1/748. Massive prehospital transfusion in multiple blunt trauma. A 15-year-old male passenger in a motor vehicle accident was transfused 15 units of blood products and 8.5 litres of polygeline while still trapped in the wreckage. This and other advanced interventions at the scene contributed to the patient's survival. This first case report of massive prehospital transfusion highlights some of the advantages of senior physician staffed emergency medical services in the prehospital phase of trauma management. ( info) |
| heparin-associated thrombocytopenia occurred in a patient during continuous renal replacement therapy (CRRT), resulting in repeated clotting of the extracorporeal circuit and spontaneous hemorrhage. The peripheral platelet count initially appeared to improve by changing to prostacyclin and dalteparin. However, repeated CRRT circuit clotting recurred, and the platelet count decreased once again. This time the synthetic heparinoid, Orgaran (danaparoid), was used and was associated with successful CRRT and return of the platelet count. ( info) |
3/748. Analysis of blunt trauma injuries: vertical deceleration versus horizontal deceleration injuries. There are several similarities found in blunt trauma injuries to humans sustained as a result of vertical deceleration (falling) and those sustained as a result of deceleration in a horizontal plane (automobile accidents). However, examination of the patterns of traumatic skeletal injuries can distinguish those injuries associated with falling from heights from those associated with automobile accidents. While there is considerable variation within each type of blunt trauma injury dependent on the angle at which one falls or is struck, there are several characteristic skeletal features associated with each type of trauma. In this study we review both the current literature and human skeletal remains from the University of new mexico's Documented Collection known to have been subjected to blunt trauma. This collection is used to characterize and differentiate the pattern of skeletal injuries to various parts of the body for each type of trauma. These assessments are applied to investigate the traumatic skeletal lesions observed in a forensic case where the manner of death is unknown. Analyses suggest two possible scenarios that would explain the death of the individual investigated, with death most likely related to a vehicular-pedestrian accident. ( info) |
4/748. Complete pyelo-calyceal avulsion as a result of blunt abdominal trauma. We present a rare case of complete avulsion of the kidney collecting system as a result of blunt abdominal trauma. Emergency celiotomy precluded radiographic studies. Perinephric hematoma was mild, the lesion was not detected and this later led to a nephrectomy. pelvis disruption diagnosis is frequently delayed, and this compromises surgical reconstruction. ( info) |
5/748. Treatment of casualties of military conflicts at the Critical medicine Clinic of the Central Hospital in georgia. INTRODUCTION: Local military conflicts continue in many areas of the world. These conflicts produce multiple casualties to military personnel and civilians. This paper describes one aspect of the medical care required for victims of the civil conflict in the Republic of georgia. methods: Interviews with patients and their accompanying persons and abstraction of medical records. RESULTS: Data were acquired on 108 victims admitted to the Center for Critical medicine in Tbilisi. Three stages in the care of these victims are described: 1) battlefield and transportation; 2) regional, front-line hospitals; and 3) the Central Hospital. The performance of each stage is described. Distribution of injuries and procedures performed in the third stage of treatment are described and survivors are defined. For illustration, two cases are reviewed in detail. CONCLUSIONS: The results are encouraging. Major problems existed in the treatment and evacuation of the wounded. Furthermore, many of the victims were injured because of their carelessness and lack of experience on the battlefield. ( info) |
6/748. Inferomedial (subsustentacular) dislocation of the navicular: a case report. A unique case of subsustentacular dislocation of the navicular is presented. The authors propose that such a severe displacement cannot occur until there is complete instability across the whole midfoot. The mechanism of injury and the treatment options are discussed. In the present case, there was late collapse of the foot into abduction because the lateral column was not primarily stabilized. Avascular necrosis is a common complication which leads to navicular collapse. A midfoot arthrodesis gave a good result in our patient. ( info) |
7/748. Fat necks: modification of a standard surgical airway protocol in the pre-hospital environmental. We report two cases of trauma where a surgical airway was required. In both cases soft tissue swelling of the neck made modification of the Advanced Trauma life Support (ATLS) airway guidelines necessary. A gum elastic bougie was used to guide a standard endotracheal tube into a cricothyroidotomy incision and secure the airway. Slight departure from standard techniques may be required in difficult circumstances to achieve a definitive airway. ( info) |
8/748. British-Czech co-operation in a mass casualty incident, Sipovo. From aeromedical evacuation from Bosnia to discharge from Central Military Hospital, Prague. On Thursday 8 January 1998, a Czech hip helicopter with 21 personnel on board crashed in Bos Krupa, northwest Bosnia, resulting in one of the largest mass casualty incidents involving peacekeepers in Bosnia since conflict broke out there in 1992. Seventeen patients were airlifted from the scene to the British Hospital Squadron in Sipovo, central Bosnia for resuscitation and initial treatment. The next day, six severely injured patients underwent aeromedical evacuation to the Central Military Hospital in Prague. The role of the British Defence Medical Services in this incident was documented in the first article of this two part series. This second article highlights the role of the Czech medical services following aeromedical evacuation of these six patients, and closes the audit trial by documenting the patients' progress and final outcome in Prague. ( info) |
9/748. The abdominal compartment syndrome: a report of 3 cases including instance of endocrine induction. Three patients with the abdominal compartment syndrome are presented and discussed. In one of the patients the condition was induced in an endocrine fashion, since trauma was sustained exclusively by the middle third of the left leg. The development of the syndrome as a remote effect of local trauma has never been reported previously. In all three instances only insignificant amounts of intraperitoneal fluid was found and the increase in abdominal pressure was due to severe edema of the mesentery and retroperitoneum. Since the condition is highly lethal, early diagnosis is imperative, and this starts by carrying a high index of suspicion. Measurement of the intraperitoneal pressure easily confirms this diagnosis. It is emphasized that measurements at various sites, like bladder and stomach, in each patient is essential to confirm the diagnosis, since one of the sites may be rendered unreliable due to intraperitoneal processes impinging on the affected site and affecting its distensibility. ( info) |
10/748. resuscitation of the multitrauma patient with head injury. head injury remains the leading cause of death from trauma. The definitive method for eliminating preventable death from traumatic brain injury remains elusive. New research underscores the danger of inadequate or inappropriate support of oxygenation, ventilation, and perfusion to cerebral tissues. The belief that sensitivity to hypotension makes the patient with head injury fundamentally different is critical to nursing strategies. The conventional concept that fluid restriction decreases cerebral edema in patients with head injury must be weighed against mounting evidence that aggressive hemodynamic support decreases the incidence of subsequent organ system failure and secondary brain injury. New evidence has triggered a scrutiny of conventional interventions. A search for optimal treatments based on prospective randomized trials will continue. Development of neuroprotective drugs and use of hypertonic saline may be on the horizon. In an effort to ensure optimal outcome, contemporary trauma nursing must embrace new concepts, shed outmoded therapy, and ensure compliance with the basic tenets of critical care for the multitrauma patient with head injury. ( info) |