Articles: trauma.
-
To analyze treatment procedures and treatment outcomes of painful missile-caused nerve injuries and factors influencing the outcome. ⋯ The treatment outcome of painful nerve injury depends on several factors, including the type of pain syndrome, severance of nerve injury, and absence of pain paroxysms. Drug therapy (carbamazepine, amitriptyline, or gabapentin) should be recommended, at least as a part of treatment, for patients with reinnervation pain, deafferentation pain, and complex regional pain syndrome Type II. Nerve surgery should be recommended for patients with posttraumatic neuralgia, either as the first treatment choice (acute nerve compression or intraneural foreign particles) or after unsuccessful pharmacological treatment (other causes of neuralgic pain).
-
Clinical cardiology · Dec 2006
Induced hypothermia following out-of-hospital cardiac arrest; initial experience in a community hospital.
Successful resuscitation from sudden cardiac death is frequently accompanied by severe and often fatal neurologic injury. Induced hypothermia (IH) may attenuate the neurologic damage observed in patients after cardiac arrest. ⋯ A program of induced hypothermia based in a community hospital is feasible, practical, and requires limited additional financial and nursing resources. Survival and neurologic recovery compare favorably with clinical trial outcomes.
-
Penetrating chest injuries account for 1-13% of thoracic trauma hospital admissions and most of these are managed with a conservative approach. Nevertheless, 18-30% of cases managed only with tube thoracostomy have residual clotted blood, considered the major risk factor for the development of fibrothorax and empyema. In addition, 4-23% of chest injury patients present persistent pneumothorax and 15-59% present an injury to the diaphragm, which is missed in 30% of cases. In order to make a correct diagnosis, reduce the number of missed injuries, chronic sequelae and late mortality we propose performing surgical exploration of all patients with a penetrating injury of the pleural cavity. ⋯ VATS is a safe and effective way to diagnose and manage penetrating thoracic injuries, and its extensive use leads to a reduction in the number of missed, potentially fatal lesions as well as in chronic sequelae.
-
Major trauma induces marked metabolic changes which contribute to the systemic immune suppression in severely injured patients and increase the risk of infection and posttraumatic organ failure. The hypercatabolic state of polytrauma patients must be recognized early and treated by an appropriate nutritional management in order to avoid late complications. ⋯ Yet many aspects of the nutritional strategies for polytrauma patients remain controversial, including the exact timing, caloric and protein amount of nutrition, choice of enteral versus parenteral route, and duration. The present review will provide an outline of the pathophysiological metabolic changes after major trauma that endorse the current basis for early immunonutrition of polytrauma patients.
-
To determine the number of brain CT scans carried out in patients with mild head injury (MHI) during 13 months of trauma registry, and to investigate means of reducing the rate of unnecessary scans. ⋯ Patients who have GCS score of 13 or 14 on admission should be considered to have a moderate rather than a mild head injury. For reduction of unnecessary brain CT scan performance in MHI patients, we must define the appropriate criteria.