Prevalence of significant intraocular sequelae in blunt orbital trauma

The purpose of this study was to describe the prevalence of significant intraocular sequelae (SIOS) and its correlation with the severity of blunt orbital trauma. Four hundred ten consecutive patients presenting to the ED who had sustained blunt orbital trauma were studied. The severity of orbital trauma was graded and SIOS was determined by the presence of an intraocular injury as listed in Table 2. The presence of SIOS was noted in 14 (41.2%) mild, 22 (59.5%) moderate, and 20 (29.4%) severe orbital trauma. In the severe group, the presence of SIOS was detected in 8 (23.5%) blowout fractures and in 12 (35.3%) non-blowout fractures. In view of the high rates of ocular complications among mild and moderate orbital injuries, such patients should have prompt ophthalmic follow up. The relatively low prevalence of SIOS in patients with severe orbital trauma could suggest a protective mechanism in this type of injury.     

Penetrating trauma to the extremity

Penetrating trauma to the extremities is a complex disease that foremost requires the evaluation for vascular injury. This monograph will address an algorithm to assess for associated vascular injury that includes current evaluation techniques. Approaches to wound management and use of antibiotics in the ED are also addressed.     

Delayed presentation of thoracic esophageal perforation after blunt trauma

Thoracic esophageal perforation after blunt trauma is a rare injury with high mortality. Prompt recognition and aggressive treatment are paramount to survival. We report a case of delayed presentation that emphasizes the diagnostic difficulties in this traumatic injury. A review of the prevalence, diagnosis, and management is also discussed.     

Penetrating orbital trauma by stiletto causing complex cranial neuropathies

Penetrating orbital injuries pose a serious threat to vision, ocular motility, and in some cases, life. Long, sharp stiletto objects may penetrate deeply, causing catastrophic damage to orbital structures, despite seemingly trivial entry wounds. The authors present two cases of penetrating orbital injuries by stiletto objects, both entering via small eyelid wounds. Traumatic optic neuropathy occurred in both cases, and was treated with corticosteroids, however the globes escaped direct injury. Injuries to the IIIrd and VIth cranial nerves were also observed. Deep orbital injuries must be excluded in patients presenting with small eyelid wounds caused by sharp penetrating objects.     

Penetrating buttock trauma: A life‐threatening injury that highlights the importance of good collaboration with trauma receiving hospitals

A 54‐year‐old lady was brought to our emergency department after falling from a stepladder onto the base of her artificial Christmas tree. The metallic rod impaled her through the right buttock. X‐rays and a computerized tomography were performed prior to transport to a trauma center causing delays to her surgery.     

彩色多普勒超声对阴囊闭合性损伤的诊断价值

目的探讨彩色多普勒超声对阴囊闭合性损伤的诊断价值。方法回顾性分析32例阴囊外伤患者的彩色多普勒超声图像资料,检测阴囊壁层次结构和睾丸的形态大小,内部有无肿块;对病变区,测量其大小,观察其形态、边界及内部同声,并用彩色多普勒观察肿块内部及周边血流情况。结果32例患者根据睾丸、阴囊的声像图表现可分为：睾丸挫伤5例,睾丸血肿10例,睾丸破裂16例,单纯阴囊壁血肿1例（另有10例阴囊壁血肿合并睾丸损伤）。结论高频彩色多普勒超声能准确诊断阴囊、睾丸的损伤,可作为阴囊闭合性损伤的首选检查方法。     

超声生物显微镜对外伤眼晶状体悬韧带异常的观察

目的通过超声生物显微镜对闭合性外伤眼的晶状体悬韧带状态进行观察,为晶状体手术方式的选择提供帮助。方法对196例闭合性眼钝伤患者207只眼进行超声生物显微镜检查并记录晶状体悬韧带损伤情况和范围。超声生物显微镜检查前裂隙灯观察晶状体推测晶状体悬韧带损伤。结果超声生物显微镜检查207只眼中,悬韧带发生异常的有67只眼(32.4%)。晶状体悬韧带异常表现有:晶状体悬韧带的断裂以及悬韧带的延长,其中46只眼(68.7%)晶状体悬韧带发生断裂,15只眼(22.4%)晶状体悬韧带发生延长,6只眼(9.0%)同时存在晶状体悬韧带断裂和延长。晶状体悬韧带断裂范围从1个象限以内到360°不等,晶状体悬韧带异常区域还表现有睫状体变平和晶状体赤道部变圆。裂隙灯检查35只眼(16.9%)发生虹膜震颤和晶状体偏位。结论超声生物显微镜能对晶状体悬韧带等眼前段结构进行准确观察,对于晶状体手术方式的选择及预后有重要意义。     

