scholarly journals Trauma craneoencefálico severo y shock hipovolémico. Reporte de un caso

2019 ◽  
Vol 3 (2) ◽  
pp. 23
Author(s):  
Vielka Stefania Briones Briones ◽  
Shirley Alejandra Prías Páez ◽  
Melania Del Consuelo Alcívar García
Keyword(s):  
Head Trauma ◽  
Hypovolemic Shock ◽  
Fire Department ◽  
Initial Assessment ◽  
Health Unit ◽  
Facial Fractures ◽  
Neurological Sequelae ◽  
Brain Mass ◽  
Palabras Clave ◽  
Car Accident

  El objetivo del presente trabajo es describir el caso de un paciente con un trauma craneoencefálico severo y shock hipovolémico para el manejo y atención de este tipo de patología en edades pediátricas. Se presenta el caso de un paciente masculino de 5 años de edad, que llega a la emergencia de una unidad de salud por cuerpo de bomberos tras accidente automovilístico caracterizado por fracturas craneales y faciales con exposición de masa encefálica. Este trabajo destaca la valoración inicial de la gravedad del traumatismo craneoencefálico en la primera hora mediante la escala de Glasgow adaptada a la edad pediátrica, que permite monitorizar la evolución, intercambiar información y orientar el tratamiento y el pronóstico y así disminuir el riesgo de secuelas neurológicas.   Palabras clave: Traumatismo craneoencefálico, choque, fracturas craneales.   Abstract The aim of the present work is to describe the case of a patient with severe head trauma and hypovolemic shock for the management and care of this type of pathology in pediatric ages. The case of a 5-year-old male patient is presented, who arrives at the emergency of a health unit by the fire department after a car accident characterized by cranial and facial fractures with exposure of a brain mass. This work highlights the initial assessment of the severity of head trauma in the first hour using the Glasgow scale adapted to pediatric age, which allows monitoring the evolution, exchanging information and orienting treatment and prognosis and thus reducing the risk of neurological sequelae.   Keywords: Head trauma, shock, cranial fractures.  

scholarly journals Massive subgaleal hematoma in a 62-year-old man treated with apixaban as a consequence of mild head trauma

Folia Medica ◽  
2021 ◽  
Vol 63 (4) ◽  
pp. 613-617
Author(s):  
Diamantoula Pagkou ◽  
Theodosios Papavramidis ◽  
Xanthippi Mavropoulou ◽  
Moysis Moysidis ◽  
Ioannis Patsalas
Keyword(s):  
Skull Base ◽  
Head Trauma ◽  
Therapeutic Strategy ◽  
Chronic Atrial Fibrillation ◽  
Hair Pulling ◽  
The Third ◽  
Subgaleal Hematoma ◽  
Car Accident ◽  
Subgaleal Space ◽  
Full Body

Subgaleal hematoma, accumulation of blood in the loose areolar tissue of the subgaleal space of the skull, is considered the most catastrophic complication of instrumental delivery. It is a rare finding in older ages, usually associated with coagulation disorders, severe head trauma leading to skull base fractures and accidental or abusive hair pulling. Complications include periorbital necrotising fasciitis, permanent blindness, infections and, in extreme rare cases, airway obstruction. Most cases of subgaleal hematoma resolve spontaneously, without the need of aspiration or drainage. We present here the case of a 62-year-old male on anticoagulant therapy with apixaban for chronic atrial fibrillation, who came to the emergency department after a car accident suffering from mild head trauma. The patient was complaining of a diffuse headache and physical examination showed a large ecchymosis and edema on the frontal area of the head. His neurological examination was unremarkable. Full-body computed tomography (CT) revealed a fracture of the third right rib. Twelve hours after admission, due to an excessive decrease of hematocrit, a second CT was performed. Although the images didn’t show intracranial hemorrhage or skull base fractures, a large and diffuse hematoma of the subaponeurotic space was observed and the diagnosis of subgaleal hematoma was confirmed. Massive subgaleal hematoma after mild head trauma is rather infrequent. Early diagnosis improves outcomes and can avert serious complications. Therapeutic strategy should be based on the severity of each case. In our case, conservative treatment appeared to be a valid alternative to surgery, as hematoma resolved spontaneously within 10 days. It is noteworthy that the use of anticoagulation is the only evident factor that could have been the precipitating factor for the development of the hematoma in our patient.

