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2.
Br J Radiol ; 93(1106): 20190017, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31899661

RESUMO

Paediatric aortic trauma is a rare injury which can be fatal if not identified and managed appropriately. Surgical repair remains the gold-standard in moderate to severe aortic injuries. In the last decade however, endovascular treatment has gained popularity in children who have suitable vascular anatomy for intervention and are either not fit for surgery or in whom, endovascular intervention is the only alternative that will make a difference in the clinical outcome. Children pose a unique set of challenges to endovascular therapy. In this article, we aim to illustrate the different endovascular options that are available for the treatment of acute traumatic aortic injury and visceral thromboembolisation through pictorial representation. We will also demonstrate the feasibility and the limitation of this technique.


Assuntos
Aorta Abdominal/lesões , Aorta Torácica/lesões , Procedimentos Endovasculares , Ferimentos não Penetrantes/cirurgia , Ferimentos Perfurantes/cirurgia , Acidentes de Trânsito , Adolescente , Aorta Abdominal/cirurgia , Aorta Torácica/cirurgia , Criança , Pré-Escolar , Angiografia por Tomografia Computadorizada , Estudos de Viabilidade , Humanos , Angiografia por Ressonância Magnética , Masculino , Ferimentos não Penetrantes/diagnóstico , Ferimentos Perfurantes/diagnóstico
3.
Prensa méd. argent ; 105(11): 783-785, dic2019. fig
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1049774

RESUMO

Background: It is widely established that the extraction of impaled objects should be carried out under direct vision. In the case of stable patients, endoscopic vision can be used as an alternative. Clinical Case: A 70-year-old male is admitted for a 5-hour impaled precordial stab wound. Evolution valued according to ATLS standards. Clinically and hemodynamically compensated patient. On physical examination: left pulmonary hypoventilation, subcutaneous emphysema, no jugular engorgement. Control of vital signs: TA: 110 / 70mmHg, FC: 70min, FR: 20min, Sat02: 97%. Complementary studies: ECO FAST: no pericardial fluid. Rx thorax: mild left pneumothorax heme. Chest CT: Puncture object of 18 cm in the left lung of AP and medial to the lateral path, hematoma of the angle, and hemopneumothorax grade I. Surgery: Patient in dorsal recumbency, under ARM with selective intubation. An incision in 5th left intercostal space, middle axillary line. 10mm trocar placement, 30 ° optics introduction. After discarding the commitment of the pericardium, active bleeding, and observing that the end of the weapon was going through the end of the angle, the weapon is removed under endoscopic vision. Clot washing/aspiration. Verification of hemostasis, absence of air leakage and pulmonary expansion. Drainage with 28 French tubes. Evolution: Derived from UTI extubated. CT scan thorax 72 h post: small intraparenchymal hematoma left, expanded lung. Minimum serohematic debit. Pleural tube and definitive discharge are removed on the 4th post-surgical day. Discussion: The literature suggests in the urgency, the removal of impaled objects under direct vision of the compromised structures. However, in stable patients, the previous study with CT should be unavoidable. Video-thoracoscopy in these wounded can avoid open surgery, but the procedure must be performed in trauma reference centers, with the appropriate means and by a trained surgical team willing to perform an emergency thoracotomy


Assuntos
Masculino , Idoso , Ferimentos Perfurantes/cirurgia , Dor no Peito/cirurgia , Toracotomia , Laparoscopia , Cirurgia Torácica Vídeoassistida , Sinais Vitais
5.
Ghana Med J ; 53(2): 181-183, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31481815

RESUMO

The inferior vena cava is the most commonly injured abdominal vessel and accounts for about 25% of abdominal vascular injuries. Despite improved preoperative care and operative techniques, the mortality rates for the inferior vena cava injuries are still high due to delayed presentation, inadequate or delayed fluid resuscitation, difficulty of diagnosis and technical problems in repair. A case of the inferior vena cava injury encountered after abdominal stab injury with about 4cm vertical tear of infrarenal vena cava, survived due to immediate transportation, appropriate and successful perioperative fluid and blood resuscitation, prompt surgical management with a team approach and critical post-operative surgical management.