儿童羟基磷灰石眼座眶内植入对眼眶发育的影响研究

From１９９５to２００１，５３anophthalmicchildrenhavebeenperformedorbitplastywithhydroxyapatiteplantwrappedupwithscleralorduramatershell，andallpatientshavegotsatisfactoryeffects．Theresultsarereportedasfollowing．１Subjectsandmethods１．１MaterialsAgroupof５３patients（aged２～１２averaged６．１，２９maleand２４female）wereafterenucleationofeyeball．Thecauseofenucleationincluded：variantocularinjuryfor３８cases，absoluteglaucomaandendophthalmitisfor６cases，con－genitalmicrophthalmiafor６case…     

Blunt cardiac trauma

The incidence of cardiac injury after blunt chest trauma is difficult to determine and ranges from 8% to 76%. Moreover, the clinical presentation varies tremendously without a real gold standard to exclude or document cardiac involvement. Electrocardiogram as a single test is not sensitive or specific for diagnosing cardiac contusion. Furthermore, creatine kinase MB is non-reliable in the setting of severe trauma involving the liver, intestines or diaphragm. Although troponins T and I are highly specific for cardiac injury, their sensitivity in the setting of trauma is poor. The echocardiogram is very useful in the evaluation of trauma patients with suspected cardiac involvement. However, poor windows in the setting of chest and lung injuries and in intubated patients might be a major problem limiting the accuracy of transthoracic echocardiogram. On the other hand, transesophageal echocardiogram seems to be more sensitive and specific in trauma patients and should be the test of choice in patients with high clinical suspicion for blunt cardiac trauma.     

重度颅脑外伤合并胸外伤的观察与护理

目的探讨重度颅脑外伤合并胸外伤的观察要点与护理方法。方法回顾总结35例重度颅脑外伤合并胸外伤的护理体会,分析护士全面细致地观察病情,做出预见性的评估,实施全面整体护理措施的重要性。结果患者恢复正常工作、生活4例,基本生活自理7例,中残9例,重残11例,死亡4例。结论通过护士全面细致地观察病情,做出预见性的评估,实施全面整体的护理措施,有效的控制了疾病的发展和并发症的发生,促进了患者的康复。     

Penetrating head injury with bilateral eye avulsion due to Himalayan bear bite

The Himalayan black bear (Ursus thibetanus or Selenarctos thibetanus), although an omnivore, is more carnivorous than its American counterpart. It is also more aggressive towards humans and is a threatened species because of the deforestation in the Himalayas. Furthermore, poverty, encroachment of the forest, extensive deforestation, lack of education and living near the forest are factors that increase the probability of such animal injuries. We report the case of a 35‐year‐old woman who suffered a severe penetrating head injury with scalp and bilateral eye avulsion, which was managed successfully.     

Blunt hepatic trauma: evaluation with contrast-enhanced sonography: sonographic findings and clinical application.

OBJECTIVE: The purpose of this study was to report our initial experience in the assessment of liver trauma with real-time contrast-enhanced sonography (CES). METHODS: From January 2000 to December 2003, there were 431 hemodynamically stable patients evaluated with sonography for blunt abdominal trauma. Among these patients, 87 were selected to undergo second-level imaging, consisting of CES and computed tomographic (CT) evaluation. Indications for further assessment were baseline sonographic findings positive for liver injury, baseline sonographic findings positive for injury to other abdominal parenchyma, baseline sonographic findings positive for free fluid only, baseline sonographic findings indeterminate, and baseline sonographic findings negative with persistent clinical or laboratory suspicion. RESULTS: There were 23 hepatic lesions shown by CT in 21 patients. Peritoneal or retroperitoneal fluid was identified in 19 of 21 positive cases by all 3 imaging modalities. Liver injury was found in 15 patients on sonography and in 19 on CES. Contrast-enhanced sonography compared better than unenhanced sonography with the criterion standard for related injury conspicuity, injury size, completeness of injury extension, and involvement of the liver capsule. Both CES and CT showed intrahepatic contrast material pooling in 2 cases. All patients with false-negative sonographic or CES findings recovered uneventfully. CONCLUSIONS: Contrast-enhanced sonography is an effective tool in the evaluation of blunt hepatic trauma, being more sensitive than baseline sonography and correlating better than baseline sonography with CT findings. In institutions where sonography is regarded as the initial procedure to screen patients with trauma, this technique may increase its effectiveness. In addition, CES may be valuable in the follow-up of patients with conservatively treated liver trauma.     

