高频超声诊断外伤后肢体软组织急性损伤

目的 应用高频超声观察外伤后肢体软组织急性损伤的特征,并评价其诊断价值.方法 对103例外伤后3周内肢体肿胀、疼痛的患者行高频超声检查.结果 103例患者中肌肉撕裂34例,肌腱断裂6例,关节腔积血19例,韧带损伤10例,肌间血肿17例,骨化性肌炎6例,异物11例.97例116处出现皮下组织增厚、肌肉水肿,回声紊乱.结论 高频超声可作为外伤后肢体软组织急性损伤后便捷的、可动态应用的首选影像学检查方法.     

Role of interventional radiology in trauma care: retrospective study from single trauma center experience

Purpose

Although interventional management is now regarded as essential in trauma care, the effect on clinical result remains uncertain. We conducted this retrospective study to figure out the role of interventional management in trauma care.

Materials and methods

Medical records of patients enrolled in the trauma database of our trauma center were reviewed for the period of January 2009 to December 2012. During this period, we have evaluated how many interventional procedures were conducted and the clinical effect of interventional procedure on trauma care.

Results

Based on our institutional trauma database, medical records of 2017 patients were reviewed (male/female, 1475:542; mean age, 50.03 years). Their mean injury severity score was approximately 26.28. Among them, 111 patients have been treated with interventional procedure. The number of interventional procedures increased significantly over time, up to 15% (P < .005). During the same period, the overall survival rate did not show significant change. The survival rate of the patients, who have been treated with interventional procedures for traumatic vascular injury, was higher than possibility of survival from trauma injury severity score (86.4% vs 65.59%).

Conclusion

The need for interventional procedure in trauma care is increasing. Although interventional procedure could not affect the overall survival rate in trauma care, it can improve survival rate remarkably in patients with traumatic vascular injury.     

Impact of London's terrorist attacks on a major trauma center in London

During the morning rush hour on Thursday, 07 July 2005, a series of four bombs exploded, affecting London's public transport system. These terrorist attacks killed 52 people and injured > 700. A major incident was declared, and the Royal London Hospital (RLH) was a primary receiving hospital. A total of 194 patients presented to the RLH. Twenty-seven patients required admission. A total of 11 amputations were performed on eight patients. One patient died intra-operatively. Another patient died on Day 6 due to complications related to a head injury. Coordination is vital to the implementation of the hospital's Major Incident Plan in such an emergency. Subsequent internal reviews of the response of the RLH on 07 July 2005 highlighted problems with communication and documentation, as well as the need for extra staffing. These areas should be improved for the management of future major incidents.     

Incremental and single trauma produce equivalent subfailure soft tissue injury of the cervical spine

BACKGROUND: Automotive collision simulations have been performed using either incremental or single trauma. In single trauma, a single impact is performed, while in incremental trauma, a series of impacts of increasing severity are executed. Equivalency of incremental and single trauma for soft tissue injury severity due to the final impact has not been established. Thus, the purpose of the present study was to investigate whether incremental and single trauma produced similar cervical spine subfailure injury severity due to simulated frontal impacts. METHODS: Porcine cervical spine specimens (C2-T1) of the incremental trauma group were subjected to five frontal impacts (2, 3.5, 5, 6.5, 8 g), while single trauma specimens were subjected to a single impact (8 g). Flexibility tests were performed on specimens while intact and following each impact. Intact and post 8 g flexibility parameters were compared within incremental and single trauma groups and between groups. FINDINGS: No significant differences (P < 0.05) were found between incremental and single trauma groups when either intact or post 8 g flexibility parameters were compared. Significant increases in flexibility parameters from intact to post 8 g were observed in both groups, indicating soft tissue injury. INTERPRETATION: Incremental and single trauma produced equivalent subfailure cervical spine injury in simulated impacts, for the experimental conditions studied. This study may facilitate greater use of the incremental trauma protocol in future experimental designs.     

Pediatric trauma: Blood product transfusion characteristics in a pediatric emergency department,a single center experience

AimTo investigate clinical and laboratory data, management and outcomes of pediatric trauma patients who initially received blood product transfusions.MethodsBetween January 2011-January 2021, traumatic children who underwent blood product transfusions within 24 h of arrival at the emergency department were included. Demographics, clinical and laboratory data, Injury Severity Score (ISS), volume of transfused blood products and crystalloid boluses in 24 h were recorded. Massive transfusion (MT) was defined as transfusion of ≥40 mL/kg of all blood products in 24 h.ResultsAmong 32 cases, 8 (25.0 %) patients met the MT threshold criterion. Length of pediatric intensive care unit (PICU) stay and mechanical ventilation (MV) were longer for patients who received MT although there was no difference for age, ISS, volume of crystalloid boluses, length of hospital stay, and 30-day mortality between those who received MT or not. Volume of crystalloid boluses was higher in patients who died than those who survived but the volume of blood products was similar for two groups. An APTT value of >37.5 s was identified as a predictor of 30-day mortality (OR = 48.000, 95 % CI: 3.704-621.998, p: 0.003).ConclusionChildren who received MT had longer durations of MV and PICU stay than those who did not receive, but there was no significance for ISS, volume of crystalloid boluses, hospital stay, or mortality between two groups. Volume of crystalloid boluses was higher in patients who died than those who survived. An APTT value of >37.5 s can be used to predict 30-day mortality.     

Therapeutic apheresis: Results from a single center in Turkey.

BACKGROUND: Therapeutic apheresis (TA) is carried out for a broad spectrum of diseases and syndromes. AIM: We retrospectively evaluated the results of therapeutic apheresis (TA) including plasma exchange, therapeutic plateletpheresis, and leukapheresis during 2000-2006. METHODS: A total of 195 procedures were performed in 44 patients (25 male and 19 female, with a mean age of 52+/-15 years). These procedures consist of 165 plasma exchanges, 20 therapeutic plateletpheresis, and 10 leukapheresis. The most common indications were hematological, neurological, and metabolic diseases. Eighty-three percent of plasma exchange, 100% of plateletpheresis and leukapheresis belonged to indication Category I or II, according to the guidelines of the American Society for Apheresis. RESULTS: While hemoglobin levels significantly increased (p<0.05), platelet counts decreased (p<0.005) after plasma exchange. Hematological parameters did not statistically change significantly with leukapheresis (p>0.05). Platelet counts significantly decreased with plateletpheresis (p<0.001). Total complications were detected in 21% of the procedures. Adverse events (AE) were seen in 17% of the procedures. None of the patients died (Grade-IV) from any complication. AEs occurred in 14% (Grade-I), 1% (Grade-II), and 2% (Grade-III) of the procedures. The most common AEs were nausea/vomiting, hypotension, and abdominal pain. CONCLUSION: TA, an important procedure in Transfusion Medicine, is safely carried out in our center in several hematological, neurological, and metabolic diseases which are similar to previous reports.     

Efficacy of a proprietary ibuprofen gel in soft tissue injuries: a randomised, double-blind, placebo-controlled study

The efficacy of a novel, proprietary topical formulation of ibuprofen 5% gel (Ibugel) was evaluated in a placebo-controlled study in patients with soft tissue injuries. Patients received either active gel (n=40) or placebo gel (n=41) for a maximum of seven days. Pain and interference with physical activity were assessed daily using visual analogue scales. There was a significant difference (p<0.001) in favour of active treatment for the time to achieve clinically meaningful reduction in pain. By day 7, 75% of patients in the active gel group had a clinically meaningful reduction of pain compared with 39% of patients who received placebo. Despite differences between study centres, the data for interference with physical activity also showed an advantage for active treatment. By day 7, 79% of patients in the active gel group had a clinically meaningful reduction in interference with physical activity, compared with 44% of patients who received placebo.     

Management of soft tissue knee injuries in an accident and emergency department: the effect of the introduction of a physiotherapy practitioner

Objective: To assess the effect of the introduction of a physiotherapist with an extended scope of practice in the management of acute soft tissue knee injuries in an accident and emergency (A&E) department.

Methods: The A&E department established an Acute Knee Screening Service (AKSS) in 1998. An experienced physiotherapist was appointed to run the AKSS after additional training. Local guidelines and protocols were developed in conjunction with trauma knee surgeons, radiologists, physiotherapists, and A&E doctors. This study describes 100 consecutive patients managed by the AKSS over a three month period and comparisons are made over a similar period before the introduction of the AKSS.

Results: The initial diagnosis of patients with acute knee injuries referred to the service showed meniscal injuries (38%), cruciate ligament injuries (18%), fractures (2%), patellofemoral joint injuries (10%), and others (32%). Ninety five per cent of patients referred to AKSS were seen within one week. Medical time was saved in both A&E and trauma clinic. Fifty nine per cent of patients were treated and discharged from the service without further medical review. Thirty nine per cent (39) were referred to trauma clinic and of these 44% (17) had MRI scans performed as requested by the physiotherapist. Eighty eight per cent (15) of these scans showed significant abnormality: (nine, anterior cruciate ligament tears, one, posterior cruciate ligament tears, and nine meniscal tears).

Conclusions: A physiotherapy practitioner working with an extended role is a valuable addition to an A&E department. The AKSS improves the quality of care of acute knee injuries, saves medical time, and fosters cooperation across services within the NHS.

     

Emergency care of traumatic brain injuries in Pakistan: a multicenter study

Background

This study assessed factors associated with emergency care outcomes and out-of-pocket treatment costs in traumatic brain injury (TBI) patients in Pakistan.

Methods

Data on TBI patients were extracted from a four-month surveillance study conducted in the emergency departments (ED) of seven large teaching hospitals. Emergency care access to physicians and imaging facilities were compared with respect to ED outcomes (discharged, admitted or dead). Out-of-pocket treatment costs (in United States dollars [USD]) were compared among different patient strata.

Results

ED outcomes were available for 1,787 TBI patients. Of them, most were males (79%), aged <25 years (46%) and arrived by ambulances (32%). Nurses or paramedical staff saw almost all patients (95%). Physicians with practice privileges (medical officers, residents or consultants) saw about half (55%) of them. Computerized tomography (CT) scans were performed in two of five patients (40%). Of all, 26% (n = 460) were admitted and 3% died (n = 52). Emergency care factors significantly associated with being admitted or died were arriving by ambulance (adjusted odds ratio [aOR] = 2.37, 95% confidence interval (CI) [95%CI] = 1.78-3.16); seen by medical officer/residents (aOR = 2.11; 95%CI = 1.49-2.99); and had CT scan (aOR = 2.93; 95%CI = 2.25-3.83). Out-of-pocket treatment costs at the ED were reported in 803 patients. Average costs were USD 8, (standard deviation [SD] = 23). Costs were twice as high in those arriving in ambulances (USD 20, SD = 49) or who underwent CT scans (USD 16, SD = 37).

Conclusion

TBI patients' access to ambulance transport, experienced physicians, and imaging facilities during emergency care needs to be improved in Pakistan.

     

急性创伤严重骨骼肌损伤后肾功能损害的护理观察

对135例急性创伤严重骨骼肌损伤患者,持续观察尿量、尿色等情况,通过实验室检查监测尿常规、血肌红蛋白、血肌酸激酶等指标,同时观察生命体征、患肢的血液循环等临床表现,发现尿色、尿量改变和血肌红蛋白升高能较早反映肾功能损害。早期的严密观察与护理,对预防急性创伤患者骨骼肌损伤后引起急性肾功能衰竭起到了重要作用。     

A multicentre comparison of piroxicam and indomethacin in acute soft tissue sports injuries

One hundred and five patients suffering from sport-associated soft tissue injuries were included in a randomized controlled trial comparing the efficacy and side-effects of piroxicam and indomethacin. Patients were treated for 7 days. Both groups showed a similar degree of improvement in joint tenderness, swelling and pain. Eighty-eight per cent of patients on piroxicam showed a marked or moderate improvement in their injury at the end of the trial and 79% of indomethacin-treated patients. Approximately 50% of patients in both groups resumed full activity within 7 days. One patient, in the indomethacin group, was withdrawn from treatment due to a side-effect.     

9例胆固醇结晶栓塞临床病理及预后分析

目的随着动脉粥样硬化发病率的增高及介入治疗的广泛普及,胆固醇结晶栓塞的发生也日益增多。本研究就北京大学第一医院肾内科诊断的9例胆固醇结晶栓塞患者的临床病理表现及预后进行总结。方法病例选自2004年1月至2010年3月在北京大学第一医院肾内科诊断的9例胆固醇结晶栓塞患者,收集其临床、实验室检查、病理及随访预后资料进行分析。结果9例患者中,男性7例,女性2例,发病年龄（67．2±5．8）岁。8例发生于冠状动脉造影和（或）血管介入治疗术后,1例为自发性。所有患者均发生非少尿型急性肾衰竭,7例发生蓝趾综合征,2例发生皮肤网状青斑。7例患者接受皮肤活检,其中6例可见胆固醇结晶。所有患者都给予他汀类降脂药、降压药物治疗,酌情停用抗血小板药物和抗凝药物;3例患者接受口服糖皮质激素治疗,2例患者接受腹膜透析治疗,1例接受血液透析。平均随访时间23个月,死亡2例,维持性腹膜透析2例,4例患者。肾功能部分恢复,其中3例为接受糖皮质激素治疗者。结论在血管造影或介入治疗术后发生急性肾衰竭者应警惕胆固醇结晶栓塞的可能,后者也可以白发出现。糖皮质激素治疗该病可能有一定效果,但需要更大规模的研究以证实。     

Psychological trauma in a relief worker--a case report from earthquake-struck areas of north Pakistan

Vicarious traumatization is now a well-known entity and may have negative influences on those that are involved in rescue efforts in any disaster or traumatic events. Healthcare workers work with trauma survivors and witness an immense array of gruesome and ghastly images. This work has the potential to cause those engaged in rescue efforts to become affected subconsciously. Job-related stress may cause psychological symptoms in care providers who provide support and listen to the survivors' account of trauma. A therapist working in disaster situations may become a victim of psychological anguish--undermining their physical and mental well-being as well as their profession, adversely affecting their traumatized patients, and leading to a counter-productive therapist-survivor relationship. This significant theme of secondary trauma must be recognized in relief workers at early stages and must be addressed at an individual as well as organizational level. The key may lie in turning to social supports, adapting positive coping mechanisms, and subsequently seeking mental health consultation. Further research is required in this area to determine the best resolution.