Assuntos
Hematoma/cirurgia , Lacerações/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Veia Cava Inferior/lesões , Ferimentos Perfurantes/cirurgia , Duodeno/lesões , Humanos , Perfuração Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Espaço Retroperitoneal , Técnicas de Sutura , Ultrassonografia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia
6.
World Neurosurg ; 131: 213-216, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31295608

RESUMO

BACKGROUND: A foreign object penetrating the brain via orbit is a rare occurrence. Accurate diagnosis and immediate intervention is essential to prevent ophthalmic or neurological deficits and to reduce chances of infection or hemorrhage. CASE DESCRIPTION: We report 2 cases of transorbital orbitocranial penetrating injury of metal objects in children. Computed tomography scan was obtained to assess the extent of the injury and to locate the objects. According to the trajectory, the best craniotomy approach was performed, and the objects were safely removed without any complication. Our cases are unique because of the absence of any neurological deficit on admission, before and after the removal. CONCLUSIONS: The importance of transorbital orbitocranial penetrating injury cannot be neglected because of possible orbital and intracranial damage. Therefore, in this report we aim to heighten awareness of the complexity and severity of transorbital penetrating brain injury.


Assuntos
Traumatismos Cranianos Penetrantes/cirurgia , Órbita/lesões , Ferimentos Perfurantes/cirurgia , Pré-Escolar , Corpo Caloso/diagnóstico por imagem , Corpo Caloso/lesões , Craniotomia/métodos , Ferimentos Oculares Penetrantes/cirurgia , Lobo Frontal/diagnóstico por imagem , Lobo Frontal/lesões , Traumatismos Cranianos Penetrantes/diagnóstico por imagem , Humanos , Masculino , Base do Crânio/lesões , Tomografia Computadorizada por Raios X , Ferimentos Perfurantes/diagnóstico por imagem
7.
Am Surg ; 85(6): 572-578, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267896

RESUMO

Despite low mortality rates, self-inflicted stab wounds (SISWs) can result in significant morbidity and often reflect underlying substance abuse and mental health disorders. This study aimed to characterize demographics, comorbidities, and outcomes seen in self-inflicted stabbings and compare these metrics to those seen in assault stabbings. A Level I trauma center registry was queried for patients with stab injuries between January 2010 and December 2015. Classification was based on whether injuries were SISWs or the result of assault stab wounds (ASWs). Demographic, injury, and outcome measures were recorded. Differences between genders, ethnicities, individuals with and without psychiatric comorbidities, and SISW and ASW patients were assessed. Within the SIWS cohort, no differences were found when comparing age, gender, or race, including need for operative intervention. However, patients with psychiatric histories were less likely to have a positive toxicology test on arrival than those without psychiatric histories (22% vs. 0%, P = 0.04). When compared with 460 ASW patients, SISW were older (41 vs. 35, P < 0.001), more likely to be white (92% vs. 64%, P < 0.001), more likely to have a psychiatric history (15% vs. 4%, P < 0.001), require operative intervention (65% vs. 50%, P = 0.008), and be discharged to a psychiatric facility (47% vs. 0.2%, P < 0.001). SISW patients have higher rates of psychiatric illness and an increased likelihood to require operative intervention as compared with ASW patients. This population demonstrates an acute need for both inpatient and outpatient psychiatric care with early involvement of multidisciplinary teams for treatment and discharge planning.


Assuntos
Mortalidade Hospitalar , Sistema de Registros , Comportamento Autodestrutivo/psicologia , Centros de Traumatologia , Ferimentos Perfurantes/epidemiologia , Ferimentos Perfurantes/cirurgia , Adolescente , Adulto , Distribuição por Idade , Idoso , Distribuição de Qui-Quadrado , Estudos de Coortes , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Incidência , Escala de Gravidade do Ferimento , Kentucky , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Grupos Minoritários/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Distribuição por Sexo , Taxa de Sobrevida , Resultado do Tratamento , Ferimentos Perfurantes/prevenção & controle , Adulto Jovem
8.
J Coll Physicians Surg Pak ; 29(8): 782-784, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31358106

RESUMO

A 21-year male, farmer by profession, was admitted in Plastic Surgery Department via outpatient department, with amputation of nose and upper lip with the knife during resistance against robbery attempt. He was having the blockage of the right side of nostril and difficulty in mouth opening. Upper lip vermilion and mucosal reconstruction with the bilateral facial artery musculo-mucosal (FAMM) flap and moustache reconstruction was done with visor flap. Split thickness skin graft (STSG) was done over the donor site. Division and insetting of visor flap was done after two weeks. After three months, all three nasal layers were reconstructed. The inner lining was reconstructed with the turn down flap, L-strut from rib cartilage, and the outer lining with forehead flap.


