RESUMO
BACKGROUND/AIMS: This study was conducted to investigate effective management strategies for patients with severe blunt liver injuries. METHODOLOGY: Treatment methods and outcomes of 77 patients with grade IV-V damage among patients with liver injury managed between 2009 and 2013 were investigated. RESULTS: Of the 77 patients, 32 were managed surgically. Packing was performed in 29 of these patients, while 26 also underwent liver surgery to maximize the hemostatic effect of packing. All 32 underwent temporary abdominal closure, and the mean amount of blood products used in the first 24 hours after admission included packed red blood cell, 13.3 units; fresh frozen plasma, 12.4 units; and platelets, 12.2 units, very close to 1:1:1. A total of 9 of 77 (11.7%) patients and 8 of 32 who underwent the operation died (operative mortality rate, 25%). Liver-related uncontrolled hemorrhage contributing to death occurred in four patients (12.5%). CONCLUSIONS: Although nonoperative management can first be pursued if the patient's condition allows for it, hemodynamic instability and evidence of peritonitis requires surgical management. Surgical management should abide by the damage control surgery principles that focus on packing to minimize surgical time, followed by aggressive critical care according to damage control resuscitation.
Assuntos
Traumatismos Abdominais/cirurgia , Hemorragia/cirurgia , Técnicas Hemostáticas , Hepatectomia , Fígado/lesões , Fígado/cirurgia , Ferimentos não Penetrantes/cirurgia , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/etiologia , Traumatismos Abdominais/mortalidade , Traumatismos Abdominais/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue , Criança , Pré-Escolar , Feminino , Hemodinâmica , Hemorragia/diagnóstico , Hemorragia/etiologia , Hemorragia/mortalidade , Hemorragia/fisiopatologia , Técnicas Hemostáticas/efeitos adversos , Técnicas Hemostáticas/mortalidade , Hemostáticos/uso terapêutico , Hepatectomia/efeitos adversos , Hepatectomia/mortalidade , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Fígado/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Peritonite/etiologia , Peritonite/cirurgia , República da Coreia , Fatores de Risco , Técnicas de Sutura , Fatores de Tempo , Adesivos Teciduais/uso terapêutico , Resultado do Tratamento , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/etiologia , Ferimentos não Penetrantes/mortalidade , Ferimentos não Penetrantes/fisiopatologia , Adulto JovemRESUMO
The presentation of traumatic abdominopelvic injuries in sport can range from initially benign appearing to hemorrhagic shock. A high clinical suspicion for injury, knowledge of the red flags for emergent further evaluation, and familiarity with the initial stabilization procedures are necessary for sideline medical providers. The most important traumatic abdominopelvic topics are covered in this article. In addition, the authors outline the evaluation, management, and return-to-play considerations for the most common abdominopelvic injuries, including liver and splenic lacerations, renal contusions, rectus sheath hematomas, and several others.
Assuntos
Traumatismos Abdominais , Medicina Esportiva , Esportes , Humanos , Medicina Esportiva/métodos , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/cirurgiaAssuntos
Parede Abdominal/cirurgia , Borracha , Técnicas de Sutura , Suturas , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/cirurgia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Reoperação/métodos , Medição de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Cicatrização/fisiologia , Adulto JovemRESUMO
Pancreatic injuries in the athlete are seldom reported in the literature. These injuries can result from atraumatic etiologies and blunt abdominal trauma. Atraumatic pancreatic injuries in the athlete are diagnosed and treated in a similar manner to the nonathletic patient. Fluid replacement, analgesic support, metabolic stabilization, and minimization of gastric stimulation are the primary management methods for this type of pancreatic injury. Athletically related traumatic pancreatic injury is associated with a high morbidity and mortality. The consequences of a delayed diagnosis make this type of injury an important diagnostic consideration in an athlete with abdominal pain. Initial clinical, radiologic, and laboratory findings of direct injury to the pancreas are often equivocal, and require clinical suspicion and further investigation. Current evidence suggests that pancreatic duct injury is the primary cause of the morbidity and mortality associated with the direct trauma. A conservative or surgical management plan should be based on a combination of serial clinical examinations, pancreatic enzyme levels, and either magnetic resonance retrograde choleopancreatogram or endoscopic retrograde chloangiopancreatography investigations to rule out ductal injury. The prevention of pancreatic and other intra-abdominal injuries is an evolving area of sports medicine research. Sports specific epidemiologic data collection and analysis are important elements in the development of evidence-based interventions.
