scholarly journals Blunt Cardiac Injury in Trauma Patients with Thoracic Aortic Injury

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Rathachai Kaewlai ◽  
Marc A. de Moya ◽  
Antonio Santos ◽  
Ashwin V. Asrani ◽  
Laura L. Avery ◽  
...  
Keyword(s):  
Cardiac Injury ◽  
Aortic Injury ◽  
Serum Creatine Kinase ◽  
Control Group ◽  
Study Group ◽  
Trauma Patients ◽  
Blunt Cardiac Injury ◽  
Creatine Kinase Mb ◽  
Thoracic Aortic Injury ◽  
Level I

Trauma patients with thoracic aortic injury (TAI) suffer blunt cardiac injury (BCI) at variable frequencies. This investigation aimed to determine the frequency of BCI in trauma patients with TAI and compare with those without TAI. All trauma patients with TAI who had admission electrocardiography (ECG) and serum creatine kinase-MB (CK-MB) from January 1999 to May 2009 were included as a study group at a level I trauma center. BCI was diagnosed if there was a positive ECG with either an elevated CK-MB or abnormal echocardiography. There were 26 patients (19 men, mean age 45.1 years, mean ISS 34.4) in the study group; 20 had evidence of BCI. Of 52 patients in the control group (38 men, mean age 46.9 years, mean ISS 38.7), eighteen had evidence of BCI. There was a significantly higher rate of BCI in trauma patients with TAI versus those without TAI (77% versus 35%,P<0.001).

Association of Scapular Fractures and Blunt Thoracic Aortic Injury: Fact or Fiction?

2005 ◽  
Vol 71 (1) ◽  
pp. 54-57 ◽  
Author(s):  
Carlos V.R. Brown ◽  
George Velmahos ◽  
Dennis Wang ◽  
Susan Kennedy ◽  
Demetrios Demetriades ◽  
...  
Keyword(s):  
Los Angeles ◽  
Blunt Trauma ◽  
Medical Center ◽  
Aortic Injury ◽  
Trauma Patients ◽  
Associated Injuries ◽  
Blunt Thoracic Aortic Injury ◽  
Scapular Fractures ◽  
Thoracic Aortic Injury ◽  
Level I

It is classically taught that scapular fractures (SF) are commonly associated with blunt thoracic aortic injury (BTAI). The purpose of this study was to determine the association between SF and BTAI. A 10-year retrospective review of blunt trauma admissions from two level I trauma centers located in different geographic regions, Washington Hospital Center (WHC) and Los Angeles County Medical Center and the University of Southern California (LAC/USC), was performed. Patients with SF and BTAI were identified, and records were reviewed to determine associated injuries. We identified 35,541 blunt trauma admissions (WHC: 12,971, LAC/USC: 22,570). SF and BTAI occurred in 1.1 per cent and 0.6 per cent of patients, respectively. Most of the patients with SF had associated injuries (99%). Only four patients with SF had BTAI (4/392; 1.0%). The most common injuries associated with SF were rib (43%), lower extremity (36%), and upper extremity (33%) fractures. SF is uncommon after blunt trauma. Patients with SF almost always have significant associated injuries. Although SF indicates a high amount of energy transmitted to the upper thorax, these patients rarely have BTAI. SF should not be used as an indicator of possible BTAI.

Using a Checklist to Improve Family Communication in Trauma Care

2016 ◽  
Vol 82 (1) ◽  
pp. 59-64
Author(s):  
Bradley M. Dennis ◽  
Tracy L. Nolan ◽  
Cecil E. Brown ◽  
Robert L. Vogel ◽  
Kristin A. Flowers ◽  
...  
Keyword(s):  
Treatment Plan ◽  
Trauma Team ◽  
Control Group ◽  
Study Group ◽  
Trauma Patients ◽  
Patient Centered ◽  
Essential Requirement ◽  
Institutional Review ◽  
Centered Care ◽  
Level I

Modern concepts of patient-centered care emphasize effective communication with patients and families, an essential requirement in acute trauma settings. We hypothesized that using a checklist to guide the initial family conversation would improve the family's perception of the interaction. Institutional Review Board–approved, prospective pre/post study involving families of trauma patients admitted to our Level I trauma center for >24 hours. In the control group, families received information according to existing practices. In the study group, residents gave patient information to a first-degree family member using a checklist that guided the interaction. The checklist included a physician introduction, patient condition, list of known injuries, admission unit or intensive care unit, any consultants involved, plans for additional studies or operations, and opportunity for family to ask questions. An 11-item survey was administered 24 to 48 hours after admission to each group that evaluated the trauma team's communication in the areas of physician introduction, patient condition, ongoing treatment, and family perception of the interaction. Responses were on a Likert scale and analyzed using the Wilcoxon-Mann-Whitney test. There were 130 patients in each group. The study group had significantly ( P < 0.05) better responses in 8 of 11 items surveyed: physician spoke to family, physician introduction, understanding of their relative's injuries, admitting unit, consultants involved, urgent surgical procedures required, ongoing diagnostic studies, and understanding of the treatment plan. In conclusion, using a checklist improves the perception of the initial communication between the trauma team and family members of trauma patients, especially their understanding of the treatment plan.

