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

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.

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The Value of Abdominal and Pelvic CT Scan in Trauma Patients With Low Injury Severity Score and High Glasgow Coma Scale

The American Surgeon ◽

10.1177/00031348211047496 ◽

2021 ◽

pp. 000313482110474

Author(s):

Tarik Wasfie ◽

Daniel Rivera ◽

Mursal Naisan ◽

Shelby Zaremba ◽

Mikayla Depuydt ◽

...

Keyword(s):

Computed Tomography ◽

Glasgow Coma Scale ◽

Physical Examination ◽

Injury Severity ◽

Surgical Intervention ◽

Trauma Patients ◽

Ct Findings ◽

Group A ◽

Fast Exam ◽

Group B

Introduction Computed tomography scans became the mainstay of emergency department (ED) evaluation of trauma patients including those with a high Glasgow Coma Scale (GCS) and a low Injury Severity Score (ISS). We elected to find the value of abdominal and pelvic CT in patients with negative physical examination and Focused Assessment of Sonography for Trauma (FAST) on arrival to the ED. Methods This study is a retrospective analysis of 901 consecutive patients from 2017 to 2019 who presented to the ED with level 2 and 3 activation criteria. Each patient received a physical examination, CT abdomen and pelvis, and FAST exam. Data were collected on external factor including GCS, ISS, age, sex, comorbidities, anticoagulation use, and surgical intervention. The patients were divided into 2 groups, Group A and B. Group A consisted of patients with a negative physical exam, FAST, and CT result. Group B included patients with a negative physical exam and FAST exam with positive CT findings. Statistical analysis was done using a Student’s t-test and chi-square test for significance value of P < .05. Institutional Review Board approval was obtained for this study. Results A total of 901 patients were analyzed which included 489 (54.3%) male and 412 (45.7%) female with a mean age of 56.2 (SD = 22.62) years. Out of the 901 patients, 461 patients received a physical, FAST, and CT exam. Group A consisted of 442 (95.9%) patients and Group B had 19 (4.1%) patients. Both groups were similar in GCS and ISS scoring with no significance difference in age, sex, comorbidities, and anticoagulation use. There was a significant difference in the ICU and hospital mean length of stay when CT scan was positive [2 (SD = 4.23) days vs. .6 (SD = 1.33) days with P < .0001 and 4.57 (SD ± 4.17) days vs. 2.5 (SD = 2.00) days with P < .0001, respectively]. The CT findings of the 19 patients in group B consisted of 6 incidentalomas, 5 vertebral compression fractures, 4 pelvic bone fractures, 1 minor liver contusion, 1 non-specific bowel thickening, 1 non-displaced rib fracture, and 1 case of small amount of free fluid in the pelvis. None of the CT findings required surgical intervention. Conclusion Computed tomography of the abdomen and pelvis in trauma patients with high GCS and low ISS with initial negative physical and FAST examination did not provide additional critical information.

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Randomized controlled trial of chest tube removal aided by a party balloon

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492317721412 ◽

2017 ◽

Vol 25 (7-8) ◽

pp. 522-527

Author(s):

Puwadon Thitivaraporn ◽

Natawat Narueponjirakul ◽

Pasurachate Samorn ◽

Supparerk Prichayudh ◽

Sukanya Sriussadaporn ◽

...

Keyword(s):

