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Rev Fac Cien Med Univ Nac Cordoba ; 78(1): 45-47, 2021 03 24.
Artigo em Espanhol | MEDLINE | ID: mdl-33787025


Introduction: In critical ill patients, a hypermetabolic state develops in response to the aggression received, which leads to a rapid process of malnutrition, and has been associated with increased morbidity and mortality. The preferred enteral feeding way is through an endoscopic gastrostomy, an alternative procedure is the laparoscopic approach. Methods: Data was collected Between January 2016 and March 2019, of patients admitted to the Intensive Care Unit of the Hospital de Urgencias de Córdoba. Patients had an indication of enteral nutrition, and underwent laparoscopic feeding gastrostomy. Demographic data, as well as preoperative assessment according to the American Society of Anesthesiologists (ASA) classification, operative and postoperative complications, beginning and feasibility of feeding were recorded. Results: 12 patients full fill the inclusion criteria. Age average was 39 years. The total average surgical time was 39 minutes, not recording perioperative complications regarding the procedure. All the patients were fed after 24 hours. Conclusion: In our institution, the indication of percutaneous endoscopic gastrostomy is the elected choice; laparoscopic gastrostomy is a low-complexity technique, which can be done immediately after the indication in selected patients.

Laparoscopia , Traumatismo Múltiplo , Gastrostomia , Humanos , Estudos Retrospectivos
Bratisl Lek Listy ; 122(4): 277-279, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33729821


PURPOSE: We aimed to evaluate the relationship between trauma patients' mortality and neutrophil/lymphocyte ratio (NLR) at intensive care units admission. METHODS: We examined 107 ICU trauma patients. Patients were divided into two groups as those who survived (Grup I) and deceased (Grup II). Patients' age, NLR, mean platelet volume (MPV), lactate value, length of stay in the intensive care unit, acute physiology and chronic health evaluation 2 (APACHE II) scores were examined. The effects of these factors on mortality were examined. RESULTS: 83 (77.58 %) patients were male, 24 (22.42 %) patients were female. The patients' mean age was 46.89 ± 19.06 years. The mean value of the lactate level was 3.25 ± 2.92, the mean value of MPV was 10.34 ± 1.02, the average value of NLR was 8.23 ± 8.11, the average score of APACHE II was 22.8 ± 8.75, and the average length of stay in the ICU was 11.33 ± 22.98 days. The relationship with mortality was evaluated between the groups, there was a statistically significant difference in APACHE II scores. There was no statistically significant difference between other variables. CONCLUSIONS: NRL, MPV, lactate levels were not suitable for the evaluation of trauma patients as an early prognostic factor like APACHE II during admission to ICU (Tab. 2, Fig. 1, Ref. 23).

Cuidados Críticos , Traumatismo Múltiplo , APACHE , Adulto , Idoso , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
Eur J Med Res ; 26(1): 19, 2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33557953


BACKGROUND: Diaphragmatic lesions as a result of blunt or penetrating trauma are challenging to detect in the initial trauma setting. This is especially true when diaphragmatic trauma is part of a polytrauma. Complications of undetected diaphragmatic defects with incarcerating bowel are rare, but as in our patient can be serious. CASE PRESENTATION: A 57-year-old female presented to the Emergency Room of our Hospital in a critical condition with 3 days of increasing abdominal pain. The initial clinical examination showed peritonism with tinkling peristaltic bowel sounds of mechanical obstruction. A thoraco-abdominal CT scan demonstrated colon prolapsed through the left diaphragmatic center with a large sero-pneumothorax under tension. As the patient was hemodynamically increasingly unstable with developing septic shock, an emergency laparotomy was performed. After retraction of the left colon, which had herniated through a defect of the tendinous center of the left diaphragm and was perforated due to transmural ischemia, large amounts of feces and gas discharged from the left thorax. A left hemicolectomy resulting in a Hartmann-type procedure was performed. A fully established pleural empyema required meticulous debridement and lavage conducted via the 7-10 cm in diameter phrenic opening followed by a diaphragmatic defect reconstruction. Due to pneumonia and recurring pleural empyema redo-debridement of the left pleural space via thoracotomy were required. The patient was discharged on day 56. A thorough history of possible trauma revealed a bicycle-fall trauma 7 months prior to this hospitalization with a surgically stabilized fracture of the left femur and conservatively treated fractures of ribs 3-9 on the left side. CONCLUSION: This is the first report on a primarily established empyema at the time of first surgical intervention for feco-pneumothorax secondary to delayed diagnosed diaphragmatic rupture following abdomino-thoracic blunt trauma with colic perforation into the pleural space, requiring repetitive surgical debridement in order to control local and systemic sepsis. Thorough investigation should always be undertaken in cases of blunt abdominal and thoracic trauma to exclude diaphragmatic injury in order to avoid post-traumatic complications.

