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3.
Zentralbl Chir ; 145(1): 108-120, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-32097982

RESUMO

The therapy of severely injured patients is demanding and promising only in an interdisciplinary context. From a thoracic surgical perspective, the blunt chest trauma is in the foreground; as it is the 2nd leading cause of death after traumatic brain injury. The first step is to identify the potentially life-threatening injury and its treatment (airway obstruction, prevention of gas exchange, tension pneumothorax, serious bleeding complications in lung-/vascular injuries). Pneumothorax or tension pneumothorax is present in 20% of all polytrauma patients and 50% of all patients with severe chest trauma. In most cases, the use of a chest tube is sufficient in the acute phase (90%). For complex injuries with persistent thoracic haemorrhage and haemodynamic instability of the patient or pleural fistulization with increasing skin emphysema, surgical treatment should be performed at an early interval. Nevertheless, emergency thoracotomy is rarely required at this early stage.


Assuntos
Traumatismo Múltiplo , Pneumotórax , Traumatismos Torácicos , Ferimentos não Penetrantes , Tubos Torácicos , Humanos , Traumatismos Torácicos/cirurgia , Procedimentos Cirúrgicos Torácicos
4.
Medicine (Baltimore) ; 99(5): e19070, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000456

RESUMO

RATIONALE: Extracorporeal membrane oxygenation (ECMO) in multiple trauma patients with post-traumatic respiratory failure can be quite challenging because of the need for systemic anticoagulation, which may lead to excessive bleeding. In the last decade, there is a growing body of evidence that veno-venous ECMO (VV-ECMO) is lifesaving in multiple trauma patients with acute respiratory distress syndrome, thanks to technical improvements in ECMO devices. PATIENT CONCERNS: We report a case of a 17-year-old multiple trauma patient who was drunken and had confused mentality. DIAGNOSES: She was suffered from critical respiratory failure (life-threatening hypoxemia and severe hypercapnia/acidosis lasting for 70 minutes) accompanied by cardiac arrest and trauma-induced coagulopathy during general anesthesia. INTERVENTIONS: We decided to start heparin-free VV-ECMO after cardiac arrest considering risk of hemorrhage. OUTCOMES: She survived with no neurologic sequelae after immediate treatment with heparin-free VV-ECMO. LESSONS: Heparin-free VV-ECMO can be used as a resuscitative therapy in multiple trauma patients with critical respiratory failure accompanied by coagulopathy. Even in cases in which life-threatening hypoxemia and severe hypercapnia/acidosis last for >1 hours during CPR for cardiac arrest, VV-ECMO could be considered a potential lifesaving treatment.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Traumatismo Múltiplo/terapia , Adolescente , Transtornos da Coagulação Sanguínea/terapia , Feminino , Parada Cardíaca/terapia , Humanos , Síndrome do Desconforto Respiratório do Adulto/terapia
5.
Khirurgiia (Mosk) ; (1): 74-79, 2020.
Artigo em Russo | MEDLINE | ID: mdl-31994503

RESUMO

A 8-year-old child with multiple skeletal injuries after car accident is presented in the article. Extensive right-sided urohematoma with impaired kidney function was diagnosed after 15 days. External drainage of urohematoma, ureteroscopy and examination of the right kidney were consecutively performed within 1.5 months. A complete rupture of the right ureter at the level of pyeloureterostomy was diagnosed. Right kidney autotransplantation with ureteral resection and pyeloureteral anastomosis were performed in 2 months after injury. Duration of surgery was 7.5 hours, cold ischemia - 55 min. Postoperative examination confirmed satisfactory function of the right kidney. This observation is relatively rare and the first in Russia.


Assuntos
Traumatismos Abdominais/cirurgia , Transplante de Rim , Reimplante , Ureter/lesões , Ureter/cirurgia , Ferimentos não Penetrantes/cirurgia , Traumatismos Abdominais/complicações , Acidentes de Trânsito , Criança , Humanos , Rim/lesões , Rim/cirurgia , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/cirurgia , Transplante Autólogo , Ferimentos não Penetrantes/complicações
6.
Am J Forensic Med Pathol ; 41(1): 52-55, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31895099

RESUMO

Characteristic injury patterns have been described in pedestrians struck by motor vehicles. The common injury pattern seen in upright pedestrians consists of a triad of head, pelvis, and lower extremity trauma. There are several factors such as vehicular type, design, mass and speed, and impact surfaces that influence the type and distribution of these injuries. We report a case that illustrates the importance of examination of the knee at autopsy when the typical lower extremity diaphyseal fractures that are usually seen in a motor vehicle-pedestrian collision are absent.