Assuntos
Traumatismos em Atletas/diagnóstico , Pâncreas/lesões , Traumatismos Abdominais/diagnóstico , Traumatismos em Atletas/cirurgia , Hematoma/diagnóstico , Hematoma/cirurgia , Humanos , Lacerações/diagnóstico , Lacerações/cirurgia , Medicina EsportivaRESUMO
HYPOTHESIS: Awareness of guidelines for damage control can improve patient outcomes after postraumatic open abdomen. DESIGN: Retrospective (November 1992 to December 1998), prospective (January 1999 to July 2001), 104-month study. SETTING: Los Angeles County and University of Southern California Medical Center, Los Angeles. PATIENTS: All patients undergoing damage control resulting in posttraumatic open abdomen. MAIN OUTCOME MEASURES: The main outcome measure was survival. Data were also collected on surgical findings and indications for damage control, including organs injured, intraoperative estimated blood loss, and intraoperative fluids, blood, and blood products administered. Postoperative complications, length of time patients had an open abdomen, and surgical intensive care unit and hospital length of stay were also recorded. RESULTS: No difference in mortality existed between patients admitted before awareness of guidelines (group 1; 21 [24%] of 86 patients died) and patients who underwent damage control following these suggested guidelines (group 2; 13 [24%] of 53 patients died) (P =.85). Of the 139 patients, 100 had penetrating injuries and 39 had blunt injuries. Estimated blood loss was 4764 +/- 5349 mL. Mean intraoperative fluid replacement was 22 034 mL. One hundred one patients (73%) experienced 228 complications, for a mean of 2.26 complications per patient. Group 1 patients spent a longer time in the operating room (mean, 4.09 +/- 1.99 hours; range, 0.4-9.5 hours) vs group 2 patients (mean, 2.34 +/- 1.50 hours; range, 0.3-6.2 hours; P<.001). The surgical intensive care unit length of stay was 23.5 +/- 18.3 days vs 8.7 +/- 14.9 days (P<.001), and the hospital length of stay was 37.4 +/- 27.5 days vs 12.4 +/- 21.0 days (P<.001) in survivors and nonsurvivors, respectively. CONCLUSIONS: We recommend close monitoring of intraoperative outcome predictors as validated within our guidelines and recommend following our model for early institution of damage control.
