1/14. Whole blood transfusion for exsanguinating coagulopathy in a US field surgical hospital in postwar kosovo.An urgent blood drive in which active duty military field surgical hospital personnel volunteered to donate whole blood was conducted, and administration of warm, whole blood prevented the exsanguination of a normothermic coagulopathic patient who had received a massive transfusion. In austere care settings in which full blood banking capability may not be available, physicians should consider that exsanguinating hemorrhage can potentially be controlled surgically, but nonsurgical bleeding requires specific replacement therapy, and whole blood may be the best selection for repleting deficiencies of components that are otherwise unavailable.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/14. Serial bedside emergency ultrasound in a case of pediatric blunt abdominal trauma with severe abdominal pain.We present a case of a teenager with isolated left renal laceration with perirenal hematoma. The patient had presented with severe left upper quadrant (LUQ) pain following blunt abdominal trauma (BAT) sustained during a sledding accident. A screening bedside focused abdominal sonogram for trauma (FAST) rapidly excluded free fluid on two serial examinations, 30 minutes apart. It provided the pediatric emergency physician with a measure of diagnostic confidence that the patient could be safely transported to the CT suite for detailed delineation of his injury. Moreover, narcotic analgesia was liberally administered early in his illness course, without the fear of unmasking potential hypovolemia when it was known that he did not have gross intra-abdominal bleeding on his bedside ultrasound (US). It also provided a working diagnosis of the primary organ of injury. Our hospital, like many pediatric hospitals around the nation, does not have in-house 24-hour radiology support. We suggest that the use of the bedside US be extended to the stable pediatric patient in severe abdominal pain following BAT. It can serve as a valuable, rapid, noninvasive, bedside, easily repeated, fairly accurate triage tool to evaluate pediatric BAT with severe pain.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/14. Seat belt syndrome in children: a case report and review of the literature.Characteristic patterns of injury to children in automobile crashes resulting from lap and lap-shoulder belts have been described for many years. These injuries are known as the "seat belt syndrome." We present a typical case of seat belt syndrome involving a 4-year-old boy and review the current literature on the topic, highlighting proposed mechanisms of intra-abdominal and spine injuries. In addition, recent research findings identifying a new pattern of injuries associated with inappropriate seat belt use in young children are reviewed. Emergency physicians must consider these seat belt-related injuries in the initial evaluation of any child involved in a motor vehicle crash who was restrained with the vehicle seat belt.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/14. Clasp knife in the gut: a case report.BACKGROUND: A wide range of foreign bodies has been retrieved from the gut and reported. The presentation may be in the form of complications like intestinal obstruction, perforation and formation of abscesses etc but there is no case report of a half open clasp knife being retrieved from the ileum, the patient having thrived, in spite of its presence for a period of eight months. CASE PRESENTATION: A 30-year-old administrative clerk had undergone emergency abdominal surgery eight months previously under mysterious circumstances at a remote district hospital and had recovered completely. Later the blade of a knife was accidentally detected when an X ray of the abdomen was done during a routine follow-up visit to his family physician. Surgery revealed a clasp knife in the ileum, which was retrieved. The presence of an entero-enteric fistula short circuiting the loop was the secret of his earlier survival. CONCLUSIONS: To the best of our information this is the first case-report of a clasp knife in the gut and of the patient thriving in spite of its presence. We report here the dramatic sequence of events.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/14. Hollow visceral injury after blunt lower thoracic and abdominal trauma.The early diagnosis of hollow viscous injury after blunt abdominal trauma remains a challenge for physicians in the Emergency Department, although the early diagnosis of hollow viscous injury decreases morbidity and mortality. After a description of two cases of hollow viscous injury after blunt abdominal trauma, a literature review is performed concerning the indications and limitations of diagnostic imaging modalities. Focused abdominal sonography for trauma, computed tomography scan and diagnostic peritoneal lavage are described. On the basis of the review a proposal for maximal diagnostic accuracy is made.