Assuntos
Lábio/lesões , Lábio/cirurgia , Nariz/lesões , Nariz/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Ferimentos Perfurantes/cirurgia , Amputação Traumática , Humanos , Masculino , Transplante de Pele , Retalhos Cirúrgicos , Adulto Jovem
9.
BMJ Case Rep ; 12(6)2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31164381

RESUMO

Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been implemented in numerous countries. However, its use has not been widespread in (South) Africa, and when used, not well reported on. Further, REBOA has been performed with devices designed for other purposes. In this case report, we describe the use of a purpose designed device for image-free use in emergent haemorrhage control and resuscitation in a patient with multicavity penetrating trauma. Implications for the use of REBOA in these challenging cases is discussed, and a novel method of insertion of a REBOA catheter is presented.


Assuntos
Traumatismos Abdominais/cirurgia , Oclusão com Balão/instrumentação , Traumatismos Torácicos/cirurgia , Ferimentos Perfurantes/cirurgia , Traumatismos Abdominais/complicações , Aorta/lesões , Procedimentos Endovasculares , Desenho de Equipamento , Evolução Fatal , Humanos , Escala de Gravidade do Ferimento , Masculino , África do Sul , Traumatismos Torácicos/complicações , Tronco/lesões , Centros de Traumatologia , Adulto Jovem
10.
J Clin Neurosci ; 67: 239-243, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31213379

RESUMO

Non-missile penetrating spinal injury (NMPSI) is a rare form of traumatic spinal injury. Cases with neurological deficit on presentation are treated surgically. In the extremely rare circumstance of NMPSI presenting with no neurological deficit the management is contentious. We report a case of a 43-year-old male presenting with a penetrating stab injury through the thoracolumbar spinal canal. On presentation he had no neurological deficits and subsequently the knife was removed in theatre without deep surgical exploration. In this report we review the literature of non-missile penetrating spinal injuries as well as their management and conclude that exploratory surgery for NMPSI without neurological deficit may not be necessary as previously thought.


Assuntos
Traumatismos da Coluna Vertebral/diagnóstico por imagem , Ferimentos Perfurantes/diagnóstico por imagem , Adulto , Humanos , Masculino , Traumatismos da Coluna Vertebral/patologia , Traumatismos da Coluna Vertebral/cirurgia , Traumatismos da Coluna Vertebral/terapia , Ferimentos Perfurantes/patologia , Ferimentos Perfurantes/cirurgia , Ferimentos Perfurantes/terapia
11.
BMJ Case Rep ; 12(4)2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31040138

RESUMO

We present two children treated with endovascular techniques to gain proximal arterial control of the internal carotid and vertebral artery prior to removal of penetrating objects from the skull base. Both siblings (8-month-old and 22-month-old boys) were injured by different sharp objects (knife and scissor) by a guardian. They were transported to the emergency room where vascular control, including coil embolisation and internal carotid balloon occlusion, was performed in the neuroendovascular suite for safe removal of penetrating objects. Both minors recovered and were discharged home without any focal neurological deficits. In two children with scissor and knife stab with intracranial penetration, endovascular technique allowed safe removal of objects and ensured proximal arterial control was maintained to control for possible extravasation of blood on removal from the skull base.


Assuntos
Oclusão com Balão , Artéria Carótida Interna/diagnóstico por imagem , Corpos Estranhos/cirurgia , Artéria Vertebral/diagnóstico por imagem , Ferimentos Perfurantes/cirurgia , Oclusão com Balão/métodos , Artéria Carótida Interna/cirurgia , Angiografia Cerebral , Vítimas de Crime , Embolização Terapêutica , Procedimentos Endovasculares , Corpos Estranhos/diagnóstico por imagem , Humanos , Lactente , Masculino , Procedimentos Neurocirúrgicos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares , Artéria Vertebral/cirurgia , Ferimentos Perfurantes/complicações , Ferimentos Perfurantes/diagnóstico por imagem , Ferimentos Perfurantes/fisiopatologia
12.
World Neurosurg ; 127: 237-240, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30965173

