J Trauma
-
In many cases blunt chest trauma involves cardiac lesions, such as pericardial effusion, aneurysma dissecans, or valvular rupture. Early diagnosis with routine transthoracic and/or transesophageal echocardiography is essential to prevent a fatal outcome. ⋯ Transesophageal echocardiography demonstrated a ruptured anterolateral papillary muscle with fourth degree mitral insufficiency. An immediate mitral valve replacement was necessary.
-
Comparative Study
Direct transport to tertiary trauma centers versus transfer from lower level facilities: impact on mortality and morbidity among patients with major trauma.
The purpose of the study was to compare the outcome of severely injured patients who were transported directly to a Level I, tertiary trauma center with those who were transferred after being first transported to less specialized hospitals. ⋯ The results of this study have shown that transportation of severely injured patients from the scene directly to Level I trauma centers is associated with a reduction in mortality and morbidity. Further studies are required for the evaluation of transport protocols for rural trauma. Economic and cost-effectiveness considerations of patient triage are also essential.
-
Comparative Study
Field trauma triage: combining mechanism of injury with the prehospital index for an improved trauma triage tool.
The objective of this study was to combine a physiologic triage score (prehospital index, PHI) with criteria regarding mechanism of injury (MOI) to increase the efficacy of trauma triage. The specific question being asked was: will the combined score improve the sensitivity and specificity over that of the individual scores? ⋯ The combined PHI/MOI score was better at identifying those patients with ISS scores > or = 16 compared with the PHI and MOI scores alone. Although this permitted superior triage (and minimized overtriage), the combined score did not identify all major trauma patients.
-
Cerebral fat embolism syndrome is an uncommon complication of trauma. We present a patient who developed cerebral fat embolism syndrome secondary to long-bone fractures. Although computed tomography of the brain failed to show any intracranial lesion, magnetic resonance imaging (MRI) detected scattered, high-signal-intensity lesions on T2-weighted images. 99mTc-d, 1-hexamethyl-propylene amine oxine single photon emission computed tomography (99mTc-HMPAO SPECT) and transcranial Doppler sonography (TCD) demonstrated low cerebral blood flow in the acute stage. MRI, 99mTc-HMPAO SPECT, and TCD correlated well with the clinical course of cerebral fat embolism syndrome.
-
To determine how often the management of patients with blunt facial trauma was altered by plain roentgenograms or facial computed tomographic (CT) scans compared with findings from physical examination. ⋯ Physical examination reliably assessed the facial skeleton for clinically significant fractures in the majority of patients. In an alert and cooperative patient, CT scan is not required before operative repair in all cases. CT scans are expensive, time-consuming, and labor-intensive and in selected cases add little clinical information to that obtained by physical examination and plain films.