Assuntos
Acidentes de Trânsito , Fraturas do Fêmur/patologia , Traumatismos do Joelho/patologia , Pedestres , Adulto , Medicina Legal/métodos , Humanos , Masculino , Traumatismo Múltiplo/patologia , Transtornos Relacionados ao Uso de Substâncias , Ferimentos não Penetrantes/patologia
7.
World Neurosurg ; 133: e385-e390, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31521761

RESUMO

BACKGROUND: Optimal management of patients with extracranial blunt cerebrovascular injury (BCVI) remains controversial, with both anticoagulation and antiplatelet therapy being recommended. The purpose of this study was to evaluate the efficacy and safety of using acetylsalicylic acid (ASA) in the management of BCVI. METHODS: Patients with BCVI were identified from the registry of a Level 1 trauma center between 2010 and 2017. Digital imaging and electronic medical records were reviewed for patient information including demographic characteristics, injury type, therapy, outcomes, and follow-up. RESULTS: Over the study period, 13,578 patients were admitted following blunt trauma, with 94 (0.7%) having confirmed BCVI (mean age, 42 years; 72% male). Mean Injury Severity Score and Glasgow Coma Score were 27 and 10, respectively. BCVI was identified in 130 vessels with Biffl grade I (38%) and grade II injury (29%) being most common. Twelve (13%) patients experienced an ischemic event, but only 3 events occurred after diagnosis. ASA was primary treatment for 56 (60%) patients. Thirty patients (32%) received no treatment; 21 patients died within 24 hours of primary injury. Only 4 patients had ASA contraindications. Four patients (7%) had ASA-related complications; there were 2 cases of intracranial hemorrhage progression and 2 cases of gastrointestinal bleeding. Follow-up vascular imaging at a mean of 36 days demonstrated stable or improved levels of BCVI in 94% of patients. CONCLUSIONS: An ASA-based management strategy for BCVI was efficacious and relatively safe in this study. This approach may be the preferred treatment for BCVI, but confirmation is needed.


Assuntos
Aspirina/uso terapêutico , Traumatismo Cerebrovascular/tratamento farmacológico , Inibidores da Agregação de Plaquetas/uso terapêutico , Ferimentos não Penetrantes/tratamento farmacológico , Adolescente , Adulto , Idoso , Aneurisma Dissecante/etiologia , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Aspirina/efeitos adversos , Lesões das Artérias Carótidas/tratamento farmacológico , Artéria Carótida Interna , Traumatismo Cerebrovascular/complicações , Traumatismo Cerebrovascular/epidemiologia , Gerenciamento Clínico , Avaliação de Medicamentos , Feminino , Hemorragia/induzido quimicamente , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/epidemiologia , Inibidores da Agregação de Plaquetas/efeitos adversos , Estudos Retrospectivos , Acidente Vascular Cerebral/etiologia , Artéria Vertebral/lesões , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/epidemiologia , Adulto Jovem
8.
Scand J Immunol ; 91(2): e12837, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31622512

RESUMO

After severe trauma, the resulting excessive inflammatory response is countered by compensatory anti-inflammatory mechanisms. The systemic inflammatory response to trauma enhanced by inappropriately timed surgical second hits may be detrimental for the patient. On the other hand, overwhelming anti-inflammatory mechanisms may put patients at increased risk from secondary local and systemic infections. The ensuing sepsis and organ dysfunction due to immune dysregulation remain the leading causes of death after injury. To date, there are no clinically applicable techniques to monitor the pro-/anti-inflammatory immune status of the patients and the remaining ability to react to microbial stimuli. Therefore, in the present study, we used a highly standardized and easy-to-use system to draw peripheral whole blood from polytraumatized patients (ISS ≥ 32, n = 7) and to challenge it with bacterial lipopolysaccharide. Secreted cytokines were compared with those in samples from healthy volunteers. We observed a significant decrease in the release of monocyte-derived mediators. Surprisingly, we detected stable or even increased concentrations of cytokines related to T cell maturation and function. For clinical practicability, we reduced the incubation time before supernatants were collected. Even after an abbreviated stimulation period, a stable release of almost all analysed parameters in patient blood could be detected. In conclusion, the data are indicative of a clinically well-applicable approach to monitor the immune status in severely injured patients in a short time. This may be used to optimize the timing of necessary surgical interventions to avoid a boost of proinflammation and reduce risk of secondary infections.


