scholarly journals Hepatothorax: A Rare Outcome of High-Speed Trauma

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Matthew Porcelli ◽  
Oksana Prychyna ◽  
Andrew Rosenthal ◽  
Joseph DeCostanza
Keyword(s):  
Early Diagnosis ◽  
High Speed ◽  
Motor Vehicle ◽  
Penetrating Trauma ◽  
Motor Vehicle Crashes ◽  
Diagnosis And Treatment ◽  
Diagnostic Tools ◽  
Common Mechanism ◽  
Trauma Unit ◽  
Level I

Diaphragmatic ruptures are the result of severe blunt trauma or penetrating trauma. Motor vehicle crashes are a common mechanism associated with blunt diaphragmatic rupture (BDR). Incorporating diagnostic tools and laparotomy assist in the diagnosis and treatment of BDR. However, diagnosing BDR can be a challenge for practitioners. Early diagnosis and treatment improve the patient's outcomes. This paper details the events of a patient received in a level I trauma unit.

scholarly journals An experience with blunt abdominal trauma: evaluation, management and outcome

2014 ◽  
Vol 4 (2) ◽  
Author(s):  
Nikhil Mehta ◽  
Sudarshan Babu ◽  
Kumar Venugopal
Keyword(s):  
Early Diagnosis ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
World Health ◽  
Common Mechanism ◽  
World Population ◽  
Diagnosis And Management ◽  
Time Of Presentation

Blunt abdominal trauma (BAT) is a frequent emergency and is associated with significant morbidity and mortality in spite of improved recognition, diagnosis and management. Trauma is the second largest cause of disease accounting for 16% of global burden. The World Health Organization estimates that, by 2020, trauma will be the first or second leading cause of <em>years of productive life</em> <em>lost</em> for the entire world population. This study endeavors to evaluate 71 cases of BAT with stress on early diagnosis and management, increase use of non operative management, and time of presentation of patients. A retrospective analysis of 71 patients of BAT who were admitted in Kempegowda Institute of Medical Sciences hospital (KIMS, Bangalore, India) within a span of 18 months was done. Demographic data, mechanism of trauma, management and outcomes were studied. Most of the patients in our study were in the age group of 21-30 years with an M:F ratio of 3.7:1. Motor vehicle accident (53%) was the most common mechanism of injury. Spleen (53%) was the commonest organ injured and the most common surgery performed was splenectomy (30%). Most common extra abdominal injury was rib fracture in 20%. Mortality rate was 4%. Wound sepsis (13%) was the commonest complication. Initial resuscitation measures, thorough clinical examination and correct diagnosis forms the most vital part of management. 70% of splenic, liver and renal injuries can be managed conservatively where as hollow organs need laparotomy in most of the cases. The time of presentation of patients has a lot to do with outcome. Early diagnosis and prompt treatment can save many lives.

scholarly journals Intra-Testicular Papaverine Injection for Testicular Salvage after Blunt Testicular Trauma: A Case Report

2019 ◽  
Vol 13 (2) ◽  
pp. 110-112
Author(s):  
Kevin Keating ◽  
Paulette C. Dreher ◽  
Jason Levy ◽  
Brian McGreen ◽  
Daniel Edwards ◽  
...  
Keyword(s):  
High Speed ◽  
Motor Vehicle ◽  
Primary Repair ◽  
Tunica Albuginea ◽  
Current Evidence ◽  
Common Mechanism ◽  
Surgical Interventions ◽  
Surgical Exploration ◽  
Valuable Treatment ◽  
Testicular Trauma

Blunt trauma is the most common mechanism of injury to the scrotum and testicle. Surgical exploration with primary repair, hematoma evacuation, and de-torsion are common surgical interventions. A 20-year-old male with no previous medical history presented after a high-speed motor vehicle collision. Ultrasonography demonstrated heterogeneous changes of the tunica albuginea and decreased arterial flow to bilateral testicles. He was subsequently taken to the operating room for surgical exploration, which revealed bilateral mottled testes with questionable viability. Papaverine was injected into each testicle, which resulted in visibly increased perfusion and subsequent preservation of the testicles. Conclusion: Current evidence on the use of papaverine is isolated to testicular torsion. Additional research should be conducted on the use of papaverine in blunt testicular trauma. Papaverine injection may be a valuable treatment option when inadequate perfusion is observed intra-operatively.

