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Aich J, Cafuta B, Klein T, Distler F, Hüttenbrink C, Pahernik S, Pandey A. [Conservative management of grade IV kidney lacerations due to stab wounds]. Urologe A 2021; 61:526-529. [PMID: 34817625 DOI: 10.1007/s00120-021-01707-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
We report on two patients who were in initially circulatory stable condition with grade IV kidney trauma after knife stab accident. Patient 1 underwent reconstructive surgery to retrieve a broken knife blade, while patient 2 was treated conservatively for bleeding that did not require intervention. Both patients could ultimately be discharged in stable condition. These case studies show that even in the case of high-grade kidney trauma with the appropriate constellation of findings, conservative management and, if exploration is necessary, a reconstructive approach is possible.
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Affiliation(s)
- Juliane Aich
- Klinik für Urologie, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität Nürnberg, Prof.-Ernst-Nathan-Straße 1, 90419, Nürnberg, Deutschland.
| | - Barbara Cafuta
- Klinik für Urologie, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität Nürnberg, Prof.-Ernst-Nathan-Straße 1, 90419, Nürnberg, Deutschland
| | - Tilman Klein
- Klinik für Urologie, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität Nürnberg, Prof.-Ernst-Nathan-Straße 1, 90419, Nürnberg, Deutschland
| | - Florian Distler
- Klinik für Urologie, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität Nürnberg, Prof.-Ernst-Nathan-Straße 1, 90419, Nürnberg, Deutschland
| | - Clemens Hüttenbrink
- Klinik für Urologie, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität Nürnberg, Prof.-Ernst-Nathan-Straße 1, 90419, Nürnberg, Deutschland
| | - Sascha Pahernik
- Klinik für Urologie, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität Nürnberg, Prof.-Ernst-Nathan-Straße 1, 90419, Nürnberg, Deutschland
| | - Abhishek Pandey
- Klinik für Urologie, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität Nürnberg, Prof.-Ernst-Nathan-Straße 1, 90419, Nürnberg, Deutschland
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Fischer NJ. Mortality following severe liver trauma is declining at Auckland City Hospital: a 14-year experience, 2006-2020. N Z Med J 2021; 134:16-24. [PMID: 34482385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Liver injuries sustained in blunt and penetrating abdominal trauma may cause serious patient morbidity and even mortality. AIM To review the recent experience of liver trauma at Auckland City Hospital, describing the mechanism of injury, patient management, outcomes and complications. METHODS A retrospective cohort study was performed, including all patients admitted to Auckland City Hospital with liver trauma identified from the trauma registry. Patient clinical records and radiology were systematically examined. RESULTS Between 2006-2020, 450 patients were admitted with liver trauma, of whom 92 patients (20%) were transferred from other hospitals. Blunt injury mechanisms, most commonly motor-vehicle crashes, predominated (87%). Stabbings were the most common penetrating mechanism. Over half of liver injuries were low risk American Association for the Surgery of Trauma (AAST) grade I and II (56%), whereas 20% were severe grade IV and V. Non-operative management was undertaken in 72% of patients with blunt liver trauma and 92% of patients with penetrating liver trauma underwent surgery. Liver complications occurred in 11% of patients, most commonly bile leaks (7%), followed by delayed haemorrhage (2%). Thirty-two patients died (7%), with co-existing severe traumatic brain injury as the leading cause of death. There was a significant reduction in death from haemorrhage in patients with grade IV and V liver trauma between the first and second half of the study period (p=0.0091). CONCLUSION Although the incidence and severity of liver trauma at Auckland City Hospital remained stable, there was a reduction in mortality, particularly death as a result of haemorrhage.
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MESH Headings
- Abdominal Injuries/epidemiology
- Abdominal Injuries/mortality
- Abdominal Injuries/therapy
- Accidental Falls
- Accidents, Traffic
- Aneurysm, False/epidemiology
- Biliary Tract/injuries
- Brain Injuries, Traumatic/mortality
- Cause of Death
- Crush Injuries/epidemiology
- Crush Injuries/mortality
- Crush Injuries/therapy
- Embolization, Therapeutic
- Hemobilia/epidemiology
- Hemorrhage/mortality
- Hepatic Artery
- Humans
- Laparoscopy
- Laparotomy
- Liver/injuries
- Mortality/trends
- Motorcycles
- Necrosis
- New Zealand/epidemiology
- Pedestrians
- Wounds, Nonpenetrating/epidemiology
- Wounds, Nonpenetrating/mortality
- Wounds, Nonpenetrating/therapy
- Wounds, Stab/epidemiology
- Wounds, Stab/mortality
- Wounds, Stab/therapy
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Affiliation(s)
- Nicholas J Fischer
- MBChB FRACS, Liver Transplantation Fellow, New Zealand Liver Transplant Unit, Auckland City Hospital
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Nwashilli NJ, Obi AE. Pattern and Outcome of Stab Injuries in a Tertiary Hospital in Nigeria. West Afr J Med 2021; 38:439-444. [PMID: 34051715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Stab injury is a variant of penetrating injury which can occur on any part of the body. AIM To determine the pattern, clinical features, treatment, and outcome of stab injuries. PATIENTS AND METHODS This was a retrospective descriptive study of patients with stab injuries carried out over 19-month period, from November 2018 to May 2020 at the Accident and Emergency Department of Universityof Benin Teaching Hospital, Benin City, Nigeria. The case files of all patients with stab injuries were retrieved from the Medical Records Department. Information obtained included age, sex, gender, injury to arrival time, time of the day that stab occurred, body region involved, type of weapon used, injury sustained, reason for the stab, symptoms and signs, treatment, duration of hospital stay and outcome. RESULTS A total of 29 patients had stab injuries. There were 27 males and two females with a male to female ratio of approximately 13.5: 1. The age range was 17-59 years. The mean age was 31 ± 10 years. Most stabs occurred in the third decade with chest being the most common body region. Conflict/fight was the most common reason for stab with broken bottle being the most common weapon. The average duration of hospital stay was 6 ± 3.99 days. There was no mortality. CONCLUSION Stab injuries occur predominantly in the males in their third decade of life resulting from conflict/fight with broken bottle being the most common weapon. The chest was the most involved body region. The outcome following treatment was good with no mortality.
