scholarly journals SPLENIC ANGIOGRAPHIC EMBOLIZATION IN IV AND V-GRADE SPLENIC INJURIES. DOES IT WORK? OUR EXPERIENCE ON THE MANAGEMENT OF SPLENIC INJURIES IN THE LAST 14 YEARS

2021 ◽  
Vol 108 (Supplement_3) ◽  
Author(s):  
V Lucas Guerrero ◽  
S Montmany ◽  
P Rebasa ◽  
A Luna ◽  
S Navarro
Keyword(s):  
Conservative Treatment ◽  
Treatment Failure ◽  
Hemodynamic Instability ◽  
Trauma Patients ◽  
Angiographic Embolization ◽  
Contrast Extravasation ◽  
Arteriovenous Fistulas ◽  
Splenic Embolization ◽  
Surgical Injuries ◽  
Emergent Surgery

Abstract INTRODUCTION Spleen is frequently damaged in abdominal trauma. Patients with splenic injury with hemodynamic instability, peritonism signs or other surgical injuries need emergent surgery. Hemodynamically stable patients are treated conservatively. Splenic embolization is indicated in injuries with blush, pseudoaneurysms or arteriovenous fistulas. It is unclear its indication in IV and V-grade splenic injuries without contrast extravasation. Our hypothesis is that IV and V-grade splenic injuries embolization decreases conservative treatment failure. MATERIAL AND METHODS Retrospective observational study, including all patients with blunt splenic injuries, prospectively included in our registry of polytraumatic patients (>16 years) since 2006. RESULTS One hundred and seventy patients have been included since 2006. In 2006-2013, when splenic injuries with active bleeding, pseudoaneurysms or arteriovenous fistulas were embolized, 94 patients were included. 37,2% required surgery and 62,8% conservative treatment. Splenic embolization was performed in 17% of patients who were treated conservatively. Conservative treatment failure was 16,9%: 10 cases out of those who underwent medical treatment (4 required embolization and 6 needed surgery). From 2014 to the present, when IV and V-grade injuries were included in the indications for embolization, 76 patients have been included. 38,2% required surgery and 61,8% were treated conservatively (40,4% were embolized and the rest were treated medically). One case (3,6%) of those treated medically and another (5,3%) of those embolized failed. Overall failure of conservative treatment was 4,3%. CONCLUSION Embolization of IV and V-grade splenic injuries decreases conservative treatment failure from 16,9% to 4,3%.

scholarly journals A Rare Case of Hemorrhagic Shock: Morel-Lavallée Lesion

2019 ◽  
Vol 3 (4) ◽  
pp. 417-420 ◽  
Author(s):  
Lieke Claassen ◽  
Myriam Franssen ◽  
Erik Robert de Loos
Keyword(s):  
Treatment Options ◽  
Hypovolemic Shock ◽  
Clinical Signs ◽  
Hemodynamic Instability ◽  
Trauma Patients ◽  
Lumbar Region ◽  
Bilateral Pneumothorax ◽  
Contrast Extravasation ◽  
Multiple Rib Fractures ◽  
Degloving Injury

Hemorrhage is a major cause of death among trauma patients. Controlling the bleeding is essential but can be difficult when the source of bleeding remains unidentified. We present a 67-year-old healthy male with a hypovolemic shock after a suicide attempt by jumping from a height. Apart from a bilateral pneumothorax with multiple rib fractures, a femur fracture and spine fractures, computer tomography (CT) revealed a closed, degloving injury of the back, also known as a Morel-Lavallée lesion. Hemodynamic instability due to hemorrhage caused by a Morel-Lavallée lesion in the lumbar region is very rare and easily overlooked. This case demonstrates the importance of clinical signs of Morel-Lavallée, and illustrates the need for total body CTs to exclude other locations of bleeding and to detect contrast extravasation. This report also discusses the possible treatment options for Morel-Lavallée lesions.

scholarly journals Accuracy of Contrast Extravasation on Computed Tomography for Diagnosing Severe Pelvic Hemorrhage in Pelvic Trauma Patients: A Meta-Analysis

Medicina ◽  
2021 ◽  
Vol 57 (1) ◽  
pp. 63
Author(s):  
Sung Nam Moon ◽  
Jung-Soo Pyo ◽  
Wu Seong Kang
Keyword(s):  
Computed Tomography ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Pelvic Trauma ◽  
Test Accuracy ◽  
Trauma Patients ◽  
Positive Finding ◽  
Summary Receiver Operating Characteristic ◽  
Contrast Extravasation ◽  
Pelvic Hemorrhage