Assuntos
Monitorização Imunológica/métodos , Traumatismo Múltiplo/diagnóstico , Adulto , Células Cultivadas , Progressão da Doença , Feminino , Humanos , Lipopolissacarídeos/imunologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto
9.
J Trauma Acute Care Surg ; 88(2): 286-291, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31343599

RESUMO

BACKGROUND: Combined traumatic injuries to the rectum and bladder are rare. We hypothesized that the combination of bladder and rectal injures would have worse outcomes than rectal injury alone. METHODS: This is an American Association for the Surgery of Trauma multi-institutional retrospective study from 2004 to 2015 traumatic rectal injury patients who were admitted to one of 22 participating centers. Demographics, mechanism, and management of rectal injury were collected. Patients who sustained a rectal injury alone were compared with patients who sustained a combined injury to the bladder and rectum. Multivariable logistic regression was used to determine if abdominal complications, mortality, and length of stay were impacted by a concomitant bladder injury after adjusting for cofounders. RESULTS: There were 424 patients who sustained a traumatic rectal injury, of which 117 (28%) had a combined injury to the bladder. When comparing the patients with a combined bladder/rectal injury to the rectal alone group, there was no difference in admission demographics admission physiology, or Injury Severity Score. There were also no differences in management of the rectal injury and no difference in abdominal complications (13% vs. 16%, p = 0.38), mortality (3% vs. 2%, p = 0.68), or length of stay (17 days vs. 21 days, p = 0.10). When looking at only the 117 patients with a combined injury, the addition of a colostomy did not significantly decrease the rate of abdominal complications (14% vs. 8%, p = 0.42), mortality (3% vs. 0%, p = 0.99), or length of stay (17 days vs. 17 days, p = 0.94). After adjusting for cofounders (AAST rectal injury grade, sex, damage-control surgery, diverting colostomy, and length of stay) the presence of a bladder injury did not impact outcomes. CONCLUSION: For patients with traumatic rectal injury, a concomitant bladder injury does not increase the rates of abdominal complications, mortality, or length of stay. Furthermore, the addition of a diverting colostomy for management of traumatic bladder and rectal injury does not change outcomes. LEVEL OF EVIDENCE: Level IV; prognostic/therapeutic.


Assuntos
Escala de Gravidade do Ferimento , Traumatismo Múltiplo/cirurgia , Reto/lesões , Bexiga Urinária/lesões , Adulto , Colostomia/estatística & dados numéricos , Cistostomia/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/diagnóstico , Traumatismo Múltiplo/mortalidade , Reto/cirurgia , Resultado do Tratamento , Bexiga Urinária/cirurgia , Adulto Jovem
10.
J Pediatr Orthop ; 40(1): 1-7, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31815855

RESUMO

BACKGROUND: Systemic inflammatory response syndrome (SIRS) is a well-recognized phenomenon in adult trauma populations. The "initial hit" of the traumatic event is often coupled with a systemic immune response characterized by changes in vital signs and laboratory indicators. A "second hit" from surgery during this time frame often results in acute lung injury, along with deterioration of the patient's clinical condition. We hypothesized that children and adolescents would experience SIRS physiology, but would not experience adult respiratory distress syndrome (ARDS) or "second hit" related death to the extent seen in the adult populations. METHODS: We queried the trauma database of our level 1 pediatric trauma center from January 2005 to December 2015 for patients with injury severity scores of >16. We used the electronic medical record to track SIRS criteria in patients days 1 to 4 posttrauma. Trends were examined in patients with an orthopaedic injury (OI) and with no orthopaedic injury. Patients were further subcategorized and analyzed by age group based on the convention for definition of pediatric SIRS. Patients in the orthopaedic cohort were further examined for pulmonary complications and death. Logistic regression was used to identify risk factors for SIRS physiology in the first 4 days of hospitalization. RESULTS: 81.4% (OI) and 69.1% no orthopaedic injury reached the threshold for SIRS within their first 4 days of hospitalization. Nine patients died in the hospital. Only 3 OI patients developed the criteria for ARDS, and only 3 patients with orthopaedic injuries died, 2 died within 24 hours of presentation and 1 within 48 hours, all had severe brain trauma. Increasing age groups showed increasing proportion of patients with SIRS. Increasing injury severity score and increasing age were independent predictors of SIRS during days 1 to 4. DISCUSSION: SIRS seems to be as common in children as the reported rates for adults, and the proportion of SIRS in children increases with increasing age and injury severity. The high mortality rate and rate of ARDS observed in adults was not observed in our cohort. The presence or absence of major orthopaedic injuries was not a significant predictor. The SIRS response in polytraumatized children is poorly understood. The clinical phenomenon of acute lung injury/ARDS is observed less often in children, but the exact mechanism by which this occurs is unknown. LEVEL OF EVIDENCE: Level III-case control.


