Current Issue : April - June Volume : 2012 Issue Number : 2 Articles : 7 Articles
Purpose: To evaluate visual outcomes and anterior segment complications in patients with ocular contusion trauma.\r\n Methods: All cases of ocular trauma were reviewed retrospectively from January 2008 to December 2010 via a computerized database; forty-six cases of ocular contusion were identified. Patients� demographic features, initial and final clinical findings and also initial and final best corrected visual acuities (BCVA) of logMar were recorded. Patients were grouped according to age; 18 years or younger were grouped in group 1, and older than 18 years group 2. Initial and final anterior segment findings affecting the initial and final BCVA were investigated. Also anterior segment findings and initial and final BCVA were compared among the groups.\r\n Results: In group 1 there were 19 (63.3%) males and 11 (26.7%) females; group 2 was comprised of 12 (75%) male and four (25%) female subjects. There was no statistically significant difference in initial BCVA between the groups (p>0.05), final BCVA difference in group 1 was found to be statistically significant (p< 0.05). Cataract and angle recession were found to be more prevalent in group 2 (p< 0.05). Initial anterior segment findings contributed to 61.4 % of initial BCVA, whereas final anterior segment findings explained 57.4 % of final BCVA.\r\n Conclusion: Exact examination and management at the proper time of findings are essential for successful treatment and an improved visual prognosis for ocular contusion....
Traumatic brain injury (TBI) is a major medical and socio-economic problem, and is the leading cause of death in\r\nchildren and young adults. The critical care management of severe TBI is largely derived from the ââ?¬Å?Guidelines for\r\nthe Management of Severe Traumatic Brain Injuryââ?¬Â that have been published by the Brain Trauma Foundation. The\r\nmain objectives are prevention and treatment of intracranial hypertension and secondary brain insults, preservation\r\nof cerebral perfusion pressure (CPP), and optimization of cerebral oxygenation. In this review, the critical care\r\nmanagement of severe TBI will be discussed with focus on monitoring, avoidance and minimization of secondary\r\nbrain insults, and optimization of cerebral oxygenation and CPP....
Severe trauma-related bleeding is associated with high mortality. Standard coagulation tests provide limited\r\ninformation on the underlying coagulation disorder. Whole-blood viscoelastic tests such as rotational\r\nthromboelastometry or thrombelastography offer a more comprehensive insight into the coagulation process in\r\ntrauma. The results are available within minutes and they provide information about the initiation of coagulation,\r\nthe speed of clot formation, and the quality and stability of the clot. Viscoelastic tests have the potential to guide\r\ncoagulation therapy according to the actual needs of each patient, reducing the risks of over- or under-transfusion.\r\nThe concept of early, individualized and goal-directed therapy is explored in this review and the AUVA Trauma\r\nHospital algorithm for managing trauma-induced coagulopathy is presented....
Background: Hospitals are cornerstones for health care in a community and must continue to function in the face\r\nof a disaster. The Hospital Incident Command System (HICS) is a method by which the hospital operates when an\r\nemergency is declared. Hospitals are often ill equipped to evaluate the strengths and vulnerabilities of their own\r\nmanagement systems before the occurrence of an actual disaster. The main objective of this study was to measure\r\nthe decision making performance according to HICS job actions sheets using tabletop exercises.\r\nMethods: This observational study was conducted between May 1st 2008 and August 31st 2009. Twenty three\r\nIranian hospitals were included. A tabletop exercise was developed for each hospital which in turn was based on\r\nthe highest probable risk. The job action sheets of the HICS were used as measurements of performance. Each\r\nindicator was considered as 1, 2 or 3 in accordance with the HICS. Fair performance was determined as < 40%;\r\nintermediate as 41-70%; high as 71-100% of the maximum score of 192. Descriptive statistics, T-test, and Univariate\r\nAnalysis of Variance were used.\r\nResults: None of the participating hospitals had a hospital disaster management plan. The performance according\r\nto HICS was intermediate for 83% (n = 19) of the participating hospitals. No hospital had a high level of\r\nperformance. The performance level for the individual sections was intermediate or fair, except for the logistic and\r\nfinance sections which demonstrated a higher level of performance. The public hospitals had overall higher\r\nperformances than university hospitals (P = 0.04).\r\nConclusions: The decision making performance in the Iranian hospitals, as measured during table top exercises\r\nand using the indicators proposed by HICS was intermediate to poor. In addition, this study demonstrates that the\r\nHICS job action sheets can be used as a template for measuring the hospital response. Simulations can be used to\r\nassess preparedness, but the correlation with outcome remains to be studied....