scholarly journals Surgical management of axis' traumatic spondylolisthesis (Hangman's frature)

2004 ◽  
Vol 62 (3b) ◽  
pp. 821-826 ◽  
Author(s):  
José Luiz Romeo Boullosa ◽  
Benedicto Oscar Colli ◽  
Carlos Gilberto Carlotti Jr ◽  
Koji Tanaka ◽  
Marcius Benigno Marques dos Santos
Keyword(s):  
Surgical Treatment ◽  
Head Trauma ◽  
Skull Fracture ◽  
Pedicle Screws ◽  
Clinical Treatment ◽  
Multiple Fractures ◽  
Halo Vest ◽  
Post Surgery ◽  
Car Accident ◽  
Traumatic Spondylolisthesis

OBJECTIVE: To evaluate the results of surgical treatment using pedicle screws going through C2 pedicles for fixating the spondylolisthesis of the axis in patients who presented pseudoarthrosis after clinical treatment, or who have no condition for fixation with "halo vest", due to serious head trauma. METHOD: Ten patients have been operated from June 1998 to April 2002, nine suffering from traumatic spondylolisthesis of the axis caused by car accident and one horse fall. Four of those patients have undergone clinical treatment and presented signs of pseudoarthrosis, suffering intense pain at the movement of the cervical spine. Two of them presented moderate head trauma with multiple fractures of the skull. Another one was submitted to a surgical treatment for an acute extradural hematoma. Three patients presented a serious dislocation of C2 over C3. The patients were submitted to arthrodesis of the fractures with two screws, placed on the C2 pedicles, which allowed a better approximation of the fractures with the alignment of C2-C3. Two other patients required additional fixation with a plate on the lateral masses of C3. RESULTS: Nine patients had a good post surgery evolution with satisfactory consolidation of the fractures and disappearance of the symptoms. One patient had a good evolution but still has cervical pain resulting from strain. CONCLUSION: The fixation of the traumatic spondylolisthesis of the axis using screws in C2 pedicles and through fractures traces is a good option for treating patients who present pseudoarthrosis after clinical treatment or who present contraindication to the "halo vest", such as skull fracture or great lacerations in the scalp.

scholarly journals Uveítis recidivante a causa de espondilitis anquilosante. Presentación de un caso

2019 ◽  
Vol 3 (1) ◽  
pp. 8
Author(s):  
David Felipe Suárez Suárez
Keyword(s):  
Visual Acuity ◽  
Ankylosing Spondylitis ◽  
Systemic Disease ◽  
Human Leukocyte ◽  
Axial Skeleton ◽  
Initial Assessment ◽  
Uveitis Anterior ◽  
Uveal Tract ◽  
Keratic Precipitates ◽  
Palabras Clave

