The American journal of emergency medicine
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Acute traumatic aortic injury (ATAI) results in several characteristic chest radiographic findings, most notably mediastinal widening. This study was based on the hypothesis that blood or fluid in the widened mediastinum might track up into the neck and be detected on lateral cervical radiographs. In a blinded, retrospective, case-control review of radiology files, 13 consecutive adult cases of ATAI were identified and compared with 19 cases of negative aortography (NAO) and 18 multiple trauma victims (MT) without aortography. ⋯ Cervical ST measurements at C3 or at C6 did not correlate with mediastinal-chest width ratios. Mediastinal widening, aortopulmonic window opacification, and blurring of the aortic knob were the most sensitive chest radiography findings in ATAI, although each of these lacked useful specificity and accuracy. Cervical ST swelling is not a useful marker for ATAI.
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A study was conducted to determine parameters indicating the current use of computed tomography (CT) in the emergency department (ED). Computerized data regarding patients seen in the ED between 1/1/92 and 9/30/95 were retrieved. A rate of 36/1,000 patients underwent CT in the ED (ED CT). ⋯ Some parameters about the use of ED CT were identified. The information obtained will allow comparison of practice between EDs in different medical centers and will be useful to hospital administrators, health planners, and clinicians. This retrospective analysis is to be followed by more comprehensive prospective studies involving different EDs in various sections of the country.
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Cardiac rupture is a frequent cause of death following blunt trauma. Most of these patients die at the scene with only a few surviving to make it to the hospital. With improvements in prehospital care and rapid regional transport, more of these patients may arrive at the hospital with signs of life. ⋯ The differential appearance of upper body cyanosis frequently accompanies these injuries. Prompt recognition and expeditious surgical treatment may increase the number of survivors of this catastrophic injury. Presented here is an illustrative case report and review of the literature.
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Non-life-threatening blunt chest trauma is a commonly occurring phenomenon. No clear guidelines exist in the literature regarding the appropriate investigation and treatment, and most clinicians' practice patterns are based on anecdote, individual experience, and the theoretical risk of complications. ⋯ No significant lung injury was detected in the study cohort of patients, on either an immediate or delayed basis. In the absence of compelling evidence of an underlying lung injury, the performance of chest or rib radiography is of no benefit, and considerable cost savings can potentially be realized.
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This study surveyed the stool appearance descriptions of 107 inpatient children with intussusception. Fifty-six patients presented with grossly bloody stools (passed spontaneously), 10 of which were determined on chart review to resemble currant jelly. Of the 51 patients without grossly bloody spontaneously passed stools, 35 patients had rectal examination results charted. ⋯ Generic terms such as blood, mucus, burgundy, red, etc, are more objective and sensitive at identifying cases of intussusception. Junior physicians who are taught the classic presentation of intussusception with currant jelly stool should also be taught that intussusception should be considered in the differential diagnosis of children passing any type of bloody stool. As a result, physicians with limited experience will be more likely to appropriately consider the diagnosis of intussusception, permitting a more timely diagnosis and a better outcome.