Assuntos
Osso e Ossos/lesões , Traumatismo Múltiplo/fisiopatologia , Traumatismo Múltiplo/cirurgia , Sistema Musculoesquelético/lesões , Síndrome do Desconforto Respiratório do Adulto/etiologia , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Adolescente , Fatores Etários , Estudos de Casos e Controles , Criança , Pré-Escolar , Registros Eletrônicos de Saúde , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Traumatismo Múltiplo/complicações , Estudos Retrospectivos , Síndrome de Resposta Inflamatória Sistêmica/etiologia
11.
Emerg Med Clin North Am ; 38(1): 125-142, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757246

RESUMO

Traumatic injuries of the hip and pelvis are commonly encountered in the emergency department. This article equips all emergency medicine practitioners with the knowledge to expertly diagnose, treat, and disposition these patients. Pelvic fractures occurring in young patients tend to be associated with high-energy mechanisms and polytrauma. Pelvic and hip fractures in the elderly are often a result of benign trauma but are associated with significant morbidity and mortality.


Assuntos
Gerenciamento Clínico , Emergências , Fraturas Ósseas/diagnóstico , Traumatismo Múltiplo , Procedimentos Ortopédicos/métodos , Ossos Pélvicos/lesões , Radiografia/métodos , Fraturas Ósseas/terapia , Humanos , Ossos Pélvicos/diagnóstico por imagem
12.
Sud Med Ekspert ; 62(6): 27-31, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825329

RESUMO

For the last thirty years, many scientific publications have been devoted to diagnostic capabilities of postmortem computer tomography (CT). Nevertheless, up to the present day, the expediency of the substitution of a traditional postmortem dissection with a postmortem CT is still not proved. Foreign countries develop methods improving visualization in case of postmortem CT, study the correlation between the time of death and artefacts encountered in the further CT of cadavers. The authors have performed a comparative analysis of the results of intravitam X-ray examinations and data of postmortem dissections basing on the data of the professional literature and authors' own research. Diagnostic capabilities of CT in case of multitrauma have been determined.


Assuntos
Traumatismo Múltiplo , Tomografia Computadorizada por Raios X , Autopsia , Cadáver , Humanos , Traumatismo Múltiplo/diagnóstico por imagem , Mudanças Depois da Morte
13.
Sud Med Ekspert ; 62(6): 32-35, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825330

RESUMO

The interpretation of symptoms of multiple injuries caused by fall from height in case of postmortem examination with the aim to establish facts of causing traumas is onerous, especially in diagnosing mechanisms of various injury formations. The objective of the study was to elaborate expert diagnostic criteria to determine mechanisms of fractures of long tubular bones caused by fall from height on the basis of the analysis of fracture morphology and information technologies. The prognostic models have been developed, which make it possible to prognosticate mechanisms of fractures basing on the elaborated expert diagnostic criteria of fractures of long tubular bones in case of catatrauma. The morphologic criteria of fractures with the use of linear regression analysis make it possible to distinguish reliably different variants of the body landing and height of fall ranges.


Assuntos
Acidentes por Quedas , Fraturas Ósseas , Traumatismo Múltiplo , Autopsia , Humanos
15.
Rev. bras. cir. plást ; 34(4): 504-508, oct.-dec. 2019. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-1047913

RESUMO

Introdução: Lesões geradas por queimaduras representam um importante problema de saúde pública, constituindo a quarta causa de morte na infância no Brasil e Estados Unidos. Além disso, poucas são as doenças que trazem prejuízos tão importantes, com considerável morbidade pelo desenvolvimento de sequelas físicas e psicossociais. Diante disso, o objetivo deste estudo é traçar o perfil epidemiológico de crianças de 0-18 anos atendidas em um hospital escola de Curitiba, Paraná. Métodos: Estudo transversal e retrospectivo realizado através da análise de 625 prontuários de internação de crianças de 0-18 anos vítimas de queimaduras, entre janeiro de 2010 a dezembro de 2017. Foram coletadas informações sobre idade, sexo, tempo de internação, óbito, região corporal atingida, extensão da superfície corporal, grau de profundidade, agente etiológico e abordagem terapêutica. Resultados: A maior parte da amostra era composta por lactentes (43%), com média de idade de 12,6 anos. O sexo mais afetado foi o masculino e os pacientes permaneceram cerca de 14,5 dias internados. No estudo, 98% das queimaduras apresentaram como etiologia o agente térmico, principalmente por líquido quente. Em relação ao grau de profundidade, a maioria das queimaduras foram de 2º grau (61,3%), atingindo até 25% de superfície corporal queimada (SCQ), sendo o tronco o mais afetado. Dentre as modalidades de tratamento, 44% dos pacientes necessitaram de intervenção cirúrgica com debridamento e enxertia. Conclusão: Crianças mais novas são mais propensas a sofrerem queimaduras principalmente no ambiente domiciliar e, além disso, uma equipe preparada e capacitada é de crucial importância no prognóstico destes doentes.


Introduction: Injuries caused by burns represent a significant public health problem, constituting the fourth leading cause of childhood death in Brazil and the United States. In addition, few diseases carry such substantial losses as burns, with considerable morbidity due to the development of physical and psychosocial sequelae. This study aimed to outline the epidemiological profile of 0­18-year-old children treated for burns at a teaching hospital in Curitiba, Paraná. Methods: This cross-sectional, retrospective study involved analysis of 625 medical records of 0­18-year-old children who were victims of burns from January 2010 to December 2017. Information was collected on age, sex, length of hospitalization, death, body region affected, burned body surface area (BSA), depth, etiologic agent, and therapeutic approach. Results: A plurality of the sample were infants (43%), and the average age of the sample was 12.6 years. Most of the sample was comprised males, and the patients remained hospitalized for an average of 14.5 days. Of the burns, 98% were caused by thermal agents, particularly hot liquids. Most burns were second-degree burns (61.3%), reaching up to 25% of the BSA, and the most affected region was the trunk. Among the treatment modalities, 44% of the patients needed surgical intervention with debridement and grafting. Conclusion: Younger children are more prone to burns, especially in the home environment. A prepared and qualified team is of crucial importance for optimizing outcomes in these patients.


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , História do Século XXI , Cirurgia Plástica , Perfil de Saúde , Queimaduras , Traumatismo Múltiplo , Inquéritos Epidemiológicos , Cirurgia Plástica/métodos , Cirurgia Plástica/estatística & dados numéricos , Queimaduras/cirurgia , Queimaduras/terapia , Traumatismo Múltiplo/cirurgia , Traumatismo Múltiplo/terapia , Inquéritos Epidemiológicos/métodos , Inquéritos Epidemiológicos/estatística & dados numéricos
17.
Ulus Travma Acil Cerrahi Derg ; 25(6): 622-627, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31701501

RESUMO

BACKGROUND: In our study, we have tried to find out how necessary whole-body computed tomography (WBCT) is to detect other body injuries that may accompany the patients, evaluating head trauma cases with WBCT. METHODS: In our study, we included 198 patients, who were referred to our hospital's emergency service after head trauma, had brain lesions detected in brain tomography (BT), had no additional examination findings and who underwent WBCT. In this retrospective study, patients' age, gender, type of lesion in brain CT, Glasgow Coma Scale (GCS) values and WBCT findings were examined. RESULTS: In this study, 85.4% of the patients were male and the average age was 25.7 years. The most common cranial CT findings were fracture, followed by parenchymal bleeding. 67% of the patients' GCS were below 8. Additional trauma was detected in 78 of the patients (39.4%). The most common additional lesion was the thoracic contusion. The mean age of the patients with cervical injuries determined in CT was significantly high (p<0.05). Statistical significance was determined between cranial fracture, foreign body incidence and thoracic injuries (p<0.05). The incidence of cervical injuries was significantly higher in patients with brain contusion detected in CT (p<0.05). Fracture frequency and presence of additional lesions in WBCT were significantly high (p<0.05). There was no correlation between other cranial lesions and additional injury areas (p>0.05). CONCLUSION: The number of studies evaluating WBCT is high in the literature. However, our study is important concerning that to our knowledge this study is the first study to evaluate the WBCT findings in the head trauma cases without the additional lesions on their bodies. WBCT scan should be recommended in patients whose clinical evaluation could not be completed. WBCT is an important diagnostic tool for the diagnosis of many pathologies, especially for intrathoracic lesions.


