Journal of emergencies, trauma, and shock
-
J Emerg Trauma Shock · Oct 2011
C-clamp and pelvic packing for control of hemorrhage in patients with pelvic ring disruption.
Exsanguinating hemorrhage is the major cause of death in patients with pelvic ring disruption. ⋯ Pelvic packing in addition to the C-clamp fixation effectively controls severe hemorrhage in patients with pelvic ring disruption. Early sequential measurements of blood lactate levels can be used to estimate the severity of shock and the response to the shock treatment.
-
J Emerg Trauma Shock · Oct 2011
Indications for brain computed tomography scan after minor head injury.
Minor head injury (MHI) is a common injury seen in Emergency Departments (ED). Computed tomography (CT) scan of the brain is a good method of investigation to diagnose intracranial lesions, but there is a disagreement about indications in MHI patients. We surveyed the post-traumatic symptoms, signs or past historical matters that can be used for the indication of brain CT scan. ⋯ WE SUGGESTED THAT ABNORMAL BRAIN CT SCAN RELATED TO THE TRAUMA AFTER MHI CAN BE PREDICTED BY THE PRESENCE OF ONE OR MORE OF THE FOLLOWING RISK INDICATORS: Headache, vomiting, LOC or amnesia, and alcohol intoxication. Thus, if any patient has these indicators following MHI, he must be considered as a high-risk MHI.
-
Penetrating brain injury (PBI), though less prevalent than closed head trauma, carries a worse prognosis. The publication of Guidelines for the Management of Penetrating Brain Injury in 2001, attempted to standardize the management of PBI. This paper provides a precise and updated account of the medical and surgical management of these unique injuries which still present a significant challenge to practicing neurosurgeons worldwide. ⋯ Cerebrospinal fluid (CSF) leaks are common in PBI patients and surgical correction is recommended for those which do not close spontaneously or are refractory to CSF diversion through a ventricular or lumbar drain. The risk of post-traumatic epilepsy after PBI is high, and therefore, the use of prophylactic anticonvulsants is recommended. Advanced age, suicide attempts, associated coagulopathy, Glasgow coma scale score of 3 with bilaterally fixed and dilated pupils, and high initial intracranial pressure have been correlated with worse outcomes in PBI patients.
-
J Emerg Trauma Shock · Apr 2011
Outcome analysis and outcome predictors of traumatic head injury in childhood: Analysis of 454 observations.
To determine factors associated with poor outcome in children suffering traumatic head injury (HI). ⋯ A significant proportion of children admitted with HI were found to have moderate disability at follow-up. We think that improving prehospital care, establishing trauma centers and making efforts to prevent motor vehicle crashes should improve the prognosis of HI in children.