Southern medical journal
-
We have described a 14-month-old white boy with a laceration of the right upper eyelid draining CSF. Careful evaluation, including computerized tomography, revealed a penetrating injury of the right frontal fossa. Determination of the glucose level in fluid draining from upper eyelid lacerations aids in the diagnosis of CSF fistulas.
-
Trauma kills more Americans from age 1 to 34 than all diseases combined. Until recently, trauma care in the United States was delivered in a nonorganized, nonintegrated fashion, with trauma victims being transported to the medical facility closest to the scene of the accident. Many recent studies confirm an unacceptably high incidence--up to 75% in some studies--of preventable deaths in trauma victims treated under the nearest hospital system. ⋯ The decision on whether to take a patient to the closest hospital or to the regional trauma center is a form of triage, with far-reaching consequences medically, ethically, and financially. Various triage instruments have been developed to try to identify those patients who would benefit from the resources of a trauma center, and to avoid overcrowding those centers with patients having less serious injuries. These triage tools are based on a combination of mechanism of injury, anatomic criteria, physiologic criteria, and co-morbidity factors.
-
Southern medical journal · Apr 1987
Seizures and hypothermia due to dietary water intoxication in infants.
I retrospectively describe 20 episodes of water intoxication in 19 infants, with hypothermia, seizures, and hyponatremia. Overdilution of formula or aggressive supplementation with water or clear juices were documented in 16 of the 20 episodes. Seizures and respiratory distress were severe enough in six cases to require intubation and ventilatory support. ⋯ The children were an average of 5.1 +/- 4.3 months of age; serum sodium values averaged 118 +/- 4.3 mmol/L. No evidence of excess production of antidiuretic hormone was found. Water intoxication in infants is common, and I discuss its possible relationship to demyelinating disease of the central nervous system.
-
Cold hemagglutinin disease is infrequently recognized before complications ensue. We describe a patient with chronic cold hemagglutinin disease who sustained an acute hemolytic crisis during a routine operative procedure in a cool operating room. ⋯ Major complications from the presence of cold agglutinins have been poorly documented and are often thought to be of only theoretic concern. This case and literature review show that such complications may occur and emphasize the importance of careful preoperative plans when the Coombs' test suggests that cold agglutinins exist.