scholarly journals Renal trauma: the current best practice

2018 ◽  
Vol 10 (10) ◽  
pp. 295-303 ◽  
Author(s):  
Tomer Erlich ◽  
Noam D. Kitrey
Keyword(s):  
Renal Injury ◽  
Best Practice ◽  
Motor Vehicle ◽  
Penetrating Trauma ◽  
High Energy ◽  
Renal Trauma ◽  
Common Mechanism ◽  
Trauma Patients ◽  
Vehicle Accidents ◽  
Enhanced Computed Tomography

The kidneys are the most vulnerable genitourinary organ in trauma, as they are involved in up to 3.25% of trauma patients. The most common mechanism for renal injury is blunt trauma (predominantly by motor vehicle accidents and falls), while penetrating trauma (mainly caused by firearms and stab wound) comprise the rest. High-velocity weapons impose specifically problematic damage because of the high energy and collateral effect. The mainstay of renal trauma diagnosis is based on contrast-enhanced computed tomography (CT), which is indicated in all stable patients with gross hematuria and in patients presenting with microscopic hematuria and hypotension. Additionally, CT should be performed when the mechanism of injury or physical examination findings are suggestive of renal injury (e.g. rapid deceleration, rib fractures, flank ecchymosis, and every penetrating injury of the abdomen, flank or lower chest). Renal trauma management has evolved during the last decades, with a distinct evolution toward a nonoperative approach. The lion’s share of renal trauma patients are managed nonoperatively with careful monitoring, reimaging when there is any deterioration, and the use of minimally invasive procedures. These procedures include angioembolization in cases of active bleeding and endourological stenting in cases of urine extravasation.

scholarly journals P053: Characteristics and patterns of major traumatic brain injury in Nova Scotia: a 12-year retrospective analysis

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S96-S96
Author(s):  
R. Green ◽  
N. Kureshi ◽  
L. Fenerty ◽  
G. Thibault-Halman ◽  
M. Erdogan ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Nova Scotia ◽  
Brain Injury ◽  
Motor Vehicle ◽  
Case Series ◽  
Penetrating Trauma ◽  
Motor Vehicle Crashes ◽  
Series Data ◽  
Vehicle Crashes ◽  
Injury Rates

Introduction: Traumatic brain injury (TBI) is a leading cause of death and disability in Nova Scotia. TBI occurs in approximately 50% of major trauma seen annually in the province. The purpose of this study was to describe the characteristics and patterns of major TBI seen in Nova Scotia over a 12-year period. Methods: This was a retrospective case series. Data were obtained from the Nova Scotia Trauma Registry for all patients presenting with major TBI (abbreviated injury score [AIS] head ≥3) between 2002 and 2013. Injury rates were calculated on the basis of 100,000 population (all ages) using population estimates from Statistics Canada. Results: Overall, 4152 major TBI patients were seen in Nova Scotia hospitals during the study period. Mean age of TBI patients was 51±25 years; 73% were male. The majority of injuries were the result of blunt trauma (93%), with relatively few major TBIs resulting from penetrating trauma (7%). The most common mechanisms of injury were falls (44%) and motor vehicle crashes (27%). Analysis of census-based subpopulations of the province showed that injury rates varied significantly among counties (from 25 to 63 per 100,000 population). We observed an increase in the number of major TBI patients over twelve years. Conclusion: Our findings suggest significant regional variation in major TBI rates in Nova Scotia. There are ongoing needs for prevention and intervention efforts that focus on unintentional falls and motor vehicle crashes, especially in older adults. These results also suggest that geographically targeted efforts may be warranted.

Pediatric Safety Restraint Use in Motor Vehicle Crashes at a Level I Safety-Net Trauma Center

2021 ◽  
Vol 258 ◽  
pp. 132-136
Author(s):  
Scott Sylvester ◽  
Jamie M. Schwartz ◽  
Albert Hsu ◽  
Marie Crandall ◽  
Joseph J. Tepas ◽  
...  
Keyword(s):  
Trauma Center ◽  
Motor Vehicle ◽  
Safety Net ◽  
Motor Vehicle Crashes ◽  
Vehicle Crashes ◽  
Restraint Use ◽  
Level I

Diffuse Axonal Injury

Neurotrauma ◽  
2019 ◽  
pp. 63-72
Author(s):  
Hussein A. Zeineddine ◽  
Cole T. Lewis ◽  
Ryan S. Kitagawa
Keyword(s):  
Cerebral Perfusion ◽  
High Speed ◽  
Motor Vehicle ◽  
Axonal Injury ◽  
Diffuse Axonal Injury ◽  
Common Mechanism ◽  
White Matter Tract ◽  
Vehicle Accidents ◽  
Wide Range ◽  
Tract Damage

