scholarly journals Shock Index as a Predictor for Angiographic Hemostasis in Life-Threatening Traumatic Oronasal Bleeding

2021 ◽  
Vol 18 (21) ◽  
pp. 11051
Author(s):  
Fang-Yu Hsu ◽  
Shih-Hsuan Mao ◽  
Andy Deng-Chi Chuang ◽  
Yon-Cheong Wong ◽  
Chih-Hao Chen
Keyword(s):  
Motor Vehicle ◽  
Early Recognition ◽  
Arterial Embolization ◽  
Maxillary Artery ◽  
Trauma Patients ◽  
Shock Index ◽  
Packed Red Blood Cells ◽  
Vehicle Accidents ◽  
Life Threatening ◽  
Craniofacial Trauma

The objective of this retrospective study was to identify predictors of angiographic hemostasis among patients with life-threatening traumatic oronasal bleeding (ONB) and determine the threshold for timely referral or intervention. The diagnosis of traumatic, life-threatening ONB was made if the patient suffered from craniofacial trauma presenting at triage with unstable hemodynamics or required a definitive airway due to ONB, without other major bleeding identified. There were 4404 craniofacial trauma patients between January 2015 and December 2019, of which 72 (1.6%) fulfilled the diagnosis of traumatic life-threatening ONB. Of these patients, 39 (54.2%) received trans-arterial embolization (TAE), 11 (15.3%) were treated with other methods, and 22 (30.5%) were excluded. Motor vehicle accidents were the most common cause of life-threatening ONB (52%), and the internal maxillary artery was the most commonly identified hemorrhaging artery requiring embolization (84%). Shock index (SI) was significantly higher in the angiographic hemostasis group (p < 0.001). The AUC-ROC was 0.87 (95% CI, 0.88–1.00) for SI to predict angiographic hemostasis. Early recognition and timely intervention are crucial in post-traumatic, life-threatening ONB management. Patients initially presenting with SI > 0.95 were more likely to receive TAE, with the TAE group having statistically higher SI than the non-TAE group whilst receiving significantly more packed red blood cells. Hence, for patients presenting with life-threatening traumatic ONB and a SI > 0.95, TAE should be considered if preliminary attempts at hemostasis have failed.

Acute aortic syndrome: traumatic aortic injury

ESC CardioMed ◽  
2018 ◽  
pp. 2605-2606
Author(s):  
Johnny Steuer ◽  
Mario Lachat
Keyword(s):  
Life Support ◽  
Motor Vehicle ◽  
Expectant Management ◽  
Aortic Injury ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Vehicle Accidents ◽  
Life Threatening ◽  
Extent Of Damage ◽  
Intimal Tear

Blunt traumatic thoracic aortic injury (BAI) is a life-threatening emergency, the second most common cause of death in trauma patients, outnumbered only by intracranial haemorrhage. BAI is most frequently related to sudden deceleration in motor vehicle accidents, and the injury most commonly occurs at points of fixation in the descending aorta. In clinical series, it is predominantly in the region of the aortic isthmus. As victims of high-impact collisions often have multiple injuries, they are initially managed according to the Advanced Trauma Life Support® (ATLS®) concept. With improved pre- and in-hospital resuscitation, expeditious computed tomography angiography on arrival to the hospital, and increased awareness of the condition, patients who survive the initial impact are more likely to undergo successful treatment. All traumatic aortic injuries are not equally severe, as the extent of damage to the aortic wall may vary from an intimal tear to complete transection and rupture. Serial imaging and expectant management is advocated in patients with only an intimal tear but no external contour abnormality, whereas repair is recommended in most other cases. In recent years, thoracic endovascular aortic repair has emerged as the preferable treatment of patients with BAI, regardless of age. The initial outcome is highly dependent on the severity of other injuries, and most deaths are unrelated to the aortic injury per se, once the stent graft is in place. Long-term survival in patients discharged from the primary hospital admission is excellent. Early reintervention is fairly common, whereas late reinterventions are very uncommon.