Valsalva Maneuver ◽

Controlled Trial ◽

Block Design ◽

Trauma Patients ◽

Optimal Method ◽

Thoracostomy Tube ◽

Recurrent Pneumothorax ◽

Tube Removal ◽

Group A ◽

Group B

Background Recurrent pneumothorax is one of the most common complications after thoracostomy tube removal. The purpose of this study was to assess the optimal method of thoracostomy tube removal by comparing party balloon-assisted Valsalva and classic Valsalva techniques. Methods Trauma patients with indications for tube thoracostomy from 2014 to 2015 were recruited. Exclusion criteria were age < 15- or > 64-years-old, history of chronic lung disease, Glasgow Coma Scale < 13, latex allergy, or tracheostomy. Participants were randomly allocated by randomized block design into 4 groups using different Valsalva maneuvers: group A: classic inspired, group B: classic expired, group C: balloon-inspired; and group D: balloon-expired. The primary and secondary outcomes were recurrent pneumothorax and respiratory complications. Results Forty-eight tube thoracostomies were randomized for analysis; 4 patients had bilateral tube thoracostomies. The mean patient age was 38.1 ± 19.9 years. The incidence of recurrent pneumothorax confirmed by chest radiography was 15.4% in group A, 16.8% in group B, and none in groups C and D ( p = 0.31). When group A combined with group B was compared with groups C and D, the incidence was 16% vs. 0%, respectively ( p = 0.11). The thoracostomy tube reinsertion rate in all 4 groups was 0%, 8.33%, 0%, and 0%, respectively, which was not significant ( p = 0.38). Conclusions Performing the Valsalva maneuver correctly during full inspiration may be the method of choice for removing thoracostomy tubes. Using a party balloon forces the patient perform the Valsalva maneuver adequately and is simpler to explain.

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Comparison of central venous oxygen saturation and serum lactate clearance as predictors of outcome in septic shock patients: a prospective control trial

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20180315 ◽

2018 ◽

Vol 6 (2) ◽

pp. 653

Author(s):

Gagan Kumar Narula ◽

Ajit Kumar Singh ◽

Anish Adya

Keyword(s):

Early Recognition ◽

Serum Lactate ◽

Therapeutic Interventions ◽

Average Hospital ◽

Mortality And Morbidity ◽

Prospective Control Trial ◽

Icu Stay ◽

Significant Difference ◽

Group A ◽

Group B

Background: Sepsis is the leading causes of mortality and morbidity in ICU. Early recognition and intervention ensures speedy recovery and early discharge. It’s possible only if good predicting parameters indicating optimum resuscitation are available. Lactate level reduction and ScvO2 level in the jugular vein can be utilized as predictors.Methods: In this prospective study after applying exclusion inclusion criteria, 99 patients were selected and randomized into 2 groups. In one group reduction in lactate levels and in other ScVo2 levels were used as a predictor of resuscitation. Therapeutic interventions, Hospital stay, ICU Stay and 28-day mortality were compared in both groups. Statistical analysis was carried out by SPSS software.Results: On comparison of demographic profile, morbidity, SOFA score and hemodynamic parameters, there was insignificant difference (P >0.05). No significant difference in the number of vasopressors, Average Hospital or ICU Stay (Group A is 10.68±21.46 while Group B is 9.49±17.22) and 28-day mortality rate (in Gp A 60% vs group B 57.1) was observed. Mean crystalloids administered in group A was 4.93±1.11 liters, significantly more than group B i. e. 4.19±1.17 liters. (P<0.05) which was statistically significant.Conclusions: Although both parameters of resuscitation are used widely and sometimes simultaneously, in this study lactate and ScvO2 both used and compared in a similar set of patients, appeared to be equivocal in term of 28-day mortality, except the volume of crystalloids required was more in ScvO2 Group.

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40 days and 40 nights: Clinical characteristics of major trauma and orthopaedic injury comparing the incubation and lockdown phases of COVID-19 infection

Bone & Joint Open ◽

10.1302/2046-3758.17.bjo-2020-0068.r1 ◽

2020 ◽

Vol 1 (7) ◽

pp. 330-338 ◽

Cited By ~ 1

Author(s):

Bisola Ajayi ◽

Alex Trompeter ◽

Magnus Arnander ◽

Philip Sedgwick ◽

Darren F. Lui

Keyword(s):

