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101.
Jeff Choi Lakshika Tennakoon Jonathan G. You Aydin Kaghazchi Joseph D. Forrester David A. Spain 《American journal of surgery》2021,221(1):211-215
BackgroundPulmonary contusions are common injuries. Computed tomography reveals vast contused lung volume spectrum, yet pulmonary contusions are defined dichotomously (unilateral vs bilateral). We assessed whether there is stepwise increased risk of pulmonary complications among patients without, with unilateral, and with bilateral pulmonary contusion.MethodsWe identified adults admitted with rib fractures using the largest US inpatient database. After propensity-score-matching patients without vs with unilateral vs bilateral pulmonary contusions and adjusting for residual confounders, we compared risk for pneumonia, ventilator-associated pneumonia (VAP), respiratory failure, intubation, and mortality.ResultsAmong 148,140 encounters of adults with multiple rib fractures, 19% had concomitant pulmonary contusions. Matched patients with pulmonary contusions had increased risk of pneumonia 19% [95%CI:16–33%], respiratory failure 40% [95%CI: 31–50%], and intubation 46% [95%CI: 33–61%]. Delineation showed bilateral contusions, not unilateral contusions, attributed to increased risk of complications.ConclusionsThere is likely a correlation between contused lung volume and risk of pulmonary complications; dichotomously classifying pulmonary contusions is insufficient. Better understanding this correlation requires establishing the clinically significant contusion volume and a correspondingly refined classification system. 相似文献
102.
Katharine E. Caldwell Al Lulla Collyn T. Murray Rahul R. Handa Ernesto J. Romo Jason W. Wagner Paul E. Wise Jennifer M. Leonard Michael M. Awad 《American journal of surgery》2021,221(2):285-290
BackgroundSuccessful trauma resuscitation relies on multi-disciplinary collaboration. In most academic programs, general surgery (GS) and emergency medicine (EM) residents rarely train together before functioning as a team.MethodsIn our Multi-Disciplinary Trauma Evaluation and Management Simulation (MD-TEAMS), EM and GS residents completed manikin-based trauma scenarios and were evaluated on resuscitation and communication skills. Residents were surveyed on confidence surrounding training objectives.ResultsResidents showed improved confidence running trauma scenarios in multi-disciplinary teams. Residents received lower communication scores from same-discipline vs cross-discipline faculty. EM residents scored higher in evaluation and planning domains; GS residents scored higher in action processes; groups scored equally in team management. Strong correlation existed between team leader communication and resuscitative skill completion.ConclusionMD-TEAMS demonstrated correlation between communication and resuscitation checklist item completion and communication differences by resident specialty. In the future, we plan to evaluate training-related resident behavior changes and specialty-specific communication differences by residents. 相似文献
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Natalie A. Winings Brian J. Daley Reagan W. Bollig R. Frank Roberts Jennifer Radtke R. Eric Heidel Jessica E. Taylor James C. McMillen 《The surgeon》2021,19(3):129-134
Backgroundand Purpose: Currently, dexmedetomidine versus propofol has primarily been studied in medical and cardiac surgery patients with outcomes indicating safe and effective sedation. The purpose of this study was to assess the efficacy of dexmedetomidine versus propofol for prolonged sedation in trauma and surgical patients.MethodsThis was a single-center prospective study conducted in the Trauma/Surgical Intensive Care Unit (ICU) at a Level I academic trauma center. It included patients 18 years of age or older requiring mechanical ventilation who were randomly assigned based on unit bed location to receive either dexmedetomidine or propofol. The primary outcome was duration of mechanical ventilation. Secondary outcomes included mortality; proportion of time in target sedation; incidence of delirium, hypotension, and bradycardia; and ICU and hospital length of stay (LOS).ResultsA total of 57 patients were included. Baseline characteristics were similar between groups. There was no significant difference in duration of mechanical ventilation (median [IQR]) between the dexmedetomidine (78.5[125] hours) and propofol (105[130] hours; p = 0.15) groups. There was no difference between groups in ICU mortality, ICU and hospital LOS, or incidence of delirium. Safety outcomes were also similar. Patients in the dexmedetomidine group spent a significantly greater percentage of time in target sedation (98[8] %) compared to propofol group (92[10] %; p = 0.02).ConclusionsOur results suggest that, similar to medical and cardiac surgery patients, dexmedetomidine and propofol are safe and effective sedation agents in critically ill trauma and surgical patients; however, dexmedetomidine achieves target sedation better than propofol for this specific population. 相似文献
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Introductioninferior vena cava IVC injury is rare with lethal outcomes, the clinical signs depends on the location and associated injuries, andt he treatment might be endovascular, surgical.Clinical caseA 25 years with no medical history was admitted to the emergency department after a car accident. After intubation and hemodynamic stabilization, the computerized tomography CT scan showed hepatic laceration with a rupture of the IVC in the retro-hepatic portion, he was admitted to the operation room for damage control laparotomy; the patient died 12 h after the operation despite appropriate management.ConclusionIVC are rare and lethal, the CT scan remains the gold standard and the evolution of endovascular techniques decreased the mortality rate. 相似文献
107.
In 54 cases of ruptured medial semilunar cartilages of the knee joint the bone mineral mass in the distal end of the femur was measured 0–5 years following removal of the injured cartilage. The bone mineral mass was significantly decreased. There was no tendency of restoration of the bone mass with time.Financial support was obtained from the Swedish Medical Research Council No: K69-23X-2737-01 and from the Gustav V 80: th Anniversary Foundation. 相似文献
108.
A 19-year-old male developed renal failure after a laparotomy for liver trauma (urinary output of 30 ml/h, plasma creatinine 220 mol/l). Surgical decompression of the abdomen was performed without any attempt at correcting the underlying pathology. This reduced the intraabdominal pressure (IAP) from 40 to 24 cm H2O and resulted in a massive diuresis (530 ml/h). Twenty-four hours later the plasma creatinine peaked at 280 mol/l and then returned to within the normal range. This case report confirms that there is a direct relationship between IAP and renal function. 相似文献
109.
N. H. Kleinsasser F. G. Priemer W. Schulze O. F. Kleinsasser 《European archives of oto-rhino-laryngology》2000,257(8):439-444
In contrast to internal trauma to the larynx caused by endolaryngeal procedures, trauma to the larynx caused by external
forces is relatively rare. Nevertheless, the great variety of these external traumata warrants a thorough diagnosis and understanding
of each case as well as a standardized and accepted method for classifying these injuries. These preconditions will facilitate
successful therapy. At our three institutions cases of external trauma to the larynx, including the mechanisms of trauma,
were reviewed and analyzed. Cases were classified according to the mechanisms and the sequelae of trauma. The three major
categories were (a) external trauma due to the impact of blunt objects, (b) trauma after tearing of the neck and the larynx
longitudinally, and (c) external trauma caused by sharp objects and gunshots. In the great majority of cases external trauma
to the larynx was caused by blunt pressure and was most often due to strangulation in the course of (attempted) suicide or
homicide. In a smaller number of cases sharp instruments caused external traumata. In patients surviving the immediate trauma
a meticulous laryngological assessment is necessary. In addition to indirect laryngoscopy, we consider microlaryngoscopy as
being indicated for investigating the soft tissues of the endolarynx. The status of the laryngeal skeleton can be determined
more precisely via high-resolution computed tomography and ultrasound. Early diagnosis and appropriate therapy have a significant
impact on the patient’s condition later, especially as regards scar formation, ease of breathing, and voice quality.
Received: 16 August 1999 / Accepted: 19 May 2000 相似文献
110.