RESUMO

BACKGROUND: We describe endovascular coil embolization of the internal carotid artery before removing a retained knife blade partially occluding the lacerum segment of the internal carotid artery. CASE DESCRIPTION: A 21-year-old male presented to the emergency department with a retained transcranial knife after sustaining a stab to the left temporal scalp. He was hemodynamically stable and neurologically intact on presentation. Computed tomography angiography followed by digital subtraction angiography revealed narrowing of the lacerum segment of the left internal carotid artery by the tip of the knife blade with adequate blood flow from the contralateral internal carotid artery. Embolization and occlusion of the internal carotid artery proximal and distal to the knife tip were performed. The patient was transferred to the neurosurgical operating room for extraction of the knife. A repeat left carotid artery angiogram post knife extraction showed no displacement of the coils and no extravasation of contrast. Follow-up imaging confirmed a good outcome. CONCLUSIONS: A staged approach of digital subtraction angiography and endovascular therapy followed by surgical treatment is a safe and effective management strategy for patients presenting with a retained transcranial knife and suspected vascular injury.


Assuntos
Artéria Carótida Interna/cirurgia , Procedimentos Endovasculares , Corpos Estranhos/cirurgia , Traumatismos Cranianos Penetrantes/cirurgia , Ferimentos Perfurantes/cirurgia , Artéria Carótida Interna/diagnóstico por imagem , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/etiologia , Traumatismos Cranianos Penetrantes/complicações , Traumatismos Cranianos Penetrantes/diagnóstico por imagem , Humanos , Masculino , Ferimentos Perfurantes/complicações , Ferimentos Perfurantes/diagnóstico por imagem , Adulto Jovem
13.
Ulus Travma Acil Cerrahi Derg ; 25(2): 137-141, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30892682

RESUMO

BACKGROUND: The clinical approach to back/flank wounds has evolved over the years. The aim of this study was to discuss the potential of computed tomography tractography in patients with a stab wound to the back or flank. METHODS: A total of 25 stable patients with stab wounds confined to the back/flank region were enrolled in this retrospective study. After initial resuscitation and physical examination, tractography was performed at the site of the stab wound. The patients subsequently underwent computed tomography with intravenous contrast. RESULTS: Computed tomography tractography helped avoid a laparotomy in 15 (60%) patients and accurately revealed a peritoneal breach in 10 (40%) patients. No missed injuries were reported in the conservatively followed patients. CONCLUSION: The addition of tractography to computed tomography is a safe, fast, and cost- and time-effective technique to evaluate back/flank stab wounds.


Assuntos
Lesões nas Costas , Tomografia Computadorizada por Raios X , Ferimentos Perfurantes , Lesões nas Costas/diagnóstico por imagem , Lesões nas Costas/epidemiologia , Lesões nas Costas/cirurgia , Humanos , Estudos Retrospectivos , Ferimentos Perfurantes/diagnóstico por imagem , Ferimentos Perfurantes/epidemiologia , Ferimentos Perfurantes/cirurgia
15.
J Laparoendosc Adv Surg Tech A ; 29(6): 785-789, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30628853

RESUMO

Background: The diagnosis of traumatic diaphragmatic injuries (TDIs) after penetrating thoracoabdominal trauma is challenging and conventional imaging is unreliable. Laparoscopy and thoracoscopy are minimally invasive modalities of choice in the diagnosis and management of TDI. A little is known on the value of thoracoscopy with single-lumen endotracheal tube intubation (SLETI) in the diagnosis of occult diaphragmatic injuries, and how it compares with laparoscopy. Methods: A prospective study evaluated thoracoscopy with SLETI as a diagnostic tool for occult TDI. Thoracoscopy was followed by diagnostic laparoscopy to confirm the findings and manage diaphragmatic and intra-abdominal injuries. Results: Thirty-one patients underwent thoracoscopy followed by laparoscopy. Majority were men (n = 27, 87%). The median age was 30 years. Twenty-six patients had stab wounds (83.8%), and 5 had gunshot wounds (16.1%). The incidence of diaphragmatic injury was 42% (n = 13). Thoracoscopy with SLETI correctly identified 12 (92%) patients with diaphragmatic injury, but 1 patient had dense pleural adhesions. Diagnostic laparoscopy identified all injuries. Conclusion: Thoracoscopy with SLETI and laparoscopy are feasible, safe, and accurate approaches in detecting TDI in stable patients with penetrating thoracoabdominal injuries. However, dense pleural adhesions may prevent thoracoscopy. Laparoscopy allows inspection of both hemidiaphragms and diagnoses associated intra-abdominal injuries. The choice of primary technique will depend on the individual clinical scenario.