Posttraumatic Resuscitation Affects Stent Graft Sizing in Patients with Blunt Thoracic Aortic Injury

2016 ◽  
Vol 82 (1) ◽  
pp. 75-78 ◽  
Author(s):  
Jordan R. H. Hoffman ◽  
Ritam Chowdhury ◽  
Laura S. Johnson ◽  
Luke P. Brewster ◽  
Yazan Duwayri ◽  
...  
Keyword(s):  
Stent Graft ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Aortic Injury ◽  
Aortic Diameter ◽  
Related Complication ◽  
Blunt Thoracic Aortic Injury ◽  
Thoracic Aortic Injury ◽  
Study Population ◽  
Level I

Patients with blunt aortic injury often present to the emergency department in a relatively hypovolemic state. These patients undergo extensive inhospital resuscitation. The effect of posttraumatic resuscitation on aortic diameter has implications for stent graft sizing. The potential utility of repeat aortic imaging after resuscitation remains unclear. A retrospective chart review of all adult patients presenting to a Level I trauma center between the years 2007 and 2013 was performed. Fifty-three patients were identified with a diagnosis of traumatic aortic injury. Of those, 10 had 2 CT scans before aortic repair and were selected as the study population for analysis. After resuscitation, there was a significant increase in aortic diameter both proximal and distal to the aortic injury: proximal aortic diameter increase of 1.97 mm and distal aortic diameter increase of 1.48 mm. This retrospective study shows that after resuscitation, there is a significant increase in proximal and distal aortic diameter. Interval reimaging of the thoracic aorta may be beneficial after adequate stabilization of the patient's other injuries. In certain cases, more appropriate sizing may prevent a device-related complication.

CT Chest with IV Contrast Compared with CT Angiography after Blunt Trauma

2015 ◽  
Vol 81 (10) ◽  
pp. 1080-1083
Author(s):  
Andrea A. Zaw ◽  
Donovan Stewart ◽  
Jason S. Murry ◽  
David M. Hoang ◽  
Beatrice Sun ◽  
...  
Keyword(s):  
Chest Trauma ◽  
Aortic Injury ◽  
Whole Body ◽  
Initial Assessment ◽  
Trauma Patients ◽  
Inclusion Criteria ◽  
Whole Body Ct ◽  
Appropriate Treatment ◽  
Urban Level ◽  
Level I

Blunt aortic injury (BAI) after chest trauma is a potentially lethal condition that requires rapid diagnosis for appropriate treatment. We compared CT with IV contrast (CTI) with CT with angiography (CTA) during the initial phase of care at an urban Level I trauma center from January 1, 2010 to December 31, 2013. Overall, 281 patients met inclusion criteria with 167 (59%) CTI and 114 (41%) CTA. There were no differences between cohorts in age, gender, initial heart rate, systolic blood pressure, and Glasgow Coma Scale. Mortality rates were similar for CTI and CTA (4% vs 8%, P = 0.20). CTI identified any chest injury in 54 per cent of patients compared with 46 per cent with CTA ( P = 0.05). The rate of BAI was similar with CTI and CTA (2% vs 2%, P = 0.80), and neither modality was falsely negative. We conclude that CTI and CTA are similar at evaluating trauma patients for BAI, although CTI may be preferable during the initial assessment phase because the contrast injection may be combined with abdominal scanning and image time is reduced when whole-body CT is required.

Blunt Cardiac Injury: A Single-Center 15-Year Experience

2020 ◽  
Vol 86 (4) ◽  
pp. 354-361
Author(s):  
Jin-Mou Gao ◽  
Hui Li ◽  
Gong-Bin Wei ◽  
Chao-Pu Liu ◽  
Ding-Yuan Du ◽  
...  
Keyword(s):  
Traffic Accidents ◽  
Early Recognition ◽  
Cardiac Injury ◽  
Shock Rate ◽  
Thoracic Injury ◽  
Trauma Patients ◽  
Myocardial Contusion ◽  
Blunt Cardiac Injury ◽  
Group A ◽  
Group B

