Screwdriver assaults and intracranial injuries

Four patients with intracranial penetrating injuries from screwdrivers are presented. Two cases were fatal; the others were left with functional deficits. In two of the patients a penetrating injury was not suspected initially because the history was limited and the significance of the small entry wounds were not appreciated. Unless these wounds are carefully examined a penetrating injury is easily overlooked.     

Penetrating orbital trauma

A small number of patients suffer penetrating injury to the orbit in the absence of trauma to the globe. Hospital records from the Jules Stein Eye Institute and affiliated hospitals were reviewed to obtain such cases. Five cases of penetrating orbital trauma, in which the globe was spared, are discussed. Many of the injuries initially appeared trivial but subsequent complications were severe. A review of these cases suggests that the shape and speed of the penetrating object, the anatomical location of the entry wound, and the physical characteristics of intraorbital structures determine the character and severity of orbital injuries.     

胸腹联合伤48例临床分析

目的探讨胸腹联合伤的特点和诊治方法。方法回顾分析经手术证实的48例胸腹联合伤临床资料。结果开放性损伤21例（占43．8％）,以锐器穿刺伤为主;闭合性损伤27例（占56．2％）,以交通车祸伤为主;受损器官3个以上23例（占47．9％）,术前休克29例（占60．4％）;术前确诊22例（占45．8％）,9例漏诊或延误诊断（占18．8％）;治愈40例,死亡8例（占16．7％）。结论胸腹联合伤伤情复杂、严重,休克发生率及死亡率高;膈肌损伤容易漏诊及延误诊断,重视院内急救、及时纠正休克及尽早手术治疗是抢救成功的关键。     

Penetrating injuries to the nerves of the lower extremity: principles of diagnosis and treatment

Background. Lower extremity nerve injuries caused by wounds are often not noticed immediately after trauma. The purpose of this article was to analyze the localization of penetrating injuries to the nerves, the mechanism and extent of the lesions, and the microsurgical techniques used. The diagnostic and therapeutic basics in penetrating injuries of lower extremity nerves are also described. Material and methods. The clinical material consisted of 67 patients treated surgically for penetrating injuries of lower extremity nerves. Results. In our material we observed penetrating injuries to the common peroneal nerve (41 cases), tibial nerve (9 cases), sciatic nerve (6 cases), combined common peroneal and tibial nerves (8 cases), and miscellaneous (foot injuries, 3 cases). The mechanism of injury included 51 cases of neurotmesis (primary injuries) and 16 cases of nerve compression (secondary injuries). In 5 cases, lesions of the major vessels and common peroneal and tibial nerves were observed. Conclusions. Penetrating injuries to the common peroneal nerve are the most frequent lesions of the peripheral nervous system within the lower limbs. The early detailed inspection of wounds, especially those localized in areas posing a particular threat to peripheral nerves, is an essential part of surgical treatment.     

Risks of human immunodeficiency virus infection to patients and healthcare personnel

The risk of nosocomial human immunodeficiency virus (HIV) infection among hospitalized patients comes almost exclusively from transfusion of fresh blood products. Current estimates of the risk of HIV infection from the transfusion of blood or components vary from 1/40,000 to 1/250,000 (0.0025% to 0.0004%), with the most probable likelihood estimated to be 1/153,000 (0.0007%). The major route of transmitting such HIV infection is via blood collected during the interval between infection of the donor and development of a detectable circulating antibody level to the AIDS virus (i.e., the "window period"). The current risk to hemophiliacs receiving treated coagulation factor concentrates is negligible. The risk to healthcare personnel of acquiring HIV infection from accidental puncture wounds and from handling HIV-infected blood or body fluids is 0.42% per episode. Most reported seroconversions have resulted from penetrating injuries with sharp objects contaminated with HIV-positive blood. The degree of risk to healthcare workers will vary with the community, the patient population served, and the frequency of penetrating injuries.     

Penetrating wounds of the back and flank: analysis of 77 cases

To determine the factors that allow early recognition of injuries to the intrathoracic and intra-abdominal organs in patients with penetrating wounds to the lower thorax and abdomen with site of entrance located in the back or flanks, we retrospectively analyzed the cases of 77 such patients. There were 65 stab wounds (85%) and 12 gunshot wounds (15%). The injuries were confined to the abdomen in 46 (60%); 39 were stab wounds and seven were gunshot wounds. The wounds were confined to the chest in 24 patients (31%) and involved both the chest and abdomen in seven cases (9%). Of the 53 abdominal wounds, 21 necessitated celiotomy; in 20 of them, an intra-abdominal organ was found injured, and one patient died (1.9%). Of the 24 injuries confined to the chest, only one patient required emergency thoracotomy due to massive hemorrhage; all 24 patients survived. All of the seven thoracoabdominal injuries, two produced by gunshot and five by stabbing, necessitated celiotomy. Most patients with gunshot wounds to the back and flanks require celiotomy, but a selective therapy can be safely used in patients with stab wounds. The rate of negative exploratory celiotomy was less than 5%; the mortality was 1.3%.     

慈溪市门诊伤害监测病例的流行病学分析

目的 了解浙江省慈溪市门诊伤害的流行病学特征和规律,为伤害防控提供科学依据.方法 分层随机抽取慈溪市县级医院、中心镇卫生院和乡卫生院各一家,以2004年7月1日至2005年6月30日到医院门诊就诊并被诊断为伤害的首诊患者作为研究对象.结果 共报告伤害病例15 808例,男女性别比为1.92:1,平均年龄为(33.7317.06)岁,15～59岁占79.8%.前4位职业依次为农民、工人、学生、待业/下岗者.伤害多发生于公路/街道、工作场所、家中和学校,主要发生于旅行、工作、体育活动时,发生时间多在9:20-20:00.导致伤害发生的原因依次为交通事故、动物咬伤、钝器伤、跌落,以非故意伤害为主.门诊伤害死亡66例,53.0%死于是交通事故.结论 交通伤害、犬伤、职业伤害及儿童伤害应是本地区伤害干预的重点.     

The Epidemiology and Diagnosis of Penetrating Eye Injuries

It is estimated that there are 3.1 penetrating eye injuries per 100,000 person-years in the United States. OBJECTIVES: To evaluate the epidemiology of penetrating eye injuries and to identify physical examination findings that facilitate the diagnosis and ophthalmologic referral of patients with these injuries. METHODS: This was a retrospective chart review of emergency department patients with penetrating eye injuries seen for evaluation from July 1987 to January 1999. The setting was a tertiary referral, university hospital. Three hundred eighty-four patients with 390 penetrating eye injuries were enrolled; 56% were transferred from outlying hospitals. RESULTS: Penetrating eye injuries were seen almost three times per month. Eighty percent of the injuries occurred in males, and the mean age was 29 years. Twenty-five percent of the patients had used alcohol in the period immediately preceding the injury. Final visual outcome was 28% with enucleation, "no light perception" (NLP) in 10%, light perception to 20/200 in 24%, and light perception of 20/200 or better in 38%. Poor visual outcome was associated with poor initial visual acuity, alcohol use, and delayed presentation (p = 0.036, 0.025, 0.036, respectively). Gun-related injuries caused 33% and motor vehicle crashes (MVCs) caused 21% of the worst outcomes (enucleation or NLP). In MVCs where seat belt use was reported, 71% of injured patients were unrestrained. The most common initial physical findings were hyphema (76%), abnormality of the pupil or uvea (94%), and initial visual acuity worse than 20/200 (77%). All patients had at least one of these findings. Complications occurred in 25% of cases, most commonly traumatic cataract or infection. Complications occurred more commonly in those patients transferred than in those presenting directly (p = 0.002). CONCLUSIONS: Penetrating eye injuries are relatively common, occur predominantly in young males, and often result in poor visual outcome in the affected eye. Motor vehicle crashes, alcohol use, and fire-arm use are associated with more severe injuries.     

腹腔镜手术与剖腹探查治疗腹部穿通伤的效果比较

目的探讨腹腔镜手术治疗腹部穿通伤的价值。方法 177例腹部穿通伤患者分别行腹腔镜手术（86例）和剖腹探查手术（91例）,对两组患者手术时间、术中出血量、肠功能恢复时间、术后住院天数、切口愈合或感染情况、术后并发症发生情况进行比较。结果两组均手术顺利。腹腔镜手术组患者术中出血量、肠功能恢复时间、术后住院天数、术后并发症发生情况均低于剖腹探查手术组（P〈0.05）。结论 腹腔镜手术治疗腹部穿通伤疗效确切,具有手术创伤小、术后康复快、住院时间短、术后并发症发生率低等优点,在无禁忌证的情况下,可推荐患者行腹腔镜腹部穿通伤手术。     