scholarly journals Risk and resilience factors of persons exposed to accidents

2016 ◽  
Vol 89 (2) ◽  
pp. 257-266
Author(s):  
Dana - Cristina Herta ◽  
Paula Brindas ◽  
Raluca Trifu ◽  
Doina Cozman
Keyword(s):  
Motor Vehicle ◽  
Motor Vehicle Accidents ◽  
Risk And Resilience ◽  
Reasons For Living ◽  
Vehicle Accidents ◽  
Physical Suffering ◽  
Accident Victim ◽  
Life Threatening ◽  
Resilience Factors ◽  
Reasons For Living Inventory

Background and aims. Resilience encompasses factors promoting effective functioning in the context of adversity. Data regarding resilience in the wake of accidental trauma is still scarce. The aim of the current study is to comparatively assess adaptive, life – promoting factors in persons exposed to motor vehicle accidents (MVA) vs. persons exposed to other types of accidents, and to identify psychological factors of resilience and vulnerability in this context of trauma exposure.Methods. We assessed 93 participants exposed to accidents out of 305 eligible patients from the Clinical Rehabilitation Hospital and Cluj County Emergency Hospital. The study used Reasons for Living Inventory (RFL) and Life Events Checklist. Scores were comparatively assessed for RFL items, RFL scale and subscales in participants exposed to motor vehicle accidents (MVA) vs. participants exposed to other life – threatening accidents.Results. Participants exposed to MVA and those exposed to other accidents had significantly different scores in 7 RFL items. Scores were high in 4 out of 6 RFL subscales for both samples and in most items comprising these subscales, while in the other 2 subscales and in some items comprising them scores were low.Conclusions. Low fear of death, physical suffering and social disapproval emerge as risk factors in persons exposed to life – threatening accidents. Love of life, courage in life and hope for the future are important resilience factors after exposure to various types of life – threatening accidents. Survival and active coping beliefs promote resilience especially after motor vehicle accidents. Coping with uncertainty are more likely to foster resilience after other types of life – threatening accidents. Attachment of the accident victim to family promotes resilience mostly after MVA, while perceived attachment of family members to the victim promotes resilience after other types of accidents.  

Clinical analysis of external laryngeal trauma

1994 ◽  
Vol 108 (3) ◽  
pp. 221-225 ◽  
Author(s):  
P. T. Yen ◽  
H. Y. Lee ◽  
M. H. Tsai ◽  
S. T. Chan ◽  
T. S. Huang
Keyword(s):  
Vocal Fold ◽  
Motor Vehicle ◽  
Clinical Analysis ◽  
Airway Patency ◽  
Laryngeal Trauma ◽  
Vehicle Accidents ◽  
Presenting Symptoms ◽  
Laryngeal Injury ◽  
Life Threatening ◽  
The Voice

AbstractThirty patients with external laryngeal trauma were analysed retrospectively. Injuries were mostly caused by motor vehicle accidents (car = 36.7 percent; motorcycle = 23.3 per cent). The main presenting symptoms and signs were hoarseness, neck tenderness, dysphagia, and neck emphysema. Sites of laryngeal injury included arytenoid swelling, vocal fold injury, soft tissue contusion or superficial mucosal laceration, cricoarytenoid dislocation, thyroid fracture, epiglottic fracture and mixed injuries. Treatment was varied depending on the severity of the injuries. Sixteen cases were managed conservatively by medical treatment; two cases received intubation; four cases were treated initially by tracheostomy; eight cases received surgical repair and/or reconstruction; 11 cases made a full recovery of the voice and 18 cases fair voice recovery due to either sustained vocal fold swelling or limitation of vocal fold movement. One case was graded as poor. Twenty-eight cases had good airway patency and two cases fair airway patency. A delay in the early detection of laryngeal trauma may precipitate into life-threatening airway problems, therefore prompt and accurate diagnosis should be followed immediately by skilful airway management.

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.