  Las uveítis son reacciones inflamatorias relativamente raras de causas variables y causantes de disminución de la agudeza visual, son frecuentemente relacionadas con enfermedades sistémicas. La sintomatología de un paciente con inflamación uveal está claramente identificada y clínicamente se puede identificar porque el paciente tiene signos como precipitados queráticos, celularidad y/o proteínas en cámara anterior, hipopion, miosis y mala dilatación pupilar a causa de sinequias anteriores y/o posteriores, membrana de fibrina en área pupilar, nódulos en el iris y reducción de la agudeza visual. Este tipo de inflamación ocular está relacionada con espondilitis anquilosante que es una enfermedad reumática crónica progresiva, que afecta primariamente el esqueleto axial. La prevalencia de esta patología oscila entre el 0,1 y el 1,4 % dependiendo directamente de la frecuencia del antígeno leucocitario humano (HLA). La espondilitis anquilosante es más frecuente en varones que, en mujeres, con una proporción estimada de 2-3. Se presenta un caso de uveítis recidivante debida a espondilitis anquilosante de una paciente de 32 años que asiste a consulta optométrica sin diagnóstico previo. En la valoración inicial, se presenta con un cuadro clínico de dolor ocular, ojo rojo y disminución de la agudeza visual, por tercera vez en menos de 10 meses, la paciente fue diagnosticada con uveítis anterior y remitida a oftalmología y reumatología para descartar enfermedad sistémica inflamatoria.   Palabras clave: espondiloartritis, espondiloartropatía, espondilitis anquilosante, uveítis anterior recidivante, uveítis.   Abstract Uveitis is relatively rare uveal tract inflammations of variable causes and causes decreased visual acuity that are often related to systemic diseases. The symptomatology of a patient with uveal inflammation is clearly identified. Clinically it can be identified because the patient has signs such as keratic precipitates, cellularity and/or proteins in the anterior chamber, hypopion, myosis and poor pupil dilation due to previous and/or subsequent synechia, fibrin membrane in pupil area, nodules in the iris and reduction of visual acuity. This type of eye inflammation is related to ankylosing spondylitis which is a chronic rheumatic disease, primarily affecting the axial skeleton. The prevalence of this disease ranges from 0.1 to 1.4 % depending directly on the frequency of the human leukocyte antigen (HLA). Ankylosing spondylitis is more common in men than in women, with an estimated ratio of 2-3. There is a case of relapsed uveitis due to ankylosing spondylitis in a 32-year-old female patient attending optometric consultation without prior diagnosis. In the initial assessment, it is presented with a clinical picture of eye pain, red eye and decreased visual acuity, for the third time in less than 10 months, the patient was diagnosed with previous uveitis and referred to ophthalmology and rheumatology to rule out inflammatory systemic disease.   Keyword Spondylarthritis, Spondylarthropathies, Spondylitis, Ankylosing, recurrent uveitis, uveitis.  

Rekonstruksi deformitas malar pada fraktur lama multipel wajah menggunakan kartilago iga dan silikon

2013 ◽  
Vol 40 (2) ◽  
Author(s):  
Dini Widiarni ◽  
Arroyan Wardhana ◽  
Endang Mangunkusumo ◽  
Yunia Irawati
Keyword(s):  
Connective Tissue ◽  
Facial Reconstruction ◽  
Facial Fractures ◽  
Facial Fracture ◽  
Facial Deformity ◽  
Rib Cartilage ◽  
History Of ◽  
The Aesthetic ◽  
And Function ◽  
Car Accident

Background: In old traumatic multiple facial fractures, connective tissue and fibrosis were formedwhich make them difficult to be repaired. Purpose: To illustrate to ENT- Head and Neck surgeons asreconstructive surgery could restore the aesthetic and function in facial deformity. Case: Two cases ofold multiple facial fracture were reported. One case was a 32 years old man with history of falling froma tree three years ago and second case was 41 years old man with history of car accident two years ago.   Case management: Those two cases were managed with facial reconstruction and malar augmentation using rib cartilage, plate and screw andsilicon implant. Conclusion: Facial reconstruction using rib cartilage autograft, plate and screw or silicon implant could be repair malar asymmetry. Facial analysisin facial reconstruction is important in determining the site of implantation precisely.Keywords: old multiple facial fracture, facial reconstruction, rib cartilage autograft, silicone implant. Abstrak : Latar belakang: Fraktur multipel wajah akibat trauma lama, telah membentuk jaringan ikatdan fibrosis sehingga sukar untuk dilakukan perbaikan. Tujuan:  sebagai ilustrasi untuk ahli THT-KL,bagaimana bedah rekonstruksi dapat memperbaiki estetika dan fungsi pada deformitas wajah.Kasus:Dua kasus fraktur lama wajah yaitu, pertama laki-laki berusia 32 tahun dengan riwayat jatuh dari pohon 3 tahun yang lalu dan kasus kedua laki-laki berusia 41 tahun dengan riwayat kecelakaan lalu lintas 2tahun yang lalu.Penatalaksanaan: Pada kedua pasien dilakukan rekonstruksi wajah dengan augmentasimalar menggunakan kartilago iga,plate and screw dan implan silikon. Kesimpulan: Rekonstruksiwajah menggunakan tandur autologus kartilago iga dan plate and screw atau implan silikon dapatmengurangi asimetri malar. Analisis wajah pada saat rekonstruksi penting untuk menentukan posisitandur atau implan dengan tepat.Kata kunci: fraktur multipel lama wajah, rekonstruksi wajah, tandur autologus kartilago iga, implansilikon.