Colo/patologia , Diafragma/lesões , Traumatismo Múltiplo/complicações , Pneumotórax/etiologia , Ciclismo , Colo/cirurgia , Diafragma/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Pneumotórax/cirurgia , Prolapso , Ruptura/etiologia , Ruptura/cirurgia , Traumatismos Torácicos/etiologia
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 13: 295-301, jan.-dez. 2021. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1151198


Objetivo: caracterizar os aspectos epidemiológicos das vitimas de trauma atendidas por um Serviço de Atendimento Móvel de Urgência 192. Método: estudo exploratório, descritivo e quantitativo, realizado no pronto socorro de um hospital de referencia. A população alvo foram as vitimas de trauma atendidas pelo Serviço de Atendimento Móvel de Urgência, transportadas para o referido hospital. Resultados: observou-se que 5,9% deram entrada na urgência por Ferimentos por Arma de Fogo, 4,9% por Ferimento por Arma Branca, 23,8% por queda, e 60,4% por acidentes de transito. Conclusão: o perfil identificado foi de homens, vitimas de acidente de transito, nas idades de 18 a 35 anos, com segundo grau completo, sendo o tórax a região mais atingida. Esse estudo pode subsidiar a elaboração de estratégias para enfrentamento desses agravos, pois a grande quantidade de óbitos por causas externas são considerados um problema de saúde publica, causando sequelas irreparáveis

Objective: to characterize the epidemiological aspects of the victims of trauma treated by a Mobile Emergency Care Service 192. Method: an exploratory, descriptive and quantitative study, carried out in the first aid hospital of a reference hospital. The target population was the victims of trauma treated by the Mobile Emergency Care Service, transported to the referred hospital. Results: It was observed that 5.9% were admitted to the emergency due to Firearm Injuries, 4.9% to White Weapon Injury, 23.8% to fall, and 60.4% due to trafficaccidents. Conclusion: the identified profile was of men, victims of traffic accident, in the ages of 18 to 35 years, with full second degree, being the thorax the most affected region. This study may support the development of strategies to deal with these diseases, since the large number of deaths from external causes are considered a public health problem, causing irreparable sequelae

Objetivo: caracterizar los aspectos epidemiologicos de las victimas de trauma atendidas por un Servicio de Atencion Movil de Urgencia 192. Método: estudio exploratorio, descriptivo y cuantitativo, realizado en el pronto socorro de un hospital de referencia. La poblacion objetivo fueron las victimas de trauma atendidas por el Servicio de Atencion Movil de Urgencia, transportadas al referido hospital. Resultados: se observo que el 5,9% ingreso en la urgencia por Feridas por Arma de Fuego, 4,9% por Lesion por Arma Blanca, 23,8% por caida, y 60,4% por accidentes de transito. Conclusión: el perfil identificado fue de hombres, victimas de accidente de transito, en las edades de 18 a 35 anos, con segundo grado completo, siendo el torax la region mas afectada. Este estudio puede subsidiar la elaboracion de estrategias para enfrentar esos agravios, pues la gran cantidad de muertes por causas externas son consideradas um problema de salud publica, causando secuelas irreparables

Humanos , Masculino , Adulto , Adulto Jovem , Traumatismo Múltiplo , Socorro de Urgência , Pesquisa sobre Serviços de Saúde , Causas Externas
Rev. medica electron ; 42(6): 2487-2498, nov.-dic. 2020. tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1150032


RESUMEN Introducción: el control de daños en Ortopedia es aplazar la reparación definitiva de lesiones traumáticas, con el objetivo de la recuperación fisiológica deteriorada por lesiones y/o complicaciones que pueden poner en peligro la vida, realizando entonces procedimientos quirúrgicos sencillos, como una estabilización quirúrgica externa de las fracturas. Objetivo: determinar el comportamiento del control de daños ortopédicos en politraumatizados pediátricos. Materiales y método: se realizó un estudio observacional, descriptivo, prospectivo, de corte transversal, de enero del 2015 a diciembre del 2018. El universo estuvo constituido por 22 pacientes menores de 19 años de edad, politraumatizados en el período; la muestra por 15 pacientes, a los que se les aplicó control de daños ortopédicos, según criterios de selección. Resultados: se aplicó control de daños ortopédicos a 15 infantes. El más afectado fue el sexo masculino con el 73,3 %. Prevalecieron los traumatismos de los miembros inferiores con el 58,3 % y las fracturas cerradas con un 53,8 %. La osteomielitis crónica fue la complicación que predominó, en el 20 % de la muestra. En el 73,3 % de los casos se evaluó como satisfactoria la aplicación del control de daños ortopédicos en los politraumatizados. Conclusiones: a la totalidad de los traumatizados se le aplicó control de daños ortopédicos. Predominó el sexo masculino y el grupo de edad de 9 -14 años. Los miembros inferiores aportan la mayor cantidad con el fémur y la tibia. El control de daños ortopédicos se evaluó satisfactoriamente en la mayoría de los pacientes estudiados (AU).

ABSTRAC Introduction: the control of damages in Orthopedics is to postpone the definitive repair of traumatic lesions, with the objective of the physiologic recovery deteriorated by lesions and/or complications that can put in danger the life, carrying out simple surgical procedures, like an external surgical stabilization of the fractures at that time. . Objective: to determine the behavior of the orthopedic damage control in pediatric politraumatized patients. Material and method: a cross-sectional, prospective, descriptive, observational study was carried out from January 2015 to December 2018. The universe was formed by 22 patients younger than 19 years politraumatized in the period and the sample formed 15 patients; they underwent orthopedic damage control, according to the selection criteria. Results: the orthopedic damage control, was applied to 15 children. Male sex was the most affected one. Trauma in the lower limbs with 58.3 % and closed fractures with 53.8 prevailed. The predominating complication was chronic poliomyelitis in 20 % of the sample. The orthopedic damage control in politraumatized patients was assessed as successful in 73.3 % of the cases. Conclusions: the orthopedic damage control was applied to the total of traumatized patients. The male sex and the 9-14 years-old age group predominated. Lower limbs contributed with the biggest quantity of trauma, in femur and tibia. The orthopedic damage control was assessed as successful in most of studied patients (AU).

Humanos , Masculino , Feminino , Traumatismo Múltiplo/prevenção & controle , Criança , Dano ao Paciente/prevenção & controle , Ortopedia/métodos , Procedimentos Cirúrgicos Menores/métodos , Ferimentos e Lesões/prevenção & controle , Procedimentos Ortopédicos/métodos , Fraturas Fechadas/diagnóstico , Fraturas Expostas/diagnóstico
Artigo em Inglês | MEDLINE | ID: mdl-33321867


BACKGROUND: Identification of malnutrition is especially important in severely injured patients, in whom hypermetabolism and protein catabolism following traumatic injury worsen their nutritional condition. The geriatric nutritional risk index (GNRI), based on serum albumin level and the current body weight/ideal body weight ratio, is useful for identifying patients with malnutrition in many clinical conditions. This study aimed to explore the association between admission GNRI and mortality outcomes of adult patients with polytrauma. METHODS: From 1 January 2009 to 31 December 2019, a total of 348 adult patients with polytrauma, registered in the trauma database of a level I trauma center, were recognized and categorized into groups of death (n = 71) or survival (n = 277) and into four nutritional risk groups: a high-risk group (GNRI < 82, n = 87), a moderate-risk group (GNRI 82 to <92, n = 144), a low-risk group (GNRI 92-98, n = 59), and a no-risk group (GNRI > 98, n = 58). Univariate and multivariate logistic regression analyses were used to identify the independent risk factors for mortality. The mortality outcomes of patients at various nutritional risks were compared to those of patients in the no-risk group. RESULTS: The comparison between the death group (n = 71) and the survival group (n = 277) revealed that there was no significant difference in gender predominance, age, pre-existing comorbidities, injury mechanism, systolic blood pressure, and respiratory rate upon arrival at the emergency room. A significantly lower GNRI and Glasgow Coma Scale score but higher injury severity score (ISS) was observed in the death group than in the survival group. Multivariate logistic regression analysis revealed that Glasgow Coma Scale (GCS), odds ratio (OR), 0.88; 95% confidence interval (CI), 0.83-0.95; p < 0.001), ISS (OR, 1.07; 95% CI, 1.04-1.11; p < 0.001), and GNRI (OR, 0.94; 95% CI, 0.91-0.97; p < 0.001) were significant independent risk factors for mortality in these patients. The mortality rates for the high-risk, moderate-risk, low-risk, and no-risk groups were 34.5%, 20.1%, 8.5%, and 12.1%, respectively. Unlike patients in the moderate-risk and low-risk groups, patients in the high-risk group had a significantly higher death rate than that of those in the no-risk group. CONCLUSIONS: This study revealed that the GNRI may serve as a simple, promising screening tool to identify the high risk of malnutrition for mortality in adult patients with polytrauma.

Avaliação Geriátrica , Desnutrição , Traumatismo Múltiplo , Avaliação Nutricional , Adulto , Idoso , Feminino , Humanos , Masculino , Desnutrição/epidemiologia , Desnutrição/mortalidade , Estado Nutricional , Fatores de Risco
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(10): 1208-1212, 2020 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-33198865