In recent years, the incidence of blunt cardiac injury (BCI) has increased rapidly and is an important cause of death in trauma patients. This study aimed to explore early diagnosis and therapy to increase survival. All patients with BCI during the past 15 years were analyzed retrospectively regarding the mechanism of injury, diagnostic and therapeutic methods, and outcome. The patients were divided into two groups according to the needs of their condition—nonoperative (Group A) and operative (Group B). Comparisons of the groups were performed. A total of 348 patients with BCI accounted for 18.3 per cent of 1903 patients with blunt thoracic injury. The main cause of injury was traffic accidents, with an incidence of 48.3 per cent. In Group A (n = 305), most patients sustained myocardial contusion, and the mortality was 6.9 per cent. In Group B (n = 43), including those with cardiac rupture and pericardial hernia, the mortality was 32.6 per cent. Comparisons of the groups regarding the shock rate and mortality were significant ( P < 0.01). Deaths directly resulting from BCI in Group B were greater than those in Group A ( P < 0.05). In all 348 patients, the mortality rate was 10.1 per cent. When facing a patient with blunt thoracic injury, a high index of suspicion for BCI must be maintained. To manage myocardial contusion, it is necessary to protect the heart, alleviate edema of the myocardium, and control arrhythmia with drugs. To deal with those requiring operation, early recognition and expeditious thoracotomy are essential.

scholarly journals Protective effects of bisoprolol against cadmium-induced myocardial toxicity through inhibition of oxidative stress and NF-κΒ signalling in rats

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Jinhua Liu ◽  
Ying Xie ◽  
Zhujun Han ◽  
Hailong Wang ◽  
Wenhu Xu
Keyword(s):  
Oxidative Stress ◽  
Cardiac Injury ◽  
Therapeutic Drug ◽  
Control Group ◽  
Protective Effects ◽  
Necrosis Factor Alpha ◽  
Tissue Samples ◽  
Gum Acacia ◽  
Tnf Α ◽  
Creatine Kinase Mb

Abstract Introduction The aim of the study was to investigate the mitigative effects of bisoprolol (BIS) in cadmium-induced myocardial toxicity on oxidative stress and its inhibitive effect on nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kB) signalling in rats. Material and Methods Male albino Wistar rats were assigned to control, Cd, BIS 2 (2 mg/kg b.w.) and BIS 8 (8 mg/kg b.w.) groups with nine rats in each. Over four weeks, the control group was administered 1% gum acacia, all other groups received 3mg/kg b.w. CdCl2 dissolved in distilled water, and the BIS groups were additionally given bisoprolol in gum acacia. Blood samples were collected for biochemical estimations. Blood pressure and serum biomarker (lactate dehydrogenase, aspirate transaminase, alanine transferase and creatine kinase-MB, enzyme (superoxide dismutase, lipid hydroxy peroxidase, catalase and malondialdehyde), and tumour necrosis factor alpha (TNF-α) concentrations were measured. Western blot analysis was conducted for NF-κB and glutathione S-transferase (GST). After sacrificing the rats, cardiac tissue samples were examined histopathologically. Results Our findings pointed to a significant decrease (P < 0.05) in the studied serum biomarkers and levels of the relevant enzymes in the BIS 8 group compared to the Cd group. A significant decrease (P < 0.05) in NF-kB p65 expression and TNF-α levels was noted in the BIS 8 group relative to the BIS 2 and Cd groups, indicating a reduction at a higher dose. In microscopy, histopathological changes in the cardiac muscles of the BIS 8 group were evident compared to those of the Cd group. Conclusion BIS seemed to have protective effects against cardiac injury induced by cadmium and could be considered a novel therapeutic drug and prognostic biomarker in the pathology of the many cardiovascular diseases caused by heavy metal intake.

Outcome of Blunt Thoracic Aortic Injury in a Level I Trauma Center

1997 ◽  
Vol 43 (5) ◽  
pp. 844-851 ◽  
Author(s):  
E. James Frick ◽  
Mark D. Cipolle ◽  
Michael D. Pasquale ◽  
Thomas E. Wasser ◽  
Michael Rhodes ◽  
...  
Keyword(s):  
Trauma Center ◽  
Aortic Injury ◽  
Blunt Thoracic Aortic Injury ◽  
Thoracic Aortic Injury ◽  
Level I

Blunt Thoracic Aortic Injury

2008 ◽  
Vol 74 (10) ◽  
pp. 1033-1037 ◽  
Author(s):  
Elizabeth R. Benjamin ◽  
Areti Tillou ◽  
Jonathan R. Hiatt ◽  
H. Gill Cryer
Keyword(s):  
Injury Severity ◽  
Aortic Injury ◽  
Diagnosis And Treatment ◽  
Successful Outcome ◽  
Operative Repair ◽  
Blunt Thoracic Aortic Injury ◽  
Thoracic Aortic Injury ◽  
Pelvic Embolization ◽  
Life Threatening ◽  
Level I