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Affiliation(s)
- N J Nwashilli
- Department of Surgery, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - A E Obi
- Department of Surgery, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
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Uchino H, Kong VY, Pantelides A, Anderson J, O'Neill H, Bruce JL, Laing GL, Clarke DL. The scourge of knife crime: trends in knife-related assault managed at a major centre in South Africa. S AFR J SURG 2020; 58:150-153. [PMID: 33231008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Knife wounds are common and represent a major burden to the South African healthcare system. This study reviews trends in spectrum, management and outcome of these injuries at a single trauma centre in KwaZulu-Natal(KZN). METHOD The regional hybrid electronic registry (HEMR) was reviewed for the period January 2013 - December 2018, and all patients who suffered a knife-related assault were identified and reviewed. RESULTS During the period under review, a total of 2117 patients suffered a knife-related assault. Regions injured were as follows: head 445, neck 572, face 258, chest 939, abdomen 649, pelvic/urogenital 49, upper limb 418, and lower limb 105. The median ISS was 9 (4-10). Imaging comprised 1242 chest X-rays, 315 abdominal X-rays, 162 abdominal ultrasounds/ FAST, and 929 CT scans of which 634 were CT angiograms. A total of 783 (37%) patients required an operation. The rate of laparotomy was 447/649 (69%) and of thoracotomy/sternotomy/thoracoscopy 95/939 (10%). The rate of vascular exploration for upper and lower limb vascular injury was 101/523 (19%). Mortality was 49/2117 (2.3%).. CONCLUSION Although our clinical outcomes over this period appear to be consistent, suggesting a familiarity with managing knife-related trauma, the persistently high rate of knife-related injury suggests that we have failed to develop a preventative strategy to try and reduce this scourge.
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Affiliation(s)
- H Uchino
- Department of Surgery, Department of Critical Care Medicine, Kurashiki Central Hospital, Okayama, Japan
| | - V Y Kong
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa and Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - A Pantelides
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - J Anderson
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - H O'Neill
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - J L Bruce
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - G L Laing
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - D L Clarke
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
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Yoneoka Y, Akiyama K, Seki Y. Glass Fragment Injury to the Craniocervical Junction with Interatlantooccipital Penetration to the Subarachnoid Space: Not-To-Be-Missed Important Aspects of Craniocervical Trauma Even in the Middle of the COVID-19 Pandemic: Case Report and Review of Literature. World Neurosurg 2020; 141:402-405. [PMID: 32561491 PMCID: PMC7297170 DOI: 10.1016/j.wneu.2020.06.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/07/2020] [Accepted: 06/07/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Nonmissile penetrating injuries to the craniocervical junction caused by a glass fragment are rare, and a standard management strategy has not been established. CASE DESCRIPTION A 75-year-old Japanese man was brought into our emergency department after receiving a left retroauricular stab wound by broken glass fragments. After spinal immobilization, a computed tomography (CT) scan revealed glass fragments penetrating at the right craniocervical junction to the interatlantooccipital subarachnoid space. CT angiography showed that both vertebral arteries were not injured. Magnetic resonance imaging demonstrated that the glass fragments did not penetrate the cervical cord or medulla oblongata. These glass fragments were removed via a midline incision from the external occipital protuberance to the C7 and with laminectomy without suboccipital craniectomy. Five of the glass fragments were found and removed in total. The dural defect was patched with a free fascia autograft. His postoperative course was uneventful. Postoperative CT angiography showed that both vertebral arteries were intact and the glass fragments had been removed completely. CONCLUSIONS CT graphical diagnosis is useful for the management of penetrating craniocervical junction trauma, and it should be considered in the evaluation of patients who have suffered craniocervical penetrating injury even in the absence of major wounds or bleeding. Spinal immobilization of patients with craniocervical penetrating injuries is crucial to avoid not only secondary neurologic damage but also secondary critical vascular damage. Incomplete or inadequate assessment of craniocervical stab wounds results in unexpected hazards that are preventable.
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Affiliation(s)
- Yuichiro Yoneoka
- Department of Neurosurgery, Uonuma Kikan Hospital, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan.
| | - Katsuhiko Akiyama
- Department of Neurosurgery, Uonuma Kikan Hospital, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Yasuhiro Seki
- Department of Neurosurgery, Uonuma Kikan Hospital, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
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Donahue C, Sarkar B, Narsule C, Taha A, Rosenblatt M. Management of an Anterior Abdominal Stab Wound in a Hostile Abdomen. Am Surg 2020; 86:e79-e80. [PMID: 32167052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Hershkovitz Y, Shohat S, Kessel B, Schecter WP, Beicker A, Jeroukhimov I. Selective Management of Multiple Anterior Abdominal Stab Wounds: Is it Safe? Isr Med Assoc J 2019; 21:330-332. [PMID: 31140225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Selective management of stable patients with anterior abdomen stab wounds (AASWs) has become a gold standard management approach throughout the world. Evidenced-based options for supporting selective management include clinical follow-up, local wound exploration with or without diagnostic peritoneal lavage, diagnostic laparoscopy, and abdominal computerized tomography. The presence of multiple AASWs might signify a more aggressive attack and limit the safety of a selective management approach. OBJECTIVES To evaluate whether multiple AASWs are associated with an increased risk of intra-abdominal injury requiring emergency surgery. METHODS We retrospectively reviewed all AASW patients admitted to Assaf Harofeh Medical Center, Zerifin, Israel, and Hillel Yaffe Medical Center in Hadera, Israel, from 2007 to 2015. Patients were divided into two groups based on the number of stab wounds: single or multiple. Data were coded for demographics, severity of injury, presence of intra-abdominal injury, laparotomy rate, length of hospital stay (LOS), length of stay in the intensive care unit (LICU), and survival. RESULTS The study included 169 patients. Of these, 143 patients had a single AASW and 26 had multiple AASWs. There were no differences between the groups regarding demographics, severity of injury, intra-abdominal penetration, specific organ injury, LOS, or LICU. There was no difference in the percentage of patients requiring laparotomy. The overall mortality was 2.36% (4/169). There was no significant difference in the mortality rate between the groups (P = 0.11). CONCLUSIONS The presence of multiple AASWs is not a risk factor for increased frequency and severity of intra-abdominal injury.