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/14. Pancreatic injury from blunt abdominal trauma in childhood.BACKGROUND: Pancreatic trauma in children is relatively uncommon, but carries high morbidity and mortality rates when diagnosis is delayed. Preoperative diagnosis of pancreatic lesion might be difficult, especially in the case of isolated injury. METHODOLOGY: Authors analyse seven cases of pancreatic trauma in childhood. In three cases surgical intervention was required due to pancreatic transection with main pancreatic duct rupture. The injuries of the 5-10 years old male patients were diagnosed and operated on within 24 hours. RESULTS: In two cases distal resection were performed with splenic preservation. In one case--where the operation was performed within 8 hours--preservation of the distal pancreas was also achieved by distal pancreatogastrostomy. The postoperative period was uneventful in all cases. Impaired glucose metabolism was not found in the operated cases during the follow up. CONCLUSIONS: Authors emphasise the importance of CT scan and the responsibility of the first attending physician regarding both diagnosis and correct surgical management.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/14. Elevated liver enzymes as a predictor of liver injury in stable blunt abdominal trauma patients: case report and systematic review of the literature.liver injury secondary to blunt abdominal trauma is a well-defined entity in emergency medicine. A challenge exists in the diagnosis of liver trauma in the stable, wellappearing patient with a history of blunt abdominal trauma. In centres lacking advanced diagnostic modalities an elevation in hepatic transaminases may provide guidance for the rural emergency physician in seeking further imaging and/or surgical consultation. We present a case report and a discussion of the literature. The literature provided a broad spectrum of results. There appears to be a direct relationship between blunt liver trauma and elevation in liver transaminases. These results are especially evident in the pediatric population. Our findings may help guide the rural emergency physician in transfer and disposition decisions in patients in this situation.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
8/14. artificial intelligence: a computerized decision aid for trauma.A computerized decision support system has been developed to advise ATLS-trained surgeons on the initial definitive management of patients with penetrating injuries of the abdomen immediately following resuscitation and stabilization. The program was developed as an "expert system," using the techniques of artificial intelligence. It is able to suggest: the need for further examination; additional tests; diagnoses; and treatments. In this study, the advice offered by the expert system was compared to that of physicians-in-training. Five actual patient care situations were presented to the system and to 13 medical students and surgical residents: four MS-III, three PGY-I, three PGY-III, and three PGY-V. The suggestions of each of the 13 trainees, the advice of the expert system, and the actual management were blinded. Five surgeons versed in trauma and otherwise not involved in the project judged whether each of the 15 purported management plans was acceptable and ranked them in order of preference. Only the actual care and the advice from the system were judged acceptable for all five problems. The rankings of the expert system were better than those of any individual trainee. The differences were statistically significant for two of the three chief residents, five of nine residents overall, and all four students. This preliminary validation of a prototype expert system is encouraging for the prospect of a computerized decision support system that can help surgeons make initial definitive management plans for patients with major trauma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/14. hemobilia: review of recent experience with a worldwide problem.Between 1981 and 1985, the reported incidence of hemobilia increased for two major reasons. First, a more sophisticated and better-trained medical community could entertain the diagnosis readily in certain settings and had broader access to diagnostic methods that precisely defined the source of bleeding into the biliary tract. Second, there was wider use of percutaneous techniques of diagnosis and treatment of biliary diseases. Once the diagnosis of hemobilia was made by endoscopic or arteriographic means, physicians and surgeons were quicker to institute proper therapeutic measures. For this reason, the mortality associated with hemobilia decreased compared with that reported earlier. The medical community must be aware that modern treatments are now the most common cause of this problem. Since invasive diagnostic methods are increasingly used by nonsurgeons, it is imperative that these patients are studied in the context of complete consultation with surgeons who can use definitive treatments when required.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/14. air gun injuries in children.air gun injuries occur frequently in children and are potentially lethal. Three cases of air gun injuries in children are described. Two children sustained air gun injuries to the neck that penetrated the platysma. Each had exploration of the wound. One had injury to the esophagus that was treated with external drainage; the other sustained no major injury to vital cervical structures. A third child received a penetrating injury to her right flank that did not appear to enter the peritoneal cavity. She was observed for 24 hours and released. After a six-month followup, all patients have remained free of complications. The emergency physician should be aware of the penetrating capabilities of these weapons, and they should be managed as would any other low-velocity gunshot wound.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
| | Next -> |