Clinical Characteristics ◽

Traffic Accidents ◽

Major Trauma ◽

Road Traffic ◽

Trauma Centre ◽

Orthopaedic Patients ◽

Major Trauma Centre ◽

Group A ◽

Group B ◽

The Uk

Aims The first death in the UK caused by COVID-19 occurred on 5 March 2020. We aim to describe the clinical characteristics and outcomes of major trauma and orthopaedic patients admitted in the early COVID-19 era. Methods A prospective trauma registry was reviewed at a Level 1 Major Trauma Centre. We divided patients into Group A, 40 days prior to 5 March 2020, and into Group B, 40 days after. Results A total of 657 consecutive trauma and orthopaedic patients were identified with a mean age of 55 years (8 to 98; standard deviation (SD) 22.52) and 393 (59.8%) were males. In all, 344 (approximately 50%) of admissions were major trauma. Group A had 421 patients, decreasing to 236 patients in Group B (36%). Mechanism of injury (MOI) was commonly a fall in 351 (52.4%) patients, but road traffic accidents (RTAs) increased from 56 (13.3%) in group A to 51 (21.6%) in group B (p = 0.030). ICU admissions decreased from 26 (6.2%) in group A to 5 (2.1%) in group B. Overall, 39 patients tested positive for COVID-19 with mean age of 73 years (28 to 98; SD 17.99) and 22 (56.4%) males. Common symptoms were dyspnoea, dry cough, and pyrexia. Of these patients, 27 (69.2%) were nosocomial infections and two (5.1%) of these patients required intensive care unit (ICU) admission with 8/39 mortality (20.5%). Of the patients who died, 50% were older and had underlying comorbidities (hypertension and cardiovascular disease, dementia, arthritis). Conclusion Trauma admissions decreased in the lockdown phase with an increased incidence of RTAs. Nosocomial infection was common in 27 (69.2%) of those with COVID-19. Symptoms and comorbidities were consistent with previous reports with noted inclusion of dementia and arthritis. The mortality rate of trauma and COVID-19 was 20.5%, mainly in octogenarians, and COVID-19 surgical mortality was 15.4%. Cite this article: Bone Joint Open 2020;1-7:330–338.

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40 days and 40 nights: Clinical characteristics of major trauma and orthopaedic injury comparing the incubation and lockdown phases of COVID-19 infection

Bone & Joint Open ◽

10.1302/2633-1462.17.bjo-2020-0068.r1 ◽

2020 ◽

Vol 1 (7) ◽

pp. 330-338 ◽

Cited By ~ 2

Author(s):

Bisola Ajayi ◽

Alex Trompeter ◽

Magnus Arnander ◽

Philip Sedgwick ◽

Darren F. Lui

Keyword(s):

Clinical Characteristics ◽

Traffic Accidents ◽

Major Trauma ◽

Road Traffic ◽

Trauma Centre ◽

Orthopaedic Patients ◽

Major Trauma Centre ◽

Group A ◽

Group B ◽

The Uk

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Efficacy of Tamsulosin as Compared to Placebo, in Reducing Post Operative Flank Pain during Voiding, in Patients with Ureteric Stent

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i57a33972 ◽

2021 ◽

pp. 88-93

Author(s):

Arif Ali ◽

Suhail Dilawar ◽

Bilal Suria ◽

Safiullah Sohu ◽

Ghulam Mujtaba ◽

...

Keyword(s):