Background and objective: The early detection of underlying hemorrhage of pelvic trauma has been a critical issue. The aim of this study was to systematically determine the diagnostic accuracy of computed tomography (CT) for detecting severe pelvic hemorrhage. Materials and Methods: Relevant articles were obtained by searching PubMed, EMBASE, and Cochrane databases through 28 November 2020. Diagnostic test accuracy results were reviewed to obtain the sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristic curve of CT for the diagnosis in pelvic trauma patients. The positive finding on CT was defined as the contrast extravasation. As the reference standard, severe pelvic hemorrhage was defined as an identification of bleeding at angiography or by direct inspection using laparotomy that required hemostasis by angioembolization or surgery. A subgroup analysis was performed according to the CT modality that is divided by the number of detector rows. Result: Thirteen eligible studies (29 subsets) were included in the present meta-analysis. Pooled sensitivity of CT was 0.786 [95% confidence interval (CI), 0.574–0.909], and pooled specificity was 0.944 (95% CI, 0.900–0.970). Pooled sensitivity of the 1–4 detector row group and 16–64 detector row group was 0.487 (95% CI, 0.215–0.767) and 0.915 (95% CI, 0.848–0.953), respectively. Pooled specificity of the 1–4 and 16–64 detector row groups was 0.956 (95% CI, 0.876–0.985) and 0.906 (95% CI, 0.828–0.951), respectively. Conclusion: Multi-detector CT with 16 or more detector rows has acceptable high sensitivity and specificity. Extravasation on CT indicates severe hemorrhage in patients with pelvic trauma.

scholarly journals Low profile REBOA device for increasing systolic blood pressure in hemodynamic instability: single-center 4-year experience of use of ER-REBOA

2021 ◽  
Author(s):  
David T. McGreevy ◽  
Mitra Sadeghi ◽  
Kristofer F. Nilsson ◽  
Tal M. Hörer
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Hemodynamic Instability ◽  
Balloon Occlusion ◽  
University Hospital ◽  
Trauma Patients ◽  
Single Center ◽  
Hemorrhage Control ◽  
Single Center Experience ◽  
Low Profile

Abstract Background Hemodynamic instability due to torso hemorrhage can be managed with the assistance of resuscitative endovascular balloon occlusion of the aorta (REBOA). This is a report of a single-center experience using the ER-REBOA™ catheter for traumatic and non-traumatic cases as an adjunct to hemorrhage control and as part of the EndoVascular resuscitation and Trauma Management (EVTM) concept. The objective of this report is to describe the clinical usage, technical success, results, complications and outcomes of the ER-REBOA™ catheter at Örebro University hospital, a middle-sized university hospital in Europe. Methods Data concerning patients receiving the ER-REBOA™ catheter for any type of hemorrhagic shock and hemodynamic instability at Örebro University hospital in Sweden were collected prospectively from October 2015 to May 2020. Results A total of 24 patients received the ER-REBOA™ catheter (with the intention to use) for traumatic and non-traumatic hemodynamic control; it was used in 22 patients. REBOA was performed or supervised by vascular surgeons using 7–8 Fr sheaths with an anatomic landmark or ultrasound guidance. Systolic blood pressure (SBP) increased significantly from 50 mmHg (0–63) to 95 mmHg (70–121) post REBOA. In this cohort, distal embolization and balloon rupture due to atherosclerosis were reported in one patient and two patients developed renal failure. There were no cases of balloon migration. Overall 30-day survival was 59%, with 45% for trauma patients and 73% for non-traumatic patients. Responders to REBOA had a significantly lower rate of mortality at both 24 h and 30 days. Conclusions Our clinical data and experience show that the ER-REBOA™ catheter can be used for control of hemodynamic instability and to significantly increase SBP in both traumatic and non-traumatic cases, with relatively few complications. Responders to REBOA have a significantly lower rate of mortality.

scholarly journals Nontraumatic Parapharyngeal Haematoma: A Rare Lesion

2018 ◽  
Vol 2018 ◽  
pp. 1-2 ◽  
Author(s):  
Pedro Carneiro de Sousa ◽  
Inês Gambôa ◽  
Delfim Duarte ◽  
Nuno Trigueiros-Cunha
Keyword(s):  
Case Report ◽  
Parathyroid Hormone ◽  
Conservative Treatment ◽  
Parathyroid Adenoma ◽  
Parapharyngeal Space ◽  
Neck Swelling ◽  
Parathyroid Adenomas ◽  
Rare Lesion ◽  
Symptoms And Signs ◽  
Emergent Surgery

Nontraumatic haematoma of parapharyngeal space is very rare and may cause dysphagia and dyspnea. The authors present a case report of a 74-year-old woman with sudden nontraumatic neck swelling without dyspnea and with left pharyngeal bulging and endolaryngeal displacement. Parathyroid hormone elevation and imaging exams confirmed bleeding from a parathyroid adenoma. Symptoms and signs resolved after one week of conservative treatment. There are few cases of parapharyngeal haematomas caused by parathyroid adenomas. Most patients can be managed without emergent surgery, but close airway monitoring is fundamental.