Diffuse axonal injury (DAI) is a type of traumatic brain injury (TBI) that results from a blunt head injury. In this particular subtype, accelerating-decelerating motions cause white matter tract damage and preferentially impact regions including the corpus callosum and brainstem. The neurological compromise therefore relates to the severity of the axonal insult. The most common mechanism for DAI is high-speed motor vehicle accidents, and the clinical presentation is typically out of proportion to the CT findings. As a result, MRI is the modality of choice. Currently, there are limited therapeutic options, and management is identical to other forms of TBI including intracranial pressure and cerebral perfusion pressure management. As this disease is heterogeneous, survivors have a wide range of functional outcomes.

scholarly journals Demographics and Incident Location of Traumatic Injuries at a Single Level I Trauma Center

2021 ◽  
Vol 14 ◽  
pp. 5-11
Author(s):  
David Watson ◽  
Blair Benton ◽  
Elizabeth Ablah ◽  
Kelly Lightwine ◽  
Ronda Lusk ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Trauma Center ◽  
Motor Vehicle ◽  
Unit Length ◽  
Motor Vehicle Crashes ◽  
Injury Incidence ◽  
Vehicle Crashes ◽  
Traumatic Injuries ◽  
Level I ◽  
Motorcycle Crashes

Introduction: Traumatic injuries are preventable and understanding determinants of injury, such as socio-economic and environmental factors, is vital.  This study evaluated traumatic injuries and identified areas of high trauma incidence.                                                                                               Methods:  A retrospective review was conducted of all patients 14 years or older who were admitted with a traumatic injury to a Level I trauma center between 2016 and 2017.  Descriptive analyses were presented and maps of high injury areas were generated.                                Results:  The most frequent mechanisms of injury were falls (58.3%), motor vehicle crashes (22.3%), and motorcycle crashes (5.7%).  Fall patients were more likely to be female (59.6%) and were the oldest age group (72.1 ± 17.2) compared to motor vehicle and motorcycle crash patients.  Severe head (22.1%, P = 0.007) and extremity (35.7%, P = 0.001) injuries were most frequent among fall patients, however more motorcycle crash patients required mechanical ventilation (16.1%, P < 0.001) and experienced the longest intensive care unit length of stay (5.3 ± 6.8, P < 0.001) and mechanical ventilation days (6.6 ± 8.5, P < 0.036).  Motorcycle crash patients also had the most number of deaths (7.5%, P < 0.001).  The generated maps of all traumatic suggest that most injuries occur near our hospital and are located in several of the most population-dense zip codes.                                                                                                       Conclusions:  Falls, motor vehicle crashes, and motorcycle crashes were the most common mechanisms of injury.  The use of Geographic Information System aided in the identification of high injury incidence location.                           

scholarly journals Impact of COVID-19 and Shelter in Place on Volume and Type of Traumatic Injuries

2021 ◽  
Vol 22 (5) ◽  
pp. 1060-1066
Author(s):  
James Murrett ◽  
Emily Fu ◽  
Zoe Maher ◽  
Crystal Bae ◽  
Wayne Satz ◽  
...  
Keyword(s):  
Motor Vehicle ◽  
Penetrating Trauma ◽  
Retrospective Chart Review ◽  
Gunshot Wounds ◽  
Health Crisis ◽  
Traumatic Injuries ◽  
Social Distancing ◽  
Level I ◽  
Novel Coronavirus ◽  
The Impact

Introduction: Very little is known about the effects of the novel coronavirus (COVID-19) pandemic and its associated social distancing practices on trauma presentations to the emergency department (ED). This study aims to assess the impact of a city-wide stay at home order on the volume, type, and outcomes of traumatic injuries at urban EDs. Methods: The study was a retrospective chart review of all patients who presented to the ED of an urban Level I Trauma Center and its urban community affiliate in the time period during the 30 days before the institution of city-wide shelter-in-place (preSIP) order and 60 days after the shelter-in-place (SIP) order and the date-matched time periods in the preceding year. Volume and mechanism of traumatic injuries were compared using paired T-tests. Results: There was a significant decrease in overall ED volume. The volume of certain blunt trauma presentations (motor vehicle collisions) during the first 60 days of SIP compared to the same period from the year prior also significantly decreased. Importantly, the volume of penetrating injuries, including gunshot wounds and stab wounds, did not differ for the preSIP and SIP periods when compared to the prior year. The mortality of traumatic injuries was also unchanged during the SIP comparison period. Conclusion: While there were significant decreases in visits to the ED and overall trauma volume, penetrating trauma, including gun violence, and other severe traumatic injuries remain a public health crisis that affects urban communities despite social distancing recommendations enacted during the COVID-19 pandemic.

