ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The metabolic responses to trauma and surgery have been well described and are observed most typically in otherwise healthy young and middle-aged individuals. To investigate the effect of age on blood glucose, insulin, and cortisol responses after mild to moderate trauma, we studied 33 patients (Injury Severity Scores, 5–38, and ages 16 to 81 years) before resuscitation and 24–96 hours postinjury. Age was associated with an increase in serum glucose during both ebb and flow phases of the injury response, but not with serum insulin. Serum glucose also increased with the degree of injury as reflected in Glasgow Coma Scale on admission and Injury Severity Score subsequently. Serum cortisol responses were increased in older patients and tended to decrease with time following injury. A more detailed knowledge of how age may alter the ability of elderly patients to respond to trauma and critical illness is essential to allow the continued development of rational therapies for such patients.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Three hundred sixty-seven consecutive pediatric trauma deaths which occurred in Ontario between 1985 and 1987 were analyzed from the coroners' records. Injuries were classified as survivable or unsurvivable, and a preventable death rate of 20% was identified. Rural preventable deaths occurred mainly before arrival at hospital, but 55% of urban preventable deaths occurred in hospitals. The causes of death in children with survivable injury suggest that the institution of prehospital resuscitation and improvement in trauma care education for physicians might reduce mortality. The high incidence of unsurvivable injury suggests that injury prevention will be more cost effective in the long term.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

A neurotrauma assessment record has been designed to aid in data collection and clinical documentation of patients with multiple injuries. The record collects data concerning patient demography, trauma and medical history, neurological and systemic examinations, investigations, and treatment planning. It consists of two pages and the clinician need only circle listed choices, write focused comments, or draw on provided diagrams. It obviates the narrative record of the history and physical examination. We reviewed the written records of 100 consecutive polytraumatized patients seen in the Trauma Room before institution of the form, transcribing their information onto the form. These were compared to a second series of 100 consecutive patients who were evaluated following the introduction of the neurotrauma form as the initial assessment record. Seventy-seven of these patients were evaluated by the Neurosurgical service. Overall, the quality and completeness of recording improved dramatically. The neurotrauma assessment record ensures more complete recording of information during initial patient assessment, allows easy transfer to computerized databases, and may assist academic centres in performing clinical research.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

From 1975 to 1987, 19 patients (pts) were operated on for a traumatic lesion of the heart or of the ascending aorta. There were 15 males and four females with a mean age of 42 years. Twelve lesions (Group I) were penetrating and seven (Group II) blunt.Nine patients were in shock upon admission, including six with cardiac tamponade. Six pts were stabbed, three sustained a gunshot wound, and two were accidental victims of a pneumatic gun. In the last pt, with previous lung surgery and mediastinal shift, a chest tube lacerated the right ventricle; this pt died in the operating room (OR), for a mortality rate of 8.3% (1/12). Associated intrathoracic and intra-abdominal lesions were present, but did not influence the outcome.All pts were involved in motor vehicle accidents. Five pts were in shock, including two with cardiac tamponade. Three pts required extracorporeal circulation (ECC) for aortic valve replacement, tricuspid valve reconstruction, and replacement of the ascending aorta. In one case, a lacerated right ventricle could be repaired without ECC, but the pt died from low cardiac output. Three pts with a ruptured left ventricle were managed in the OR, and two pts exsanguinated for a mortality rate of 43% (3/7). Associated lesions were present and death was related to ventricular rupture. Intrapericardial lesions are relatively rare in our Canadian experience. High survival can be obtained in penetrating injuries, while blunt injuries are more complex and remain highly lethal. ECC should be available for definitive treatment.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The interaction between the pedestrians, drivers, and vehicles involved in pedestrian trauma often receives less attention than motor vehicle occupant accidents. To better define these factors, records of 161 pedestrians admitted to two urban university hospitals were reviewed. There were 87 females and 74 males. Females were older, with a median age of 62 years, compared to 43 years for males. Alcohol was a factor in 39 (52%) males and ten (12%) females. The mean Injury Severity Score (ISS) was 14.6, with injuries most commonly to the extremities in 135 (84%), external surfaces in 103 (64%), and the head and neck in 71 (44%). There were 18 deaths (11.2%) with a mean ISS of 40.3. Of the 143 survivors, 18 (12.5%) with a mean age of 68.4 years required placement in long-term care facilities. Elderly survivors also had longer hospital stays, consuming 51% of all hospital days.Driver information from the governmental universal automobile insurance agency was available for 134 accidents. Drivers failed to yield the right of way in 31 instances (23%). Fifteen (11%) were driving without due care and five (4%) at an unsafe speed. Nine (7%) had documented alcohol involvement. Forty drivers (30%) incurred a total of 50 traffic charges. Previous driving records were available for 109. Forty-six (42%) had been involved in two or more previous accidents and 40 (37%) had five or more previous citations for moving violations. Pedestrian action at road intersections was recorded in 75 accidents. Twelve (16%) were crossing against a signal light; the remainder at both signal controlled and uncontrolled intersections were rightfully occupying the intersection.It is concluded that female pedestrians were often older and that male pedestrians frequently had been drinking. Elderly pedestrian victims had a greater impact on the hospital care system. Many drivers had poor previous driving records and were not following the rules of the road at the time of the injury events. These findings may be useful in targeting specific groups for prevention programs.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

This retrospective study of multiple trauma patients requiring SICU admission was undertaken to determine to what extent, if any, head injury affected patient outcome. One hundred seventy such patients with head injuries had further analysis. Glasgow Coma Scale (GCS) values at approximately 5 hours postinjury were evaluated, and the Glasgow Outcome Scale was determined 1 month postinjury.A good recovery was seen in 99% of the 87 patients with GCS 15–13. This fell to 71% of the 24 patients with GCS 12–9. Among 59 patients having a GCS below 9, 41% died and an additional 17% had a poor recovery, leaving only 35% with an eventual good outcome.By using both Injury Severity Score and GCS at 6 hours postinjury, physicians will be more accurate in assessing outcome of multiple trauma patients with head injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

An absolute lymphocyte count is included in the routine results provided by most automated blood cell counters, providing a prompt indication of peripheral blood lymphocytosis. Transient lymphocytosis is seen in many acutely ill patients, including those with multiple injuries. We have observed a significantly higher death rate among trauma patients with lymphocytosis at presentation; patients with lymphocytosis, on subsequent assessment of injury, proved to have higher Injury Severity Scores than those without lymphocytosis. Investigation of lymphocyte subsets in nine patients with lymphocytosis showed an increase in T cells, reversal of the CD4:CD8 ratio, and, in seven patients, an increase in “natural killer” cells. The presence of lymphocytosis and its early detection as part of a routine blood count may supply a readily available means of identifying a high-risk trauma patient.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID