DOCSLIB.ORG

A CASE of CRUSH INJURY of the CHEST a Saturday Forum Held at the Western Infirmary, Glasgow, on Saturday, October 22, 1960 Chairman: Professor E

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
A CASE of CRUSH INJURY of the CHEST a Saturday Forum Held at the Western Infirmary, Glasgow, on Saturday, October 22, 1960 Chairman: Professor E o$0 Postgrad Med J: first published as 10.1136/pgmj.37.423.50 on 1 January 1961. Downloaded from POSTGRAD. MED. J., 1961, 37, 50 Clinicopathological Conference A CASE OF CRUSH INJURY OF THE CHEST A Saturday Forum held at the Western Infirmary, Glasgow, on Saturday, October 22, 1960 Chairman: Professor E. J. Wayne, M.Sc., Ph.D., M.D., F.R.C.P., F.R.F.P.S.G. Editors: H. I. Tankel, M.D., F.R.C.S., and B. Lennox, Ph.D., M.D., F.R.F.P.S.G., M.R.C.P. Protected by copyright. http://pmj.bmj.com/ A B FIG. Shows the central of crushed chest in which there is a transverse fracture of the sternum. Shows the i.-(a) type (b) on September 26, 2021 by guest. lateral type in which the sternum is intact. (Reproduced by kind permission of the Journal of Bone and Joint Surgery). MR. D. H. CLARK: Professor Wayne, Ladies bronchitis. On September 8th he and a workmate and Gentlemen, I wish to present a case of crush were at the bottom of a I2-ft. trench when the injury of the chest. There are two common types sides suddenly caved in. His workmate was killed of crush injury (Fig. i), a central type in which and the patient sustained a severe crush injury of the sternum is fractured, and a lateral type in the chest. He was admitted to this hospital and, which there is a large number of fractures of the although not in extremis, he was seriously ill and ribs on one or both sides. The patient I wish to so distressed that oxygen was immediately ad- present was of the latter type and had two large ministered. He was sweating, cyanosed and in lateral flail fragments. severe pain. He had marked surgical emphysema The patient is a labourer, aged 40, with chronic of his chest, fore and aft, on his neck and spreading A Case Crush the Chest 51 January 1961 ..........,,,..,.,.......j... ..j of Injury of Postgrad Med J: first published as 10.1136/pgmj.37.423.50 on 1 January 1961. Downloaded from Protected by copyright. .... ...... ... ' FIG. 2.-The patient in bed showing the tracheostomy, a water-seal drain in the second right interspace and traction applied to wires around the ribs. on to his face. Paradoxical respiration was obvious operation then proceeded and consisted of putting in two large lateral segments. The blood pressure slings of wire sheathed in polythene tubing round was I50/90 and the pulse rate about Ioo. An the 7th and 8th ribs on both sides in the mid- X-ray was taken which showed fore and aft axillary line. A tracheostomy was then performed. fractures of the 5th to 9th ribs inclusive on both Towards the end of the operation it was again http://pmj.bmj.com/ sides and surgical emphysema, but no evidence reported by the anaesthetists that there was diffi- of pneumothorax. culty in inflating the lungs. Further X-ray of the We watched the patient while an intravenous patient now revealed a tension pneumothorax on infusion was being installed and reached the the opposite (right) side. An intercostal drain following conclusions: (i) He had not lost a was inserted in the second right interspace and great deal of blood; (2) he had a purely thoracic again air came off under pressure. The patient cage and lung injury and there was no intra- was then transferred to the ward and the slings abdominal lesion; and (3) he had no sternal frac- were attached to weights over the sides of the on September 26, 2021 by guest. ture. We decided to proceed with the anaesthetic, bed. He was given no oxygen. Further progress and this was begun by Dr. Fleming who was will be discussed under separate headings. later joined by Dr. Wishart. As in all these cases the patient improved immediately. However, the The Thoracic Cage improvement was short-lived; in about o minutes After traction was applied the rib cage gave no he began to deteriorate, and the anaesthetists further cause for concern. Fig. 2 shows the reported that the amount of pressure required to patient in bed with traction applied. He was inflate his lungs was increasing. A spontaneous allowed up on the I th day, and Fig. 3 shows him tension pneumothorax on the left side was diag- standing with the traction still maintained by nosed and an intercostal water-seal drain was means of a spinal brace to which encircling arms inserted through the second left interspace, have been attached. The emphysema subsided whereupon air came out under pressure. The rapidly and he lost a considerable amount of C2 MEDICAL 1961 5POSTGRADUATE JOURNAL January Postgrad Med J: first published as 10.1136/pgmj.37.423.50 on 1 January 1961. Downloaded from wai<i. .. l -: i | - :a . .............. -···;:::; ·sQ |n .. ··: :·:. Dig .................................i~::...i~iii~~ii:i:. ........ :l ·l :·I: i:ii·.. ·· ·xsX *Allrtsie0. ............o ..1-11 ::.·:::j: ::1i·' e@1r~ Protected by copyright. liani. ....... ..s.- ........... '.O ......... *)-* .5.- .. ... ........ http://pmj.bmj.com/ FIG. 3.-The patient standing. Traction is maintained by means of the encircling arms attached to a standard spinal brace. on September 26, 2021 by guest. weight. On the i5th day after operation one and probably also of the middle lobe. Broncho- wire cut out. The traction was released on the scopy was performed under local anaesthesia but I8th day. did little good. He continued to be very ill with a high temperature, rapid respiration and cyanosis. The Lungs On the 5th day after operation air again began to Both intercostal drains were removed on the leak from the right supraclavicular region with 2nd day and from then on his left lung gave no emphysema spreading subcutaneously over the further trouble. By the 3rd day it was noticeable chest and into the neck and face. X-ray con- that the right lung was not inflating properly. firmed the presence of a further pneumothorax lThe respiratory murmur was poor and there and an intercostal drain was again inserted in the appeared to be a collapse of the right lower lobe second right interspace. Thereafter he gradually A Case Crush the Chest January I961 of Injury of 53 Postgrad Med J: first published as 10.1136/pgmj.37.423.50 on 1 January 1961. Downloaded from P.D.- BLOOD PRESSURE mm Hg 200 180 - 160 140 120 100 80- 60 40 day I 2 3 4 5 6 7 | 28 29 30 31 Protected by copyright. FIG. 4.-Blood pressure chart showing hypertension due to carbon dioxide retention during the first week. The late readings show the patient's normal levels. improved, despite a haemoptysis on the I4th day, as he was a chronic bronchitic. As time passed which was felt to be due to secondary haemorrhage the amount of aspiration required became less. from lacerated lung or the opening of an area of After about a week the rubber tracheostomy tube atelectasis. The most recent X-ray shows that was changed for a metal one, and he found this the right lung has cleared considerably though more comfortable. These tubes were changed there is probably still a very small pneumothorax regularly. at the apex. Bacteriology at different times revealed the I do not think there is any doubt that this man presence of staphylococci, B. proteus, diphtheroids had CO2 retention for at least ten days. Unfor- and streptococci. The only antibiotic to which all http://pmj.bmj.com/ tunately we have no readings of the arterial CO2 were constantly sensitive was chloramphenicol. tension. However, we did record his blood At this point the patient was presented and the pressure faithfully and I have summarized the chest expansion demonstrated to be I inch. The findings in Fig. 4. His blood pressure on admis- chest was stable and the wounds healed. There was sion was I50/9o, and during the first few days no cough. it rose, until on the 4th and 5th days it was in PROFESSOR WAYNE: Thank you very much, the region of 190/120. In the two or three days Mr. Clark. It seems that many of the problems prior to his discharge from hospital his blood had to do with the anaesthetic and I would ask on September 26, 2021 by guest. pressure remained in the region of I20 to 130 Dr. Wishart to talk about these. systolic, and this would appear to be his normal DR. H. Y. WISHART: The main interest in this blood pressure. We submit this as evidence that case from our point of view was the fact that the he probably did have a significant degree of CO2 patient came in without a tension pneumothorax retention. and that this became evident during anesthesia. The patient was curarized in the normal way and The Tracheostomy breathing was being controlled by hand when it He had a tracheostomy for 24 days. At first was noticed that increasing pressure was needed a cuffed tube was used and we released the cuff to do this. When this happens there may be three for five minutes in every hour. Aspiration of the causes: (i) The muscle paralysis may be wearing bronchi through a Tieman's catheter was required off, (2) secretions may be blocking the tracheo- every half-hour and sometimes more frequently bronchial tree, or (3) a tension pneumothorax POSTGRADUATE MEDICAL 1961 54 JOURNAL January Postgrad Med J: first published as 10.1136/pgmj.37.423.50 on 1 January 1961. Downloaded from may be developing. In this case the patient was making small respiratory efforts and so he was recurarized but without improvement.
Load more

Recommended publications
  • Crush Injuries Pathophysiology and Current Treatment Michael Sahjian, RN, BSN, CFRN, CCRN, NREMT-P; Michael Frakes, APRN, CCNS, CCRN, CFRN, NREMT-P
    LWW/AENJ LWWJ331-02 April 23, 2007 13:50 Char Count= 0 Advanced Emergency Nursing Journal Vol. 29, No. 2, pp. 145–150 Copyright c 2007 Wolters Kluwer Health | Lippincott Williams & Wilkins Crush Injuries Pathophysiology and Current Treatment Michael Sahjian, RN, BSN, CFRN, CCRN, NREMT-P; Michael Frakes, APRN, CCNS, CCRN, CFRN, NREMT-P Abstract Crush syndrome, or traumatic rhabdomyolysis, is an uncommon traumatic injury that can lead to mismanagement or delayed treatment. Although rhabdomyolysis can result from many causes, this article reviews the risk factors, symptoms, and best practice treatments to optimize patient outcomes, as they relate to crush injuries. Key words: crush syndrome, traumatic rhabdomyolysis RUSH SYNDROME, also known as ology, pathophysiology, diagnosis, and early traumatic rhabdomyolysis, was first re- management of crush syndrome. Cported in 1910 by German authors who described symptoms including muscle EPIDEMIOLOGY pain, weakness, and brown-colored urine in soldiers rescued after being buried in struc- Crush injuries may result in permanent dis- tural debris (Gonzalez, 2005). Crush syn- ability or death; therefore, early recognition drome was not well defined until the 1940s and aggressive treatment are necessary to when nephrologists Bywaters and Beal pro- improve outcomes. There are many known vided descriptions of victims trapped by mechanisms inducing rhabdomyolysis includ- their extremities during the London Blitz ing crush injuries, electrocution, burns, com- who presented with shock, swollen extrem- partment syndrome, and any other pathology ities, tea-colored urine, and subsequent re- that results in muscle damage. Victims of nat- nal failure (Better & Stein, 1990; Fernan- ural disasters, including earthquakes, are re- dez, Hung, Bruno, Galea, & Chiang, 2005; ported as having up to a 20% incidence of Gonzalez, 2005; Malinoski, Slater, & Mullins, crush injuries, as do 40% of those surviving to 2004).
    [Show full text]
  • Thoracic Gunshot Wound: a Tanmoy Ganguly1, 1 Report of 3 Cases and Review of Sandeep Kumar Kar , Chaitali Sen1, Management Chiranjib Bhattacharya2, Manasij Mitra3
    2015 iMedPub Journals Journal of Universal Surgery http://www.imedpub.com Vol. 3 No. 1:2 ISSN 2254-6758 Thoracic Gunshot Wound: A Tanmoy Ganguly1, 1 Report of 3 Cases and Review of Sandeep Kumar Kar , Chaitali Sen1, Management Chiranjib Bhattacharya2, Manasij Mitra3, 1 Department of Cardiac Anesthesiology, Abstract Institute of Postgraduate Medical Thoracic gunshot injury may have variable presentation and the treatment plan Education and Research, Kolkata, India differs. The risk of injury to heart, major blood vessels and the lungs should be 2 Department of Anesthesiology, Institute evaluated in every patient with rapid clinical examination and basic monitoring and of Postgraduate Medical Education and surgery should be considered as early as possible whenever indicated. The authors Research, Kolkata, India present three cases of thoracic gunshot injury with three different presentations, 3 Krisanganj Medical College, Institute of one with vascular injury, one with parenchymal injury and one case with fortunately Postgraduate Medical Education and no life threatening internal injury. The first case, a 52 year male patient presented Research, Kolkata, India with thoracic gunshot with hemothorax and the bullet trajectory passed very near to the vital structures without injuring them. The second case presented with 2 hours history of thoracic gunshot wound with severe hemodynamic instability. Corresponding author: Sandeep Kumar Surgical exploration revealed an arterial bleeding from within the left lung. The Kar, Assistant Professor third case presented with post gunshot open pneumothorax. All three cases managed successfully with resuscitation and thoracotomy. Preoperative on table fluoroscopy was used for localisation of bullet. [email protected] Keywords: Horacic trauma, Gunshot injury, Traumatic pneumothorax, Emergency thoracotomy, Fluoroscopy.
    [Show full text]
  • Femoral Shaft Fracture Fixation and Chest Injury After Polytrauma
    This is an enhanced PDF from The Journal of Bone and Joint Surgery The PDF of the article you requested follows this cover page. Femoral Shaft Fracture Fixation and Chest Injury After Polytrauma Lawrence B. Bone and Peter Giannoudis J Bone Joint Surg Am. 2011;93:311-317. doi:10.2106/JBJS.J.00334 This information is current as of January 25, 2011 Reprints and Permissions Click here to order reprints or request permission to use material from this article, or locate the article citation on jbjs.org and click on the [Reprints and Permissions] link. Publisher Information The Journal of Bone and Joint Surgery 20 Pickering Street, Needham, MA 02492-3157 www.jbjs.org 311 COPYRIGHT Ó 2011 BY THE JOURNAL OF BONE AND JOINT SURGERY,INCORPORATED Current Concepts Review Femoral Shaft Fracture Fixation and Chest Injury After Polytrauma By Lawrence B. Bone, MD, and Peter Giannoudis, MD, FRCS Thirty years ago, the standard of care for the multiply injured tients with multiple injuries, defined as an ISS of ‡18, and patient with fractures was placement of the fractured limb in a patients with essentially an isolated femoral fracture and an splint or skeletal traction, until the patient was considered stable ISS of <18. Pulmonary complications consisting of ARDS, enough to undergo surgery for fracture fixation1. This led to a pulmonary dysfunction, fat emboli, pulmonary emboli, and number of complications2, such as adult respiratory distress pneumonia were present in 38% (fourteen) of thirty-seven syndrome (ARDS), infection, pneumonia, malunion, non- patients in the late fixation/multiple injuries group and 4% union, and death, particularly when the patient had a high (two) of forty-six in the early fixation/multiple injuries group; Injury Severity Score (ISS)3.
    [Show full text]
  • Practice Management Guidelines for Screening of Blunt Cardiac Injury
    PRACTICE MANAGEMENT GUIDELINES FOR SCREENING OF BLUNT CARDIAC INJURY EAST Practice Parameter Workgroup for Screening of Blunt Cardiac Injury Michael D. Pasquale, MD Kimberly Nagy, MD John Clarke, MD © Copyright 1998 Eastern Association for the Surgery of Trauma 1 Practice Management Guidelines for Screening of Blunt Cardiac Injury I. Statement of the problem The reported incidence of blunt cardiac injury (BCI), formerly called myocardial contusion, depends on the modality and criteria used for diagnosis and ranges from 8% to 71% in those patients sustaining blunt chest trauma. The true incidence remains unknown as there is no diagnostic gold standard, i.e. the available data is conflicting with respect to how the diagnosis should be made (EKG, enzyme analysis, echocardiogram, etc.) The lack of such a standard leads to confusion with respect to making a diagnosis and makes the literature difficult to interpret. Key issues involve identifying a patient population at risk for adverse events from BCI and then appropriately monitoring and treating them. Conversely, patients not at risk could potentially be discharged from the hospital with appropriate follow-up. II. Process A Medline search from January 1986 through February 1997 was performed. All English language citations during this time period with the subject words “myocardial contusion”, “blunt cardiac injury”, and “cardiac trauma” were retrieved. Letters to the editor, isolated case reports, series of patients presenting in cardiac arrest, and articles focusing on emergency room thoracotomy were deleted from the review. This left 56 articles which were primarily well-conducted studies or reviews involving the identification of BCI. III. Recommendations A.
    [Show full text]
  • An Update on the Management of Severe Crush Injury to the Forearm and Hand
    An Update on the Management of Severe Crush Injury to the Forearm and Hand a, Francisco del Piñal, MD, Dr. Med. * KEYWORDS Crush syndrome Hand Compartimental syndrome Free flap Hand revascularization Microsurgery Forzen hand KEY POINTS Microsurgery changes the prognosis of crush hand syndrome. Radical debridement should be followed by rigid (vascularized) bony restoration. Bringing vascularized gliding tissue allows active motion to be restored. Finally, the mangement of the chronic injury is discussed. INTRODUCTION the distal forearm, wrist, or metacarpal area and fingers separately. Severe crush injuries to the hand and fingers often carry an unavoidably bad prognosis, resulting in stiff, crooked, and painful hands or fingers. In ACUTE CRUSH TO THE DISTAL FOREARM, follow-up, osteoporosis is often times seen on ra- WRIST, AND METACARPAL AREA OF THE diographs. A shiny appearance of the skin and HAND complaints of vague pain may lead the surgeon Clinical Presentations and Pathophysiology to consider a diagnosis of reflex sympathetic dys- Two striking features after a severe crush injury are trophy,1 to offer some “explanation” of the gloomy prognosis that a crush injury predicates. Primary 1. The affected joints tend to stiffen and the or secondary amputations are the common end affected tendons tend to stick. options of treatment. 2. The undamaged structures distal to the area of In the authors’ experience, the prompt and pre- injury usually get involved. cise application of microsurgical techniques can The trauma appears to have a “contagious” ef- help alter the often dismal prognosis held by those fect that spreads distally, similar to a fire spreading suffering from severe crush injuries.
    [Show full text]
  • With Crush Injury Syndrome
    Crush Syndrome Made Simple Malta & McConnelsville Fire Department Division of Emergency Medical Service Objectives Recognize the differences between Crush Injury and Crush Syndrome Understand the interventions performed when treating someone with Crush Syndrome Assessing the Crush Injury victim S&S of crush injuries Treatment of crush injury Malta & McConnelsville Fire Department Division of Emergency Medical Service INJURY SYNDROME • Cell Disruption/ • Systemic effects injury at the point of when muscle is impact. RELEASED from Compression • Occurs < 1 hour • Occurs after cells have been under pressure >4 hours* • Suspect Syndrome with lightening strikes Malta & McConnelsville Fire Department Division of Emergency Medical Service CRUSHING MECHANISM OF INJURY • Building and Structure Collapse • Bomb Concussions • MVAs’ and Farm Accidents • Assault with blunt weapon Malta & McConnelsville Fire Department Division of Emergency Medical Service AKA: COMPRESSION SYNDROME First described by Dr. Minami in 1940 Malta & McConnelsville Fire Department Division of Emergency Medical Service INVOLVED ANATOMY Upper Arms Upper Legs Thorax and Buttocks Malta & McConnelsville Fire Department Division of Emergency Medical Service Crush Injuries Crush injuries occur when a crushing force is applied to a body area. Sometimes they are associated with internal organ rupture, major fractures, and hemorrhagic shock. Early aggressive treatment of patients suspected of having a crush injury is crucial. Along with the severity of soft tissue damage and fractures, a major concern of a severe crush injury is the duration of the compression/entrapment. Malta & McConnelsville Fire Department Division of Emergency Medical Service Crush Injuries Prolonged compression of a body region or limb may lead to a dangerous syndrome that can become fatal. Crush Syndrome is difficult to diagnose and treat in the pre-hospital setting because of the many complex variables involved.
    [Show full text]
  • Sternal Insufficiency Fracture Related to Steroid-Induced Osteoporosis: a Case Report Jessica J
    0008-3194/2013/48–54/$2.00/©JCCA 2013 Sternal insufficiency fracture related to steroid-induced osteoporosis: A case report Jessica J. Wong, BSc, DC, FCCS(C)1 Brian Drew, MD, FRCPS2 Paula Stern, BSc, DC, FCCS(C)1 Osteoporosis often results in fractures, deformity L’ostéoporose cause souvent des fractures, des and disability. A rare but potentially challenging difformités et l’invalidité. Une complication rare, mais complication of osteoporosis is a sternal insufficiency potentiellement grave, de l’ostéoporose est la fracture fracture. This case report details a steroid-induced par insuffisance osseuse du sternum. Ce rapport osteoporotic male who suffered a sternal insufficiency décrit en détail le cas d’un mâle atteint d’ostéoporose fracture after minimal trauma. Prompt diagnosis causée par les stéroïdes et qui a subi une fracture par and appropriate management resulted in favourable insuffisance osseuse du sternum après un traumatisme outcome for the fracture, though a sequalae involving a minime. Grâce à un diagnostic rapide et une gestion myocardial infarction ensued with his osteoporosis and appropriée, on a obtenu de bons résultats pour la complex health history. The purpose of this case report fracture, mais des séquelles ont été laissées sous forme is to heighten awareness around distinct characteristics d’un infarctus du myocarde en raison de ses antécédents of sternal fractures in osteoporotic patients. Discussion médicaux complexes. Le but de cette étude de cas est focuses on the incidence, mechanism, associated de sensibiliser sur les caractéristiques distinctes des factors and diagnostic challenge of sternal insufficiency fractures du sternum chez les patients ostéoporotiques. fractures. This case report highlights the role primary La discussion porte sur l’incidence, le mécanisme, contact practitioners can play in recognition and les facteurs associés et la difficulté de diagnostic des management of sternal insufficiency fractures related to fractures par insuffisance osseuse du sternum.
    [Show full text]
  • Approach to the Trauma Patient Will Help Reduce Errors
    The Approach To Trauma Author Credentials Written by: Nicholas E. Kman, MD, The Ohio State University Updated by: Creagh Boulger, MD, and Benjamin M. Ostro, MD, The Ohio State University Last Update: March 2019 Case Study “We have a motor vehicle accident 5 minutes out per EMS report.” 47-year-old male unrestrained driver ejected 15 feet from car arrives via EMS. Vital Signs: BP: 100/40, RR: 28, HR: 110. He was initially combative at the scene but now difficult to arouse. He does not open his eyes, withdrawals only to pain, and makes gurgling sounds. EMS placed a c-collar and backboard, but could not start an IV. What do you do? Objectives Upon completion of this self-study module, you should be able to: ● Describe a focused rapid assessment of the trauma patient using an organized primary and secondary survey. ● Discuss the components of the primary survey. ● Discuss possible pathology that can occur in each domain of the primary survey and recommend treatment/stabilization measures. ● Describe how to stabilize a trauma patient and prioritize resuscitative measures. ● Discuss the secondary survey with particular attention to head/central nervous system (CNS), cervical spine, chest, abdominal, and musculoskeletal trauma. ● Discuss appropriate labs and diagnostic testing in caring for a trauma patient. ● Describe appropriate disposition of a trauma patient. Introduction Nearly 10% of all deaths in the world are caused by injury. Trauma is the number one cause of death in persons 1-50 years of age and results in significant life years lost. According to the National Trauma Data Bank, falls were the leading cause of trauma followed by motor vehicle collisions (MVCs) and firearm related injuries with an overall mortality rate of 4.39% in 2016.
    [Show full text]
  • Ad Ult T Ra Uma Em E Rgen Cies
    Section SECTION: Adult Trauma Emergencies REVISED: 06/2017 4 ADULT TRAUMA EMERGENCIES TRAUMA ADULT 1. Injury – General Trauma Management Protocol 4 - 1 2. Injury – Abdominal Trauma Protocol 4 - 2 (Abdominal Trauma) 3. Injury – Burns - Thermal Protocol 4 - 3 4. Injury – Crush Syndrome Protocol 4 - 4 5. Injury – Electrical Injuries Protocol 4 - 5 6. Injury – Head Protocol 4 - 6 7. Exposure – Airway/Inhalation Irritants Protocol 4 - 7 8. Injury – Sexual Assault Protocol 4 - 8 9. General – Neglect or Abuse Suspected Protocol 4 - 9 10. Injury – Conducted Electrical Weapons Protocol 4 - 10 (i.e. Taser) 11. Injury - Thoracic Protocol 4 - 11 12. Injury – General Trauma Management Protocol 4 – 12 (Field Trauma Triage Scheme) 13. Spinal Motion Restriction Protocol 4 – 13 14. Hemorrhage Control Protocol 4 – 14 Section 4 Continued This page intentionally left blank. ADULT TRAUMA EMERGENCIES ADULT Protocol SECTION: Adult Trauma Emergencies PROTOCOL TITLE: Injury – General Trauma Management 4-1 REVISED: 06/2015 PATIENT TRAUMA ASSESSMENT OVERVIEW Each year, one out of three Americans sustains a traumatic injury. Trauma is a major cause of disability in the United States. According to the Centers for Disease Control (CDC) in 2008, 118,021 deaths occurred due to trauma. Trauma is the leading cause of death in people under 44 years of age, accounting for half the deaths of children under the age of 4 years, and 80% of deaths in persons 15 to 24 years of age. As a responder, your actions within the first few moments of arriving on the scene of a traumatic injury are crucial to the success of managing the situation.
    [Show full text]
  • Traumatic Deceleration Injury of the Thoracic Aorta
    ECHO ROUNDS Section Editor: Edmund Kenneth Kerut, M.D. Traumatic Deceleration Injury of the Thoracic Aorta Edmund Kenneth Kerut, M.D.,∗,∗∗ Glenn Kelley, M.D.,† Vivian Carina Falco, M.D.,† Ty Ovella, M.D.,‡ Lisa Diethelm, M.D.,‡ and Frederick Helmcke, M.D.† ∗Departments of Pharmacology and Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, ∗∗Heart Clinic of Louisiana, Marrero, Louisiana, †Division of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, and ‡Department of Radiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana (ECHOCARDIOGRAPHY, Volume 22, September 2005) deceleration, trauma, transection, aorta, transesophageal echocardiography, multislice computed tomography A 42-year-old intoxicated male pedestrian to surgery, where a spiral, subtotal, subadventi- was struck by a motor vehicle and “thrown” 45 tial aortic disruption (see discussion) involving feet. The patient did not lose consciousness. He three-fourths of the circumference of the aorta had no specific localized pain, and was initially was found.1,2 The tear was successfully resected noted to have only minor limb abrasions. He and replaced with a composite thoracic graft. was then admitted to the trauma center for ob- Blunt traumatic chest injury (deceleration in- servation. A screening CT was performed using jury) most often occurs from a steering wheel in- a16row multidetector CT scanner. It revealed jury or from a fall from a height. This may result a mediastinal hematoma, and also an aortic in myocardial contusion, traumatic ventricular pseudoaneurysm with an intraluminal defect septal defect, tricuspid or mitral valve trauma, at the level of the aortic isthmus (Fig.
    [Show full text]
  • Crush Injury Management
    Crush Injury Management In the Underground Environment Background • 1910 - Messina Earthquake • WW2 - Air Raid Shelters fell on people crushing limbs - First time called Crush Syndrome • Granville Rail Disaster - Sydney Australia • Chain Valley Bay Colliery fatality 2011 What is it? Definition: Crush Injury • Injury that occurs because of pressure from a heavy object onto a body part • Squeezing of a body part between two objects Definition: Crush Syndrome The shock-like state following release of a limb or limbs, trunk and pelvis after a prolonged period of compression Crush Syndrome Basic Science • Muscle groups are covered by a tough membrane (fascia) that does not readily expand • Damage to these muscle groups cause swelling and/or bleeding; due to inelasticity of fascia, swelling occurs inward resulting in compressive force • Compressive force leads to vascular compromise with collapse of blood vessels, nerves and muscle cells • Without a steady supply of oxygen and nutrients, nerve and muscle cells die in a matter of hours • Problem is local to a limb or body area Traumatic • Crush syndrome - loss of blood to supply muscle tissue rhabdomyolysis toxins produced from muscle metabolism without oxygen as well as normal intracellular contents • Muscles can withstand approx. 4 hours without blood flow before cell death occurs • Toxins may continue to leak into body for as long as 60 hours after release of crush injury • The major problem is not recognising the potential for its existence, then removing the compressive force prior to arrival
    [Show full text]
  • Incidence of Asymptomatic Pulmonary Embolism in Moderately to Severely Injured Trauma Patients David J
    The Journal of TRAUMA௡ Injury, Infection, and Critical Care Incidence of Asymptomatic Pulmonary Embolism in Moderately to Severely Injured Trauma Patients David J. Schultz, MD, Karen J. Brasel, MD, MPH, Lacey Washington, MD, Lawrence R. Goodman, MD, Robert R. Quickel, MD, Randolph J. Lipchik, MD, Todd Clever, BS, and John Weigelt, MD Background: Chest computed tomo- sessed using an anatomic scoring system. patients receiving pharmacologic prophy- graphic (CT) scanning is used frequently Patients not receiving anticoagulation laxis had a PE. to evaluate symptomatic patients for pul- were followed. Conclusion: Asymptomatic PE occur monary embolus (PE). The incidence of Results: Twenty-two of 90 patients in 24% of moderately to severely injured PE diagnosed by helical CT scanning in had a PE. Four had major clot burden, patients. Age, head, chest, and lower ex- asymptomatic patients is unknown. including one patient with a saddle embo- tremity injury are associated with an in- Methods: Asymptomatic trauma pa- lus. Risk factors for asymptomatic PE in- creased risk. Standard thromboembolic tients with an Injury Severity Score > 9 clude age (odds ratio [OR], 1.04), head prophylaxis is not reliably protective. were studied with contrast-enhanced heli- injury (OR, 6.78), chest injury (OR, 4.51), Key Words: Computed tomographic cal CT images of the chest, pelvis, and lower extremity injury (OR, 5.03), and scanning, Pulmonary embolus, Head in- lower extremities. Clot burden was as- transfusion (OR, 3.42). Thirty percent of jury, Chest injury, Transfusion. J Trauma. 2004;56:727–733. hromboembolic complications are common in the uate respiratory symptoms in these patients.
    [Show full text]