Background: Blunt implementation of Western trauma system models is not feasible in low-resource communities\r\nwith long prehospital transit times. The aims of the study were to evaluate to which extent a low-cost prehospital\r\ntrauma system reduces trauma deaths where prehospital transit times are long, and to identify specific life support\r\ninterventions that contributed to survival.\r\nMethods: In the study period from 1997 to 2006, 2,788 patients injured by land mines, war, and traffic accidents\r\nwere managed by a chain-of-survival trauma system where non-graduate paramedics were the key care providers.\r\nThe study was conducted with a time-period cohort design.\r\nResults: 37% of the study patients had serious injuries with Injury Severity Score = 9. The mean prehospital\r\ntransport time was 2.5 hours (95% CI 1.9 - 3.2). During the ten-year study period trauma mortality was reduced\r\nfrom 17% (95% CI 15 -19) to 4% (95% CI 3.5 - 5), survival especially improving in major trauma victims. In most\r\npatients with airway problems, in chest injured, and in patients with external hemorrhage, simple life support\r\nmeasures were sufficient to improve physiological severity indicators.\r\nConclusion: In case of long prehospital transit times simple life support measures by paramedics and lay first\r\nresponders reduce trauma mortality in major injuries. Delegating life-saving skills to paramedics and lay people is a\r\nkey factor for efficient prehospital trauma systems in low-resource communities....
A syndrome of bleeding in the brain with retinopathy, but no external evidence of trauma, is known in infants. \nThere is an association with excessive crying and feeding difficulties in this condition. This has led to the hypothesis \nthat the injuries arise during violent shaking by an angry carer, causing the brain to rotate relative to the skull, \n(Shaken Baby Syndrome, SBS). \nAn alternative hypothesis, described here, (Dysphagic Infant Death Syndrome DIDS), is that injuries similar \nto those in SBS can result from venous hypertension during excessive coughing or vomiting. Such injuries occur \nââ?¬Å?naturallyââ?¬Â during paroxysms of coughing in Whooping Cough. High intra-abdominal pressure drives abdominal \nvenous blood up into the head, rupturing intracranial veins and capillaries. This results in subdural haemorrhages, \npetechiae in skin, and Valsalva Retinopathy in the eyes. This article considers when the excessive intra-abdominal \npressures are caused by violent vomiting and retching in pyloric stenosis.\nSome DIDS additional features, not occurring in SBS, may give warning of impending intracranial catastrophe. \nInfant skull suture growth rate depends on local stretch induced in the underlying Dura Mater. This will be increased \nduring venous hypertension, accelerating head growth rate analogous to the hydrocephalous mechanism. The \nprolonged inconsolable crying would be explained by Mallory-Weiss tears at the oesophageal-stomach junction \nduring repeated vomiting. Edema resulting from local leakage from over-distended cerebral veins and capillaries \nmay temporarily disable axon transmission, causing temporary loss of consciousness. Transient ââ?¬Å?spikingââ?¬Â fevers \nmay be seen in this condition if the temperature limiter center in the hypothalamus is temporarily disabled by such \nflooding. (Brainstem tissue is drained by the vertebral vein system whose tortuous nature smoothes out pressure \nspikes. This provides some protection of breathing and cardiac mechanisms which may remain normal.)\nIt is concluded that, unlike SBS, preventative measures should be possible for DIDS...
A rotator cuff tear in a polytraumatized patient can be a devastating injury if not identified early. Traumatic rotator cuff tears are often massive, and generally retract within a short period of time. If the tear is missed, the consequences are profound especially if the tear becomes irreparable and especially in the younger, more active population. These consequences include pseudoparalysis, persistent pain, and rotator cuff tear arthropathy. Specific examination of the polytraumatized patient with shoulder pain on secondary/tertiary survey should include a detailed assessment of the rotator cuff. Ultrasound has been advocated as a potential adjunct to MRI but most surgeons would agree that MRI is imaging study of choice for evaluation of the rotator cuff. The treatment of acute or acute on chronic traumatic rotator cuff tear in the polytraumatized patient should be early rotator cuff repair when the patient�s medical status allows....
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