If substantial muscle mass was found to be nonviable then amputation was considered. Fourteen (32.6%) of the patients had primary amputations. They averaged 22.3 days hospitalization, 1.6 surgical procedures to the involved lower extremity, and 28,964 hospital costs (range, 5,344-81,282). The 29 patients with delayed amputations had an average of 53.4 days hospitalization, 6.9 surgical procedures, and 53,462 hospital costs (range, 14,574-102,434). Six (20.7%) of the delayed amputation patients developed sepsis secondary to their involved lower extremity and died; no patient in the primary amputation group developed sepsis or died.Delay in amputation resulted in a statistically significant increase in sepsis and death, disability, number of surgical procedures, and hospital costs. While limb salvage is still a desirable goal, this study points to the need for the development of objective means for early assessment of tissue viability. When amputation is inevitable, performing surgery early enhances patient survival, reduces pain and disability, and shortens hospitalization. The use of technology such as fiberoptic pH sensors and MRI is promising but their clinical efficacy has not yet been established.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We studied the in vivo survival of packed red blood cells (RBC's) which had been warmed using the new technique of admixture with high-temperature saline. Packed RBC's from five normal male subjects were stored in CPDA-1 at 4°C for 14 days. They were then warmed via admixture with an equal amount of saline heated to 70°C. Osmotic fragility, and supernatant hemoglobin and potassium levels of the warmed RBC's were not significantly different from baseline values. Aliquots of the warmed RBC's were labeled with ''Chromium and transfused into autologous donors. Mean radiolabeled RBC survival at 24 hours was 90.2% (S.D. 6.2%), and mean radiolabeled RBC survival time was 25.3 days (S.D. 2.7 days). These results are within the normal range for RBC's stored for 14 days. This study suggests that RBC survival after transfusion is not impaired by admixture blood warming using saline at 70°C.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

In a 10-year period, we have seen and treated 70 patients with trauma to the genitalia. There were 42 penile, 38 scrotal, and 16 testicular injuries. Patients with severe multisystem or extensive genital wounds were successfully managed by early conservative debridement with delayed definitive repair.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

This retrospective study of multiple trauma patients sustaining spinal column fractures was done to assess whether evaluation of the cervical spine alone is adequate. Sixty-three such patients were identified and further descriptive analyses performed. The majority of spinal fractures occurred not in the cervical spine, but in the thoracic and lumbosacral spine areas. Since a number of these spinal fractures have associated neurologic complications, only by prompt evaluation of the entire spinal column can further injuries be prevented. Based on our data, we feel that patients with multiple injuries and an altered sensorium should have the entire spine protected and evaluated radiologically before being cleared.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The well documented increased susceptibility of the asplenic host to overwhelming sepsis by encapsulated organisms has led to three popular prophylactic measures in patients: 1) pneumococcal vaccination; 2) vaccination with oral penicillin prophylaxis; or 3) vaccination with penicillin use at the first sign of infection. An animal model (weanling CD-1 rats) was utilized to evaluate these prophylactic measures. One hundred sixty rats underwent splenectomy and were divided into four treatment groups: I) sham vaccination; II) pneumococcal vaccination; III) vaccination and IM penicillin 24 hours after intraperitoneal inoculation of 106Streptococcus pneumoniae type III; IV) vaccination and IM penicillin starting 3 days before IP inoculation. Six days following the bacterial challenge survival rates by group were: I) 5%; II) 25%; III) 100%; IV) 100% (p< 0.001 by x2likelihood ratio). Mantel- Cox log rank analysis of survival curves yielded significant differences between all groups except HI and IV (p< 0.001). This study in weanling rats supports the use of penicillin in the asplenic host. Daily prophyactic penicillin or penicillin started at the first sign of infection appears to be equally effective. Randomized studies in humans would determine the best regimen.

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1988

数据来源: OVID