Danger at every rung: Epidemiology and outcomes of ICU-admitted ladder-related trauma

IntroductionThe incidence of ladder-related falls is increasing, and this represents a disturbing trend, particularly in the context of increased life expectancy and the impending retirement of the populous ‘baby-boomer’ generation. To date, there have been no critical illness-focused studies reporting on the incidence, severity and outcomes of severe ladder-related injuries requiring ICU management.MethodsMajor trauma patients admitted to ICU over a 5 year period to June 2011 after ladder falls >1 m were identified from prospectively collected trauma data at a Level 1 trauma service. Demographic and ICU clinical management data were collected and non-parametric statistical analyses were used to explore the relationships between variables in hospital mortality/survival.ResultsThere were 584 ladder fall admissions, including 194 major trauma cases, of whom 29.9% (n = 58) fell >1 m and were admitted to ICU. Hospital mortality was 26%, and fatal cases were almost entirely older males in domestic falls of ≤3 m who died as a result of traumatic brain injury. Non-survivors had lower GCS at the scene (p = 0.02), higher AIS head code (p = 0.01), higher heart rate and lower mean arterial pressure (p < 0.01) in the initial 24 h period in ICU, and were ≥55 years of age (p = 0.05). Only 46% of patients available for follow-up were living at home at 12 months without requiring additional care.ConclusionsThe incidence of ladder falls requiring ICU management is increasing, and severe traumatic brain injury was responsible for the majority of deaths and for poor outcomes in survivors. In-hospital costs attributable to the care of these patients are high, and fewer than half were living independently at home at 12 months post-fall. A concerted public health campaign is required to alert the community to the potential consequences of this mechanism of injury. The use of helmets for ladder users in domestic settings, where occupational health and safety regulations are less likely to be applied, is strongly recommended to mitigate the risk of severe brain injury. The benefits of this simple strategy far outweigh any mild inconvenience for the wearer, and may prevent catastrophic injury.     

The radiological diagnosis of infection

Musculoskeletal infections can involve bone, joints, muscles and soft tissues. The interpretation of imaging in musculoskeletal infections can be a diagnostic challenge and requires an integrated approach with clinical details and blood inflammatory markers. Imaging also plays a vital role in treatment planning and follow up. Conventional plain film radiography is still the cornerstone, which provides an overview of the bone and surrounding soft tissue pathology and should routinely be the first imaging procedure in patients with suspected musculoskeletal infection. The sensitivity of radiographs for the detecting of acute osteomyelitis is limited. Ultrasound can be used to assess soft tissue collections, joint effusions, and foreign body localization. It is invaluable in providing guidance for diagnostic joint aspiration, biopsy or therapeutic drainage of a soft tissue abscess/collection. CT scans are useful in providing bony detail and are particularly useful for evaluation of presence of sequestrum and in cases where MRI is contraindicated. MRI provides excellent anatomical details and evaluates both the soft tissues and bones and is the most sensitive and specific imaging modality for evaluating musculoskeletal infection. Radionuclide imaging can be helpful in cases of acute osteomyelitis and multifocal infection and has a high negative predictive value when normal.     

Propionibacterium skull base osteomyelitis complicated by internal carotid artery pseudoaneurysm

The microbiology of skull base osteomyelitis (SBO) is evolving. We present here the first case of SBO caused by Propionibacterium acnes leading to the development of a pseudoaneurysm of the internal carotid artery. Otolaryngologists should recognize this pathogen as a potential cause of invasive temporal bone infection to optimize prompt diagnosis and treatment. Laryngoscope , 127:2337–2339, 2017     

颅脑损伤在手术室中的护理救治流程

创伤已成为青壮年人群的“第一杀手”［1］，是社会劳动力丧失的主要原因。而在创伤人群中，颅脑损伤居全身各部位损伤中的第二位，仅次于四肢损伤，但其病死率和致残率均居首位，平均为30％～40％［2］，其主要死亡原因为急性顽固性高颅压、大面积脑缺血、脑水肿，目前最有效的治疗方法为手术。近年来，本院全军战创伤中心建立和完善严重创伤救治绿色通道，提高了创伤急救人员的素质和相关科室的急诊意识，使严重创伤患者的救治成功率大为提高。我科护理组人员根据该项工作的经验，结合本科室工作特色，进一步梳理和规范了有关工作流程，使其操作性更强，更易于本专科人员学习和掌握。手术室救治流程再造后，患者到达医院至手术开始的时间，从2008年的82．6min缩短到现在的48．6min，手术室护理救治流程再造促进了“绿色通道”的建设，并取得了显著成效。现将我科手术室护理救治流程再造汇报如下。     

拳击运动伤的诊治

目的 拳击运动职业化已过百年,由于反复用力击打头部,拳击运动所带来颅脑创伤引起国内外神经外科医生重视,本文旨在对拳击运动伤的诊治和机制进行回顾性研究.方法 总结笔者经治的拳击运动伤54例,通过对其治疗效果进行总结分析,并检索国内外文献进行研究.结果 54例患者4例因CT示明确的颅内病变入院治疗后好转,余急症和门诊患者经对症治疗后症状多数消失或缓解,仅4例好转不明显.结论 拳击运动伤的损伤情况与拳手承受击打的力度和从业时间有直接的关系,特别是慢性损伤近似于Alzheimer病,应该引起重视,进一步研究其相互关系.     

外伤性血尿患者膀胱痉挛的护理干预

目的探讨护理干预对降低外伤性血尿患者膀胱痉挛发生率的作用.方法回顾性分析昆明市延安医院2010年4月至2012年9月之间不同方式护理干预处理的外伤性血尿147例患者的护理经验.结果改进护理措施处理78例患者中有18例发生过膀胱痉挛,发生率为23%;采用常规护理措施的69例患者中计有27例发生过膀胱痉挛,发生率为39%.两者相比差异有统计学意义(P<0.05).结论改进护理干预可有效降低外伤性血尿患者膀胱痉挛的发生率.     

右旋美托咪啶在创伤性脑损伤中应用的研究进展

背景 右旋美托咪啶( dexmedetomidine,DEX)是新型的高选择性α2肾上腺素受体激动剂,具有镇静、镇痛和抗交感等作用,其特点为镇静易于唤醒,且对呼吸无抑制作用.脑损伤患者需要适当镇静降低脑氧耗,减少继发性脑损伤,同时又要求易于唤醒便于临床医生判断神智.目的 综述DEX在创伤性脑损伤(traumatic brain injury,TBI)中应用的研究进展,为该药在临床工作中的应用提供参考.内容 从作用机制、对脑损伤的影响及临床应用3个方面论述DEX对TBI的影响.趋向 DEX具有镇静、抗交感、抗凋亡等多种神经保护作用,且其无呼吸抑制,不影响对患者神智判断,这些特性似乎使其成为较有前景的脑创伤镇静剂.但目前DEX在脑创伤动物模型或患者中研究甚少,我们仍然不清楚其在脑创伤动物模型或患者的综合作用如何.     

“五常法”在颅脑损伤患者康复病房管理中的应用

目的探讨＂五常法＂在颅脑损伤患者康复病房管理中的作用。方法采用＂五常法＂理论加强病房规范化管理,并对76名颅脑损伤患者康复病房应用＂五常法＂管理前后物品完好率、患者家属满意率等进行对比。结果医护人员的工作环境及患者住院环境得到改善,团队协作精神、物品完好率、患者家属满意率得到提高。差异均有统计学意义（P〈0.05）。结论 ＂五常法＂是有效的科学管理方法,容易实施,效果明显,可有效提高颅脑损伤患者康复病房的服务质量,值得推广。