Assuntos
Traumatismos Abdominais/cirurgia , Laparoscopia/métodos , Traumatismos Torácicos/cirurgia , Toracoscopia/métodos , Ferimentos por Arma de Fogo/cirurgia , Ferimentos Penetrantes/cirurgia , Adulto , Diafragma/cirurgia , Feminino , Humanos , Incidência , Intubação Intratraqueal , Masculino , Pessoa de Meia-Idade , Doenças Pleurais/cirurgia , Estudos Prospectivos , Ferimentos Perfurantes/cirurgia , Adulto Jovem
16.
Scand J Trauma Resusc Emerg Med ; 27(1): 7, 2019 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-30674331

RESUMO

BACKGROUND: Studies on penetrating injuries in Europe are scarce and often represent data from single institutions. The aim of this study was to describe the incidence and demographic features of patients hospitalized for stab injury in a whole nation. MATERIALS AND METHODS: This was a retrospective nationwide population-based study on all consecutive adult patients who were hospitalized in Iceland following knife and machete-related injuries, 2000-2015. Age-standardized incidence was calculated and Injury Severity Score (ISS) was used to assess severity of injury. RESULTS: Altogether, 73 patients (mean age 32.6 years, 90.4% males) were admitted during the 16-year study period, giving an age-standardized incidence of 1.54/100,000 inhabitants. The incidence did not vary significantly during the study period (P = 0.826). Most cases were assaults (95.9%) occurring at home or in public streets, and involved the chest (n = 32), abdomen (n = 26), upper limbs (n = 26), head/neck/face (n = 21), lower limbs (n = 10), and the back (n = 6). Median ISS was 9, with 14 patients (19.2%) having severe injuries (defined as ISS > 15). The median length of hospital stay was 2 days (range 0-53). Forty-seven patients (64.4%) underwent surgery and 26 of them (35.6%) required admission to an intensive care unit (ICU), all with ISS scores above 15. Three patients did not survive for 30 days (4.1%); all of them had severe injuries (ISS 17, 25, and 75). CONCLUSION: Stab injuries that require hospital admission are rare in Iceland, and their incidence has remained relatively stable. One in every five patients sustained severe injuries, two-thirds of whom were treated with surgical interventions, and roughly one-third required ICU care. Although some patients were severely injured with high injury scores, their 30-day mortality was still low in comparison to other studies.


Assuntos
Ferimentos Perfurantes/epidemiologia , Adolescente , Adulto , Idoso , Cuidados Críticos , Feminino , Hospitalização , Humanos , Islândia/epidemiologia , Incidência , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ferimentos Perfurantes/diagnóstico , Ferimentos Perfurantes/cirurgia , Adulto Jovem
17.
BMJ Case Rep ; 12(1)2019 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-30683660

RESUMO

Penetrating injuries can lead to multiple retained foreign bodies. To present a case of a penetrating stab injury on to the right orbital region of a 37-year-old woman which resulted in lacerations on both eyelids, loss of vision in addition to the retention of glass particle and woven artificial hair strands at the anterior end of the floor of the orbit. The woven artificial hair strand, being flexible in nature, was apparently logged in by the penetrating force of the broken glass used as the stab injury object. Under local anaesthesia, a gentle intermittent pull on one hair strand led to the dislodgement of a piece of broken glass particle along with the other end of the hair strand. The resultant wound was repaired. Stab injuries can result in retained multiple foreign bodies. This possibility should be considered during assessment and management of facial injuries to avoid complications of retention.