Assuntos
Traumatismos Craniocerebrais , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Imagem Corporal Total/estatística & dados numéricos , Adulto , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/diagnóstico por imagem , Traumatismos Craniocerebrais/epidemiologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/diagnóstico por imagem , Traumatismo Múltiplo/epidemiologia , Guias de Prática Clínica como Assunto , Traumatismos Torácicos/complicações , Traumatismos Torácicos/diagnóstico por imagem , Traumatismos Torácicos/epidemiologia
18.
Acta Clin Croat ; 58(Suppl 1): 118-123, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31741570

RESUMO

Multiply injured patients with severe chest trauma have different combinations of associated extra thoracic injuries making their treatment complex. Severe pain is a prominent symptom in a vast majority of severe chest injuries and causes deterioration of respiratory function. Epidural analgesia provides efficient pain relief but its use in this group of patients is burdened with complications, contraindications and technical difficulties. We present two cases in which epidural analgesia was successfully used in polytrauma patients with severe chest injuries and hypoxemic respiratory failure, and discuss advantages, possible pitfalls and complications.


Assuntos
Analgesia Epidural , Traumatismo Múltiplo/complicações , Dor/tratamento farmacológico , Traumatismos Torácicos/complicações , Adulto , Analgesia Epidural/efeitos adversos , Contraindicações , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Insuficiência Respiratória/etiologia
20.
Acta Chir Orthop Traumatol Cech ; 86(5): 334-341, 2019.
Artigo em Tcheco | MEDLINE | ID: mdl-31748108

RESUMO

PURPOSE OF THE STUDY The study aimed to map the use of imaging techniques and results reporting in polytrauma patients by the trauma centres in the Czech Republic. MATERIAL AND METHODS The representatives of radiology departments and units of all 12 trauma centres in the Czech Republic completed a questionnaire regarding the imaging in polytrauma patients. RESULTS The Focused Assessment with Sonography for Trauma (FAST) as an initial imaging is used by all the centres, the WholeBody CT scan (WBCT) is the dominant imaging technique everywhere and all the centres have standards in place for its performance. The WBCT examination protocol varies across the centres, just like the evaluation procedures of the CT scan and reporting of the results over to the indicating physicians. In majority of centres, there is a high percentage of WBCT with normal findings. One of the centres which uses also X-rays as a part of imaging algorithm, reports a notably higher percentage of WBCT positive findings. DISCUSSION When considering the radiation dose, data and time necessary for WBCT, work required to assess the WBCT and a large number of negative findings, it is disputable whether in a number of cases the WBCT is a suitable method for polytrauma patient examination. Similar conclusions have been drawn also by other authors who recommend that the WBCT is always used for unconscious polytrauma patients, in whom a clinical examination is virtually impossible. In the other cases, based on the clinical parameters the other imaging techniques and the focused CT (and in the indicated cases also the wholebody CT) can be safely used. CONCLUSIONS he diagnostic procedure in a polytrauma patient is not uniform in trauma centres and even the procedure for urgent reporting of crucial WBCT findings to clinical physicians has not been standardised. In a number of cases the indication for WBCT seems to be unnecessary. A more careful consideration of indications for imaging examinations based on the clinical finding may reduce the radiation exposure of patients while maintaining the diagnostic accuracy. A structured report on WBCT in polytrauma is not used even though it is recommended by the European Society of Radiology. Key words:polytrauma, diagnostic imaging, Whole-Body Computed Tomography, structured report.


Assuntos
Traumatismo Múltiplo/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Centros de Traumatologia/estatística & dados numéricos , República Tcheca/epidemiologia , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Traumatismo Múltiplo/epidemiologia , Exposição à Radiação , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/estatística & dados numéricos
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