J Trauma
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The changing profiles of spinal cord injuries in South Africa are addressed in this study. ⋯ Gunshots carry a heavier prognosis. Only 32% of our gunshot cases underwent a significant recovery as opposed to 61% of stab cases and 44% of the motor vehicle crash victims.
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Great emphasis is placed on the lethality of modern high-powered street weapons, and their impact on mortality from firearm injuries. Presented is a case of an air rifle BB injury to the chest, resulting in a penetrating injury of the right heart, with apparent retrograde embolization to the inferior vena cava. ⋯ This case exemplifies three important principles regarding penetrating chest trauma and air guns: (1) Modern air rifles, capable of muzzle velocities as high as 900 fps, are intrinsically lethal weapons; (2) missiles within the cardiovascular system have a propensity for embolization, and often follow an intuitively unexpected course; and (3) young healthy patients with potentially lethal penetrating cardiac injuries, particularly those caused by low velocity firearms, may appear stable and minimally injured in the emergency room. A strong suspicion of cardiac injury and prompt intervention should be extended to airgun injuries of the thorax.
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Comparative Study
Comparison of high-field magnetic resonance imaging with computed tomography in the evaluation of blunt renal trauma.
To compare magnetic resonance (MR) imaging and computed tomography (CT) in radiographic staging of blunt renal trauma. ⋯ Although CT remains the method of choice in radiographic staging of renal injury, MR imaging can complement CT in patients with severe renal injury, pre-existing renal abnormality, equivocal CT findings, or when repeated radiographic follow-up is required. MR imaging could replace CT in patients with iodine allergy and be used for initial staging if CT is not available.
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To investigate the effects of inhaled nitric oxide (NO) in adult respiratory distress syndrome (ARDS) associated with a therapeutic optimization strategy on oxygen parameters, barotrauma, and evolution in a medical and surgical intensive care unit. ⋯ This study was shorter to demonstrate an improvement in the survival rate. Nevertheless, these preliminary results are encouraging. Because of its safety, effectiveness, and easy use, inhaled NO should be used as a part of a therapeutic optimization protocol before considering more invasive and expensive procedures, such as extracorporeal respiratory support or intravascular oxygenation.
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A case is reported of a patient who sustained a cardiac injury from a 16-penny nail fired from a nail gun and who was successfully treated at a small rural hospital.