OBJECTIVE: To establish a prognostic Nomogram model for predicting the risk of early death in polytrauma patients. METHODS: Data extracted from a polytrauma study on Dryad, an open access database, was selected for secondary analysis. Patients from 18 to 65 years old with polytrauma in the original data were included. All patients with missing variables, such as blood lactic acid (Lac), Glasgow coma score (GCS) and injury severity score (ISS) at admission, were excluded. The differences of gender, age, Lac, ISS and GCS scores between the patients who died within 72 hours and those who survived were analyzed. The risk factors for 72-hour death were analyzed by Logistic regression, and the Nomogram prediction model was established using R software. The receiver operating characteristic (ROC) curve was used to evaluate the predictive ability of the model, and the Bootstrap method was used for internal verification by repeating sample for 1 000 times. Decision curve (DCA) was applied to analyze the clinical practical value of the model. RESULTS: A total of 2 315 polytrauma patients were included. Logistic regression analysis showed that Lac, GCS score and age > 55 years old were the risk factors for early death in polytrauma patients [Lac: odds ratio (OR) = 1.36, 95% confidence interval (95%CI) was 1.29-1.42, P < 0.001; GCS score: OR = 0.76, 95%CI was 0.73-0.79, P < 0.001; age > 55 years old: OR = 1.92, 95%CI was 1.37-2.66, P < 0.001]. The prediction model was established by using the above risk factors and displayed by Nomogram. ROC curve analysis showed that the area under the ROC curve (AUC) of Nomogram model to predict the risk of death within 72 hours was 0.858, and the predictive ability of Nomogram model was significantly higher than that of Lac (AUC = 0.743), GCS score (AUC = 0.774) and ISS score (AUC = 0.699), all P < 0.05. The model calibration chart showed that the predicting probability was consistent with the actual occurrence probability, and the DCA showed that Nomogram model presented excellent clinical value in predicting the 72-hour death risk for polytrauma patients. CONCLUSIONS: The prognostic Nomogram model presents significantly predictive value for the risk of death within 72 hours in polytrauma patients. Prognostic Nomogram model could offer individualized, visualized and graphical prediction pattern, and provide physicians with practical diagnostic tool for triage system and management of polytrauma according to precision medicine.

Traumatismo Múltiplo , Nomogramas , Adolescente , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Estudos Retrospectivos , Adulto Jovem
Nursing (Säo Paulo) ; 23(270): 4861-4872, nov.2020.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1145470


OBJETIVO: Descrever os cuidados de enfermagem ao paciente politraumatizado grave. MÉTODO: Revisão integrativa com buscas nas bases de dados CINAHL, MEDLINE/BIREME, IBECS, BDENF e LILACS, utilizando os MeSH (Medical Subject Headings) obtidos através da estratégia PVO e operador booleano em duas estratégias distintas: estratégia 01 "nursing care AND multiple trauma" e estratégia 02 "nursing care AND patient AND multiple trauma". RESULTADOS: Após buscas e aplicação dos critérios de elegibilidade restaram uma totalidade de 09 artigos. Nesse sentido, observou-se que os cuidados de enfermagem ao paciente politraumatizado estão ligados ao âmbito do manejo adequado com a estrutura corporal, com ênfase na técnica de imobilização; aos cuidados à restauração e manutenção da pele; à administração medicamentosa e controle da dor; e, ao monitoramento de sistemas fisiológicos. CONCLUSÃO: O cuidado de enfermagem é um instrumento complexo que abrange o ser em sua totalidade, onde na assistência ao politraumatizado várias intervenções são necessárias para que haja progressão no estado de saúde deste individuo, demonstrando a importância desta profissão em virtude das inúmeras atividades desempenhadas.(AU)

OBJECTIVE: To describe nursing care for severe polytrauma patients. METHOD: Integrative review with searches in the following databases: CINAHL, MEDLINE/BIREME, IBECS, BDENF and LILACS, using MeSH (Medical Subject Headings) obtained through the PVO strategy and Boolean operator in two different strategies: strategy 01 "nursing care AND multiple trauma "and strategy 02" nursing care AND patient AND multiple trauma". RESULTS: After searching and applying the eligibility criteria, a total of 09 articles remained. In this sense, it was observed that nursing care for polytrauma patients is linked to the scope of adequate management with body structure, with an emphasis on the immobilization technique; care for the restoration and maintenance of the skin; medication administration and pain control; and, the monitoring of physiological systems. CONCLUSION: Nursing care is a complex instrument that encompasses the being in its entirety, where in assistance to multiple trauma patients, several interventions are necessary for there to be progression in the health status of this individual, demonstrating the importance of this profession due to the numerous activities performed.(AU)

OBJETIVO: Describir la atención de enfermería a pacientes politraumatizados graves. METODO: Revisión integrativa con búsquedas en las bases de datos CINAHL, MEDLINE/BIREME, IBECS, BDENF y LILACS, utilizando el MeSH (Medical Subject Headings) obtenido a través de la estrategia PVO y operador booleano en dos estrategias distintas: estrategia 01 "cuidado de enfermería y trauma múltiple" y estrategia 02 "cuidado de enfermería y y y trauma múltiple del paciente". RESULTADOS: Después de buscar y aplicar los criterios de elegibilidad, se mantuvieron un total de 09 artículos. En este sentido, se observó que la atención de enfermería para pacientes politraumatizados está vinculada al ámbito de un manejo adecuado con estructura corporal, con énfasis en la técnica de inmovilización; cuidado de la restauración y mantenimiento de la piel; administración de drogas y control del dolor; y, el monitoreo de los sistemas fisiológicos. CONCLUSION: La atención de enfermería es un instrumento complejo que abarca el ser en su totalidad, donde en el cuidado de la politraumatizada son necesarias varias intervenciones para que haya progresión en el estado de salud de este individuo, demostrando la importancia de esta profesión debido a las numerosas actividades realizadas.(AU)

