摘要:

Between 1 June 1976 and 30 June 1985 Sunnybrook Medical Centre Regional Trauma Unit admitted 2,016 patients of whom 220 (11%) sustained liver injury. Of these 220 patients, 211 (96%) sustained blunt liver trauma; 175 of 176 patients who underwent open peritoneal lavage had a true positive lavage. Resuscitation was successful in 212 patients, of whom 209 underwent laparotomy and three were treated nonoperatively: 129 of 209 patients (62%) required only minor surgical treatment; the remaining 80 patients (38%) required major surgical procedures. The overall mortality was 29% (64/220). Eight patients died during resuscitation, one of them of liver hemorrhage. Of the 56 patients who died after admission, the cause of death was head injury in 31, liver hemorrhage in 11 (five intraoperatively) and 14 died of other causes. Overall, liver hemorrhage was the cause of death in 12 of 64 deaths (19%). In other words, 12 of the total of 220 patients (6%) died from liver-related mortality.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Of 210 multiple trauma patients admitted to our Intensive Care Unit (ICU), 12 (5%) presented with severe hypoxemic respiratory failure needing mechanical ventilation with an FIO2of 1.0 because of severe intrapulmonary shunting (IS). Five (42%) of these patients survived and two (17%) died because of their underlying respiratory failure. We found a mean of three etiologic factors in each patient to account for their IS. Nonsurvivors had a lower cardiac index than survivors when they first needed FIO2of 1.0 and ARDS was more frequent among this group. All patients who survived were in severe hypoxemic respiratory failure in the first 5 days post-trauma; all patients who needed FIO2of 1.0 later than 5 days post-trauma died. Data collected for patients with similar degree of respiratory failure in coronary care ICU (n= 18), in medical ICU (n= 19), and surgical ICU (n= 21) demonstrated that multiple trauma patients with severe hypoxemic respiratory failure were younger and were hospitalized and ventilated for longer periods of time. In multiple trauma patients, as for patients with cardiogenic pulmonary edema, death was seldom related to respiratory failure itself. We concluded that severe hypoxemic respiratory failure in trauma patients is usually of mixed etiologies. It is a serious cause of morbidity in these patients; however, mortality is seldom directly related to this condition. Severe IS occurring shortly after trauma is of better prognosis than late IS.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Injury patterns and use of passenger restraints were studied in 91 children injured while riding in motor vehicles and admitted to The Hospital for Sick Children, Toronto, from June 1984 through December 1985. Of these, 44 had used restraints and 38 had not. Nine were excluded from the study because restraint use could not be determined. Age and sex distributions were closely matched in both study groups. The no-restraint group had more massive head injuries, thoracic injuries, and liver and spleen injuries than the restraint group. Classic “seatbelt syndrome” injuries were seen in the seatbelt group. The overall Injury Severity Scores were not significantly different between the groups. Despite mandatory legislation, many children do not use restraints, and many who do still suffer severe or fatal injuries. We conclude that better compliance with existing passenger restraint laws and more effective restraint systems are needed.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Seventy cases of blunt splenic trauma were retrospectively reviewed for the period 1979–1984. There were 57 adults and 13 children. Motor vehicle accidents were implicated in 62%. Forty-five splenectomies and eight splenorrhaphies were performed. The patients fell into two groups. Group A, numbering 48 patients, were those operated upon within 24 hours of injury. The mortality rate was 16%, and no deaths were attributable to splenic injury. Indications for surgery were hemodynamic instability in 46% and positive peritoneal lavage in 40%. Group B included 22 patients, 17 of whom were managed nonoperatively with no deaths. Five patients eventually went to laparotomy. Fifty per cent of all patients had associated intra-abdominal injury but only 17% needed repair; 31% of patients were initially managed conservatively with a 77% success rate and no mortality. It is concluded that conservative management is safe in stable patients with blunt splenic trauma.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

A prospective study was designed to document course and outcome. Two hundred fifty-three patients with 274 spinal injuries were reviewed at the time of injury and discharge from hospital, as well as at 1, 2, and 5 years postinjury. Thirty-eight of these patients were identified who had been misdiagnosed at the initial assessment. Fracture location, cause of injury, neurologic deficit, and delay in diagnosis were all documented: 22.9% of cervical injuries, and 4.9% of the thoracolumbar injuries had a delayed diagnosis ranging from less than 1 day to 36 days. The causes of delayed diagnosis were: 1) failure to take X-rays, 2) fractures missed on X-ray, and 3) failure of patients to seek medical attention. Associated factors such as intoxication of the patient, multiple injuries, level of consciousness, or two levels of spinal injury contributed to the delayed diagnosis of these injuries. Certain “at-risk” populations for missed spinal injuries have been identified. In spite of delays in diagnosis, progression of an established neurologic deficit did not appear to occur in our study. However, the development of secondary deficits was significant in the delayed diagnosis group.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

An 11-year retrospective review of 51 patients with diaphragmatic injuries revealed 33 blunt and 18 penetrating injuries. In the blunt trauma group 24 were left-sided and nine were on the right side. Preoperative diagnosis was made in 24 patients. Delayed diagnosis (greater than 24 hours) during life occurred in four patients and two injuries were found at autopsy. Chest X-ray was diagnostic or highly suggestive in 23 patients. All patients in this group had associated extra-abdominal injuries; 23 patients had concomitant intra-abdominal injuries. Transabdominal repair was performed in 24 patients. Four deaths occurred in the blunt injury group. The penetrating diaphragmatic wounds consisted of 14 left-sided, three right-sided, and one pericardial wound. Preoperative diagnosis occurred in only three patients. The penetrating wound, hypotension, or peritoneal signs dictated operation in the remaining 15 patients. One death occurred from peritonitis and septic shock. Blunt and penetrating diaphragmatic injuries remain a diagnostic challenge and associated injuries determine the outcome.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