An uncommon potentially lethal injury: Traumatic pericardial rupture with herniation of the heart

Trauma ◽  
2016 ◽  
Vol 19 (2) ◽  
pp. 139-141
Author(s):  
TA Yuvaraj Davidson ◽  
Parma Nand
Keyword(s):  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Fatal Outcome ◽  
Traumatic Rupture ◽  
Trauma Patients ◽  
Vehicle Accident ◽  
Life Threatening ◽  
High Index Of Suspicion ◽  
Treatable Condition ◽  
Insight Into

Traumatic rupture of the pericardium with herniation of the heart can be a potentially lethal injury that can be easily overlooked. Prompt diagnosis and repair can be lifesaving. We report such a case with successful repair of this injury in a 45-year-old male who sustained multiple injuries following a motor vehicle accident. CT scan revealed rupture of the pericardium with herniation of the heart. The pericardial tear was promptly repaired by primary closure. This report gives an insight into this life threatening, yet promptly treatable condition, which can be easily missed resulting in a fatal outcome. Having a high index of suspicion while treating thoracic trauma patients can prevent fatalities. Immediate referral to a cardiothoracic service or closure of the tear through a thoracotomy, if the expertise is available, can be lifesaving.

scholarly journals Factors affecting mortality in major trauma patients in Trinidad and Tobago – A view from the developing world

Trauma ◽  
2019 ◽  
Vol 22 (3) ◽  
pp. 220-228
Author(s):  
Saleem Varachhia ◽  
Vidya Ramcharitar Maharaj ◽  
Joanne F Paul ◽  
Paula Robertson ◽  
Paula Nunes ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Trinidad And Tobago ◽  
Severity Score ◽  
Major Trauma ◽  
Injury Severity ◽  
Developing World ◽  
Motor Vehicle ◽  
Motor Vehicle Accidents ◽  
Trauma Patients ◽  
Vehicle Accidents

Introduction There are few data on major trauma in the developing world. This study investigated the characteristics and outcomes of seriously injured patients in Trinidad and Tobago, using Trauma and Injury Severity Score (TRISS) methodology. We also aimed to assess the predictive accuracy of the TRISS model in patients in Trinidad and Tobago. Methods Retrospective data from major trauma patients attending the Emergency Department of a tertiary hospital in Trinidad between 2010 and 2014 were analysed. Patients ≥18 years having an Injury Severity Score >15 were included. The impact of age, gender, comorbidities, mechanisms and patterns of injury on mortality was investigated. Using TRISS methodology, predicted mortality was calculated and compared to actual mortality. Results Of 323 patients analysed, 284 were male and 24 were aged ≥65 years. The commonest injury mechanisms in younger people were motor vehicle accidents (34.1%) and stabbings (30.8%) compared to falls (66.7%) and motor vehicle accidents (20.8%) in people aged ≥65 years. The commonest areas injured were the chest in younger patients (81.9%) and the head and neck in patients aged ≥65 years (58.3%). Women’s mortality rates were similar to men (RR 1.8; 95% CI 0.7–4.9). Mortality was higher with age ≥65 years (RR 7.0; 95% CI 3.1–15.9), blunt trauma (RR 7.6; 95% CI 1.8–32.4) and Charlson Comorbidity Index of 1 or more (RR 3.2; 95% CI 1.3–8.0). The TRISS model performed well at lower ISS scores and was excellent at predicting survival (discrimination statistic 0.94). Conclusion Multiple factors influence mortality in major trauma patients in Trinidad and Tobago, including age, co-morbidities and injury mechanism. TRISS methodology accurately predicted survival in this population but was better at predicting mortality in patients with lower Injury Severity Score.

scholarly journals Maxillofacial Injuries in the Pediatric Patient: An Overview

2011 ◽  
Vol 2 (1) ◽  
pp. 77-81 ◽  
Author(s):  
Ranjit B Singh ◽  
Jeevan V Prakash ◽  
SN Chaitan ◽  
Prakash S Tandur ◽  
Shilpa Kokate
Keyword(s):  
Pediatric Patient ◽  
Growth And Development ◽  
Motor Vehicle ◽  
Pediatric Population ◽  
Facial Trauma ◽  
Facial Fractures ◽  
Maxillofacial Injury ◽  
Anatomy And Physiology ◽  
Vehicle Accidents ◽  
Craniofacial Trauma