Pain Score ◽

Renal Calculi ◽

Pain Scale ◽

Flank Pain ◽

P Value ◽

Trauma Patients ◽

Ureteric Stent ◽

Group A ◽

Group B ◽

Centre Hospital

Objective: To evaluate the efficacy of tamsulosin in reducing post operative flank pain during voiding, in patients with ureteric stent. Study Design: This is a Randomized control trial (RCT) study. Place and Duration: Study carried out at Department of Urology, Jinnah Post Graduate Medical Centre, Hospital, Karachi, Pakistan, from June 2016 to November 2016. Methodology: 60 patients aged between 15 – 45years, undergone placement of ureteric stent to treat ureteric and renal calculi and have pain score >4, were included in the study. Divided into two groups ‘group A’ and ‘group B’. In group ‘A’ and group ‘B’ Tamsulosin and Placebo was given respectively in patients with ureteric stent and reduction in post-operative flank pain was measured and compared. Tamsulosin was given post operatively when NPO is broken after 2 hours – 6 hours. Patients having uretral trauma, patients having BPH, patient underwent TURP or TURBT, patent having urinary tract infection and patients with pregnancy or lactating females were excluded. All patients were received intravenous antibiotic (Ceftrixone 1gr). Also all patients were receive oral analgesic (diclofenic sodium 50mg BID) and antispasmodics (Drotaverine 80mg BID). Patients were discharged after 24 hours. Postoperatively stent related flank pain during voiding was assessed via Pain Scale. Results: 60 Patients who got operated for ureteric stent. In group ‘A’ there were 21 males (70%) and 9 females (30%), the mean age of group A was 35.67±5.99 as In group ‘B’ there were of 21 males (70%) and 9 females (30%) and mean age of group B was 35.04±6.42 (Table 1). Mean Pain score in ‘Group A’ (Tamsulosin) in week 1, 2, 3, 4, 5, 6 was 4.1, 3.5, 2.9, 2.3, 1.9, 1.3 respectively as shown in Table 2. Mean Pain score in ‘group B’ (Placebo) in week1, 2, 3, 4, 5, 6 was 6.9, 6.3, 5.9, 5.6, 5, 4.2 respectively as shown in Table 2. Average pain score in ‘group A’ and ‘group B’ came out to be 2.67 and 5.64 respectively (P value 0.005). Conclusion: Alpha blockers reduces the post-operative flank pain and voiding complaints in patients with ureteric stent. Our study shows that the efficacy of Tamsulosin in reducing post-operatice flank pain in patients with uretercic stent is better than placebo.

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Comparison of two whole-body computer tomography protocols for polytrauma patients

British Journal of Surgery ◽

10.1093/bjs/znab202.049 ◽

2021 ◽

Vol 108 (Supplement_4) ◽

Author(s):

N van Veelen ◽

S Studer ◽

B van de Wall ◽

R Babst ◽

B -C Link ◽

...

Keyword(s):

Radiation Dose ◽

Upper Extremities ◽

Whole Body ◽

Trauma Patients ◽

Two Phase ◽

Whole Body Ct ◽

Additional Imaging ◽

Group A ◽

Group B ◽

Extremity Injuries

Abstract Objective The use of whole-body computed tomography (CT) is an established standard primary diagnostic method in the work up of polytrauma patients. The protocols used for such CTs however vary between trauma centers. In our Level 1 trauma Centre the protocol was changed from a three phase to a two phase protocol with different positioning of the patient. The primary aim of this study was to compare the estimated radiation dose and scan duration of the two protocols. The secondary aim was to evaluate whether the revision of the CT protocol led to a reduction of required additional imaging of the upper extremities. Methods For this retrospective, cross-sectional study two groups of consecutive trauma patients, which were treated in a level 1 trauma center in Switzerland and received a whole-body CT were analyzed. Group A consisted of patients, who presented between January and August 2016. These patients received a three-phased CT in which a repositioning of the arms from the side of the torso to above the head between phases two and three was needed. Group B consisted of those, who presented between January and July 2017. These patients received a CT according to a revised protocol, which was performed in two phases with the arms positioned ventral on a pillow to the torso throughout the entire CT. Scan duration, estimated radiation dose, number of upper extremity injuries, number of addition imaging (xray and CT) of the upper extremities within 24 hours of initial CT. Results A total of 182 patients were included in group A and 218 in group B. Baseline characteristics didn't differ, except for there being more males in group B (p 0.006). The estimated radiation dose was lower (15.0 mSv vs 22.9 mSv, p < 0.001) and the scan duration shorter (4 vs 7 minutes, p < 0.001) in group B. No difference could be shown in the number of upper extremity injuries detected. Further, the number of additional images of the upper extremities needed within 24 hours of the initial CT did not differ between the groups. Conclusion Both the estimated radiation dose and the scan duration of a whole-body CT scan in trauma patients can be reduced when a two phase protocol in which the arms are positioned on a pillow ventral to the torso is used instead of a three phase protocol with repositioning of the arms. The amount of additional imaging of the upper limb could not be reduced by having the arms visible on the scan.