Humanos , Traumatismo Múltiplo/enfermagem , Fraturas Múltiplas , Cuidados de Enfermagem , Ferimentos e Lesões , Assistência Centrada no Paciente
Ann Palliat Med ; 9(5): 3710-3715, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33065808


Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a newly identified strain of coronavirus in the human body and was reported in Wuhan at the end of 2019. So far, the epidemic is continuing and very serious, with the number of infections and deaths increasing. Despite active investigations around the world to better understand the dynamics of transmission and the scope of clinical disease, COVID-19 continues to spread rapidly from person to person. The common signs and symptoms of SARS-CoV-2 infection include fever, fatigue, dry cough, and dyspnea; in severe cases, patients may have acute respiratory distress syndrome, septic shock, metabolic acidosis difficult to treat and coagulation disorder. However, some patients who test positive for SARS-CoV-2 in their respiratory tract may not have such clinical signs and symptoms. This report presents a case study analysis of a patient admitted in the Fourth Taiyuan People's Hospital, who had suffered traumatic injuries from a car accident and survived COVID-19, with pleural effusion as the initial symptom. We report a case of 2019-NCOV with pleural effusion as the first symptom. Describe in detail the differential diagnosis, diagnosis, clinical management, and cure of this case. In order to combat the novel CoronaviruscoVID-19 in the process to provide lessons and help.

Acidentes de Trânsito , Infecções por Coronavirus/diagnóstico , Traumatismo Múltiplo/diagnóstico , Derrame Pleural/diagnóstico , Pneumonia Viral/diagnóstico , Adulto , Betacoronavirus , Otorreia de Líquido Cefalorraquidiano/complicações , Otorreia de Líquido Cefalorraquidiano/diagnóstico , Infecções por Coronavirus/complicações , Progressão da Doença , Sinusite Etmoidal/complicações , Sinusite Etmoidal/diagnóstico , Feminino , Traumatismos do Pé/complicações , Traumatismos do Pé/diagnóstico , Humanos , Pulmão/diagnóstico por imagem , Fraturas Maxilares/complicações , Fraturas Maxilares/diagnóstico , Seio Maxilar/lesões , Traumatismo Múltiplo/complicações , Fraturas Orbitárias/complicações , Pandemias , Derrame Pleural/etiologia , Pneumonia Viral/complicações , Fraturas das Costelas/complicações , Fraturas das Costelas/diagnóstico , Falanges dos Dedos do Pé/lesões , Tomografia Computadorizada por Raios X , Fraturas da Ulna/complicações , Fraturas da Ulna/diagnóstico
Cochrane Database Syst Rev ; 10: CD006212, 2020 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-33027844


BACKGROUND: Pulmonary emboli (PE), or blood clots in the lungs,can be potentially fatal. Anticoagulation is the first line therapy to prevent PE. In some instances anticoagulation fails to prevent more emboli, or cannot be given because the person has a high risk of bleeding. Inferior vena caval filters (VCFs) are metal alloy devices that mechanically trap fragmented emboli from the deep leg veins en route to the pulmonary circulation. Retrievable filters are designed to be introduced and removed percutaneously. Although their deployment seems of theoretical benefit, their clinical efficacy and adverse event profile is unclear. This is the third update of a Cochrane Review first published in 2007. OBJECTIVES: To assess the evidence for the effectiveness and safety of vena caval filters (VCFs) in preventing pulmonary embolism (PE). SEARCH METHODS: For this review update, the Cochrane Vascular Information Specialist (CIS) searched the Specialised Register (last searched 10 September 2019) and the Cochrane Register of Controlled Trials (CENTRAL) (2019, Issue 8) via the Cochrane Register of Studies Online. The CIS also searched MEDLINE Ovid, EMBASE Ovid, CINAHL, and AMED (1 January 2017 to 10 September 2019) and trials registries to 10 September 2019. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and controlled clinical trials (CCTs) that examined the efficacy of VCFs in preventing PE. DATA COLLECTION AND ANALYSIS: For this update, studies were assessed and data extracted independently. We assessed study quality with Cochrane's 'Risk of bias' tool and used the GRADE approach to assess the overall certainty of the evidence. The outcomes of interest were PE, mortality, lower limb venous thrombosis, filter-related complications and major bleeding. MAIN RESULTS: We identified four new studies for this update, bringing the total to six included studies involving 1388 participants. The six studies were clinically heterogeneous and we were unable to carry out meta-analysis. Only two studies were considered to be both applicable in current clinical settings and of good methodological quality. One was a randomised open-label trial studying the effect of a retrievable inferior vena caval filter plus anticoagulation versus anticoagulation alone on risk of recurrent pulmonary embolism (PE) in 399 participants over three months. There was no evidence of a difference in the rates of PE, death, lower extremity deep vein thrombosis (DVT), or bleeding at three and six months after the intervention (moderate-certainty evidence). A filter was inserted in 193 people, but could only be successfully retrieved from 153. Minor filter complications were noted at six months. The second clinically relevant study was a randomised open-label trial of 240 participants who had sustained multiple traumatic injuries, allocated to a filter or no filter, three days after injury, in conjunction with anticoagulation and intermittent pneumatic compression. Prophylactic anticoagulation was initiated in both groups when it was thought safe to do so. There was no evidence of a difference in symptomatic PE, death, or lower limb venous thrombosis rates (moderate-certainty evidence). The only major filter complication was that one person required surgical removal of the filter. We are unable to draw any conclusions from the remaining four included studies. One study showed an increased incidence of long-term lower extremity DVT at eight years. Three studies are no longer clinically applicable because they utilised permanent filters which are seldom used now, or they did not use routine prophylactic anticoagulation which is current standard practice. The fourth study compared two filter types and was terminated prematurely as one filter group had a higher rate of thrombosis compared to the other filter type. AUTHORS' CONCLUSIONS: Two of the six identified studies were relevant for current clinical settings. One showed no evidence of a benefit of retrievable filters in acute PE for the outcomes of PE, death, DVT and bleeding during the initial three months in people who can receive anticoagulation (moderate-certainty evidence). The other study did not show any benefit for prophylactic filter insertion in people who sustained multiple traumatic injuries, with respect to symptomatic PE, mortality, or lower extremity venous thrombosis (moderate-certainty evidence). We can draw no firm conclusions regarding filter efficacy in the prevention of PE from the remaining four RCTs identified in this review. Further trials are needed to assess vena caval filter effectiveness and safety, and clinical differences between various filter types.

