Ultrasound in Trauma and Other Acute Conditions in Sports, Part I.

The utility of ultrasound in sports medicine is improving the sports medicine physician's ability to rapidly diagnose and treat a multitude of sports related pathologies. In this article, we clearly outline the current status of the evidence in support of using sports ultrasound in the setting of acute abdominal and thoracic trauma, acute lung illness, limited cardiac evaluation of a collapsed athlete, volume status assessment, and fracture evaluation.

Seat-Belt Abdominal Aortic Injury-Treatment Modalities.

Blunt abdominal aortic injuries are extremely rare, diagnosed in less than 0.05% of all trauma admissions. Aortic injury caused by a seat belt during a car accident is often referred as "seat-belt aorta". We present a case of an 18-year-old woman, restrained back passenger involved in a vehicular collision, sustaining vertebral column and multiple rib fractures, mesenterium and colonic injury, and infrarenal aortic contusion with localized dissection and partial thrombosis.

Surgical treatment of traumatic eventration with polyester button and polypropylene mesh to strengthen the suture technique in equine.

BACKGROUND: Defects in the abdominal wall of horses have high relapse rate. This is mainly in lateral eventrations and hernias caused by trauma from kicks of other horses or installation structures. The eventration region normally becomes swollen and there may be complications due to intestinal loop incarceration. The surgical treatment, consisting of reconstruction of the abdominal wall, frequently require biological or synthetic materials for the reinforcement of the suture line and tension support. Therefore, several studies have reported new materials for the repair of the abdominal wall, with the aim of improving the integration among adjacent tissues and reducing risks and complications such as rejection and infection. This report describes for the first time the use of a regular polypropylene mesh reinforced with polyester buttons for the herniorrhaphy. CASE PRESENTATION: A male, three-year-old, Appaloosa with 500 Kg presented to our hospital with a 10 days history of an increased volume on the left ventro-lateral region of the abdomen. During the physical examination, a deventration following traumatic rupture of the abdominal wall was diagnosed via ultrasonography. Then, the equine was anesthetized and moved to surgery for correction of the eventration which was performed according to conventional technique described in literature. Two days later, an eventration relapse was observed and confirmed via ultrasonography. After that, a second surgical intervention was performed using polyester buttons and polypropylene mesh. After the second surgical procedure, no complications related to eventration were observed either intra or postoperatively. After that, a recheck was performed thirty days later where satisfactory wound healing and total recovery were observed. CONCLUSION: The use of polypropylene mesh reinforced with polyester buttons is an effective technique for the repair of traumatic eventration in horses. This technique provides effective reinforcement against the abdominal tension and was a good option for reconstruction of lacerated muscles in cases of equine post-traumatic eventration, including relapsing cases.

An Unusual Case of Anaphylaxis after Blunt Abdominal Trauma.

BACKGROUND: Due to current human migratory patterns, emergency physicians in developed countries are facing emergent clinical presentations of neglected tropical diseases with increasing frequency. In those situations, the clinician's diagnosis is often delayed due to a lack of familiarity with the disease. CASE REPORT: We present the case of a 25-year-old Peruvian man who presented to the Emergency Department complaining of dyspnea and abdominal pain after upper abdominal trauma. His physical examination revealed mouth and eyelid edema in association with epigastric pain. An abdominal computed tomography scan revealed a liver hydatid cyst. Emergent surgical evacuation of the cyst was required to control the anaphylactic reaction. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Anaphylaxis in the setting of a complicated hydatid cyst is a life-threatening disease. Critical care management and emergent surgical evacuation of the cyst are indicated.

Sports medicine ultrasound (US) beyond the musculoskeletal system: use in the abdomen, solid organs, lung, heart and eye.

The use of point-of-care ultrasound (US) by non-radiologists is not new and the expansion into sports medicine practice is relatively young. US has been used extensively to evaluate the musculoskeletal system including the diagnosis of muscle, tendon and bone injuries. However, as sports medicine practitioners we are responsible for the care of the entire athlete. There are many other non-musculoskeletal applications of US in the evaluation and treatment of the athlete. This paper highlights the use of US in the athlete to diagnose pulmonary, cardiac, solid organ, intra-abdominal and eye injuries.

Nuking the radiation: minimizing radiation exposure in the evaluation of pediatric blunt trauma.

PURPOSE OF REVIEW: Our objective is to highlight recent literature investigating low-radiation diagnostic strategies in the evaluation of pediatric trauma. RECENT FINDINGS: In the area of minor head injury, research has focused on implementation of validated clinical decision rules into practice to reduce unnecessary computed tomography scans. Clinical observation may also serve as an adjunct to initial assessment and a potential substitute for computed tomography imaging. Subgroups of children with special needs or severe injury mechanisms may also be safely characterized by the clinical decision rule and spared radiation exposure. Physical examination techniques may be useful in diagnosing mandibular fractures. In addition, evidence suggests that plain radiography for evaluation of blunt thoracic trauma may be sufficient in many cases, and computed tomography could be reserved for those with abnormal radiographs, high-risk mechanisms, or abnormal physical findings. Clinical decision rules are able to predict intra-abdominal injury with high sensitivity. Data suggest that skeletal surveys may be modified to limit radiation exposure in the case of suspected nonaccidental trauma. SUMMARY: More research is needed in development of pediatric-specific clinical decision rules and risk stratification and in testing low-radiation diagnostic modalities in the pediatric trauma population.

Wound irrigation before abdominal computed tomography scanning.

The management of penetrating abdominal trauma has evolved considerably over the last 30 years. The goal of any algorithm for penetrating abdominal trauma should be to identify injuries requiring surgical repair and avoid unnecessary laparotomy with its associated morbidity. We describe a case where the infusion of povidone-iodine (Videne) and air into the wound uncovered the peritoneal breach clinically and guided the radiologist to the site of the internal injury. This case report raises an intriguing possible role for povidone-iodine and air to be used both for wound toilet and to aid identification of occult wound tracks on computed tomography imaging. We advocate the routine use of wound irrigation with a mixture of povidone-iodine and air as described, in a select group of patients, as an adjunct to diagnosis before abdominal computed tomography scanning.

Radiographic evaluation of the patient with sport-related abdominal trauma.

Abdominal injuries are rare in sports, but they can be very serious, even life threatening when they occur. With the increasing popularity of snowboarding and extreme skiing, the rate of abdominal injuries is beginning to rise slightly. It is imperative that physicians be able to recognize signs of injury to the liver, spleen, kidney, and hollow abdominal viscera and order appropriate diagnostic tests to investigate these injuries. This article focuses on the imaging modalities physicians can use to assist in diagnosis of sport-related abdominal trauma. Although the sports medicine physician will likely not provide definitive care and treatment of these injuries, because a team approach works best, it is important to know how to diagnose them through the proper studies.

Rapid physical assessment of the injured child.

Traumatic injuries that involve the dentition and maxillofacial region may occur as isolated events in pediatric patients but are often associated with multisystem injuries and traumatic brain injuries. The primary trauma survey serves to identify and treat life-threatening injuries. The secondary trauma survey is a complete examination of the patient after the stabilization of physiological parameters. Frequent neurologic and physical assessments of the injured child are crucial to preventing deterioration. The role of the dental professional is to identify and refer for medical evaluation patients who present with concerning neurologic signs and symptoms after traumatic injuries to the maxillofacial region.

A retrospective analysis of timing of mobilisation and start of enteral feeding in 19 patients treated non-surgically for splenic trauma.

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.