ABSTRACT
Objectives: In hospital attendance, 75% of diaphragmatic hernias occur on left as opposed to 25% on the right side. Right side hernias are associated with abdominal injuries, mainly the liver. However, right-side injuries are frequently underdiagnosed due to the complexity of associated injuries and high mortality rates. The aim of this study was to perform a retrospective analysis of records from our clinical experience to investigate demographics, TM, diagnosis, morbidity, and mortality associated with right sided TDH. These findings may provide insights into improving the clinical management of patients with this serious injury, potentially reducing morbidity and mortality rates. Material and Methods: Retrospective analysis of the medical records of patients from the trauma database of the Division of Trauma Surgery at University of Campinas in 32-year period was performed. Only records of patients with right sided TDH were included in the analysis. Results: Blunt trauma was the most common mechanism. Diagnoses were made by laparotomy in eight cases, all these cases were hemodynamically unstable. TDH grade III injury occurred in most cases followed by grade IV. Liver injuries were present in almost all cases, most of them high grade, followed by colon and small bowel. Extra-abdominal associated injuries with a predominance of femur fractures, pelvic fractures and hemothorax. Post-operative complications were associated with length of stay in intensive care unit. Pneumonia was the most frequent complication. The overall mortality rate was 16%. Conclusion: Most diagnoses were performed through laparotomy and not by radiologic exams, due to hemodynamic instability on admission. There is underdiagnosis of right-side TDH due to the high-energy trauma mechanism with high grade associated injuries and mortality on pre-hospital.
Subject(s)
Education, Medical/methods , First Aid , Teaching/methods , Curriculum , Emergencies , First Aid/methods , Humans , LearningABSTRACT
A ocorrência de trauma no idoso vem crescendo de forma significativa, mediante ao crescimento desta população. Atualmente, o estilo de vida mais ativa do idoso eleva a exposição ao risco de acidentes. Além desse fator, o próprio envelhecimento fisiológico contribui: diminuição da acuidade visual, diminuição da audição, uso de medicações, doenças associadas e marcha lentificada. Outros sistemas orgânicos também possuem diminuição de suas funções: renal, pulmonar, cardiovascular, osteomuscular e endócrino. A queda é o mecanismo de lesão mais freqüente, seguido por atropelamento. Após o trauma o idoso possui uma decadência na sua qualidade de vida, não conseguindo retornar plenamente ao seu estado inicial. A prevenção por meio da redução de exposição aos riscos de trauma é a melhor ferramenta para diminuir a morbidade e mortalidade. Qualquer mínima alteração dos parâmetros fisiológicos pode ser indício de uma lesão potencialmente letal. Portanto, a abordagem inicial do idoso traumatizado deve ser realizada com maior atenção e rigorosamente monitorizada.
The occurrence of trauma in the elderly is growing significantly due to the increaseof number of this population. Currently, the more active lifestyle of the elderly leads them to be more exposed to the risk of accidents. Besides that, physiological ageing itself contributes to such risk: reduction of sight, reduction of hearing, use of medication, associated diseases and slow locomotion. Other organic systems also present reduction of their functions: renal, pulmonary, cardiovascular, musculoskeletal and endocrine. Fall is the most frequent mechanism of trauma, followed by motor vehicle crash. After the trauma there is a decline in the quality of life of the elderly since they have difficulty to fully recover. The best method to diminish morbidity and mortality is to prevent the elderly from being exposed to risks. Minimum alteration of the physiological parameters can suggest potentially lethal injury. Therefore, the initial approach to the traumatized elderly should be with careful attention and rigorous monitoring.