Pre-hospital hypothermia is associated with transfusion risk after traumatic injury

CJEM ◽  
2020 ◽  
Vol 22 (S2) ◽  
pp. S12-S20
Author(s):  
Naheed K. Jivraj ◽  
Lilia Kaustov ◽  
Kennedy Ning Hao ◽  
Rachel Strauss ◽  
Jeannie Callum ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Traumatic Injury ◽  
Multivariable Analysis ◽  
Hospital Setting ◽  
Multivariable Logistic Regression Analysis ◽  
Trauma Patients ◽  
Injured Patients ◽  
Emergent Surgery ◽  
Rbc Transfusion

ABSTRACTObjectivesIn traumatically injured patients, excessive blood loss necessitating the transfusion of red blood cell (RBC) units is common. Indicators of early RBC transfusion in the pre-hospital setting are needed. This study aims to evaluate the association between hypothermia (<36°C) and transfusion risk within the first 24 hours after arrival to hospital for a traumatic injury.MethodsWe completed an audit of all traumatically injured patients who had emergent surgery at a single tertiary care center between 2010 and 2014. Using multivariable logistic regression analysis, we evaluated the association between pre-hospital hypothermia and transfusion of ≥1 unit of RBC within 24 hours of arrival to the trauma bay.ResultsOf the 703 patients included to evaluate the association between hypothermia and RBC transfusion, 203 patients (29%) required a transfusion within 24 hours. After controlling for important confounding variables, including age, sex, coagulopathy (platelets and INR), hemoglobin, and vital signs (blood pressure and heart rate), hypothermia was associated with a 68% increased odds of transfusion in multivariable analysis (OR: 1.68; 95% CI: 1.11-2.56).ConclusionsHypothermia is strongly associated with RBC transfusion in a cohort of trauma patients requiring emergent surgery. This finding highlights the importance of early measures of temperature after traumatic injury and the need for intervention trials to determine if strategies to mitigate the risk of hypothermia will decrease the risk of transfusion and other morbidities.

scholarly journals Bleeding from Small Intestine: No Man's Land

2020 ◽  
Vol 33 (01) ◽  
pp. 016-021 ◽  
Author(s):  
Ara Sahakian ◽  
Sang W. Lee ◽  
Joongho Shin
Keyword(s):  
Small Intestine ◽  
Nonoperative Management ◽  
Hemodynamic Instability ◽  
Accurate Diagnosis ◽  
Angiographic Embolization ◽  
Mortality And Morbidity ◽  
Surgical Exploration ◽  
Intraoperative Enteroscopy ◽  
No Man's Land ◽  
Mass Lesions

AbstractBleedings from small intestine account for 5% of all gastrointestinal bleeding. With advanced endoscopic tools, such as video capsule endoscopy and deep enteroscopy, accurate diagnosis and treatment is possible in majority of cases with low mortality and morbidity. Nonoperative management includes endoscopic hemostasis and angiographic embolization. Recurrence after initial treatment is relatively common. Surgery is reserved for the cases that are refractory to endoscopic or angiographic treatment, bleeding from tumor or mass lesions, or hemodynamic instability. At the time of surgical exploration, unless the lesion has been marked by endoscopic tattoo or clip, intraoperative enteroscopy is often necessary to localize the lesion.

Juvenile osteochondritis dissecans of the talus: predictors of conservative treatment failure

2015 ◽  
Vol 135 (10) ◽  
pp. 1337-1341 ◽  
Author(s):  
Thomas J. Heyse ◽  
Karl F. Schüttler ◽  
Annette Schweitzer ◽  
Nina Timmesfeld ◽  
Turgay Efe ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Treatment Failure ◽  
Osteochondritis Dissecans ◽  
Juvenile Osteochondritis Dissecans

scholarly journals Whole-body computed tomography is safe, effective and efficient in the severely injured hemodynamically unstable trauma patient

2020 ◽  
Author(s):  
Carlos Alberto Ordoñez ◽  
Michael Parra ◽  
Alfonso Holguín ◽  
Carlos Garcia ◽  
Monica Guzmán-Rodríguez ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Decision Making ◽  
Damage Control ◽  
Hemodynamic Instability ◽  
Whole Body ◽  
Trauma Patients ◽  
Severely Injured ◽  
Hemostatic Resuscitation ◽  
Whole Body Computed Tomography ◽  
Technological Advances

Trauma is a complex pathology that requires an experienced multidisciplinary team with an inherent quick decision-making capacity, given that a few minutes could represent a matter of life or death. These management decisions not only need to be quick but also accurate to be able to prioritize and to efficiently control the injuries that may be causing impending hemodynamic collapse. In essence, this is the cornerstone of the concept of Damage Control Trauma Care. With current technological advances, physicians have at their disposition multiple diagnostic imaging tools that can aid in this prompt decision-making algorithm. This manuscript aims to perform a literature review on this subject and to share the experience on the use of Whole Body Computed Tomography as a potentially safe, effective, and efficient diagnostic tool in cases of severely injured trauma patients regardless of their hemodynamic status. Our general recommendation is that, when feasible, perform a Whole-Body Computed Tomography without interrupting ongoing hemostatic resuscitation in cases of severely injured trauma patients with or without signs of hemodynamic instability. The use of this technology will aid in the decision-making of the best surgical approach for these patients without incurring any delay in definitive management and/or increasing significantly their radiation exposure.

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