Eur J Trauma Emerg S
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Eur J Trauma Emerg S · Dec 2013
Is computed tomography necessary to determine liver injury in pediatric trauma patients with negative ultrasonography?
Abdominal trauma is the third most common cause of all trauma-related deaths in children. Liver injury is the second most common, but the most fatal injury associated with abdomen trauma. Because the liver enzymes have high sensitivity and specificity, the use of tomography has been discussed for accurate diagnosis of liver injury. ⋯ According to our findings, abdominal CT may not be necessary to detect liver injury if the patient has ALT and AST levels below 100 IU/L with a negative abdominal USG at admission and during follow-up.
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Temporary vascular shunts have been used for nearly 100 years in patients. Originally, they were used as vascular grafts that were likely to thrombose as collaterals would hopefully develop. ⋯ Indications for the use of shunts are a "damage control" procedure for a peripheral or truncal vascular injury, Gustilo IIIC fracture of an extremity, need for perfusion as a complex revascularization is performed, and planned replantation of a hand, forearm, or arm. They are used in approximately 8% of vascular injuries treated in urban trauma centers in the United States and have an excellent patency rate without heparinization.
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Eur J Trauma Emerg S · Dec 2013
Increased mortality with undertriaged patients in a mature trauma center with an aggressive trauma team activation system.
The American College of Surgeons Committee on Trauma (ACS-COT) has determined that a 5 % pre-hospital undertriage [UT; defined as Injury Severity Score (ISS) > 15 and not sent to a trauma center] is an acceptable rate for pre-hospital transfer to a non-trauma center. We sought to determine if this level of undertriage is acceptable within a mature Level II trauma center as a measure of the adequacy of its trauma activation system. ⋯ Standard trauma activation criteria may not be adequate to identify the at-risk severely injured trauma patient. Further refinement of in-house trauma triage protocols is necessary if trauma centers are to improve outcomes following trauma.
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Eur J Trauma Emerg S · Dec 2013
Special considerations in the interpretation of plain radiographs of the cervical spine in children. A review of the literature.
This review provides an overview of the special considerations with regard to correct diagnosis of plain radiographs of the pediatric cervical spine. Injuries to the cervical spine are rare in children. The leading trauma mechanism is motor vehicle injury. Plain radiographs are a common tool in the search for a diagnosis. Taking the growth process into account there are many differences to be found compared to the adult c-spine. Knowledge of these differences is important when working towards the correct interpretation of plain radiographs of the pediatric c-spine. ⋯ Knowledge of the c-spines characteristics is of major importance for every physician involved in pediatric trauma care. This could lead to not only avoiding misdiagnosis but could also lead to avoiding the overuse of computed tomography of the pediatric c-spine.
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The evaluation and management of patients with vascular trauma or injury often involve rapid decision making in less than ideal circumstances. Immediate consequences such as hemorrhage, ischemia, compartment syndrome, thrombosis, and embolization may be life threatening and require immediate intervention. In addition, a number of regional and systemic complications of the initial vascular pathology are possible, such as shock, acute renal failure, myocardial infarction, or stroke. ⋯ These problems include traumatic injuries to the arterial or venous system, failure of vascular repairs or reconstructions, surgical site and graft infections, anastomotic complications, and compartment syndromes. In addition, arterial and venous complications secondary to the use of illicit intravenous drug use and cocaine-related vascular injury will be discussed. Finally, the increasingly important topic of iatrogenic or procedure-related vascular injuries and complications will be reviewed.