Articles: trauma.
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J. Korean Med. Sci. · Jul 2014
Application of damage control resuscitation strategies to patients with severe traumatic hemorrhage: review of plasma to packed red blood cell ratios at a single institution.
When treating trauma patients with severe hemorrhage, massive transfusions are often needed. Damage control resuscitation strategies can be used for such patients, but an adequate fresh frozen plasma: packed red blood cell (FFP:PRBC) administration ratio must be established. We retrospectively reviewed the medical records of 100 trauma patients treated with massive transfusions from March 2010 to October 2012. ⋯ Kaplan-Meier plots revealed that the 24-hr survival rate was significantly higher in the high-ratio group (71.9% vs. 97.1%, P<0.001). In severe hemorrhagic trauma, raising the FFP:PRBC ratio to 0.5 or higher may increase the chances of survival. Efforts to minimize bloodstream infections during the resuscitation must be increased.
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Lung ultrasound has emerged as a rapid and accurate screening tool for pneumothorax. The lung point sign, a sonographic representation of the point on the chest wall where the pleural layers re-adhere, is 100% specific to confirm the diagnosis. Double lung point sign for a single pneumothorax is extremely unusual and has only been reported twice in the literature. ⋯ Chest computed tomography was notable for an anterior left pneumothorax with underlying pulmonary contusion. Bedside ultrasound of this region revealed a double lung point sign. Our case report is the first to confirm association of the double lung point sign with a single pneumothorax on corresponding computed tomographic imaging.
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Agitation is a frequent complication in critically ill adults, can result in life-threatening events for patients or care providers, and extends the hospital length of stay, thereby increasing hospital costs. ⋯ Agitation was present in more than one-half of the patients in the sample, typically developed on the first day, and involved consecutive days.
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Observational Study
Computed tomography is not justified in every pediatric blunt trauma patient with a suspicious mechanism of injury.
Computed tomography (CT) has become an important tool for the diagnosis of intra-abdominal and chest injuries in patients with blunt trauma. The role of CT in conscious asymptomatic patients with a suspicious mechanism of injury remains controversial. This controversy intensifies in the management of pediatric blunt trauma patients, who are much more susceptible to radiation exposure. The objective of this study was to evaluate the role of abdominal and chest CT imaging in asymptomatic pediatric patients with a suspicious mechanism of injury. ⋯ The routine use of CT in asymptomatic pediatric patients with a suspicious mechanism of blunt trauma injury is not justified.
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The focused assessment with sonography for trauma examination has assumed the role of initial screening examination for the presence or absence of hemoperitoneum in the patient with blunt abdominal trauma. Sonographic pitfalls associated with the examination have primarily been related to mistaking contained fluid collections with hemoperitoneum. We present a case in which an elongated left lobe of the liver was misdiagnosed as a splenic subcapsular hematoma. It is imperative that emergency physicians and trauma surgeons be familiar with this normal variant of the liver and its associated sonographic appearance on the perisplenic window in order to prevent nontherapeutic laparotomies or embolizations.