Trauma Team Activation at a Level I Trauma Center in Southern California: Time of Day Matters

2019 ◽  
Vol 85 (10) ◽  
pp. 1142-1145
Author(s):  
Morgan Schellenberg ◽  
Kenji Inaba ◽  
Bryan E. Love ◽  
Zachary Warriner ◽  
Matthew J. Forestiere ◽  
...  
Keyword(s):  
Injury Severity ◽  
Motor Vehicle ◽  
Penetrating Trauma ◽  
Trauma Team ◽  
Time Of Day ◽  
Operative Intervention ◽  
Trauma Patients ◽  
Mechanism Of Injury ◽  
Trauma Team Activation ◽  
Level I

The ACS Committee on Trauma specifies prehospital criteria that trigger trauma team activation (TTA). The study aims to define the relationship between TTA and time of day, mechanism of injury, and need for operative intervention. All trauma patients presenting to LAC1USC (January 2008–July 2018) after triggering TTA were screened. Patients were excluded if time of ED arrival was undocumented. Demographics, injury data, and outcomes were analyzed. After exclusions (<1%), 54,826 patients were enrolled. The median age was 35 [IQR 23–53]. The median Injury Severity Score was 4 [1–10]. The most common mechanisms of injury were falls (n = 14,166; 31%), auto versus pedestrian collisions (n = 11,921; 26%), and motor vehicle collisions (n = 11,024; 24%). Penetrating trauma comprised 16 per cent (n = 8,686). The busiest hour for TTAs was 19:00 to 20:00, although penetrating trauma was most common between 23:00 and 01:00. Emergent surgical intervention in absolute numbers was most frequent between 20:00 and 01:00. As a proportion of the number of TTAs per hour, emergent operative intervention was most frequent between 23:00 and 06:00. In conclusion, the volume of TTAs and the triggering mechanism of injury vary significantly by time of day. The need for operative intervention is highest overnight. This information can be used to help increase hospital preparedness and allocate resources accordingly.

Trauma Laparotomy: Evaluating the Necessity of Histological Examination

2009 ◽  
Vol 75 (11) ◽  
pp. 1124-1127
Author(s):  
Carrie Laituri ◽  
Andre Teixeira ◽  
Matthew W. Lube ◽  
Aaron Seims ◽  
Jeremy Cravens
Keyword(s):  
Histological Examination ◽  
Care Setting ◽  
Current Practice ◽  
Motor Vehicle ◽  
Traumatic Injury ◽  
Penetrating Trauma ◽  
Motor Vehicle Crash ◽  
Normal Specimen ◽  
Level I ◽  
Abnormal Pathology

Trauma laparotomy is the most commonly performed procedure in the acute care setting. As current practice, removed specimens are sent for histological examination. A retrospective review of all trauma laparotomies with specimens removed and sent to pathology during a 12-month period was performed in a Level I trauma center. One hundred five procedures of 244 trauma laparotomies yielded specimens sent for examination. Eighty-six patients were male and 19 patients were female with an average age of 34 ± 14 years. Fifty-six per cent of the injuries resulted from penetrating trauma and 44 per cent were from blunt trauma. Gunshot wound and motor vehicle crash were the most common penetrating and blunt injuries, respectively. One hundred thirteen specimens were sent to pathology. Forty-three per cent of the specimens were spleen, 24 per cent small bowel, 16 per cent large bowel, 4 per cent kidney, 2 per cent omentum, 3 per cent appendix, 3 per cent pancreas, and 1 per cent for gallbladder and lung. One hundred twelve of 113 grossly normal specimens had normal pathology. One grossly normal specimen exposed abnormal pathology revealing benign appendiceal mucocele. Therefore, 99.1 per cent of grossly normal specimens sent for histological examination after trauma laparotomy were normal. Based on our review, in select patients routine histological examination of tissues removed for traumatic injury is unnecessary.

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