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Affiliation(s)
- Yehuda Hershkovitz
- Department of Surgery, Assaf Harofeh Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shirly Shohat
- Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel
- Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Boris Kessel
- Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel
- Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - William P Schecter
- Department of Surgery, University of California San Francisco, San Francisco General Hospital, San Francisco, CA, USA
| | - Alexander Beicker
- Department of Surgery A, Emek Medical Center, Afula, Israel
- Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Igor Jeroukhimov
- Department of Surgery, Assaf Harofeh Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Teuben M, Spijkerman R, Pfeifer R, Blokhuis T, Huige J, Pape HC, Leenen L. Selective non-operative management for penetrating splenic trauma: a systematic review. Eur J Trauma Emerg Surg 2019; 45:979-985. [PMID: 30972434 PMCID: PMC6910899 DOI: 10.1007/s00068-019-01117-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 03/27/2019] [Indexed: 12/02/2022]
Abstract
Introduction The treatment of abdominal solid organ injuries has shifted towards non-operative management (NOM). However, the feasibility of NOM for penetrating splenic trauma is unclear and outcome is believed to be worse than NOM for penetrating liver and kidney injuries. Hence, the aim of the current systematic review was to evaluate the feasibility of selective NOM in penetrating splenic injury. Methods A review of literature was performed using Pubmed, Embase and Cochrane databases. Studies on adult patients treated by NOM for splenic injuries were included and outcome was documented and compared. Results Five articles from exclusively level-1 and level-2-traumacenters were selected and a total of 608 cases of penetrating splenic injury were included. Nonoperative management was applied in 123 patients (20.4%, range 17–33%). An overall failure rate of NOM of 18% was calculated. Mortality was not seen in patients selected for nonoperative management. Contra-indicatons for NOM included hemodynamic instability, absence of abdominal CT-scanning to rule out concurrent injuries and peritonitis. Conclusions This review demonstrates that non-operative management for penetrating splenic trauma in highly selected patients has been utilized in several well-equipped and experienced trauma centers. NOM of penetrating splenic injury in selected patients is not associated with increased morbidity nor mortality. Data on the less well-equipped and experienced trauma centers are not available. More prospective studies are required to further define exact selection criteria for non-operative management in splenic trauma. Electronic supplementary material The online version of this article (10.1007/s00068-019-01117-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michel Teuben
- Department of Trauma, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
- Department of Trauma, University Hospital Zurich, Zurich, Switzerland.
| | - Roy Spijkerman
- Department of Trauma, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Roman Pfeifer
- Department of Trauma, University Hospital Zurich, Zurich, Switzerland
| | - Taco Blokhuis
- Department of Surgery, University Medical Center Maastricht, Maastricht, The Netherlands
| | - Josephine Huige
- Department of Trauma, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | | | - Luke Leenen
- Department of Trauma, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Resch TR, Kufera JA, Chiu W, Scalea TM. Penetrating Renal Trauma: Nonoperative Management Is Safe in Selected Patients. Am Surg 2019; 85:266-272. [PMID: 30947772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Present literature seems to support the nonoperative management of penetrating renal trauma although data remain limited. We conducted a nine-year retrospective review of nonoperative versus operative management and mechanism of injury [stab wound (SW) versus gunshot wound (GSW)] among patients admitted with penetrating renal trauma. Of 203 patients, the median age was 24 years, with the majority being male and having GSW injuries. More than half (52.2%) were treated nonoperatively (69.9% of SW and 40% of GSW injured patients). When compared with all operative patients combined, nonoperative patients had a lower median Injury Severity Score (17 vs 26, P < 0.001), lower transfusion requirement (27.4% vs 77.3%, P < 0.001), shorter median hospital stay (4.7 vs 12.6 days, P < 0.001), and lower mortality (1.9% vs 13.4%, P = 0.002). Gunshot wound patients had a higher median Injury Severity Score (26 vs 14, P < 0.001), higher median American Association for the Surgery of Trauma-Organ Injury Score (3 vs 2, P = 0.001), greater need for transfusion (69.2% vs 29.3%, P < 0.001), longer median hospital length of stay (12.1 vs 3.9 days, P < 0.001), and greater mortality (12.5% vs 0%, P < 0.001) than SW patients. Nonoperative management of penetrating renal injury is safe in selected patients. In addition, renal GSW injuries are associated with a greater morbidity and mortality.
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Abstract
A survey was performed of 425 consecutive patients attending Lewisham Hospital as a result of deliberate physical violence. Eighty-two per cent attended ‘out of hours’, and in at least 50% alcohol was a contributing factor. Less than half the incidents were reported to the police. Fifteen per cent of the attacks were due to knives and accounted for 47% of the admissions and 90% of the serious injuries. The results support the view that it is becoming common for youths to be armed. Assault victims, particularly those with knife wounds place a considerable burden on hospital resources. Accident and Emergency departments are ideal places to monitor the epidemiology of assaults.
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Affiliation(s)
- M A Hocking
- Department of Accident & Emergency, Lewisham Hospital, London
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Abstract
We present the prehospital management of a 23-year-old Australian Aboriginal man with an isolated knife stab wound to the posterior right chest. The lead author attended to the prehospital management of this young man during tenure as a registrar in retrieval medicine for CareFlight Medical Services (CMS) in North Queensland, Australia. The case is noteworthy because it involved a combination of a life-threatening injury with a superimposed iatrogenic injury. The case will be of interest to physicians and clinicians in prehospital medicine as well as those in low-volume emergency departments or facilities in which major trauma may present infrequently.
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Affiliation(s)
- Seetal Snoek
- Specialty Registrar, Careflight Medical Services, Queensland, Australia.
| | - Benjamin Butson
- Consultant Emergency Physician, Careflight Medical Services, Queensland, Australia
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McLeroy RD, Ellis JL, Karnopp JM, Dellavolpe J, Gurney JM, Keenan S, Powell D, Riesberg JC, Edwards M, Matos R, Pamplin JC. Case of a 5-Year-Old Foreign National Who Sustained Penetrating Abdominal Trauma. J Spec Oper Med 2016; 16:110-113. [PMID: 28088829 DOI: 10.55460/dgs0-q8or] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2016] [Indexed: 06/06/2023]
Abstract
Review application of telemedicine support for penetrating trauma. Clinical context: Special Operations Resuscitation Team (SORT) deployed in Africa Area of Responsibility (AOR) Organic expertise: Internal Medicine physician, two Special Operations Combat medics (SOCMs), and one radiology technician Closest surgical support: Non-US surgical support 20km away; a nonsurgeon who will perform surgeries; neighboring country partner-force surgeon 2 hours by fixedwing flight. Earliest evacuation: Evacuated 4 days after presentation to a neighboring country with surgical capability.