彩色多普勒超声观察猪爆炸伤创面的实验研究

目的 研究爆炸伤创面的二维及彩色多普勒血流成像（CDFI）特征.方法 使用电雷管建立6头健康成年猪双侧臀部软组织爆炸伤模型,创面按左、右配对分为A、B两组.A组采用常规疗法处理,B组的消毒和清创方法同A组,创面使用封闭负压技术处理.使用彩色多普勒超声分别于伤后1 h和72 h观察两组爆炸伤创面的二维和CDFI特征.结果 伤后1 h,两组爆炸中心区均见肌束断裂,回声减低,结构紊乱,可见数个不规则的无回声区和低回声区,未探及到血流信号.伤后72 h,A组肌束排列欠规整,回声减低,可见较小无回声区和低回声区,偶见点状血流信号;B组肌肉组织回声略增强,无回声区和低回声区消失,肌束排列尚整齐,创面内可探及血流信号,部分呈＂短棒＂状.结论 二维及CDFI对观察爆炸伤创面组织结构的演变过程和了解微循环重建有重要价值;封闭负压技术对早期处理爆炸伤创面有显著的临床意义.     

CEUS in abdominal trauma: multi-center study

The objective of this study was to evaluate the concordance of US and contrast-enhanced US (CEUS) with CT in the assessment of solid organ injury following blunt trauma. Patients underwent complete US examination, including free fluid search and solid organ analysis. CEUS followed, using low-mechanical index techniques and SonoVue. CT was performed within 1 h. Among 156 enrolled patients, 91 had one or more abnormalities (n = 107) at CT: 26 renal, 38 liver, 43 spleen. Sensitivity, specificity, and accuracy for renal trauma at baseline US were 36%, 98%, and 88%, respectively, after CEUS values increased to 69%, 99%, and 94%. For liver baseline US values were 68%, 97%, and 90%; after CEUS were 84%, 99%, and 96%. For spleen, results were 77%, 96%, and 91% at baseline US and 93%, 99%, and 97% after CEUS. Per patient evaluation gave the following results in terms of sensitivity, specificity and accuracy: 79%, 82%, 80% at baseline US; 94%, 89%, and 92% following CEUS. CEUS is more sensitive than US in the detection of solid organ injury, potentially reducing the need for further imaging. False negatives from CEUS are due to minor injuries, without relevant consequences for patient management and prognosis.     

Analysis of trauma intubations

The timing of trauma patient intubation is dependent on clinical presentation and clinician judgment. We sought to correlate the timing of intubation with the presenting of physiologic parameters and clinical outcome to identify potential quality assurance audit filters. Patients (n = 82) were grouped by timing of intubation: PREHOSPITAL, paramedic intubation; IMMEDIATE, within 10 minutes of arrival; DELAYED, beyond 10 minutes but within 2 hours of arrival; and NONURGENT, beyond 2 hours or at the time of surgery. While mean revised trauma scores and Glasgow Coma Scale (GCS) scores differed for the groups, the mean length of hospital stay and the incidence of aspiration pneumonia were not significantly different. In the DELAYED group, 80% of those who developed aspiration pneumonia had a GCS < or = 13. Patients in the NONURGENT group were older and commonly presented with tachypnea. The survival rate for the NONURGENT group was lower than predicted by the TRISS method (P = .004). A GCS < or = 13 and age greater than 50 years with presenting respiratory rates of more than 25 breaths/min represent potential trauma intubation audit filters.     

Patterns of fluid accumulation in splenic trauma: Demonstration by CT

Detection of hemoperitoneum in splenic trauma is as important as detection of the visceral injury itself. Observation of a consistent spectrum of fluid accumulation in patients with splenic trauma prompted us to investigate the patterns in more detail. Twenty-three computed tomographic (CT) scans in 20 patients were evaluated with respect to presence of fluid collections in various peritoneal and retroperitoneal compartments. These were correlated with severity of injury and operative and pathologic findings. Hemoperitoneum was detected in the pelvis (65%), paracolic gutters (52%), left subphrenic space (48%), perihepatic space (48%), Morison's pouch (17%) and in the lesser sac (9%). In addition to free fluid, pleural fluid (39%) and retroperitoneal hematoma in the left anterior pararenal space (13%) were also encountered. These ancillary findings may help to substantiate the diagnosis of splenic trauma in equivocal cases, particularly when the spleen itself is obscured by artifacts. Early detection may reduce mortality and morbidity associated with splenic trauma.     

骨创伤治疗仪用于骨创伤疾病的临床应用研究

目的研究骨创伤治疗仪用于各种骨创伤疾病时,对骨折部位疼痛的缓解、肿胀的消除、骨密度的改善及骨质疏松的预防、促进骨折愈合等方面的临床效果。方法将400例骨创伤疾病患者随机分为研究组和对照组,研究组200例采用骨创伤治疗仪配合常规治疗护理方法;对照组200例采用常规的治疗护理方法。观察对比两组患者在临床上治疗后患处疼痛减轻、消肿情况、骨密度测量对比及同一时间内骨质疏松、骨折愈合等方面的效果。结果经统计学处理,研究组在临床疼痛症状改善情况、消肿症状改善情况、骨密度测量对比率和预防骨质疏松等方面明显优于对照组（P〈0.01）。结论骨创伤治疗仪临床应用中可明显减轻疼痛、消肿快,有利于改善骨密度、预防骨质疏松、促进骨折的愈合。     

Use of a forensic technique to identify blood contamination of emergency department and ambulance trauma equipment

Using a Kastle-Meyer (KM) technique, the following equipment from the emergency departments of six UK hospitals (four trusts) and three regional ambulance services was tested for blood contamination: extrication ("spinal") boards, cervical collars, straps, box splints, head blocks, and headboards. Only equipment ready for patient use was tested. Over half of trauma equipment (57%) tested positive for blood, including 15% of equipment that was visibly stained with blood. There have been no recorded cases of infection from contaminated trauma equipment but our study has identified the potential risk. Disposable covers for boards, disposable straps, and disposable radiolucent head blocks which are currently available provide a solution but have resource implications.     

外伤、手术相关性吉兰-巴雷综合征的临床观察

目的 观察外伤、手术相关性吉兰-巴雷综合征的临床表现、对静脉注射免疫球蛋白治疗的疗效。方法 回顾性分析16例病前有外伤、手术史的吉兰-巴雷综合征病例,并与同期住院治疗的无外伤或手术的吉兰-巴雷综合征患者的临床表现、治疗效果相比较。结果 外伤、手术继发吉兰-巴雷综合征发生在外伤或手术后3周内,发病前可有咽痛、腹泻史,主要表现为四肢无力,可伴有四肢麻木,严重病例有呼吸困难。主要体征为四肢肌力下降、肌腱反射减弱或消失,可有感觉异常。与同期住院治疗的吉兰-巴雷综合征患者相比,外伤、手术继发吉兰-巴雷综合征患者临床表现较重（P＜0.05）。大部分病例脑脊液化验表现为脑脊液蛋白-细胞分离现象。肌电图检查有髓鞘脱失、轴索变性表现。在接受静脉注射免疫球蛋白治疗后,与无外伤或手术的吉兰-巴雷综合征患者比较,外伤、手术继发吉兰-巴雷综合征患者效果差（P＜0.01）。结论 静脉注射免疫球蛋白治疗外伤、手术继发的吉兰-巴雷综合征效果差。应重视外伤、手术继发吉兰-巴雷综合征,及时诊断、治疗,改善患者预后。     

闭合性肾损伤合并胸外伤79例临床诊治分析

目的探讨闭合性肾损伤合并胸外伤的致伤原因以及诊治特点。方法回顾性总结79例闭合性肾损伤合并胸外伤患者的临床诊断和抢救治疗措施。结果闭合性肾损伤合并胸外伤发生率较高,占同期闭合性肾损伤患者的39.9%(79/198)。且该类患者往往有相似的致伤原因。79例闭合性肾损伤合并胸外伤患者胸外伤的不同受伤方式与损伤类型的比较,差异有统计学意义(χ2=15.9488,P<0.05)。而CT对于胸外伤检出率分别与临床诊断比较(χ2=25.4432,P<0.01)、与X线比较(χ2=15.0176,P<0.01),差异均有极显著意义。79例中,闭合性肾损伤保守治疗75例,手术治疗4例;胸外伤中血气胸23例,行胸腔闭式引流术者12例。本组患者均有较好转归。结论闭合性肾损伤患者较常见合并胸外伤,绝大多数经CT检查可明确,需引起重视。早期发现和处理合并胸外伤,对于病情诊断、治疗抢救均有重要意义。