Assuntos
Ferimentos Oculares Penetrantes/cirurgia , Corpos Estranhos/cirurgia , Ferimentos Perfurantes/cirurgia , Adulto , Ferimentos Oculares Penetrantes/diagnóstico por imagem , Feminino , Vidro , Humanos , Radiografia , Ferimentos Perfurantes/diagnóstico por imagem
18.
Injury ; 50(1): 156-159, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30146368

RESUMO

INTRODUCTION: Organ evisceration following abdominal stab wound (SW) is currently considered as an absolute indication for mandatory laparotomy due to the high incidence of associated intra-abdominal injuries, but literature describing the spectrum of organ injury encountered is limited. MATERIALS AND METHODS: We reviewed our experience of 301 consecutive patients who were subjected to mandatory laparotomy over an eight-year period at a major trauma centre in South Africa. RESULTS: Of the 301 patients with organ evisceration, 92% were male (mean age: 28 years). Ninety per cent (270/301) of the laparotomies were positive (85% (229/270) therapeutic, 15% (41/270) non-therapeutic). The frequencies of eviscerated organs were small bowel (70%), large bowel (26%), and stomach 3%. Three (1%) patients had combined evisceration of more than one of the above organs. The most commonly injured organs were small bowel and large bowel. The mean length of hospital stay was nine days. Seven patients required intensive care admission. The morbidity rate was 21% and mortality was 2%. CONCLUSIONS: The spectrum of injury associated with abdominal SW with organ evisceration is similar to smaller published series. Multiple organ injuries are common. The most commonly eviscerated organs were small bowel, large bowel and stomach, while the most commonly injured organs were small bowel and large bowel.


Assuntos
Traumatismos Abdominais/cirurgia , Laparotomia , Tempo de Internação/estatística & dados numéricos , Centros de Traumatologia , Vísceras/patologia , Ferimentos Perfurantes/complicações , Adulto , Feminino , Humanos , Incidência , Masculino , Estudos Retrospectivos , África do Sul/epidemiologia , Resultado do Tratamento , Vísceras/cirurgia , Ferimentos Perfurantes/cirurgia , Adulto Jovem
19.
A A Pract ; 12(10): 369-371, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-30543541

RESUMO

A patient presented with a stab injury caused by a knife penetrating the orbital floor and maxillary sinus along the skull base with the tip situated adjacent to the left internal carotid artery. A flexible fiberoptic bronchoscope loaded with an endotracheal tube was initially positioned superior to the vocal cords and advanced into the trachea immediately following induction. The blade was removed after occluding endovascular balloons were positioned distal and proximal to the potential internal carotid artery injury site. Therefore, contralateral nasal fiberoptic intubation might be safely performed in patients with unilateral maxillofacial trauma, no intracranial penetration, and minimal bleeding.


Assuntos
Lesões das Artérias Carótidas/etiologia , Artéria Carótida Interna/cirurgia , Intubação Intratraqueal/instrumentação , Ferimentos Perfurantes/cirurgia , Adolescente , Broncoscopia/instrumentação , Lesões das Artérias Carótidas/cirurgia , Humanos , Masculino , Resultado do Tratamento
20.
Am J Surg ; 217(4): 653-657, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29935906

RESUMO

INTRODUCTION: The spectrum of injury associated with anterior abdominal stab wounds (SWs) is well established. The literature in the specific setting of isolated omental evisceration is limited. MATERIALS AND METHODS: We reviewed our experience of 244 consecutive patients with established indications for laparotomy over an eight year period at a major trauma centre in South Africa. RESULTS: Of the 244 patients (93% male, mean age: 27 years), 224 (92) underwent immediate laparotomy (IL). Twenty were initially observed and eventually required a laparotomy (delayed laparotomy, DL). The mean time from injury to decision for laparotomy was <3 h in 92% (224/244), <6 h in 6% (14/244), <12 h 2% (4/244) and <18 h in 1% (2/244). Ninety-eight per cent (238/244) of laparotomies were positive and 96% of the positive laparotomies (229/238) were considered therapeutic. The mostly commonly injured organ encountered on laparotomy were small bowel, stomach and colon. CONCLUSIONS: The most commonly injures encountered are intestinal and gastric. Clinicians must remain vigilant as injuries may be subtle.


Assuntos
Traumatismos Abdominais/epidemiologia , Traumatismos Abdominais/cirurgia , Omento/lesões , Omento/cirurgia , Ferimentos Perfurantes/epidemiologia , Ferimentos Perfurantes/cirurgia , Adulto , Feminino , Humanos , Laparotomia , Masculino , Estudos Retrospectivos , África do Sul/epidemiologia , Vísceras/lesões , Vísceras/cirurgia
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