Embolia Pulmonar/prevenção & controle , Filtros de Veia Cava , Anticoagulantes/uso terapêutico , Terapia Combinada/métodos , Humanos , Dispositivos de Compressão Pneumática Intermitente , Traumatismo Múltiplo/complicações , Embolia Pulmonar/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Filtros de Veia Cava/efeitos adversos , Veia Cava Inferior , Trombose Venosa/complicações
Medicine (Baltimore) ; 99(42): e22412, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080675


In many German trauma centres, it is routine to perform abdominal follow-up sonography (AFS) 6 h after admission for patients with multiple trauma, even if the clinical course is uneventful and multi-slice computed tomography (MSCT) reveals no abdominal pathology. However, this approach is not recommended in the German Guidelines for trauma, and recent studies have questioned the value of AFS to these patients. The present study aimed to evaluate the revised German Guidelines for trauma with respect to the omission of AFS.We included patients with multiple injuries with no clinical signs of abdominal trauma and with normal abdominal MSCT. We collected clinical data of 370 consecutive patients who underwent AFS (Group A) and another 370 consecutive patients who did not undergo AFS (Group B).No abdominal injury was missed by the omission of AFS, and thus, no patient suffered from its omission or benefitted from the use of AFS. In our study population, the negative predictive value of normal MSCT results combined with no clinical signs of abdominal trauma was 100% (95% confidence interval: 99.5%-100.0%).This single-centre study conducted in a large German trauma centre demonstrates AFS to have no utility in the diagnosis of abdominal injury. Moreover, omission of AFS for conscious patients without clinical signs of abdominal trauma and with negative abdominal MSCT does not appear to have negative consequences in terms of missed abdominal injury.Therefore, AFS can be safely omitted in the majority of cases of polytrauma, which simplifies the imaging workup tremendously.

Traumatismos Abdominais/diagnóstico por imagem , Traumatismo Múltiplo/diagnóstico por imagem , Guias de Prática Clínica como Assunto , Ultrassonografia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Alemanha , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Traumatologia , Índices de Gravidade do Trauma , Procedimentos Desnecessários
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(9): 1128-1130, 2020 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-33081904


On April 6, 2020, a case of severe crush injuries in head, neck, chest and right upper extremity was admitted to Qingzhou Hospital Affiliated to the First Medical University of Shandong Province. In addition to the crush injuries, the case also suffered from shock, crush syndrome, trauma-induced coagulopathy (TIC), and acute respiratory distress syndrome (ARDS). The female patient was 44 years old, and was admitted to the hospital at 07:00 on April 6, 2020 due to traffic accident with head, neck, chest, right upper limb injuries with disturbance of consciousness for 1 hour. Admission physical examination: body temperature was 35.6 centigrade. The patient was drowsy, with swelling and cyanosis around the right orbit and right cheek. The skin was severely abraded with blood seepage. The conjunctiva was pale. The lips were slightly cyanotic. The right chest collapsed and deformed with abnormal breathing. The skin of chest wall was blue and purple with extensive feeling of holding snow under the skin. The breath sound of right lung was low and dry and wet rales could be heard. Laboratory examination: routine blood test showed that white blood cell count (WBC) was normal, red blood cell count (RBC), hemoglobin (Hb) and platelet count (PLT) decreased, blood glucose increased; urine routine examination showed glucose +++, urine occult blood +++, urinary protein +++, visible transparent and granular tube type; coagulation indicators and blood biochemical examination were abnormal. Arterial blood gas analysis showed that pH and arterial partial pressure of oxygen (PaO2) decreased. X-ray showed comminuted fracture of distal humerus and proximal end of right ulna and radius with dislocation of right elbow joint. CT showed swelling of soft tissue around the right orbit and depressed fracture of inner wall. After admission, single-lung ventilation, tracheotomy and prone ventilation were applied to increase oxygenation level and relieving ARDS. Fluid of damage control for resuscitation was applied to reverse shock and blood transfusion was used to control hemorrhage and TIC. According to the patient's conditions and theory of damage control surgery, right chest drainage and amputation of the right upper extremity amputation were performed in time. Then, the resection in the middle and lower part of right lung, lung repairment, and internal rib fixation were performed. Finally, selective operation was performed to cover the open wound with healing dressing, using negative pressure for suction and carrying out "stamp" skin grafting on the right chest. After treatment, the patient was out of danger, and satisfactory clinical results were achieved in the end.

