RESUMEN
Advances in medical technology have provided clinicians with the means to successfully treat life-threatening illnesses and injuries. For trauma surgeons, the acuteness and severity of thoracic and abdominal injuries may not allow time for complete, continuous neurologic examination, including computed tomography. The situation may arise in which urgent, major surgical intervention is necessary in a neurologically moribund patient. One such patient is presented herein; the Argon Beam Coagulator is used to repair a severe liver injury in this unstable trauma victim on whom a complete neurologic examination could not be performed. Cerebral death ensued and the repaired liver was successfully transplanted.
Asunto(s)
Argón/uso terapéutico , Electrocoagulación/métodos , Trasplante de Hígado/normas , Hígado/lesiones , Heridas Penetrantes/cirugía , Accidentes de Tránsito , Adulto , Muerte Encefálica/diagnóstico , Electrocoagulación/instrumentación , Electrocoagulación/normas , Humanos , Masculino , Heridas Penetrantes/etiología , Heridas Penetrantes/mortalidadRESUMEN
During a 3-year period (1986-1989), 8 patients were seen at St. Louis University Medical Center exhibiting the stigmata of traumatic asphyxia. Fewer than 200 cases of traumatic asphyxia have been reported and there is only a single report of a cardiac injury. In this series, 3 of 8 (37.5%) patients were found to have an injury to the heart: two cardiac contusions and a ventricular rupture. Five patients were crushed in motor vehicle collisions, one by an elevator counterweight, and two patients by river barges. Injuries associated with these patients include pulmonary contusion, hemopneumothorax, traumatic pneumatocele, traumatic retinopathy, bone fractures, mental confusion, and liver contusion. There was one death in the series, a patient with rupture of the right ventricle and severe splenic and liver injuries. The cardiac status of the patients was evaluated by serial serum cardiac enzyme determinations, electrocardiograms, and echocardiography. This report illustrates the importance of complete cardiac evaluation in patients with traumatic asphyxia.
Asunto(s)
Asfixia/etiología , Lesiones Cardíacas/etiología , Traumatismos Torácicos/complicaciones , Accidentes de Trabajo , Accidentes de Tránsito , Adolescente , Adulto , Niño , Preescolar , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Traumatismos Torácicos/patología , Heridas no Penetrantes/complicacionesRESUMEN
The Keith Antireflux Valve (ARV) is a one-way valve placed on the sump port of a double-lumen NG tube. ARV use in critically injured patients significantly prevents reflux through the sump port and decreases the incidence of both patient gown and linen change and NG tube repositioning. There is no evidence to indicate that the ARV may lead to malfunction of the NG tube, aspiration, or gastric dilation. The cost savings in materials and nursing time are significant.