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Murry JS, Hoang DM, Ashragian S, Liou DZ, Barmparas G, Chung R, Alban RF, Margulies DR, Ley EJ. Selective Nonoperative Management of Abdominal Stab Wounds. Am Surg 2015; 81:1034-1038. [PMID: 26463303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Stab wounds (SW) to the abdomen traditionally require urgent exploration when associated with shock, evisceration, or peritonitis. Hemodynamically stable patients without evisceration may benefit from serial exams even with peritonitis. We compared patients taken directly to the operating room with abdominal SWs (ED-OR) to those admitted for serial exams (ADMIT). We retrospectively reviewed hemodynamically stable patients presenting with any abdominal SW between January 2000 and December 2012. Exclusions included evidence of evisceration, systolic blood pressure ≤110 mm Hg, or blood transfusion. NON-THER was defined as abdominal exploration without identification of intra-abdominal injury requiring repair. Of 142 patients included, 104 were ED-OR and 38 were ADMIT. When ED-OR was compared with ADMIT, abdominal Abbreviated Injury Score was higher (2.4 vs 2.1; P = 0.01) and hospital length of stay was longer (4.8 vs 3.3 days; P = 0.04). Incidence of NON-THER was higher in ED-OR cohort (71% vs 13%; P ≤ 0.001). In a regression model, ED-OR was a predictor of NON-THER (adjusted odds ratio 16.6; P < 0.001). One patient from ED-OR expired after complications from NON-THER. There were no deaths in the ADMIT group. For those patients with abdominal SWs who present with systolic blood pressure ≥110 mm Hg, no blood product transfusion in the emergency department and lacking evisceration, admission for serial abdominal exams may be preferred regardless of abdominal exam.
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Affiliation(s)
- Jason S Murry
- Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Petrikov SS, Kartavenko VI, Badygov SA, Klychnikova EV, Rak KG. [CORRECTION OF HEMOSTASIS DISORDER IN HEMORRHAGIC SHOCK]. Anesteziol Reanimatol 2015; 60:61-64. [PMID: 26596035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
It is a clinical case of successful correction of hemostasis disorder in hemorrhagic shock. This case demonstrates the need to perform advanced tests that assess hemostatic system in patients with ongoing bleeding. Using of thromboelastography helped us to make a comprehensive assessment of hemostatic system that allowed to detect the point of application of drugs and substitution therapy. Coagulation disorder was treated by intravenous injection of Ca2+. In this case the cause of hypocalcemia was combination offactors such as electrolytes losing during massive bleeding and progressing metabolic acidosis. Therefore, monitoring the level of ionized calcium is especially important in patients undergoing massive blood loss and receiving large doses of donor blood components.
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Reva VA, Kiselev MA, Platonov SA, Tulupov AN, Kandyba DV. [Selective embolization of branches of the profunda femoris artery in stab-cut injury]. Vestn Khir Im I I Grek 2015; 174:67-69. [PMID: 26390592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Hur'iev SO, Shuryhin OI, Zahriĭchuk MS. [Analysis of immediate causes of mortality in the injured persons, suffering open hepatic injury on a prehospital stage]. Klin Khir 2014:26-28. [PMID: 25417282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The results of a medical help delivery on prehospital stage to 200 injured persons, suffering penetrating abdominal wounding with hepatic damage, were analyzed. The main cause of death in 87.5% of the injured persons with open hepatic damage is a non-compensated blood loss, in 12.5%--traumatic shock and a prehospital stage duration. In accordance to data of the expert estimation, the anesthesiologic adequacy have constituted in the group of survivors--80.76%, and in those, who died--68.75%, confirming a very high level of the anesthesy adequacy. Level of adequacy of the blood loss compensation have constituted in group of survivors--57.69%, and in the group of patients, who died--37.50%, what could not be considered satisfactory. In patients--survivors a conditional adequacy of application of hemostatics have constituted 76%, and in a group of the injured persons, who have died--0.
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Sochala M, Aïssou L, Sorbets E, Pop N, Sleiman C, Goudot FX, Meune C. Delayed cardiac tamponade following management of a massive hemothorax related to a penetrating thoracic trauma. Int J Cardiol 2014; 172:e69-70. [PMID: 24412463 DOI: 10.1016/j.ijcard.2013.12.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 12/21/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Maximilien Sochala
- Department of Cardiology, Avicenne Hospital, Hopitaux Universitaires Paris-Seine-Saint-Denis, APHP, France
| | - Linda Aïssou
- Department of Cardiology, Avicenne Hospital, Hopitaux Universitaires Paris-Seine-Saint-Denis, Université Paris XIII, APHP, France.
| | - Emmanuel Sorbets
- Department of Cardiology, Avicenne Hospital, Hopitaux Universitaires Paris-Seine-Saint-Denis, APHP, France; Department of Cardiology, Bichat Hospital, Université Paris Diderot, APHP, France
| | - Natalia Pop
- Department of Cardiology, Avicenne Hospital, Hopitaux Universitaires Paris-Seine-Saint-Denis, APHP, France
| | - Carla Sleiman
- Department of Cardiology, Avicenne Hospital, Hopitaux Universitaires Paris-Seine-Saint-Denis, APHP, France
| | - François-Xavier Goudot
- Department of Cardiology, Avicenne Hospital, Hopitaux Universitaires Paris-Seine-Saint-Denis, APHP, France
| | - Christophe Meune
- Department of Cardiology, Avicenne Hospital, Hopitaux Universitaires Paris-Seine-Saint-Denis, APHP, France; Department of Cardiology, Cochin Hospital, Université Paris Descartes, APHP, France
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Taghavi S, Vora HP, Jayarajan SN, Gaughan JP, Pathak AS, Santora TA, Goldberg AJ. Prehospital intubation does not decrease complications in the penetrating trauma patient. Am Surg 2014; 80:9-14. [PMID: 24401498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Intubation in the prehospital setting does not result in a survival benefit in penetrating trauma. However, the effect of prehospital intubation (PHI) on the development of in-hospital complications has yet to be determined. The goal of this study was to determine if PHI in patients with penetrating trauma results in reduced mortality and in-hospital complications. Patient records for all Category 1 trauma activations as a result of penetrating injury admitted to our institution from 2006 to 2010 were reviewed. There were 1615 Category 1 trauma activations with 152 (9.8%) intubated in the field. A total of 1311 survived initial resuscitative efforts to permit hospital admission with 55 (4.2%) being intubated in the field. For patients surviving to admission, prehospital intubation was associated with increased mortality (hazard ratio, 8.266; 95% confidence interval [CI, 4.336 to 15.758; P < 0.001). After correcting for Injury Severity Score, PHI was not protective against pulmonary complications (odds ratio [OR], 0.724; 95% CI, 0.229 to 2.289; P = 0.582), deep vein thrombosis/pulmonary embolus (OR, 0.838; 95% CI, 0.281 to 2.494; P = 0.750), sepsis (OR, 0.572; 95% CI, 0.201 to 1.633; P = 0.297), wound infections (OR, 1.739; 95% CI, 0.630 to 4.782; P = 0.286), or complications of any kind (OR, 1.020; 95% CI, 0.480 to 2.166; P = 0.959). For victims of penetrating trauma, immediate transportation by emergency medical personnel may result in improved outcomes.