Traumatismo Múltiplo , Ventilação Monopulmonar , Adulto , Drenagem , Feminino , Humanos , Traumatismo Múltiplo/terapia
Artigo em Alemão | MEDLINE | ID: mdl-33053587


Seriously injured patients represent only a small group of patients in the emergency medical service with 0.5% (ground based) to 5% (HEMS), but they are associated with a high mortality rate. Among people younger than 45, trauma is the most common cause of death, mostly as a result of severe traumatic brain injury (TBI) and/or extreme hemorrhage. As the outcome of severe TBI prehospitally can only be influenced to a very limited extent, a majority of preventable deaths in prehospital setting are caused by "critical" bleeding. The "critical" bleeding is defined by its life-threatening dimension. Anticoagulation medication can have a reinforcing effect. Adequate prehospital therapy strategies exist for external bleeding. In contrast, internal bleeding regularly evades a causal prehospital care, so that in such cases, transport prioritization and rapid definitive surgical intervention remain the only option. In the civilian environment the tested and evaluated "ABCDE" scheme must be preceded by the (for "critical bleeding") in order to react time-critically to compressible external bleeding, possibly even prior to airway management. These findings have found their way into the current version of the S3 guideline on treatment of multi system trauma by the German Society for Trauma Surgery (DGU). According to this "severely bleeding injuries that can impair vital functions should be treated with priority". Thus, this publication focuses on prehospital bleeding control.

Lesões Encefálicas Traumáticas , Serviços Médicos de Emergência , Traumatismo Múltiplo , Manuseio das Vias Aéreas , Hemorragia/terapia , Humanos
Cir. Esp. (Ed. impr.) ; 98(8): 433-441, oct. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-188970


La infección por el nuevo coronavirus SARS-CoV-2 (enfermedad por coronavirus 2019 [COVID-19]) ha determinado la necesidad de la reorganización de muchos centros hospitalarios en el mundo. España, como uno de los epicentros de la enfermedad, ha debido asumir cambios en la práctica totalidad de su territorio. Sin embargo, y desde el inicio de la pandemia, en todos los centros que atienden urgencias quirúrgicas ha sido necesario el mantenimiento de su cobertura, aunque igualmente ha sido inevitable introducir directrices especiales de ajuste al nuevo escenario que permitan el mantenimiento de la excelencia en la calidad asistencial. Este documento desarrolla una serie de indicaciones generales para la cirugía de urgencias y la atención al politraumatizado desarrolladas desde la literatura disponible y consensuadas por un subgrupo de profesionales desde el grupo general Cirugía-AEC-COVID-19. Estas medidas van encaminadas a contemplar un riguroso control de la exposición en pacientes y profesionales, a tener en cuenta las implicaciones de la pandemia sobre diferentes escenarios perioperatorios relacionados con la urgencia y a una adaptación ajustada a la situación del centro en relación con la atención a pacientes infectados

New coronavirus SARS-CoV-2 infection (coronavirus disease 2019 [COVID-19]) has determined the necessity of reorganization in many centers all over the world. Spain, as an epicenter of the disease, has been forced to assume health policy changes in all the territory. However, and from the beginning of the pandemic, every center attending surgical urgencies had to guarantee the continuous coverage adopting correct measures to maintain the excellence of quality of care. This document resumes general guidelines for emergency surgery and trauma care, obtained from the available bibliography and evaluated by a subgroup of professionals designated from the general group of investigators Cirugía-AEC-COVID-19 from the Spanish Association of Surgeons, directed to minimize professional exposure, to contemplate pandemic implications over different urgent perioperative scenarios and to adjust decision making to the occupational pressure caused by COVID-19 patients

Humanos , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pandemias , Serviços Médicos de Emergência/organização & administração , Equipamentos de Proteção/normas , Gestão da Segurança , Procedimentos Cirúrgicos Operatórios/normas , Traumatismo Múltiplo/cirurgia , Infecções por Coronavirus/prevenção & controle , Pneumonia Viral/prevenção & controle
J Rehabil Med ; 52(10): jrm00108, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-32940713