School Nurses on the Front Lines of Medicine

2016 ◽  
Vol 32 (1) ◽  
pp. 25-29 ◽  
Author(s):  
Robert P. Olympia
Keyword(s):  
Emergency Department ◽  
Children And Adolescents ◽  
Head Trauma ◽  
School Nurse ◽  
School Nurses ◽  
Chief Complaint ◽  
Initial Assessment ◽  
Local Emergency Department

Head trauma is a common chief complaint encountered by school nurses. This article describes the initial assessment and management of head trauma in children and adolescents, delineates reasons that may prompt the school nurse to transfer a student to a local emergency department, and discusses the role of the school nurse when a student is diagnosed with a concussion.

Evaluation and Management of Shock States

2010 ◽  
Vol 24 (1) ◽  
pp. 44-60 ◽  
Author(s):  
Michael P. Moranville ◽  
Katherine D. Mieure ◽  
Elena M. Santayana
Keyword(s):  
Patient Outcomes ◽  
Treatment Plan ◽  
Hypovolemic Shock ◽  
Clinical Signs ◽  
Specific Treatment ◽  
Signs And Symptoms ◽  
Therapeutic Interventions ◽  
Initial Assessment ◽  
Patient Specific ◽  
Therapeutic Goals

Shock states have multiple etiologies, but all result in hypoperfusion to vital organs, which can lead to organ failure and death if not quickly and appropriately managed. Pharmacists should be familiar with cardiogenic, distributive, and hypovolemic shock and should be involved in providing safe and effective medical therapies. An accurate diagnosis is necessary to initiate appropriate lifesaving interventions and target therapeutic goals specific to the type of shock. Clinical signs and symptoms, as well as hemodynamic data, help with initial assessment and continued monitoring to provide adequate support for the patient. It is necessary to understand these hemodynamic parameters, medication mechanisms of action, and available mechanical support when developing a patient-specific treatment plan. Rapid therapeutic intervention has been proven to decrease morbidity and mortality and is crucial to providing the best patient outcomes. Pharmacists can provide their expertise in medication selection, titration, monitoring, and dose adjustment in these critically ill patients. This review will focus on parameters used to assess hemodynamic status, the major causes of shock, pathophysiologic factors that cause shock, and therapeutic interventions that should be employed to improve patient outcomes.

scholarly journals Occurrence of traumatic brain injury due to short falls with or without a witness by a nonrelative in children younger than 2 years

2020 ◽  
Vol 26 (6) ◽  
pp. 696-700
Author(s):  
Shunsuke Amagasa ◽  
Satoko Uematsu ◽  
Satoshi Tsuji
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Trauma ◽  
Subdural Hematoma ◽  
Prevalence Rate ◽  
Skull Fracture ◽  
Retinal Hemorrhage ◽  
Intracranial Injury ◽  
Neurological Sequelae ◽  
Clinical Records

