Southern medical journal
-
Southern medical journal · Dec 1988
Review Case ReportsBlunt injuries of the cervical trachea: review of 51 patients.
The low incidence of blunt trauma to the cervical portion of the trachea limits management experience in most centers. Hence, we combined our patients with those in published reports containing essential information on injury, treatment, and results. Among 51 patients (93% male), ages ranged from 3 to 65 years. ⋯ Two patients died of other injuries, and six patients (four with delayed repair) required subsequent tracheal reconstruction. Repair over a stent was used in seven patients, four of whom had satisfactory results. From this review we conclude that (1) the diagnosis of blunt trauma to the cervical trachea requires a high index of suspicion, since this injury can easily be overlooked; (2) tracheostomy (vs intubation or cricothyroidotomy) is the preferred means of airway control; (3) preoperative laryngoscopy/bronchoscopy should be done to assess vocal cord function, possible laryngeal damage, and level of tracheal injury; (4) good long-term results, measured by voice and airway quality, are best obtained by immediate repair of significant injuries.
-
Southern medical journal · Dec 1988
Pediatric prehospital care in a southern regional emergency medical service system.
A retrospective review of 2,302 ambulance run reports from the Birmingham Regional Emergency Medical Service System indicated that 6% of all runs are for patients in the pediatric age group (less than 18 years of age). Injuries related to emergencies were responsible for more than 65% of pediatric runs, and 30% were related to motor vehicle accidents. Surprisingly, 8% of calls were for seizure disorders, a figure much higher than in the adult population. ⋯ Significantly more male than female patients were involved. This descriptive epidemiologic study is antecedent to effective planning and implementation of pediatric prehospital care programs. Training of emergency personnel should be targeted toward treating motor vehicle injuries, seizures, poisoning, and upper airway obstruction in children.
-
Southern medical journal · Nov 1988
Review Clinical Trial Controlled Clinical TrialTranscutaneous electrical nerve stimulation for pain control after cholecystectomy: lack of expected benefits.
We did a prospective study of two groups of patients having elective cholecystectomy through a right subcostal incision to evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS). Of 64 patients, 30 received TENS postoperatively and 34 did not. Narcotic use in total dose or on a weight basis was not statistically different between the two groups, nor was there any difference in the occurrence of pulmonary or gastrointestinal complications. The use of TENS after this particular operation did not appear to lessen narcotic use or pain-related complications.
-
Southern medical journal · Oct 1988
ReviewHeadache after lumbar puncture: review of the epidural blood patch.
The incidence of accidental dural puncture during epidural block is 2.9%; headache follows in as many as 76.5% of these patients. Treatment by injection of autologous blood into the epidural space has gained wide acceptance since its introduction in 1960, though it is contraindicated by blood dyscrasias, anticoagulant therapy, bleeding, and localized infection. The procedure is done by slowly injecting 15 to 20 ml of blood into the same interspace, no sooner than 24 hours after the original puncture. Serious complications are rare.