OBJECTIVE: To determine the effectiveness of multidisciplinary rehabilitation in improving functional and psychological outcomes in person with multiple trauma. DATE SOURCES: A comprehensive literature review was conducted using medical and health science electronic databases up to February 2019. DATA EXTRACTION: Two independent reviewers selected studies, extracted data and assessed study quality using the Critical Appraisal Skills Programme (CASP) checklists and Grading of Recommendations, Assessment, Development and Evaluations (GRADE). DATA SYNTHESIS: One randomized controlled trial, 1 clinical controlled trial and 4 observational studies (1 with 2 reports) were included. Qualitative analysis was used to synthesize the evidence due to the heterogeneity of included trials. The quality of the studies varied (CASP approach); the majority were of "low quality". The findings suggest "very low to moderate" evidence (GRADE) for the effectiveness of multidisciplinary rehabilitation in improving functional ability and participation. The majority of studies (n = 6) reported functional improvements after multidisciplinary rehabilitation in the short-term. CONCLUSION: The lack of "high-quality" evidence for multidisciplinary rehabilitation in improving outcomes following trauma highlights gaps in the available evidence, signifying the need for more robust studies.

Traumatismo Múltiplo/reabilitação , Humanos
Chirurgia (Bucur) ; 115(4): 530-536, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32876028


The enlarged number of powerful vehicles in our country led to an increased speed of travel and hence the high number of traffic accidents with severe consequences, even death. Along with polytrauma caused by occupational accidents, these types of traumas require complex and often multidisciplinary surgical therapy against the clock, which places the surgeon in front of situations that are not found in the everyday practice. Injuries involving damage to the thoracic-phreno-abdominal region fall into this specific category that we have chosen to discuss in the present work. We will further present three clinical cases of patients with thoraco-phreno-abdominal injuries produced by different mechanisms. A work-accident wound produced by an angle grinder, causing left thoracoabdominal injuries; a polytrauma caused by a road accident, with a thoraco-phreno abdominal wound produced by a piece of wood that penetrated obliquely through the right thorax, in the 5th and 6th intercostal spaces, crossed the right lower lung lobe, the diaphragm, the 7th liver segment, and stopped in the right posterior costal grid, and a polytrauma following a fall from a height, with a torn diaphragm and mesentery.

Traumatismos Abdominais/cirurgia , Traumatismo Múltiplo/cirurgia , Traumatismos Torácicos/cirurgia , Ferimentos Penetrantes/cirurgia , Traumatismos Abdominais/complicações , Acidentes por Quedas , Acidentes de Trânsito , Humanos , Traumatismo Múltiplo/complicações , Traumatismos Ocupacionais/complicações , Traumatismos Ocupacionais/cirurgia , Traumatismos Torácicos/complicações , Resultado do Tratamento , Ferimentos Penetrantes/complicações
Unfallchirurg ; 123(11): 843-848, 2020 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-32856148


The increasing digitalization of social life opens up new possibilities for modern health care. This article describes innovative application possibilities that could help to sustainably improve the treatment of severe injuries in the future with the help of methods such as big data, artificial intelligence, intelligence augmentation, and machine learning. For the successful application of these methods, suitable data sources must be available. The TraumaRegister DGU® (TR-DGU) currently represents the largest database in Germany in the field of care for severely injured patients that could potentially be used for digital innovations. In this context, it is a good example of the problem areas such as data transfer, interoperability, standardization of data sets, parameter definitions, and ensuring data protection, which still represent major challenges for the digitization of trauma care. In addition to the further development of new analysis methods, solutions must also continue to be sought to the question of how best to intelligently link the relevant data from the various data sources.

Inteligência Artificial , Serviços Médicos de Emergência , Traumatismo Múltiplo , Bases de Dados Factuais , Alemanha , Humanos , Sistema de Registros
Ann R Coll Surg Engl ; 102(9): e1-e3, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32735136


The Rockwood type VI acromioclavicular joint injury describes subcoracoid dislocation of the distal end of the clavicle. This injury pattern is exceedingly rare, with only 12 cases described in the literature. Diagnosis can be challenging; it is often the result of a high-energy mechanism and patients frequently have other severe distracting injuries. We report the case of a 23-year-old man who presented to our department after falling from a fifth-floor balcony. Alongside multiple intra-abdominal and musculoskeletal injuries, the patient sustained a type VI acromioclavicular joint dislocation. This injury was not picked up on the initial clinical assessment or described in the initial radiology report, with the diagnosis only made upon subsequent repeat review of the imaging by the admitting team. Fortunately, this delay did not increase the time to the patient receiving appropriate treatment. Despite its rarity, awareness of this injury pattern and its association with polytrauma is essential to reduce the risk of the diagnosis being overlooked in the acute setting.

Articulação Acromioclavicular/lesões , Luxações Articulares/diagnóstico , Traumatismo Múltiplo/diagnóstico , Acidentes por Quedas , Articulação Acromioclavicular/patologia , Humanos , Luxações Articulares/patologia , Masculino , Traumatismo Múltiplo/patologia , Adulto Jovem