Eur J Trauma Emerg S
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Eur J Trauma Emerg S · Apr 2009
Conservative Management of Major Blunt Renal Trauma with Extravasation: A Viable Option?
To evaluate our experience in the management of patients with major blunt renal trauma treated at a major urban trauma center during the last ten years. ⋯ Our data supports the conservative management of grade IV blunt renal parenchymal injuries in the absence of hemodynamic instability of renal origin. Even select patients with grade V parenchymal injuries can undergo a trial of conservative management.
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Eur J Trauma Emerg S · Apr 2009
Cervical Prevertebral Soft Tissue Swelling in the Traumatized Patient: What is Normality in the Intubated Patient?
Interpretation of prevertebral soft tissue swelling is generally thought to be invalid in the presence of an endotracheal tube (ETT). There is however little scientific data to support this. We evaluate the prevertebral soft tissue swelling of 43 traumatized patients that have had an endotracheal tube (ETT) placed in the acute setting. ⋯ There was no significant difference between the two groups at the C4 and C6 levels. We feel that interpretation of prevertebral swelling in the traumatized patient at the C2 level is invalid in the presence of an ETT, and indeed is significantly increased after intubation despite no injury at this level. However, the interpretation of soft tissue swelling at and below C4 remains a useful tool in the evaluation of an occult cervical injury.
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Proximal embolization of the splenic artery (PSAE) has recently been reported for traumatic splenic injury. The suggested mechanism of action entails a decrease in the splenic blood pressure without ischemia due to collateral blood supply. The main complications of selective embolization are continuous bleeding, splenic infarcts and splenic abscesses. The main complications of observation alone are continuous bleeding and formation of splenic pseudoaneurysms. Our aim was to assess the efficacy of PSAE in the cessation of bleeding without formation of pseudoaneurysms, and the outcome of the spleen after such intervention. ⋯ Proximal embolization of the splenic artery for severe splenic injury is highly successful in cessation of bleeding while preserving splenic architecture. There were minimal complications in this series demonstrated by clinical and Doppler examinations.