Injury
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Anatomical proximity of the eye and the intracranial space is a fact but the existence of physiological and pathophysiological relationships between them is elusive. The objective of this study was to explore anatomical and pathophysiological interactions between the eye and the intracranial space and to assess clinical utility of intraocular pressure measurement in estimation of intracranial pressure in patients with brain injuries and to discover how haemodynamic instability could influence these interactions. Controversy surrounds the recent literature concerning this problem and the consensus has not been achieved. ⋯ There is no anatomical and pathophysiological basis for the statement that intraocular pressure can be used as an indirect estimator of intracranial pressure.
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Comparative Study
Clinical predictors of occult pneumothoraces in severely injured blunt polytrauma patients: A prospective observational study.
The supine antero-posterior (AP) chest radiograph (CXR) is an insensitive test for detecting post-traumatic pneumothoraces (PTXs). Computed tomography (CT) often identifies occult pneumothoraces (OPTXs) that were not diagnosed on CXR. The purpose of this study was to prospectively determine the incidence, and validate previously identified clinical predictors, of OPTXs after blunt trauma. ⋯ OPTXs were missed in up to 76% of all seriously injured patients when CXRs were interpreted by the trauma team. This is higher than previously reported in retrospective studies and is likely based on the difficult conditions in which the trauma team functions. Subcutaneous emphysema remains a strong clinical predictor for concurrent OPTXs.
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Comparative Study
Venous glucose and arterial lactate as biochemical predictors of mortality in clinically severely injured trauma patients--a comparison with ISS and TRISS.
Early assessment of injury severity is important in trauma. Trauma scores are calculated after the fact and are useful for audit and research, but not in the emergency clinical setting. Glucose metabolism is altered in trauma, and we hypothesised that alterations in glucose and lactate levels would be an early predictor of mortality. ⋯ Glucose and lactate can predict mortality in severe trauma. The predictive value of glucose is comparable to that of ISS, and can be more easily employed in the clinical setting.
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Stab wounds to the thorax and upper abdomen have the potential to cause pneumothorax (PTX). When a CXR (CXR) obtained during initial resuscitation is negative, a second CXR (CXR-2) is commonly performed with the goal of identifying delayed PTX. ⋯ Occurrence of delayed PTX in patients with stab wounds to the thorax and upper abdomen and negative triage CXR is rare.
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Survival of patients with severe trauma presenting with Glasgow Coma Score (GCS) 3 and bilateral fixed dilated pupils is uncertain. Pre-hospital management of these patients affects the true measurement of the GCS and other factors may affect pupillary status. ⋯ Pre-hospital GCS scores, prior to the effects of intubation, sedation and paralysis should be given more attention when assessing prognosis in patients who are GCS 3 on admission. Trauma patients with GCS 3 persisting from the scene with bilaterally fixed dilated pupils have no appreciable chance of survival. Further interventions such as ICU admission and surgery may not be warranted. Physicians may need to consider stopping treatment and discussing organ donation.