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Myocardial Contusion (Blunt Cardiac Injury)

Essence of Anesthesia Practice ◽

10.1016/b978-1-4377-1720-4.00227-2 ◽

2011 ◽

pp. 259

Author(s):

Andrew L. Rosenberg

Keyword(s):

Cardiac Injury ◽

Myocardial Contusion ◽

Blunt Cardiac Injury

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Differences in Brain Metabolic Impairment between Chronic Mild/Moderate TBI Patients with and without Visible Brain Lesions Based on MRI

BioMed Research International ◽

10.1155/2016/3794029 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 9

Author(s):

Keiichi Ito ◽

Yoshitaka Asano ◽

Yuka Ikegame ◽

Jun Shinoda

Keyword(s):

Fdg Pet ◽

Traffic Accidents ◽

Brain Metabolism ◽

Statistical Tests ◽

Brain Lesions ◽

Cognitive Tests ◽

Mri Findings ◽

Moderate Traumatic Brain Injury ◽

Group A ◽

Group B

Introduction.Many patients with mild/moderate traumatic brain injury (m/mTBI) in the chronic stage suffer from executive brain function impairment. Analyzing brain metabolism is important for elucidating the pathological mechanisms associated with their symptoms. This study aimed to determine the differences in brain glucose metabolism between m/mTBI patients with and without visible traumatic brain lesions based on MRI.Methods.Ninety patients with chronic m/mTBI due to traffic accidents were enrolled and divided into two groups based on their MRI findings. Group A comprised 50 patients with visible lesions. Group B comprised 40 patients without visible lesions. Patients underwent FDG-PET scans following cognitive tests. FDG-PET images were analyzed using voxel-by-voxel univariate statistical tests.Results.There were no significant differences in the cognitive tests between Group A and Group B. Based on FDG-PET findings, brain metabolism significantly decreased in the orbital gyrus, cingulate gyrus, and medial thalamus but increased in the parietal and occipital convexity in Group A compared with that in the control. Compared with the control, patients in Group B exhibited no significant changes.Conclusions.These results suggest that different pathological mechanisms may underlie cognitive impairment in m/mTBI patients with and without organic brain damage.

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The Effect of Manual Lung Hyperinflation and Postural Drainage on Pulmonary Complications in Mechanically Ventilated Trauma Patients

Anaesthesia and Intensive Care ◽

10.1177/0310057x9802600503 ◽

1998 ◽

Vol 26 (5) ◽

pp. 492-496 ◽

Cited By ~ 45

Author(s):

G. Ntoumenopoulos ◽

A. Gild ◽

D. J. Cooper

Keyword(s):

Nosocomial Pneumonia ◽

Pulmonary Complications ◽

Control Group ◽

Trauma Patients ◽

Mechanically Ventilated ◽

Clinical Criteria ◽

Lung Hyperinflation ◽

Postural Drainage ◽

Group A ◽

Group B

This study questioned whether manual lung hyperinflation (MHI) and postural drainage reduced the incidence of nosocomial pneumonia or improved other outcome variables in mechanically ventilated trauma patients. Patients were withdrawn from the study if they developed nosocomial pneumonia according to a predetermined definition or on the clinical suspicion of nosocomial pneumonia by the attending intensivist. Of the 46 patients who fulfilled all the inclusion criteria and were enrolled into the study, 22 patients were randomized to group A (physiotherapy) and 24 patients to group B (control group). Twice as many patients were withdrawn in group B (8/24) compared with group A (4/22), although the differences were not statistically significant, [X2(1, 1) = 1.36, P = 0.24]. The length of time receiving mechanical ventilation and in the ICU was similar between the two groups and there were no differences in pulmonary dysfunction (“worst” daily PaO2/FiO2 ratio) between the two groups. There were no ICU deaths in either group. Physiotherapy as used in this study was not associated with a reduced incidence of nosocomial pneumonia based on standard clinical criteria. Nevertheless the trend to more frequent nosocomial pneumonia in the control patients suggests that a larger study in more severely injured patients with stricter clinical criteria for the definition of nosocomial pneumonia is indicated.

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