摘要:

Today injuries are the most serious health problem facing this country, whether measured in dollar costs, physician contacts, premature deaths, or lost productive years of life. Available means for preventing many injuries and reducing the resulting disability or death are often ignored, and for many decades there was little emphasis on effective preventive measures. Examples of successful efforts to prevent injury illustrate the effectiveness of measures that provide automatic protection rather than requiring repeated individual action. Traditionally, funding for research on trauma has had an inverse relationship to its importance as a public health problem. Recent progress toward a federal Center for Injury Control reflects the hard work of many members of the trauma community and provides cause for optimism that there will be greater support for training and research in trauma epidemiology, prevention, biomechanics, acute care, and rehabilitation.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Blast injury remains an important source of trauma in both civilian and military settings. We have studied a recently developed blast wave generator to evaluate its effectiveness for laboratory study of blast injury. In order to determine the reliability of the device and the pathology of the lesions caused by the short duration (0.5–1.0 msec), and high intensity (60–375 psi) pressure wave, laboratory rats were exposed to the pressure waves generated by the machine. The animals were divided into three groups: the first exposed to mid-thoracic blasts, the second to abdominal blasts, and a group of controls exposed to a gentle stream of gas. Group I showed gross and microscopic evidence of lung blast injury of “rib imprint” hemorrhages, intra-alveolar hemorrhage, marked increase in lung weight, prolonged apnea, and bradycardia. Group II showed typical blunt abdominal trauma at the closest ranges, but characteristic submucosal hemorrhages up to 4.0 cm from the blast nozzle. In both groups, a protective effect was seen in heavier animals. The blast wave generator permits reproducible blast injury in the laboratory that is safer and faster than current methods. The lung and bowel lesions induced are grossly and microscopically similar to injuries of blast exposure seen in clinical patients.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The incidence of respiratory tract infections was determined in 59 multiple trauma patients requiring prolonged intensive care (>5 days) and receiving no antibiotic prophylaxis. Early pneumonia (<48 hr) withS. aureus, S. pneumoniae, and/orH. influenzaewas found in 44% of patients. Secondary colonization of the oropharynx and respiratory tract with ICU-associated Gram-negative bacilli followed by pneumonia occurred in 12 patients (20%). The overall incidence of respiratory tract infections was 59%.In a prospective open trial three prophylactic antibiotic regimens were compared: 17 patients were treated with intestinal decontamination using nonabsorbable antibiotics (polymyxin E 400 mg, tobramycin 320 mg, amphotericin B 2,000 mg/day). No difference in infection rate was found. Twenty-five patients were treated with intestinal and oropharyngeal decontamination using an ointment containing 2% of the same antibiotics. Secondary colonization and infection of the respiratory tract with Gram-negative bacilli was significantly reduced (p< 0.001). The incidence of early (Gram-positive) infections, however, was unchanged. Another group of 63 patients was treated with systemic antibiotic prophylaxis during the first days in combination with oropharyngeal and intestinal decontamination. The incidence of early pneumonia was significantly reduced (p< 0.001). Five patients (8%) developed an infection. Superinfections were not observed.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The mortality of 128 consecutive severely brain-injured patients (Glasgow Coma Score ≤8) treated by a land advanced life support system and transported to a trauma center was compared to the mortality of 104 consecutive severely brain-injured patients treated during the same time period by an advanced care rotorcraft aeromedical emergency service and transported to the same trauma center. The two patient groups had statistically similar distribution of CNS lesions and Glasgow Coma Scores, The mortality of the patients treated by the land ALS system was 40%. The mortality of the patients treated by the aeromedical service was 31%. The 9% reduction in mortality in the patients treated by the aeromedical service was statistically significant (p< 0.001). There was also a statistically significant (p< 0.05) reduction in the Glasgow Outcome Scores of the patients treated by the aeromedical service compared with patients treated by the land advanced life support system.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Evaluation of trauma care must be an integral part of any system designed for care of seriously injured patients. However, outcome review should offer comparability to national standards or norms. The TRISS method offers a standard approach for evaluating outcome of trauma care. Anatomic, physiologic, and age characteristics are used to quantify probability of survival as related to severity of injury. TRISS offers a means of case identification for quality assurance review on a local basis, as well as a means of comparison of outcome for different populations of trauma patients. Methods for calculating statistics associated with TRISS are presented. TheZandMstatistics are explained with the nonstatistician in mind. We feel this article is a source for those interested in developing or upgrading trauma care evaluation.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

