Airbag-related penetrating injuries: A case series from a level 1 trauma center.

Background: Airbags have significantly reduced the morbidity and mortality associated with trauma following motor vehicle crashes. However, airbags can also be associated with unusual and complex patterns of injuries which could be fatal in some cases. Methods: We collected data and described a series of six cases of penetrating injuries related to airbag deployment that were treated at the Hamad Trauma Center (HTC) of Hamad Medical Corporation which is the only level 1 trauma center in the country. Results: The penetrating injuries were caused by a metal fragment from the inflator component of the airbag which acted as a projectile and was associated with two fatalities. Four of the victims were involved in head on collisions. Most injuries were directly attributable to the airbag projectile, and they occurred in vehicles that were 9 years or more since manufacture. Conclusion: This case series would help the trauma healthcare providers to better understand the airbag-related injuries which influence the management approach for road traffic injuries associated with penetrating trauma. Also, it would bring attention to injury prevention teams as well as state and industrial authorities to reevaluate safety standards in vehicles. Sharing this information with local authorities who govern product safety standards and recalls is essential to ensure that more safety actions are taken to prevent further airbag deployment injuries.

Meat grinder injury of the arm: how to extract an arm safe, fast and pain free: case report and literature review.

Among the work-related injuries, meat grinder injuries are not uncommon. One of the major challenges in the trauma resuscitation room is the appropriate choice of anesthesia/analgesia when the patient is still conscious and the second challenge is to find the best way to early extract the patient's limb out of the machine without adding more suffering. Herein, we presented a 23-year-old male patient who was brought fully conscious in a kneeling position with the right forearm entrapped in a big meat grinder machine with part of the crushed fingers being extruded out of the machine. The patient was in severe pain; however, his vital signs were stable. Analgo-sedation with Midazolam/Ketamine followed by ultrasound guided upper limb regional anesthesia was used and showed to be a fast and safe alternative in a conscious, not fasting patient when the extremity is still entrapped in a meat grinder machine.

The use of Indocyanine green fluorescent in patients with abdominal trauma for better intraoperative decision-making and less bowel anastomosis leak: case series.

Despite technological advances in the management of blunt abdominal trauma, the rate of bowel anastomotic leakage (AL) remains high. The etiology of AL is multifactorial, but insufficient blood perfusion is considered to play a substantial role in the pathogenesis. In recent years, angiography with Indocyanine green (ICG), a fluorescent dye, has been introduced in the clinical practice to assess organ perfusion in several conditions. Given the scarcity of publications describing the use of ICG in trauma patients as a potentially useful strategy that may facilitate intraoperative decisions and limit the extent of bowel resection, we presented the utility of intraoperative ICG fluorescent in abdominal trauma patients in a level 1 trauma center. The use of ICG fluoroscopy in patients with abdominal trauma is feasible and useful; however, large prospective studies in trauma patients are warranted.

Traumatic Kidney Injury: An Observational Descriptive Study.

BACKGROUND: Trauma is a major cause of death and disability worldwide. Renal injuries account for 8-10% of abdominal trauma. We aimed to describe the incidence, presentation, and management of traumatic kidney injury in our institution. METHODS: This is a retrospective analysis of all patients admitted with traumatic kidney injury at a level 1 trauma center between January 2014 and December 2017. RESULTS: During a period of 3 years, a total of 152 patients with blunt renal trauma were admitted to a level 1 trauma center; 91% of these were males, with a mean age of 32.8 ± 13.7 years. Motor vehicle crashes accounted for 68% of cases, followed by fall from height (23%). Seventy-one percent of patients had associated chest injuries, 38% had pelvis injuries, and 32% had head injury. Associated abdominal injuries included the liver (35%) and spleen (26%). The mean abdominal abbreviated injury scale was 2.8 ± 1.0; and for those with severe renal injury, it was 3.9 ± 0.9. The mean injury severity score was 24.9 ± 13.7 (31.8 ± 14.2 with renal vs. 21.9 ± 12.9 without renal injury, p = 0.004). Most of the patients were treated conservatively (93%), including severe renal injuries (grades IV and V), and 7% had surgical exploration, mainly those with severe injuries (grades IV and V). The mortality rate was 11%. CONCLUSIONS: High-grade renal injuries in hemodynamically stable patients can be managed conservatively. A multidisciplinary approach coordinated by trauma, urology, and radiology services facilitates the care of these patients in our trauma center.

Delayed presentation of intussusception with perforation after splenectomy in patient with blunt abdominal trauma.

Adult intussusception (AI) following blunt abdominal trauma (BAT) is a rare surgical condition. We present a case of delayed diagnosis of ileocecal junction intussusception with a perforation of small bowel in a 34-year-old male with a history of fall from height. Initial exploratory laparotomy revealed shattered spleen requiring splenectomy. Initial abdominal computerized tomography scanning (CT) scan showed dilated small bowel with no organic obstruction. Patient started to improve with partial distention and was shifted to rehabilitation unit. On the next day, he experienced severe abdominal distention and vomiting. Abdominal CT showed characteristic intussusception at the distal ileum. Secondary exploratory laparotomy revealed severe adhesions of stomach and small bowel to the anterior abdominal wall with dilated small bowel loops and intussusception near the ileocecal junction with perforation of small bowel. The affected area was resected and side-to-side stapled anastomosis was performed. Though small bowel intussusception is a rare event, BAT patients with delayed symptoms of bowel obstruction should be carefully evaluated for missed intussusception.