Blunt thoracic aortic injury (BAI) is a rare but often fatal injury that occurs with severe polytrauma. Immediate diagnosis and treatment of BAI are essential for a successful outcome. We reviewed our experience with 20 patients with BAI treated at a Level I trauma center between 1995 and 2006. The mean Injury Severity Score was 38 ± 14 and 14 patients had an abnormal Glasgow Coma Score; associated injuries included abdomen in 13 patients, extremity in 12, and head in six. Chest x-ray (CXR) findings were suggestive of aortic injury in 15 patients, equivocal in three, and showed no evidence of aortic injury in two. Diagnosis was made by CT angiography (CTA) in 17 patients, transesophageal echocardiography (TEE) in two, and formal angiography in one. Sixteen patients underwent operative repair of BAI. Of these, eight also underwent laparotomy, six had operative repair of extremity fractures, and three had pelvic embolization. Five patients died, three of whom were treated nonoperatively, and length of hospitalization in survivors was 32 ± 20 days. BAI is rare and often associated with multiple life-threatening injuries complicating diagnosis and treatment. Our data support the aggressive use of CTA even when classic CXR findings are not present. When CT must be delayed for abdominal exploration, intraoperative TEE is useful.

CT Chest with IV Contrast Compared with CT Angiography after Blunt Trauma

2016 ◽  
Vol 82 (1) ◽  
pp. 41-45 ◽  
Author(s):  
Andrea A. Zaw ◽  
Donovan Stewart ◽  
Jason S. Murry ◽  
David M. Hoang ◽  
Beatrice Sun ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Chest Trauma ◽  
Aortic Injury ◽  
Initial Evaluation ◽  
Whole Body ◽  
Initial Assessment ◽  
Trauma Patients ◽  
Intravenous Contrast ◽  
Whole Body Ct ◽  
Level I

Blunt aortic injury (BAI) after chest trauma is a potentially lethal condition. Rapid diagnosis is important to appropriately treat patients. The purpose of this study was to compare CT with intravenous contrast (CTI) to CT with angiography (CTA) in the initial evaluation of blunt chest trauma patients. This was a retrospective review of all blunt trauma patients who received a CTI or CTA during the initial evaluation at an urban Level I trauma center from January 1, 2010 to December 31, 2013. Two-hundred and eighty-one trauma patients met inclusion criteria. Most, 167/281 (59%) received CTI and 114/281 (41%) received CTA. There were no differences between cohorts in age, gender, initial heart rate, systolic blood pressure, and Glasgow Coma Scale in emergency department. Mortality rates were similar for CTI and CTA (4% vs 8%, P = 0.20). CTI identified an injury in 54 per cent compared with 46 per cent in CTA ( P = 0.05). Overall, 2 per cent of patients had BAI with similar rates in CTI and CTA (2% vs 2%, P = 0.80). BAI was not missed using either CTI or CTA. Trauma patients studied with CTI had similar diagnostic findings as CTA. CTI may be preferable to CTA during the initial assessment for possible BAI because of a single contrast injection for whole body CT.

scholarly journals Mortality and morbidity in COVID-19 orthopedic trauma patients: is early surgery the keystone?

2020 ◽  
Author(s):  
Paolo Capitani ◽  
Enrico Gallazzi
Keyword(s):  
Clinical Laboratory ◽  
Perioperative Complications ◽  
Trauma Surgery ◽  
Early Surgery ◽  
Control Group ◽  
Study Group ◽  
Trauma Patients ◽  
Orthopedic Trauma ◽  
Mortality And Morbidity ◽  
Infection Age

Purpose. In the pandemic disease caused by Sars-Cov-2 virus, trauma surgery continued the management of patients with fractures. The purpose of the study is to evaluate mortality and morbidity in orthopedic trauma patients surgically treated with a diagnosis of COVID-19 infection, comparing them to a control group of COVID-19 negative.Methods. We retrospectively identified patients admitted to our Emergency Room from March 8th to May 4th 2020 with a diagnosis of fracture that were subsequently surgically treated. For each patient included demographics, clinical, laboratory, radiological data and type of treatment for COVID-19 infection were collected.Results. 65 patients were identified. Of those, 17 (6 women and 11 men) were COVID-19 positive (study group), while the others were control group. Preoperative laboratory tests showed leukocytosis in six and lymphopenia in 15 cases. 14 patients had a high level of C-reactive protein. 15 patients had an abnormal level of D-dimer. The overall mortality of our series was 4.6% (3 patients). Of those, one patient was in the study group (5.8%) and 2 were in the control group (4.1%) (p&gt;0.05). Perioperative adverse events were registred in 5 cases (29.4%) in the study group and in 8 (16.6%) in the control group (p&gt;0.05).Conclusion. Early surgery and short hospitalization could be key for a better clinical outcomes in trauma patients with a concomitant COVID-19 infection. Age and ASA grade could represent independent risk factors for perioperative complications

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