ABSTRACT Children are uniquely susceptible to craniofacial trauma because of their greater cranial mass-to-body ratio. The pediatric population sustains 1 to 14.7% of all facial fractures. The majority of these injuries are encountered by boys (53.7-80%) who are involved in motor vehicle accidents (up to 80.2%). The incidence of other systemic injury concomitant to facial trauma is significant (10.4-88%). The management of the pediatric patient with maxillofacial injury should take into consideration, the differences in anatomy and physiology between children and adults, the presence of concomitant injury, the particular stage in growth and development (anatomic, physiologic and psychological), and the specific injuries and anatomic sites that the injuries affect. The greatest concern when treating the pediatric patient is the effect of the injury or treatment on growth and development. This is both anatomically and psychologically important and may have various effects on management for the different stages of psychological development.

scholarly journals Retrospective evaluation of canine and feline maxillomandibular trauma cases

2014 ◽  
Vol 27 (03) ◽  
pp. 192-197 ◽  
Author(s):  
B. L. Mulherin ◽  
J. W. Soukup ◽  
S. Hetzel ◽  
C. J. Snyder
Keyword(s):  
Medical Records ◽  
Motor Vehicle ◽  
Motor Vehicle Accidents ◽  
Trauma Patients ◽  
Retrospective Evaluation ◽  
Traumatic Injuries ◽  
Vehicle Accidents ◽  
One Year ◽  
Type Of Injury ◽  
Comparison Patient

SummaryObjectives: To determine differences in signalment between maxillomandibular (MM) and non-maxillomandibular (non-MM) trauma patients to help predict the type of injury sustained.Methods: A medical records database was searched from December 2003 to September 2012 to identify all MM trauma patients. A random sample of non-MM trauma patients was generated for comparison. Patient species, age, sex, weight, and injury aetiology were recorded for both populations.Results: Sixty-seven MM trauma patients and 129 non-MM trauma patients were identified. Feline patients were almost twice as likely to be presented for MM trauma compared with non-MM trauma. The median weight of canine patients suffering MM injury was significantly less than that of non- MM patients (p = 0.025). A significant association existed between the causes of injuries associated with MM and non-MM trauma populations (p = 0.000023). The MM trauma patients were more likely to sustain injury as a result of an animal altercation (Bonferroni p = 0.001) while non-MM injuries were more likely to result from motor vehicle accidents (Bonferroni p = 0.001). Overall, animals that were less than one year of age with traumatic injuries were overrepresented (65/196) in comparison to the entire patient population.Clinical significance: The results of this study may help guide clinicians in the evaluation and screening of trauma patients that are presented as an emergency. Cats, small dogs and animals suffering from animal altercations should all be closely evaluated for MM injury.

Out and Out It Goes . . . Where It Stops . . . Who Knows

2020 ◽  
pp. 23-32
Author(s):  
Danny Lammers ◽  
Christopher Marenco ◽  
Woo Do ◽  
John Horton
Keyword(s):  
Hemorrhagic Shock ◽  
Blood Cells ◽  
Early Recognition ◽  
Pediatric Trauma ◽  
Standard Of Care ◽  
Fresh Frozen Plasma ◽  
Trauma Patients ◽  
Packed Red Blood Cells ◽  
Fresh Frozen ◽  
Frozen Plasma

Pediatric trauma is the leading cause of death among children and adolescents. Unique variations in pediatric trauma patients require different approaches for pediatric patients than for adult patients. Early recognition of the subtle presentation of hemorrhagic shock is critical to initiate adequate resuscitation. The early use of blood transfusions is indicated for those nonresponsive to crystalloid boluses. Standard of care targets a goal of balanced administration of packed red blood cells (PRBC), fresh frozen plasma (FFP), and platelets (PLT): 1PRBC:1FFP:1PLT. Thromboelastography (TEG) and tranexamic acid (TXA) may have a role in the management of children in hemorrhagic shock.

Sign in / Sign up

Export Citation Format

Share Document