重型颅脑损伤中的弥漫性轴索损伤

报告５１例脑弥漫性轴索损伤，占同期重型颅脑损伤的１３．３５％，其主要临床特点为患者由事故等致伤，伤后即持续昏迷，而ＣＴ检查表现较轻微。作者结合文献对发病机制、病理、临床论断进行初步总结。认为使用ＭＲＩ检查有助于ＤＡＩ的临床诊断。     

Spinal cord injury: preventing secondary injury.

Spinal cord injury is devastating to the victim, as well as being costly in terms of medical expenses, lost wages, and lost independence. The initial damage to the spinal cord results from several mechanisms of injury--flexion, extension, compression, penetration, rotation, and the disease process. When the spinal cord is injured and there is necrosis of the nervous tissue, no regeneration of that tissue occurs. Unlike in the peripheral nervous system, where regeneration is possible, the spinal cord is part of the central nervous system, as is the brain. The spinal cord extends from the base of the skull to the L1 vertebrae: the cervical levels innervate the diaphragm and muscles of the arms; the thoracic levels innervate the muscles of the chest and abdomen; and the lumbar and sacral levels innervate the muscles of the legs. In addition, the sacral levels are responsible for bowel, bladder, and sexual function. The higher the level of injury, the more severe the loss of function because, not only is the level of injury affected, but also the levels below. Injury occurs by initial trauma to the surrounding ligaments, bones, and muscles, which then affect the spinal cord. There may be total loss of function with damage completely across the cord or partial loss of function with damage affecting only part of the cord. No current treatment can reverse this initial injury, which causes irreversible damage within minutes of injury. Secondary damage occurs as the injury spreads over several hours. Treatment can help prevent this secondary damage.     

Immersion injury

Methanol, or wood alcohol, is present as a solvent in many products found in the average household. Health problems can result from inadvertent exposure, such as spilling concentrated solvents onto the skin, or conscious abuse, such as inhaling fumes or drinking solutions. The authors describe the pharmacokinetics involved and discuss the clinical presentation of patients with methanol intoxication, the expected clinical course, and important treatment considerations.     

Inviting injury

PPE equals one thing personal safety. Employers must ensure that responders are provided with applicable PPE and taught how to use it for the incidents and environments they may encounter. Responders who fail to wear PPE or wear it inappropriately invite injury. Employers should not assume that responders know how or even when to use certain PPE--regular in-service training should be provided. As a responder, you have a responsibility to always undertake safe actions. If you follow this monthly column, you have no doubt heard me say repeatedly that nothing, absolutely nothing, supercedes safety. You are not an expendable resource. Wear your PPE and, most important, wear it the right way.     

Dance-related injury

Although dance medicine has derived extensive knowledge from sports medicine, some aspects covered in the practice of dance medicine are unique to this field. Acute and overuse injuries must be analyzed within the scope of associated mechanisms of injury, mainly related to the practice of specific dance techniques. Even though most available medical literature concerning dance medicine is specific to ballet-related conditions, many of the concepts covered here and in other articles can be helpful in the treatment and diagnosis of participants in other dance disciplines. Continued research is expanding the knowledge on injury patterns of different dance disciplines. It is the experience of dance practitioners that dancers are quite in touch with their bodies; thus, when their ailments are systematically analyzed, and underlying cause can usually be identified. In this sense, it is evident that the principles of dance medicine and rehabilitation allow the practitioner to arrive at a diagnosis and treat the underlying causes to prevent reinjury, ameliorate sequelae from injury, and minimize residual deficits after injury.     

Emergencyneedlestick injury

During the course of a year, there aremany healthcare workers nationwide who sustain sharps injuries whilst carrying out their duties. Staff who work in the Accident and Emergency (A & E) units are no different from anyone else in this respect. The emotional cost of such an accident cannot be calculated, whereas the financial costs can. This article aims to show how the cost of an injury to a member of staff can be calculated, thus allowing a manager to assess the financial implications of sharps injuries to their department.In the absence of access to an Occupational Health (OH) department, most A & E units have to respond to sharps injuries to healthcare workers in the hospital. This task must be attended to by the medical staff as well as the nursing staff of the A & E unit. Within the following text the appropriate responses and methods to ensure uniformity of response are discussed.The tables and the calculation figures shown are taken directly from the information held in the St James's University Hospital Trust's OH department. All calculations are based on the middle band of the salary scale for each discipline. Accurate costings for each member of staff injured cannot be shown in this article, but the general principle is laid down and can be easily followed for any situation.