OBJECTIVEThere is disagreement about the occurrence of severe traumatic brain injury, especially subdural hematoma, caused by short falls in very young children. To verify intracranial injury due to these falls and examine its characteristics, the authors compared infants and toddlers with head trauma witnessed by a nonrelative with those whose injuries were not witnessed by a nonrelative.METHODSThe authors retrospectively reviewed clinical records of children younger than 2 years with head trauma due to a short fall who visited the emergency department of the National Center for Child Health and Development in Japan between April 2015 and March 2018. Patients were classified into two groups: falls that were witnessed by a nonrelative and falls not witnessed by a nonrelative. The authors compared the age in months, sex, mechanism of injury, fall height, prevalence rate of intracranial injury, skull fracture, type of traumatic brain injury, retinal hemorrhage, rib or long-bone fracture, and outcomes between patients whose fall was witnessed by a nonrelative and those whose fall was not witnessed by a nonrelative.RESULTSAmong 1494 patients included in the present analysis, 392 patients were classified into the group of falls witnessed by a nonrelative, and 1102 patients were classified into the group of falls that were not witnessed by a nonrelative. The prevalence rates of intracranial injury, skull fracture, epidural hematoma, and subarachnoid hemorrhage were equal between the groups. The prevalence rate of subdural hematoma in the group whose falls were witnessed by a nonrelative was significantly lower than that of the other group (p = 0.027). There were no patients with subdural hematoma, retinal hemorrhage, or neurological sequelae in the group whose fall was witnessed by a nonrelative.CONCLUSIONSSubdural hematoma, retinal hemorrhage, and neurological sequelae due to short falls were not seen after witnessed falls in the present study.

scholarly journals Emergent Neurosurgical Management of a Rapidly Deteriorating Patient with Acute Intracranial Hemorrhage and Alcohol-Related Thrombocytopenia

2018 ◽  
Vol 09 (04) ◽  
pp. 625-627 ◽  
Author(s):  
Hansen Deng ◽  
John K. Yue ◽  
Beata Durcanova ◽  
Javid Sadjadi
Keyword(s):  
Head Trauma ◽  
Alcohol Intoxication ◽  
Alcoholic Cirrhosis ◽  
Medical Personnel ◽  
Intracranial Bleeding ◽  
Initial Assessment ◽  
Field Hospital ◽  
Blunt Head Trauma ◽  
Critical Care Management ◽  
High Index Of Suspicion

ABSTRACTAlcohol intoxication is a common risk factor of traumatic brain injury (TBI) and carries a significant health-care burden on underserved patients. Patients with chronic alcohol use may suffer a spectrum of bleeding diatheses from hepatic dysfunction not well studied in the context of TBI. A feared sequela of TBI is the development of coagulopathy resulting in worsened intracranial bleeding. We report the clinical course of an intoxicated patient found down with blunt head trauma and concurrent alcoholic cirrhosis who was awake and responsive in the field. Hospital course was characterized by a rapidly deteriorating neurological examination with progressive subdural and subarachnoid hemorrhage and precipitating neurosurgical decompression and critical care management. Our experience dictates the need for timely consideration of the possibility of rapid deterioration from coagulopathic intracranial bleeding in the initial assessment of intoxicated patients with head trauma of unknown severity, for which a high index of suspicion for extra-axial hemorrhage should be maintained, along with the immediate availability of operating room and the necessary medical personnel.

scholarly journals Rhinolith: Delayed Presentation after Head Trauma—A Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-2 ◽  
Author(s):  
Ali S. Al Mastour ◽  
Wagih M. Ghnnam ◽  
Abdu H. Zubaidi
Keyword(s):  
Case Report ◽  
Clinical Practice ◽  
Head Trauma ◽  
Nasal Obstruction ◽  
Nasal Discharge ◽  
Delayed Presentation ◽  
Nasal Symptoms ◽  
Foul Smell ◽  
Car Accident ◽  
Saudi Male

Rhinoliths are uncommon clinical entities reported in clinical practice as unusual cause of unilateral nasal obstruction and foul smell nasal discharge. Rhinolith is calcified material found in the nasal cavity incidentally or due to patient complaint. It should be suspected when patient presents with nasal symptoms and found to have stony mass showed radiologically. We reported a 28-year-old Saudi male with left sided (LT) nasal obstruction and foul smell discharge for 5 years suspected as being due to foreign body presence since childhood due to head trauma following car accident in sandy area.

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