Is the "Golden Hour" a valid concept for the injured child?

The "Golden Hour" is predicated upon immediate surgical management limiting exsanguination, restoring perfusion, and maintaining oxygenation. The validity and relevance of this concept as it applies to the injured child has not been assessed. We analyzed 737 fatalities from blunt injuries recorded in a large mutli-centre trauma registry. Data were analyzed to determine: age, time of death, cause of death and injury patterns using ICDA-9-CM (ICD9) codes and Abbreviated Injury Scale (AIS). Age (yrs; mean ñ SD was 7.9 ñ 5.8. Although there was a bimodal distribution to length of survival, 20 percent of these children were dead within an hour, 60 percent were dead within 24 hours, and only 4 percent survived longer than 10 days. 698 had a least one central nervous system (CNS) injury. Comparison of ICD9 codes and AIS of 5 or 6. Isolated central neuraxis derangement occurred as the sole injury in 191 children. Polysystem trauma was recorded in 507 patients (68 percent), 39 of whom had no CNS component. Of 125 children presenting with a systolic BP <50 mm Hg, only 39 had potentially exsanguinating extracranial injury. The thorax sustained the highest injury severity associated with CNS trauma and was reported in 221 patients with pulmonary contusion, hemopneumothorax, to rib fracture in decreasing frequency. These observations indicate that hte paediatric "Golden Hour" is a respiratory rather than circulatory phenomenon. The fact that only 17 percent of this group of blunt trauma victims presented in shock underscores the importance of judicious volume resuscitation that avoids fluid overload as well as hypoperfusion.(AU)

Acute myocardial infraction following blunt chest trauma due to the kick of a cow

A previously healthy 29-year-old man developed electrocardiographic evidence of an anterolateral myocardial infarction following the kick of a cow to the left precordial area. This was complicated by three episodes of ventricular fibrillation and cardiogenic shock. After five months, electrocardiographic and echocardiographic evidence of ventricular aneurysm persists (AU)

Rupture of the right hemi-diaphragm secondary to blunt trauma

Injuries to the right hemidiaphragm secondary to blunt trauma are unusual. Three new cases are reported, demonstrating the need for a high index of suspicion in patients with blunt abdomino-thoracic trauma. Routine examination ofthe hemidiaphragm should also be performed when laparotomy is pursued in such patients. Radiological investigations are often helpful in evaluating the patient with the "high right hemidiaphragm" and here the possibility of a traumatic right hemidiaphragmatic hernia should always be considered, even if no history of recent trauma is given (AU)

Non-penetrating pancreatic trauma

The pathogenesis and management of trauma to the pancreas as a result of non-penetrating injury are discussed, and two illustrative cases presented (AU)

Modern concepts in the pathology of blunt head injury

Head injury is a common cause of death and disability particularly in the first half of life and the mortality from severe head injury still approached 50 percent even in highly specialized neurosurgical units. This consistent mortality and morbidity is a challenge to better understand the pathology of blunt head injury and by so doing to find improved methods of management