消毒供应中心工作人员锐器伤现状与影响因素分析

目的探讨消毒供应中心工作人员锐器伤现状及影响因素。方法选取我院2016年8月至2019年5月消毒供应中心80名工作人员作为研究对象,调查消毒供应中心工作人员锐器伤现状及影响因素。结果单因素分析显示,有无资格证书、对锐器伤态度、物品处置情况、锐器接触频率、环境情况、院内防护措施、锐器伤上报与否、工作人员是影响消毒供应中心工作人员发生锐器伤的相关因素(P<0.05)。多因素logistic回归分析显示,有资格证书、锐器伤后进行上报、认为锐器伤可避免、采取院内防护措施是消毒供应中心工作人员发生锐器伤的保护因素(P<0.05),而嘈杂的环境以及经常接触锐器是消毒供应中心工作人员发生锐器伤的独立危险因素(P<0.05)。结论消毒供应中心工作人员发生锐器伤,与个人因素、环境因素均有关系,应加强相关知识培训,提高其防范意识与能力,相关部门必须给予重视。     

医院工作人员锐器伤发生情况的调查与分析

目的了解医院工作人员锐器伤的发生情况,为提出针对性的措施提供依据。方法2012年8月,采用自制问卷对第二军医大学东方肝胆外科医院的450名工作人员进行调查。结果450名医院工作人员中,267名发生过锐器伤,其中发生安瓿伤210名（占78．7％）共765次,不同工作年限、科室、是否参加过职业防护的培训、工作类别、性别医院工作人员安瓿伤发生情况的差异有统计学意义（P〈0．05）;发生针刺伤57名（占21．3％）共75次,不同科室、是否参加过职业防护的培训医院工作人员针刺伤发生情况的差异有统计学意义（P〈0．05）;是否参加过职业防护的培训是锐器伤发生的重要影响因素。结论应加强对医院工作人员的职业安全教育,提高其职业防护意识,同时医院应健全锐器伤的监测、上报制度,从而确保医院工作人员的职业安全。     

Retroperitoneal organ injury caused by anterior penetrating abdominal injury in children.

OBJECTIVE: To describe the retroperitoneal organ injury pattern after anterior penetrating abdominal injury in children. SETTING: The paediatric surgical department of a university teaching hospital. PATIENTS AND METHODS: All children presenting with firearm and stab wounds to the anterior abdomen between January 1983 and April 2001. RESULTS: Forty-nine children (34%) with penetrating anterior abdominal wounds had retroperitoneal organ injury. The most injured organs were the descending colon in 17 patients (35%), ascending colon in eight patients (16%), and kidney in seven (14%). The most commonly associated injured organ was the small bowel. Postoperative septic complications were seen in 10 patients (20%). The most common postoperative complication was wound infection. When we compared patients with intraperitoneal organ injury with patients with retroperitoneal injury, there was no difference in parameters such as age, associated organ injury, morbidity and mortality between both groups. The main causative factor of retroperitoneal injuries was shotgun wounds, whereas it was stabbing in intra-abdominal injuries (P<0.05). The number of injured organs and the hospital stay is significantly greater in retroperitoneal organ injuries, and the trauma scores such as the Injury Severity Score (P<0.001) and the Penetrating Abdominal Trauma Index (P<0.001) were found to be significantly higher. CONCLUSION: Retroperitoneal organ injury is commonly associated with anterior penetrating abdominal trauma. Even if there is no preoperative sign of retroperitoneal organ injury, an exploratory laparotomy and a meticulous retroperitoneal exploration should also be performed for associated retroperitoneal organ injury.     

Penetrating facial trauma: a management plan

Penetrating wounds of the face present a spectrum of injuries and multiple management dilemmas. The surgeon's first concern remains the establishment of a proper airway and control of life-threatening injuries. Selected ancillary diagnostic procedures should be used to confirm vascular, aerodigestive, or central nervous system injuries. Diagnosis of injuries may require arteriography, endoscopic examination, barium studies, computerized tomography, and detailed ophthalmologic examination. We review 16 cases of penetrating facial trauma treated at the University of South Alabama Trauma Center over a one-year period. The injuries resulted from 13 gunshot wounds and three stab wounds. Injuries of the central nervous system occurred in three patients, mandibular fractures in four, optic nerve or globe injury in three, and maxillary sinus fracture in seven. Our experience with these patients demonstrates the spectrum of injuries and serves as a basis for a management algorithm.     

Penetrating injuries of the face and neck.

Experience with 547 consecutive cases of cervical and facial penetrating trauma has indicated the value of an individualized approach rather than a firm policy of exploration for all wounds penetrating the platysma. In addition, the accumulated data suggest that the concept of separate classes of carotid injuries based on presence or absence of neurologic deficits bears further evaluation with respect to the advisability of reconstituting carotid artery flow.     

Gunshot wounds to the leg causing neurovascular compromise—A case study

Background

Gunshot wounds are responsible for considerable damage to the body and its structures. Between 1995 and 2005, Gunshot wounds were the second most common cause of murders in NSW, although in comparison to other countries, are uncommon in Australia. However, they do produce high velocity injuries and are associated with numerous potential complications including bony, vascular and nerve injuries, soft tissue destruction, compartment syndrome, delayed wound healing, potential for infection and, a number of psycho-social complications.

Methods

The following paper is a case study based on a de-identified patient who presented following a gunshot injury, focussing on neurovascular assessment and communication.

Results

This case study generates numerous discussion points including pre-hospital notification, efficient in-hospital trauma team response, effective primary and secondary surveys, intravenous fluid use in penetrating injuries, regular nursing observations and methods for neurovascular assessment, potential causes of vascular compromise in limb injuries, communication and assertiveness, analgesia, and forensic considerations in the emergency department.

Conclusion

The importance of neurovascular observations cannot be understated and must be effectively conducted and reported upon in a timely manner when results are not within the normal parameters. Further, patient advocacy and effective inter-disciplinary communication is essential to ensure the patient is provided with a recovery that is uncomplicated and with as minimal morbidities as possible.     

儿童周围神经损伤康复治疗的肌电视察

目的观察儿童神经损伤后采用康复治疗的肌电变化。方法　康复治疗采用理疗,穴位水针注射,神经促通手法,传统按摩和功能锻炼的综合手段。每例治疗前及治疗后１—３个月做肌电图检查,观察３１例周围神经损伤患儿共观察１５５块肌肉的肌电变化：失神经电位,运动单位电位波幅,相数,运动单位电位募集型,神经传导速度。结果治疗前后效果,差异有显著性,Ｐ＜０．００５。结论综合康复对儿童神经损伤有明显疗效。     

26例心脏创伤的外科处理

本文报道26例心脏创伤处理经过,其中穿人性12例,医源性8例,闭合性6例。16例行急诊手术,包括缝合心肌裂口,去除心肌异物,闭式二尖瓣分离,清除心包腔血块和胸腔引流术。Ⅱ期和 /或择期手术10例,其中二尖瓣替换术 2例,三尖瓣替换术2例,主动脉瓣成形术1例。心内膜起搏电极感染去除2例,心室间隔缺损和右心室室壁瘤缝补术1例,左冠状动脉至肺动脉瘘1例。心包积血缩窄和右下肺弹头去除1例。 诊断主要依据为大量失血休克,心脏压塞,心脏出现杂音,心电图显示心肌损害,心包穿刺阳性等。条件允许时可行超声心动图和床旁摄片检查,心脏创伤合并瓣膜损害,VSD,室壁瘤和动脉心腔瘘等需施行超声心动图和多普勒检查确诊,必要时需施行心腔或大血管造影明确诊断。26例均经手术治疗,25例痊愈出院。死亡 1例,死亡率为 3.7％。     

An unusual case of a compound depressed skull fracture after an assault with a stiletto heel

Compound depressed skull fractures occur commonly from assault with various sharp and blunt objects. The use of a stiletto heeled shoe as an offensive weapon has not been reported before as a cause of such an injury. However unusual the history of assault, a clear picture of the mechanism of the injury is vital. Patients with scalp lacerations following a direct blow to the head must be evaluated thoroughly. Early investigation and treatment are necessary to reduce the risk of complications, as illustrated by this case.     

Two Cases of Penetrating Abdominal Injury From Needlefish Impalement

Background: Needlefish injuries to humans are extremely rare. An extensive review of the medical literature reveals only 22 cases previously reported. Most injuries reported have occurred in the Indo-Pacific region, but there are scattered reports worldwide. Objective: To report two cases of life-threatening penetrating abdominal injuries from needlefish impalement. Case Report: A 19-year-old man and a 40-year-old woman were both struck in the abdomen by a needlefish and required emergent exploratory laparotomy for instability. Their injuries were a laceration of a branch of the left portal vein and a small bowel perforation, respectively. Both patients survived and recovered without incident. Conclusion: Although rare, penetrating injuries from needlefish can be life threatening. Treatment should be directed at the organ injured with appropriate antibiotic coverage.     

提升护理人员执行锐器物品操作正确性的实践

本专案以“知信行模式”为理论指导,通过提升护理人员执行锐器物品操作认知水平,同时修订预防针刺伤手册、制作预防针刺伤DV D及执行预防针刺伤教育训练等方式,增强护理人员操作行为的正确性,降低护理人员针刺伤发生率,保证职业安全。