From 1965 to 1985, 76 patients were admitted to Sacré-Coeur Hospital, Montreal, with a diagnosis of penetrating chest trauma (PCT). The majority were under the age of 30 years and almost two thirds suffered gunshot wounds. Sixty-seven (88.1%) sustained a lateral or thoracic (T) injury and in nine (11.8%) the lesion was central or mediastinal (M). In the first group (T), 53.7% were treated surgically with thoracotomy, laparotomy, and chest tube (CT) insertion or both; 46.2% were managed conservatively. In the second group (M) the pericardium or the heart was involved, eight patients (88.8%) were managed surgically without the use of extracorporeal circulation and one patient was observed only. Eight (11.9%) died in the thoracic group; all survived in the mediastinal group, for an overall mortality of 10.5%. Shock was associated with increased morbidity and mortality in the thoracic group (T) and infection was the most frequent complication for the entire group of patients under study. There has been a steady increase in the total number of PCT at our hospital during the last two decades suggesting an increase in crime and violence in our urban surroundings.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Fifteen patients with unstable pelvic fractures were treated with immediate anterior external fixation followed by delayed posterior fixation, including five sacroiliac lag screws, six transiliac rods, and four iliac plates. Initial anterior external fixation aided in resuscitation of hemodynamically unstable patients and allowed early mobilization. Delayed posterior internal fixation avoided infection and hemorrhage but failed to achieve anatomic reduction of disrupted sacroiliac joints and sacral fractures. Followup examination confirmed maintenance of fixation and fracture healing but pain and persistent neurologic deficits were common findings. Lumbosacral nerve plexus injuries occurred in patients with fractures through the sacral foramina. Fixation of these fractures with sacroiliac screws and transiliac rods caused overcompression and the resulting foraminal encroachment may be a factor in the lack of neurologic recovery. In this study, delayed posterior internal fixation was not associated with perioperative morbidity and achieved better reductions than those obtained with external fixation alone. Delaying the fixation, however, increased the difficulty of obtaining anatomic reduction of certain posterior arch disruptions.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Cerebral Perfusion Pressures (CPP) and GlasgowComaScale (GCS) scores were monitored to guide the management of severely head-injured patients. These measures were correlated to outcome (GlasgowOutcomeScale-GOS) in 136 consecutive patients at least 1 year after injury. The GOS showed highly significant positive correlations to either CPP or GCS assessments (p<0.001). Two parameters that are correlated with subsequent death in most patients include 1) highest (h) GCS = 3 or 4 (Day 1: 31 of 32 patients died, and Day 2: 19 of 19 patients died), and 2) CPP ≤60 mm Hg more than 33% of the hourly measures during Day 2 (36% of all subsequent deaths; 11% overlap with the highest Glasgow Coma Scale). The Day 2 measures identifying two groups that have a >75% incidence of “good outcome” or GOS = 4 or 5 include 1) hGCS ≤6 (N= 45) and 2) the average (a) CPP ≥90 mm Hg (N= 26). Of the 45 patients with a GOS = 4 or 5 who had both CPP and GCS recorded on the third day, 44 were identified by these “good outcome” parameters.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Hypothermia is a well recognized consequence of severe injury, even in temperate climates, and the physiologic consequences of hypothermia are known to be detrimental. To analyze the frequency and risk factors for hypothermia and its effect on patient outcome, we prospectively studied 94 intubated injured patients at a regional trauma center during a 16-month period. Esophageal temperature probes were placed in the field or ER and core temperatures (T) were followed for 24 hours or until rewarming. Patients were designated as normothermic >36°C), mildly hypothermic (34°C-36°C) or severely hypothermic (<34°C) based on initial T. The risk factors for hypothermia evaluated included age, severity and location of injuries, blood alcohol level, blood transfusion requirements, and time spent in the field, ER, or OR.The average initial T was 35°C, with no seasonal variation. Injury severity and survival correlated with severe hypothermia. Normothermic patients had an average ISS of 28 with a 78% survival. Severely hypothermic patients had an average ISS of 36 with a 41% survival (p<0.05). Patient age strongly correlated with outcome although there was no relationship between age and initial temperature. Sixty-two per cent of patients tested were positive for blood alcohol, and one half were legally intoxicated (BAC >100 mg%). However, no consistent correlation was found between alcohol intoxication and initial temperature or patient survival. Blood transfusion requirements paralleled injury severity and patients receiving greater than 10 unit transfusions had significantly lower core temperature (p<0.05). The average temperature change was positive in the ER, OR, and ICU with time to rewarming correlating with the aggressiveness of warming measures.We conclude that: 1) The majority of severely injured patients are hypothermic. 2) Awareness of potential detrimental effects of hypothermia resulted in an average positive T change during initial care. 3) Rapid prehospital care and transport may offset the effects of age and alcohol intoxication on temperature regulation. 4) Severe hypothermia is common among severely injured patients.

ISSN:0022-5282    

出版商:OVID    

年代:1987

数据来源: OVID