J Trauma
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Tension pneumopericardium is a rare complication of blunt chest trauma. We present two case reports of tension pneumopericardium, with clinical, hemodynamic, and radiographic evidence supporting the diagnosis. Although tension pneumopericardium is uncommon in blunt chest trauma, it should be considered in patients with pneumopericardium and hemodynamic instability.
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Hypothermia in trauma patients is generally considered an ominous sign, although the actual temperature at which hypothermia affects survival is ill defined. In this study, the impact of body core hypothermia on outcome in 71 adult trauma patients with Injury Severity Scores (ISS) greater than or equal to 25 was analyzed. Forty-two per cent of the patients had a core temperature (Tc) below 34 degrees C, 23% below 33 degrees C, and 13% below 32 degrees C. ⋯ Mortality and the incidence of hypothermia increased with higher ISS, massive fluid resuscitation, and the presence of shock. Within each subgroup (i.e., greater ISS, massive fluid administration, shock) the mortality of hypothermic patients was significantly higher than those who remained warm. No patient whose core temperature fell below 32 degrees C survived.
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Hypothermia is a well recognized consequence of severe injury, even in temperate climates, and the physiologic consequences of hypothermia are known to be detrimental. To analyze the frequency and risk factors for hypothermia and its effect on patient outcome, we prospectively studied 94 intubated injured patients at a regional trauma center during a 16-month period. Esophageal temperature probes were placed in the field or ER and core temperatures (T) were followed for 24 hours or until rewarming. ⋯ However, no consistent correlation was found between alcohol intoxication and initial temperature or patient survival. Blood transfusion requirements paralleled injury severity and patients receiving greater than 10 unit transfusions had significantly lower core temperature (p less than 0.05). The average temperature change was positive in the ER, OR, and ICU with time to rewarming correlating with the aggressiveness of warming measures.(ABSTRACT TRUNCATED AT 250 WORDS)