Injury
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While mandatory surgery for all thoracoabdominal penetrating injuries is advocated by some, the high rate of unnecessary operations challenges this approach. However, the consequences of intrathoracic bile remains poorly investigated. We sought to evaluate the outcome of patients who underwent non-operative management of right side thoracoabdominal (RST) penetrating trauma, and the levels of bilirubin obtained from those patients' chest tube effluent. ⋯ Non-operative management of RST penetrating trauma appears to be safe. Bile originating from the liver injury reaches the right thoracic cavity but does not reflect the severity of that injury. The highest concentration was found in the patient failing non-operative management. The presence of intrathoracic bile in selected patients who sustain RST penetrating trauma, with liver injury, does not preclude non-operative management. Our study suggests that monitoring chest tube effluent bilirubin may provide helpful information when managing a patient non-operatively.
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To determine predictive factors of mortality among children after traumatic brain injury. ⋯ In Tunisia, head injury is a frequent cause of hospital admission and is most often due to road traffic accidents. Short-term prognosis is poor, with a high mortality rate (24.3%), and is influenced by demographic, clinical, radiological and biological factors.
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Traumatic brain injury is a leading cause of mortality and long-term morbidity, particularly affecting young people. With our best therapies, one half of the patients with severe traumatic brain injury are never capable of living independently. ⋯ Despite the recent guidelines and publications recommending these interventions, critical care clinicians should be conservative towards implementing these therapies outside clinical trials due to substantial efficacy and safety concerns. Nevertheless the high morbidity and mortality associated with severe traumatic brain injury (TBI) demands that we investigate the safety and efficacy of these promising potential therapies as a matter of urgency.
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To establish whether total parenteral nutrition (TPN) for ventilated trauma victims is associated with late-onset acute respiratory distress syndrome (ARDS) independent of ventilation and transfusion parameters. ⋯ TPN administration is independently associated with late ARDS, and its use among critically ill trauma victims should be carefully scrutinised.
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Bicycle riding is a popular leisure activity and an important means of transportation in Hong Kong. Young cyclists' riding behaviour causes injury patterns which may differ from older riders. The aim of this study is firstly to describe bicycle related injuries presenting to a regional trauma centre in Hong Kong, and secondly to compare patients aged > 15 years with those patients aged < or = 15 years. ⋯ Prevention strategies should include more widespread helmet use and increasing bicycle lane provision to enable traffic separation in Hong Kong. The three 'E' approaches (education, enforcement and environment) should be implemented to prevent bicycle injuries in Hong Kong.