A second suppressive state (S-SupS) in interferon (IFN) response was demonstrated when mice with third-degree burns of approximately 30% of the body surface area (TI-mice) were stimulated in vivo by Staphylococcal enterotoxin A, a gamma IFN inducer. The first suppressive state in IFN production, appearing 3 to 7 days after thermal injury, was mediated by the generation of splenic suppressor macrophages. The S-SupS was demonstrated approximately 3 weeks post thermal injury. It persisted for almost 3 weeks and gradually disappeared by 7 weeks. Spleen cells from mice during the S-SupS produced less IFN in vitro than normal mouse splenic mononuclear cells (MNC) when stimulated with concanavalin A (Con A). Splenic MNC of mice during the S-SupS inhibited IFN production when they were co-cultured with normal mouse splenic MNC in the presence of Con A. Since this suppressor cell activity could not be removed from Tl-mice splenic MNC by carbonyl iron treatment, or by a technique of adherence to a plastic surface, it is suggested that two different cell populations which are capable of suppressing the IFN response of Tl-mice exist at different time periods following burn injury.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

When samples were taken within 2 hr of accidental injury, plasma cortisol levels increased with injury severity score (ISS) in patients with minor and moderate injuries (ISS, 1–12) but decreased at higher ISS. Radioimmunoassay of adrenocorticotrophin (ACTH) showed very variable plasma concentrations at all ISS ranges. Like cortisol, ACTH increased with ISS up to a score of about 13, but it thereafter plateaued, and in patients with severe injuries plasma cortisol fell in relation to ACTH as well as in absolute terms. This suggested that although ACTH secretion was generally far from maximal the relatively low cortisol concentrations in the most severely injured were at least partly due to a poor response of the adrenal cortex to ACTH. In patients who presented late (more than 2 hr after injury) plasma cortisol levels were more variable and more strongly related to ACTH than at shorter times after injury. The variability of cortisol also increased with age. Patients with severe head injuries had cortisol and ACTH concentrations similar to those without head injuries but with a similar ISS from injuries in other parts of the body.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

In Finland during the period 1972–1983, there were 3,564 severe traffic accidents involving one or more victims dying within 30 days of the accident. Forty-two of the victims had been wearing a seatbelt and had an abdominal trauma as the main cause of death or as first diagnosis of injury. Small intestine and colon injuries were more common in the severely injured victims than was the case with the fatally injured ones and in these accidents the injury mechanism was always deceleration or contusion, which was in most cases caused by the seatbelt. Liver injuries seem to be the major abdominal cause of fatality, and in the fatally injured group, half of the victims sustained the fatal abdominal injury through gross crushing impact. When the direction of the impact was analyzed, all the victims seated on the receiving side of the vehicle in lateral impact collisions sustained an abdominal injury with fatal outcome. It seems that the seatbelt is less effective in protecting wearers from severe or fatal abdominal injuries in lateral impact collisions.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

In a current review of the literature regarding the management of patients with suspected penetrating cardiac injuries there appears to be no place for conservative management. Nine patients with penetrating cardiac injuries were successfully treated conservatively and are reported. This series aims to emphasize the point that there is a place for conservative management of selected cases.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Surgical treatment of supracondylar fractures of the femur has become commonplace. A variety of surgical implants are available. In carefully chosen patients treated with appropriate surgical technique, early motion and good knee function can be obtained with open reduction and internal fixation. However, the morbidity (and mortality) are substantial following complications of open reduction and internal fixation of supracondylar fractures of the femur. We present a series of 30 consecutive patients referred to Rancho Los Amigos Medical Center for complications following open reduction and internal fixation of supracondylar femur fractures. Three patients with septic pseudarthrosis underwent above-knee amputations. Two of these three patients died of systemic sepsis. Fourteen additional patients were treated for nonunions, with 13 patients achieving union at an average time of 36.5 months from the date of injury. Six patients underwent quadricepsplasties for residual knee stiffness. Only 16 patients were returned to their preinjury ambulatory status.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID