J Trauma
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Abdominal compartment syndrome (ACS) has multiple well-described etiologies, but almost no attention has focused on ACS in the absence of abdominal injury. This study describes a secondary ACS that occurs after severe hemorrhagic shock with no evidence of abdominal injury. ⋯ ACS can occur with no abdominal injury; The incidence of secondary ACS was 0.5% in this cohort trauma intensive care unit patients, so it probably occurs more frequently than is currently appreciated. Because survivors were decompressed 20 hours before nonsurvivors, early recognition might improve outcomes. On the basis of these observations, we recommend that bladder pressures should be routinely checked and acted on appropriately when resuscitation volumes approach 10 liters of crystalloid or 10 units of packed red cells.
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The neurologic outcome of comatose patients has a wide variation from complete reawakening to death. Methods of predicting the outcome of coma caused by either head injury or cardiac arrest have been the subject of much discussion in the literature. However, prediction of neurologic prognosis in comatose trauma patients without head injury has rarely been discussed. We reviewed our experience in treating patients with presumptive hypoxic-ischemic coma after trauma and tried to identify factors relating to their neurologic outcomes. ⋯ Hypoxic-ischemic coma in patients sustaining major trauma yielded a significantly better survival and neurologic outcome than that induced by cardiac arrest or head injury. Decision-making in the first 24 hours after injury should not be affected by the patient's neurologic status at that time. A motor response worse than withdrawal at 24 hours after injury and an absence of pupillary light reflex at 48 hours after injury predicted a poor neurologic outcome.
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Comparative Study
Railway train versus motor vehicle collisions: a comparative study of injury severity and patterns.
This study compares the demographics, injury severity, resource use, and injury patterns of patients involved in railway train-motor vehicle (RT-MV) to motor vehicle-motor vehicle (MV-MV) collisions. ⋯ RT-MV collisions are a marker for more severe injuries, but not a different pattern of injury, compared with MV-MV collisions.
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Despite improvements in burn wound care, infections, particularly pneumonia, remain a major hurdle to recovery from thermal injury. After burns, a variety of systemic immune and inflammatory changes contribute to the risk of infection. Clinically, infection coupled with burn injury seems to adversely affect susceptibility to subsequent infection. ⋯ Small thermal injuries coupled with transient infection of the lungs or peritoneum delay the clearance of bacteria from the lungs and contribute to infection of the lungs, liver, burn site, and blood by endogenous organisms. These studies support the synergy of relatively small thermal injuries with infectious exposures in the pathogenesis of pneumonia and systemic infections after burns.