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Affiliation(s)
- Sharven Taghavi
- Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania, USA
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Popov VL, Egorova OA. [Peculiarities of the assessment of harm to human health from maxillofacial and neck injuries accompanied by the infectious process]. Sud Med Ekspert 2013; 56:53-54. [PMID: 23888507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The objective of the present study was to elucidate the peculiarities of the assessment of harm to human health from maxillofacial and neck injuries accompanied by the infectious process. The case report described in this paper demonstrates that the unfavourable outcome of an injury is not infrequently attributable to the inadequacy and drawbacks of the existing schemes for the provision of medical aid. However, the health status of the victim depends on the life-threatening character of the primary injury and its naturally developing infectious complications.
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Omari A, Bani-Yaseen M, Khammash M, Qasaimeh G, Eqab F, Jaddou H. Patterns of anterior abdominal stab wounds and their management at Princess Basma teaching hospital, North of Jordan. World J Surg 2013; 37:1162-8. [PMID: 23400590 DOI: 10.1007/s00268-013-1931-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND With the progressive use of new diagnostic techniques, the management of penetrating abdominal stab wounds is changing. Most studies have been conducted in well-equipped trauma centers in developed countries, and there is a paucity of reports from general teaching hospitals with limited resources. We reviewed the assessment of anterior abdominal stab wounds in patients presenting to our hospital hoping to establish an evidence-based algorithm for managing such patients in busy general hospitals. METHODS The medical records of all 393 patients treated at our hospital for anterior abdominal stab wounds over a 7-year period were reviewed. Information regarding age, gender, site of the stab wound, management, and complications were analyzed. RESULTS Twenty-six patients with hemodynamic instability at presentation underwent urgent laparotomy (LAP); 24 (92.3 %) of those procedures were therapeutic. Local wound exploration (LWE) proved that 114 (31 %) of all hemodynamically stable patients had no abdominal fascia penetration and consequently could be discharged home from the emergency department (ED). A total of 253 patients were found to have fascial penetration, and all were admitted for repeat clinical assessments (RCA) and imaging studies. A total of 121 (48 %) of the patients underwent abdominal exploration with 102 (84 %) therapeutic LAP procedures. CONCLUSIONS Hemodynamic instability and evisceration should continue to prompt urgent LAP. For stable patients, a sequence of LWE followed by focused abdominal sonography for trauma and computed tomography scanning for unclear cases primed by RCA was found to be efficient in limiting hospital admissions and reducing the rate of non-therapeutic LAP.
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Affiliation(s)
- Abdelkarim Omari
- Department of General Surgery, Faculty of Medicine Jordan University of Science and Technology (JUST), P.O. Box 3030, Irbid, Jordan.
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Kuy S, Codner PA, Guralnick M, Dua A, Paul J. Combined rectovesicular injuries from low velocity penetrating trauma in an adult. WMJ 2013; 112:32-34. [PMID: 23513312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The most common concomitant site of injury following a penetrating anorectal injury is the genitourinary tract. In anorectal penetrating injuries, other organ injuries must be thoroughly evaluated. In the presence of concomitant rectal and posterior bladder injury, consideration should be given to omental interposition between the surgically repaired organs to prevent fistula formation. Fecal diversion may be required depending upon the integrity of the anal sphincters. Combined rectal and genitourinary trauma from stab wounds or impalement is rare, and requires an interdisciplinary approach utilizing the collaborative expertise of both trauma surgical and urology teams to optimize the intraoperative and postoperative care of the patient.
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Affiliation(s)
- Sreyram Kuy
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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Hudson A. Cricoid pressure in penetrating neck trauma: time for a rethink? Emerg Med J 2012; 29:781. [PMID: 22736721 DOI: 10.1136/emermed-2012-201591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Wærsted S, Schou-Jensen K, Jensen T, Steensberg J. [Successful conservative treatment after accidental stab wound to the chest]. Ugeskr Laeger 2012; 174:1467-1468. [PMID: 22640793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A five year-old girl was admitted to hospital following an accidental stab wound to the chest, inflicted by a knife placed in a dishwasher's cutlery tray. Investigations revealed a traumatic ventricular septum defect of the heart, with a pericardial effusion. Since the patient remained haemodynamically stable, surgical intervention was considered unnecessary. At the first follow-up, an echocardiogram showed no visible pericardial effusion. At ten month follow-up, she showed initial symptoms of cardiac failure, and a renewed echocardiogram revealed a new pericardial effusion. It is important to perform long-term follow-up on patients with traumatic chest wounds.
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Subaşi M, Cakar-Ozdal MP, Nalcioğlu-Yüksekkaya P, Alakuş A. Management of an orbitocranial knife injury: a case report. Turk J Pediatr 2012; 54:184-186. [PMID: 22734308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A 10-year-old girl suffering from a penetrating orbital stab wound with a knife on the inner canthus of her right eye is reported. Clinical examination of the patient displayed no signs of globe perforation or neurological deficits. The knife was removed slowly with careful and controlled motions. At the last visit three months after the surgery, visual acuity was 20/20, anterior and posterior segment findings were normal, and no binocular eye movement abnormalities were observed.
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Affiliation(s)
- Mahmut Subaşi
- Department of Ophthalmology, Sanliurfa Research Hospital, Sanliurfa, Turkey
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Paydar S, Salahi R, Izadifard F, Jaafari Z, Abbasi HR, Eshraghian A, Hosseini SV, Farrokhnia F, Golshan Y, Bolandparvaz S. Comparison of conservative management and laparotomy in the management of stable patients with abdominal stab wound. Am J Emerg Med 2011; 30:1146-51. [PMID: 22100482 DOI: 10.1016/j.ajem.2011.08.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 08/15/2011] [Accepted: 08/16/2011] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The management of the hemodynamically stable patients with penetrating abdominal stab wounds is a problematic issue among trauma surgeons. METHODS In a retrospective study, we analyzed stable patients with anterior abdominal stab wound from August 2009 to 2010. The patients who were hemodynamically unstable or had developed peritonitis were excluded. In our center, the patients are treated through conservative or operative management depending on the protocol of management of the stable penetrating abdominal stab wound in our center. We compared the effectiveness, mean duration of hospital admission, and the time of starting diet in 2 groups. RESULTS There were 99 cases including 47 patients in the conservative group and 52 in the laparotomy group. The laparotomy was negative in 73% and positive in 27% of the patients. In the conservative group, all the patients remained asymptomatic and stable except for 6 patients who needed subsequent laparotomy. The maximum period between admission and delayed laparotomy in these 6 patients was 17 hours. The mean length of hospital stay and the time of starting diet were 70.4 vs 43 hours and 42.3 vs 30.6 hours in the operative group and conservative group, respectively. P < .05 was considered significant. CONCLUSION Our study showed that conservative management of asymptomatic and stable patients with anterior abdominal stab wound with physical examination can decrease the rate of normal laparotomy and the length of hospitalization and help to start diet earlier. This study made this hypothesis that after 17 hours of observation, diet can be started for the stable asymptomatic patients.
