RESUMO
We present the management of a 16-year-old female patient with a complete transection of the right brachial artery, following a close-range high velocity penetrating gunshot wound. Due to the unique challenges posed in a regional setting, lack of formal vascular expertise on-site, and inability to transfer to a vascular trauma centre, a Temporary Intravascular Shunt was employed using a paediatric feeding tube to revascularise the limb. This article highlights the successful temporary revascularization approach and the importance of resourcefulness in managing complex vascular trauma in non-specialized centres.
RESUMO
The spleen is one of the most commonly injured organs in blunt abdominal trauma, accounting for a vast portion of solid organ injuries, and may lead to rapid haemodynamic instability, requiring urgent operative intervention. Total splenectomies result in relative immunocompromise, with a risk of overwhelming post-splenectomy infection (OPSI) post splenectomy. This case reports the surgical management of a 20-year-old male with a grade IV splenic laceration after a motor vehicle accident. The patient underwent a trauma laparotomy with a partial splenectomy because of early take-off of the upper-lobar branch of his splenic artery, with an absorbable mesh wrap to tamponade the spleen. The patient avoided the need for a total splenectomy and was discharged after six days in the hospital with an uncomplicated recovery.
RESUMO
BACKGROUND: Horse and cattle-related trauma is a common presentation to regional hospitals in Australia. We review local incidence and patterns of injuries relating to horse and cattle trauma over a three-year period at the Toowoomba Base Hospital within the Darling Downs region in Queensland, an area rich in cattle farming and equestrian recreation. METHODS: We conducted a single-centre retrospective cohort study. The inclusion criteria were all patients presenting with injuries following cattle or horse-related incidents between January 2018 and April 2021. Primary outcomes were the mechanism of trauma, confirmed injuries, and the need for admission, operative intervention, or inter-hospital transfer. RESULTS: A total of 1002 individuals (55% female; mean age 34 years; median Injury Severity Score (ISS) 2) were identified during the study period. Presentations relating to horses (81%) were more frequent than cattle (19%). The most common mechanism of injury was "falling" for horse incidents (68%) and "trampling" for cattle incidents (40%). Horse incidents often resulted in soft tissue injury (55%), upper limb fracture (19%), or lower limb fracture (9%). Cattle incidents often resulted in soft tissue injury (57%), upper limb fracture (15%), and rib fracture (15%). Overall, 14% required admission, 13% required operative intervention, and 1% required inter-hospital transfer. CONCLUSIONS: This local series demonstrates a high volume of cattle and horse-related trauma in our region. Whilst most patients are managed locally without operative intervention, the high frequency of injuries observed necessitates further development of preventative measures and safety advocacy.
RESUMO
An otherwise healthy 45-year-old man presented to our emergency department holding his left arm in abduction and external rotation. He reported pain in his left shoulder and chest for the preceding 10 days that had become much worse over the last 48 h and was eased only by holding his arm in this position. The CT of the chest revealed soft tissue swelling around the left sternoclavicular joint consistent with sternoclavicular joint septic arthritis with significant inflammatory involvement of the medial component of the left pectoralis major muscle. The patient was taken to theatre for washout of the left sternoclavicular joint and is currently recovering well at home on intravenous antibiotics.