J Trauma
-
Epidural emphysema is a rare condition, and when occurs in isolation it is usually benign and resolves spontaneously after the underlying cause has been treated. Epidural emphysema is usually accompanied by pneumothorax, subcutaneous emphysema, or pneumomediastinum. ⋯ Although nonsurgical pneumoperitoneum can arise in different ways, generally pneumomediastinum or pneumothorax is observed in cases with an intrathoracic source. We report two cases of combined traumatic epidural emphysema and nonsurgical pneumoperitoneum in patients with pneumothorax, pneumomediastinum, and extensive subcutaneous emphysema after blunt trauma.
-
Burn patients with inhalation injury (INHI) require more fluid resuscitation than patients without INHI. However, the relation between INHI and fluid resuscitation may be confounded by a ventilation-induced increase in fluid retention. We therefore evaluated whether INHI was independently of continuous positive pressure ventilation (CPPV) associated with increased fluid retention. ⋯ These results suggest that increased fluid retention, which is conventionally associated with INHI, is due to the effects of ventilation and not to the effects of INHI itself. This warrants a closer evaluation of patients who are ventilated in the absence of INHI, with a view to early extubation.
-
Currently, specific triage criteria, such as blood pressure, respiratory status, Glasgow Coma Scale, and mechanism of injury are used to categorize trauma patients and prioritize emergency department (ED) and trauma team responses. It has been demonstrated in previous literature that an abnormal shock index (SI = heart rate [HR]/systolic blood pressure, >0.9) portends a worse outcome in critically ill patients. Our study looked to evaluate the SI calculated in the field, on arrival to the ED, and the change between field and ED values as a simple and early marker to predict mortality in traumatically injured patients. ⋯ Trauma patients with SI >0.9 have higher mortality rates. An increase in SI from the field to the ED may predict higher mortality. The SI may be a valuable addition to other ED triage criteria currently used to activate trauma team responses.
-
Randomized Controlled Trial
Incidence, management, and prognosis of early ulnar nerve dysfunction in type C fractures of distal humerus.
Displaced comminuted of the distal humerus in adults are among the most complex fractures to be managed effectively. The ulnar nerve is at high risk of impingement secondary to injury, operation, and postoperative rehabilitation in these fractures. In this study we focus on the incidence, management, and prognosis of early ulnar nerve dysfunction in the course of treating type C fractures of distal humerus. ⋯ We conclude that neurolysis and anterior subfascial transposition of vascularized ulnar nerve during open reduction and internal fixation of type C fractures of the distal humerus is beneficial in cases of early ulnat nerve dysfunction.
-
Comparative Study
Comparison of the plasma volume-expanding effects of 6% dextran 70, 5% albumin, and 6% HES 130/0.4 after hemorrhage in the guinea pig.
We still lack comparing data of the plasma volume (PV)-expanding effect of the most commonly used colloids including dextran 70. This study compares the PV-expanding effects of 6% dextran 70, 5% albumin, and 6% hydroxyethylstarch (HES) 130/0.4 after a standardized hemorrhage. ⋯ After hemorrhage, the PV-expanding capacity of 6% dextran 70 was better than that of 5% albumin, which was in turn better than that of HES 130/0.4 given in equal volumes.