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Affiliation(s)
- Shahram Paydar
- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Beuran M, Negoi I, Paun S, Runcanu A, Gaspar B. [History of trauma care]. Chirurgia (Bucur) 2011; 106:573-580. [PMID: 22165054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Since its inception, the man suffered injuries through falls, fire, drowning and interpersonal conflict. While the mechanism and frequency of different specific injuries has changed passing of millennia, trauma remains an important cause of mortality and morbidity in modern society. Although the war is presented as one of the four knights of the Apocalypse, we must emphasize the important developments of surgical experience during war. The purpose of this study is to highlight the lessons learned during the history and how they changed the modern trauma care. METHOD Systematic review of English language literature using computer searching of Library of Medicine and the National Institutes of Health International MEDLINE database using PubMed Entre interface. RESULTS The first historical record of a trauma medical care is 3605 years ago. Over the past decades, one of the most important changes in trauma patient care is the selective nonoperative management (SNOM) of significant abdominal visceral injuries. SNOM was first described in 1968, for splenic trauma, by Upadhyay and Simpson. It was accepted much later for liver injuries. Beginning from 1960 - 1970, SNOM was introduced for abdominal stab wounds. Exploratory laparotomy remains the standard approach for abdominal gunshot wounds until 1990, when centers from United States and South Africa first reported cases successfully managed nonoperatively. CONCLUSIONS The trauma surgery has evolved continuously over the centuries, according to more and more severe modem injuries.
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MESH Headings
- Abdominal Injuries/history
- Abdominal Injuries/therapy
- Emergency Medical Services/history
- Europe
- History, 15th Century
- History, 16th Century
- History, 17th Century
- History, 18th Century
- History, 19th Century
- History, 20th Century
- History, 21st Century
- History, Ancient
- History, Medieval
- Humans
- Laparotomy/history
- South Africa
- Trauma Centers/history
- United States
- Warfare
- Wounds and Injuries/history
- Wounds and Injuries/surgery
- Wounds and Injuries/therapy
- Wounds, Gunshot/history
- Wounds, Gunshot/therapy
- Wounds, Nonpenetrating/history
- Wounds, Nonpenetrating/therapy
- Wounds, Stab/history
- Wounds, Stab/therapy
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Affiliation(s)
- M Beuran
- Spitalul Clinic de Urgenţă Bucureşti, România.
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29
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Rossy KM, Lawrence N. Aquatic antagonists: how to surgically remove a fishhook. Cutis 2011; 88:11-12. [PMID: 21877499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Kathleen M Rossy
- Center for Dermasurgery, Cooper University Hospital, Marlton, New Jersey 08053, USA.
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Egorova OA, Popov VL, Skrizhinskiĭ SF. [Assessment of injuries to the neck and dentomandibular system complicated by the infectious process]. Sud Med Ekspert 2010; 53:15-18. [PMID: 20821985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The objective of the present work was to consider problems pertaining to forensic medical examination of injuries to the neck and dentition system complicated by pyoinflammatory processes. Two clinical observations are reported to illustrate significant difficulties encountered by forensic medical experts during assessment of the severity of harm inflicted to human health in the cases requiring differential characteristic of injuries, evaluation of opportuneness and completeness of the provided medical aid, and the role of these factors in the development of fatal pyoseptic complications. Special emphasis is laid on the analysis of possibilities to attain these goals based on the "Medical criteria for the assessment of severity of harm inflicted to human health" (2008).
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Gandhi AD, Saleem A, Sperling D, Piccorelli GO. Leptomeningitis: a rare outcome after cervical stab wound. J Trauma 2010; 68:E57-E60. [PMID: 20220401 DOI: 10.1097/ta.0b013e318166d754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Alok D Gandhi
- Departments of Surgery, St. Barnabas Hospital, Bronx, New York, USA.
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Paiva WS, Saad F, Carvalhal ES, De Amorim RLO, Figuereido EG, Teeixera MJ. Transorbital stab penetrating brain injury. Report of a case. Ann Ital Chir 2009; 80:463-465. [PMID: 20476680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Penetrating injury of the skull and brain is relatively uncommon, representing about 0.4% of head injuries. In this paper the Authors describe a case of patient victim of transorbital stab with brain injury with good recovery and review the literature about cranial stab wound. CASE REPORT A 23-year-old man was involved in an altercation which resulted in the patient sustaining wounds to the head, with penetrating in left transorbital, affecting the eye. At arrival to the first trauma center the patient was conscent and complete responsive with 15 points in Glasgow Coma Scale, and motor deficit grade III. CT scan demonstrated left periventricular brain hematoma and supraorbital fracture. A four-vessel cerebral angiogram demonstrated no abnormality. In this evolution patient presented good neurologic outcome. CONCLUSION In patients conscents with no surgical lesion like our patient, the hospital discharge must occur after the angiogram have excluded intracranial vascular lesion.
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Affiliation(s)
- Wellingson Silva Paiva
- Division of Neurosurgery, Hospital das Clinicas University of Sao Paulo Medical School, Brazil.
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Tremayne V. Pistol crossbow injuries. Emerg Nurse 2009; 17:28-30. [PMID: 19552331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This article describes the wounding potential of pistol crossbows to prepare nurses who may have to provide immediate care for patients with injuries from these inexpensive and readily available weapons.
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Vinces FY, Madlinger RV. Laparoscopic exploration and lavage in penetrating abdominal stab wounds: a preliminary report. ULUS TRAVMA ACIL CER 2009; 15:109-112. [PMID: 19353311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND To determine the role of a combined laparoscopic exploration and lavage (LELA) in abdominal stab wounds (ASW). We hypothesized that peritoneal penetration (PP) is not an indication for exploratory laparotomy (EL) if LELA is negative. METHODS A prospective study (Jan 2002-Dec 2003) was carried at our Level I Trauma Center. Patients with anterior fascia penetration in wound exploration and with systolic blood pressure greater than 90 mmHg were included. Patients with back and flank injuries, evisceration and presentation after six hours were excluded. LELA was considered positive if red blood cell count was >5000 and white blood cell count was >150 in a lavage without the presence of bile, gross blood, food fibers or stool. RESULTS Eighty-nine patients with anterior ASW (AASW) were included. Twenty-eight patients underwent laparoscopy to rule out PP. Seventeen patients had PP and 8 demonstrated injuries that required immediate exploratory laparotomy. The remaining 9 underwent LELA. Four patients had positive LELA that demonstrated injuries (sigmoid, right colon, and small bowel [n: 2]). Five patients had a negative LELA and avoided an unnecessary EL. CONCLUSION LELA in AASW shows a promising role to rule out mainly hollow viscus injuries. This technique could decrease the number of non-therapeutic laparotomies, length of stay and hospital costs without increasing the incidence of missed abdominal injuries.