Assuntos
Traumatismos Abdominais/mortalidade , Traumatismos Abdominais/cirurgia , Mortalidade Hospitalar/tendências , Avaliação de Resultados em Cuidados de Saúde , Guias de Prática Clínica como Assunto , Gestão da Qualidade Total , Traumatismos Abdominais/diagnóstico , Centros Médicos Acadêmicos/normas , Resinas Acrílicas , Adulto , Conscientização , California , Cuidados Críticos , Tratamento de Emergência/normas , Tratamento de Emergência/tendências , Feminino , Humanos , Escala de Gravidade do Ferimento , Laparotomia/efeitos adversos , Laparotomia/métodos , Tempo de Internação , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Probabilidade , Estudos Prospectivos , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Resultado do TratamentoAssuntos
Hérnia Abdominal/cirurgia , Hérnia Diafragmática Traumática/cirurgia , Traumatismo Múltiplo/cirurgia , Telas Cirúrgicas , Ferimentos não Penetrantes/diagnóstico , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/cirurgia , Acidentes de Trânsito , Idoso , Feminino , Seguimentos , Hérnia Abdominal/diagnóstico , Hérnia Diafragmática Traumática/diagnóstico por imagem , Humanos , Escala de Gravidade do Ferimento , Traumatismo Múltiplo/diagnóstico , Politetrafluoretileno/uso terapêutico , Radiografia , Procedimentos de Cirurgia Plástica/métodos , Ruptura/diagnóstico , Ruptura/cirurgia , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/cirurgia , Resultado do Tratamento , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/cirurgiaRESUMO
Sports medicine physicians should be aware of the many injuries that are associated with blunt abdominal trauma. From benign diaphragmatic spasms and rectus abdominis hematomas to the more concerning liver, splenic, renal, and pancreatic injuries, the sideline physician needs to be able to triage athletic-related injuries. Furthermore, many athletes will ask their physician about return-to-play recommendations and continuing care following blunt abdominal trauma. The sports medicine physician should have a working knowledge of the pathophysiology of various abdominal injuries to best advise and treat his or her team members.
Assuntos
Traumatismos Abdominais/diagnóstico , Ferimentos não Penetrantes , Traumatismos em Atletas/classificação , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/epidemiologia , Feminino , Humanos , Masculino , Vigilância da População , Medicina Esportiva , Índices de Gravidade do Trauma , Estados Unidos/epidemiologiaRESUMO
Professional boxing has done an admirable job in promoting safety standards in its particular sport. However, injuries occur during the normal course of competition and, unfortunately, an occasional life-threatening emergency may arise. Although most common medical emergencies in boxing are injuries from closed head trauma, in this article those infrequent but potentially catastrophic nonneurologic conditions are reviewed along with some less serious emergencies that the physician must be prepared to address.
Assuntos
Traumatismos em Atletas/terapia , Boxe/lesões , Serviços Médicos de Emergência , Medicina Esportiva , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/terapia , Traumatismos em Atletas/diagnóstico , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/terapia , Emergências , Humanos , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/terapia , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/terapia , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapiaRESUMO
PURPOSE: Analysis of outcome in terms of the moment at which mobilisation and enteral feeding may be started in patients undergoing non-surgical treatment for splenic trauma. MATERIALS & METHODS: 19 patients, median age 29 years, admitted to our hospital between 1988 and 1993. The diagnosis of splenic trauma was confirmed by abdominal computerized axial tomography and the lesions classified according to severity. Initial clinical and paraclinical diagnostic indices, evolution, duration of bed-rest and of nil by mouth-regimen, clinical follow-up at 30 months were recorded. RESULTS: 12 patients had type I or II lesions and 6 had type III lesions according to the Buntain classification [5]. 2 patients with type III lesions underwent laparotomy on the 4th day posttrauma. 11 patients had other associated lesions and 12 were admitted to the surgical intensive care unit (SIC). Bed rest was continued for an average of 2.7 days and enteral nutrition was restarted an average of two days after trauma when bowel sounds reappeared. All patients survived to leave hospital and 90% were alive at 30 months. CONCLUSIONS: Mobilisation and enteral feeding in patients treated non-surgically for Buntain type I, II and III splenic lesions should be restarted as soon as the clinical course allows.
Assuntos
Deambulação Precoce , Nutrição Enteral , Baço/lesões , Ferimentos não Penetrantes/terapia , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo , Estudos Retrospectivos , Baço/diagnóstico por imagem , Esplenectomia , Fatores de Tempo , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Abdominal injuries are rare in sports, but when they do occur it is important that the physician recognize the warning signs of potentially life-threatening injury to the liver, spleen, or hollow abdominal viscera. Though the sports medicine physician may not always provide definitive treatment of many of these conditions, he or she should be familiar with the preferred diagnostic modalities and latest treatment options. This information is not only essential to appropriately participate in treatment decisions, but is also important in order to make return-to-play determinations.