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Affiliation(s)
- Fausto Y Vinces
- Department of Surgery, Lutheran Medical Center, Brooklyn, New York, USA.
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Abstract
This article discusses the assessment, management and treatment of patients with stab wounds on arrival in the emergency department. It describes the immediate approach to assessment. The assessment of stab wounds to the chest, abdomen and limbs is also examined.
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Affiliation(s)
- James Bird
- Accident and Emergency Department, St Mary's Hospital, London.
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Affiliation(s)
- Joe McDevitt
- Emergency Department, Altnagelvin Hospital, Londonderry
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38
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Barinov EK, Romodanovskiĭ PO. [A case of injury inflicted by a harpoon]. Sud Med Ekspert 2008; 51:40. [PMID: 18756767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Abboud JA, Wiesel B, Tomlinson D, Ramsey M. Intraosseous stab wound to the arm. Am J Orthop (Belle Mead NJ) 2008; 37:E52-E54. [PMID: 18438478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Joseph A Abboud
- University of Pennsylvania Health System, Pennsylvania Hospital, Philadelphia, PA 19107, USA.
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Abstract
Stab wounds of the spinal canal are rare and constitute an uncommon cause of spinal cord injury. They are usually responsible for an immediate neurological deficit that requires emergency therapeutic management to minimize the extent of neurological deficit and to prevent further loss of neurological function. Magnetic resonance imaging (MRI) is used to evaluate damage to the spinal cord, including contusions, hematoma and compression of extramedullary origin. We report the MRI findings in three patients admitted for spinal canal penetrating injury with neurological symptoms.
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Affiliation(s)
- I Kamaoui
- Department of Radiology, University Hospital of Fez, Morocco.
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du Toit DF, Lambrechts AV, Stark H, Warren BL. Long-term results of stent graft treatment of subclavian artery injuries: management of choice for stable patients? J Vasc Surg 2008; 47:739-43. [PMID: 18242938 DOI: 10.1016/j.jvs.2007.11.009] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Revised: 11/08/2007] [Accepted: 11/08/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND The management of penetrating subclavian artery injuries poses a formidable surgical challenge. The feasibility of stent graft repair is already established. General use of this modality is not widely accepted due to concerns regarding the long-term outcome in a generally young patient population. We review our stent graft experience to examine long-term outcomes. METHODS All patients with penetrating subclavian artery injuries were evaluated for stent graft repair. Patients were excluded when hemodynamically unstable or unsuitable on other clinical and angiographic grounds. Patients were followed prospectively for early (<30 days) and late (>30 days) complications. Clinical and telephone evaluation, Doppler pressures, duplex Doppler, and angiography (when indicated), were used to asses patients at follow-up. Outcomes were recorded as technical success of procedure, graft patency, arm claudication, limb loss, the need for open surgical repair, the presence or absence of other complications, and death. RESULTS Fifty-seven patients underwent stent graft treatment during the 10-year period. Mean age was 34, and 91% were men. There were 53 stab wounds and four gunshot injuries. Pathology included false aneurysms (n = 42), arteriovenous fistula (n = 12), and three arterial occlusions. Early complications: One patient (2%) had a femoral puncture site injury which was managed with open surgical repair. One patient died early due to multiple organ failure related to concomitant injuries. Three patients (5%) presented with graft occlusion and nonlimb threatening ischemia in the first week after treatment. All three patients were managed successfully with a second endovascular intervention. Late complications: Twenty-five (44%) of the 57 patients with subclavian artery injuries were followed-up with a mean duration of 48 months. Two patients died as a result of fatal stab wounds months after their first injuries. Five patients (20%) and three patients (12%) presented with angiographically significant stenosis and occlusions, respectively. The stenotic lesions were successfully managed with endovascular intervention, and the occluded lesions were managed conservatively. No patient experienced life or limb loss or any incapacitating symptoms at the end of the study period. There was no need for conversion to open surgery. CONCLUSIONS This study has reaffirmed the feasibility and safety of stent graft repair in treating stable patients with selected penetrating subclavian artery injuries. The results of this study also confirmed acceptable long-term follow-up without any limb or life threatening complications. We conclude that endovascular repair should be considered the first choice of treatment in stable patients with subclavian artery injuries.
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Affiliation(s)
- Daniel F du Toit
- Department of Surgery, University of Stellenbosch, Tygerberg Hospital, Tygerberg, South Africa.
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Simmons JD, Haraway AN, Schmieg RE, Burgdorf M, Duchesne J. Is there a role for secondary thoracic ultrasound in patients with penetrating injuries to the anterior mediastinum? Am Surg 2008; 74:11-14. [PMID: 18274421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Pericardial tamponade (PT) after penetrating thoracic injury can be lethal if not diagnosed and treated promptly. Most patients present with PT shortly after their injuries occur, but delayed presentation of PT (delayed pericardial tamponade [DPT]) has occurred as late as 73 days after initial injury. Initial evaluation of patients with an anterior mediastinal penetrating injury includes physical examination, chest x-ray, and echocardiography. CT scans of the chest can clarify the tracts of penetrating injuries in stable patients. With increased accessibility to these radiographic modalities, PT has been diagnosed in a more timely fashion, and the incidence of DPT has decreased. However, the absence of pericardial effusions on all of these studies at initial presentation does not clear the patient from risk for developing DPT.
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Affiliation(s)
- Jon D Simmons
- Department of Trauma and Surgical Critical Care, The University of Mississippi Medical Center, Jackson, Mississippi 39216, USA.
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Affiliation(s)
- Peter C Bautz
- Trauma Service, Royal Adelaide Hospital, Adelaide, Australia
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Sugrue M, Balogh Z, Lynch J, Bardsley J, Sisson G, Weigelt J. Guidelines for the management of haemodynamically stable patients with stab wounds to the anterior abdomen. ANZ J Surg 2007; 77:614-20. [PMID: 17635271 DOI: 10.1111/j.1445-2197.2007.04173.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Clinical practice guidelines have been shown to improve the delivery of care. Anterior abdominal stab wounds, although uncommon, pose a challenge in both rural and urban trauma care. A multidisciplinary working party was established to assist in the development of evidence-based guidelines to answer three key clinical questions: (i) What is the ideal prehospital management of anterior abdominal stab wounds? (ii) What is the ideal management of anterior abdominal stab wounds in a rural or urban hospital without an on-call surgeon? (iii) What is the ideal emergency management of stable patients with anterior abdominal stab wounds when surgical service is available? A systematic review, using Cochrane method, was undertaken. The data were graded by level of evidence as outlined by the Australian National Health and Medical Research Council. Stable patients with anterior abdominal stab wounds should be transported to the hospital without delay. Any interventions deemed necessary in prehospital care should be undertaken en route to hospital. In rural hospitals with no on-call surgeon, local wound exploration (LWE) may be undertaken by a general practitioner if confident in this procedure. Otherwise or in the presence of obvious fascial penetration, such as evisceration, the patient should be transferred to the nearest main trauma service for further management. In urban hospitals the patient with omental or bowel evisceration or generalized peritonitis should undergo urgent exploratory laparotomy. Stable patients may be screened using LWE. Abdominal computed tomography scan and plain radiographs are not indicated. Obese and/or uncooperative patients require a general anaesthetic for laparoscopy. If there is fascial penetration on LWE or peritoneal penetration on laparoscopy, then an urgent laparotomy should be undertaken. The developed evidence-based guidelines for stable patients with anterior abdominal stab wounds may help minimize unnecessary diagnostic tests and non-therapeutic laparotomy rates.
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Affiliation(s)
- Michael Sugrue
- Trauma Department, Liverpool Hospital, Sydney, New South Wales, Australia.
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Abstract
BACKGROUND The incidence of abdominal stab wounds treated at the Royal Melbourne Hospital, Parkville, Vic., Australia has noticeably increased over the 12 month period to March 2006, mirroring an increase in penetrating abdominal trauma throughout many Australian trauma centres. Management protocols for abdominal stab wounds are still contentious. The current study quantifies the increase in stab wounds at the Royal Melbourne Hospital over a 24 month period and analyses the management modalities used. METHODS A review of the Trauma Unit of the Royal Melbourne Hospital was performed for the period of 20 March 2004 until 20 March 2006. All anterior abdominal stab wounds were collated for the site of injury, investigations performed on admission, results of investigations, operations performed and findings at operation. RESULTS There were 4244 emergency trauma presentations over the 24 month period between 20 March 2004 and 20 March 2006. The second 12 month period showed a 21.5% increase in overall trauma admissions and a 91.3% increase in anterior abdominal stabbings. The percentage of stab wounds treated conservatively fell by 21.8%, with the percentage of laparotomies increasing by 14.2%. Almost 30% of all patients undergoing surgery had no visceral injury at operation. Twenty CT scans were performed preoperatively, with a sensitivity of 79% and specificity of 100%. CONCLUSION Abdominal stab wounds treated at Royal Melbourne Hospital have substantially increased over the past 12 months. Although management is still contentious, a management protocol for anterior abdominal stab wounds is proposed, outlining the role of CT scanning, conservative management, laparoscopy and laparotomy.
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Affiliation(s)
- Warren Matthew Rozen
- Department of Surgery, Trauma Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia.
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Abstract
OBJECTIVES Australasian trauma centres receive relatively low numbers of penetrating injuries from stabbings. There is limited agreement regarding protocols to guide the management of haemodynamically stable patients with penetrating injuries. This has resulted in a wide variation in practice with anecdotally high negative laparotomy rates. The aim of the present study was to review the ED procedures, investigations and disposition of this group of patients. METHODS A retrospective review of all patients presenting with abdominal penetrating injury was undertaken over a 5 year period. Data on demographics, presenting features and management were collected. RESULTS There were 109 patients who were haemodynamically stable (systolic blood pressure > 90) on arrival to the trauma centre. Diagnostic ED procedures and investigations consisted of wound exploration in 47 (43.1%) patients, focused abdominal sonography in trauma in 44 (40.4%) patients and a CT abdomen in 36 (33.0%) of patients. The sensitivity for focused abdominal sonography in trauma and CT when used together was 77.8%. There were 39 laparotomies performed with a negative laparotomy rate of 23.1%. There were 10 laparoscopies performed, none went on to require a laparotomy. Patients undergoing negative laparotomies spent significantly longer times in hospital than patients managed conservatively or those undergoing laparoscopies. CONCLUSIONS The number of penetrating abdominal injuries remains low. Imaging alone cannot reliably exclude intraperitoneal injury. A greater utilization of ED wound exploration and laparoscopy based on agreed guidelines could improve management. An algorithm for the management of these patients is suggested.
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Affiliation(s)
- Biswadev Mitra
- The Alfred Emergency & Trauma Centre, and Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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Li H, Li CD. [A case of stab wound of cervical spinal cord in a child]. Beijing Da Xue Xue Bao Yi Xue Ban 2007; 39:385-7. [PMID: 17657265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The stab wound of cervical spinal cord is rare in clinic. A four-year boy was encountered a directly posterior stab wound in neck by a knife in an accident. He was sent to hospital with hypovolemia shock. After treatment for hypovolemia shock MRI in cervical spine was performed which showed cervical spinal cord was partly cut from dorsal in C4.At the same time the leakage of cerebrospinal fluid was found near the cervical spine C4.He was treated with operation of decompression with local debridement and ligation hemostasis. After operation he received neuro nutrition drugs and Prednisolone because of neurologic deficit. A 14-month follow-up was made. His neurologic deficit was improved but deformity of cervical kyphosis appeared.
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Affiliation(s)
- Hong Li
- Department of Orthopedic, Peking University First Hospital, Beijing 100034, China
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Abstract
Emergency practitioners routinely encounter patients who suffer from abdominal trauma, be it blunt or penetrating. These injuries are often confounded by altered mental status, distracting injuries, or lack of historical information, and may present challenges in management. However, in the last several years new approaches to the diagnosis and management of abdominal trauma, including bedside ultrasound, newer generation computed tomography scans, laparoscopy, and the ability for selected nonoperative management expedite identification of life threatening injury and offer new options in treatment.
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Affiliation(s)
- Jennifer L Isenhour
- Department of Emergency Medicine, Carolinas Medical Center, 1000 Blythe Boulevard, Charlotte, NC 28203, USA.
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Abstract
In the United States, jail and prison populations continue to be on the rise. In 1976, the US Supreme Court mandated correctional facilities to provide necessary medical care to all incarcerated individuals. Often, this population is frequently associated with chronic illnesses and accidental injuries that require admission to the intensive care unit. This article will be a case presentation of a critically ill patient and a brief discussion of safe and effective interventions of the incarcerated patient in the intensive care unit.
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