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crashing ventilated patient

Gabriel Estremera, Ellen Chieko Omi, Eduardo Smith-Singares
The management of flail chest continues to evolve as scientific evidence and surgical experience accumulates. Flail chest injuries that span the sternum present a rare and complicated injury pattern that can be challenging to manage both medically and surgically. Our patient is a 69-year-old involved in a high-speed motor vehicle crash with respiratory failure secondary to an anterior flail chest. Tomographic examination confirmed a sternal fracture with bilateral sternochondral dislocations and multiple rib fractures...
January 19, 2018: Surgical Case Reports
Hitesh Gidwani, Hernando Gómez
PURPOSE OF REVIEW: Rapid restoration of tissue perfusion and oxygenation are the main goals in the resuscitation of a patient with circulatory collapse. This review will focus on providing an evidence based framework of the technological and conceptual advances in the evaluation and management of the patient with cardiovascular collapse. RECENT FINDINGS: The initial approach to the patient in cardiovascular collapse continues to be based on the Ventilate-Infuse-Pump rule...
December 2017: Current Opinion in Critical Care
Ismail Mahmood, Ayman El-Menyar, Basil Younis, Khalid Ahmed, Syed Nabir, Mohamed Nadeem Ahmed, Omer Al-Yahri, Saeed Mahmood, Rafael Consunji, Hassan Al-Thani
BACKGROUND Pulmonary contusion (PC) is the most frequent blunt chest injury which could be used to identify patients at high-risk of clinical deterioration. We aimed to investigate the clinical correlation between PC volume and outcome in patients with blunt chest trauma (BCT). MATERIAL AND METHODS BCT patients with PC were identified retrospectively from the prospectively collected trauma registry database over a 2-year period. Contusion volume was measured and expressed as percentage of total lung (CTCV) volume using three-dimensional reconstruction of thoracic CT images on admission...
July 26, 2017: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Desmond Khor, Kenji Inaba, Alberto Aiolfi, Samantha Delapena, Elizabeth Benjamin, Kazuhide Matsushima, Aaron M Strumwasser, Demetrios Demetriades
BACKGROUND: Helmet use in a motorcycle collision has been shown to reduce head injury and death. Its protective effect on the cervical spine (C-spine), however, remains unclear. The objective of this study was to explore the relationship between helmet use and C-spine injuries. METHOD: Retrospective National Trauma Data Bank (NTDB) study. All motorcycle collisions between 2007 and 2014 involving either a driver or passenger were included. Data collected included demographics, vital signs, Abbreviated Injury Scale (AIS), Injury Severity Score (ISS) and specific injuries...
May 2017: Injury
Naman Agrawal, Akshay Kumar, Praveen Aggarwal, Nayer Jamshed
Sympathetic crashing acute pulmonary edema (SCAPE) is the extreme end of the spectrum of acute pulmonary edema. It is important to understand this disease as it is relatively common in the emergency department (ED) and has better outcomes when managed appropriately. The patients have an abrupt redistribution of fluid in the lungs, and when treated promptly and effectively, these patients will rapidly recover. Noninvasive ventilation and intravenous nitrates are the mainstay of treatment which should be started within minutes of the patient's arrival to the ED...
December 2016: Indian Journal of Critical Care Medicine
Emine Türkmen, Selvet Sevinç, Marziye İlhan
BACKGROUND: International and national standards for ICUs have been developed to ensure patient safety and provide effective and efficient service in these units. However, global economic crises along with shortages in professional health care staff affect the ability of ICUs to meet and maintain these standards. AIMS AND OBJECTIVES: The aim of this study was to ascertain whether the equipment and workforce in intensive care units (ICUs) in Turkish hospitals meet current ICU standards...
September 2016: Nursing in Critical Care
Rebecca H Striker, Alistair J Chapman, Rachel A Titus, Alan T Davis, Carlos H Rodriguez
BACKGROUND: Michigan repealed a 35-year mandatory helmet law in April 2012. We examined the impact of this legislation on a level 1 trauma center. METHODS: A retrospective cohort study comparing the 7-month period before and the 3 motorcycle seasons after the helmet law repeal. RESULTS: A total of 345 patients were included in the study. Nonhelmeted riders increased from 7% to 28% after the repeal. Nonhelmeted crash scene fatalities were higher after the repeal (14% vs 68%)...
March 2016: American Journal of Surgery
Cassandra V Villegas, Stephen M Bowman, Cheryl K Zogg, Valerie K Scott, Elliott R Haut, Kent A Stevens, David T Efron, Adil H Haider
BACKGROUND: Off-road motorsports are an increasing popular activity, yet the relative safety profile of all-terrain vehicles (ATV) to off-road motorcycles (ORMC) has not been compared. STUDY DESIGN: A retrospective review of the 2002-2006 US National Trauma Data Bank of ATV and ORMC crash victims. Patients were described according to demographic (age, sex, race and ethnicity, insurance status) and injury characteristics (Injury Severity Score, hypotension, motor component of the Glasgow Coma Score, presence of a severe head or extremity injury) known to affect trauma outcomes...
January 2016: Injury
Fumihiro Ohchi, Nobuyasu Komasawa, Noriko Kadono, Toshiaki Minami
We report a case of impossible ventilation in a patient with severe nasal bleeding. A 47-year-old man with intractable nasal bleeding was scheduled for emergent hemostasis under general anesthesia. He also had alcohol-related cirrhosis and was highly obese (165 cm, 93 kg). Although he sufficiently fasted and did not experience nausea in the supine position, we planned crash intubation in the head-elevated position with the Pentax-AWS Airwayscope (AWS) in order to avoid vomiting after induction of anesthesia...
January 2015: Masui. the Japanese Journal of Anesthesiology
Shahla Siddiqui, Edwin Seet, Wing Yan Chan
We herein report a witnessed cardiopulmonary collapse of a patient with difficult mask ventilation and near-impossible laryngoscopy-cum-intubation in the critical care unit. The airway was successfully rescued with a laryngeal mask airway Supreme™, followed by an open, crash tracheostomy by the otolaryngologist.
December 2014: Singapore Medical Journal
Saeed Mahmood, Mushrek Alani, Hassan Al-Thani, Ismail Mahmood, Ayman El-Menyar, Rifat Latifi
OBJECTIVES: To determine the causes, predictors and outcomes of re-intubation. METHODS: Retrospective analysis of data collected from the trauma data base registry was conducted to identify the extubation failure cases in Trauma ICU at Hamad General Hospital, the only Level I trauma center in Qatar between January 2009 and December 2010. Demographics, mechanism of Injury, complications, injury severity score (ISS), Glasgow Coma Scale (GCS), ICU-length of stay (LOS), and mortality were analyzed among trauma patients who need reintubation within 48 hrs after extubation (group 1) compared to successfully extubated patients (group 2)...
July 2014: Oman Medical Journal
Ashok Parchani, Ayman El-Menyar, Hassan Al-Thani, Ahmed El-Faramawy, Ahmad Zarour, Mohammad Asim, Rifat Latifi
BACKGROUND: Traumatic brain injury (TBI) is a common cause of morbidity and mortality worldwide. It is difficult to estimate the real incidence of traumatic subarachnoid hemorrhage (TSAH). Although TSAH after trauma is associated with poor prognoses, the impact of mechanism of injury (MOI) and the pathophysiology remains unknown. We hypothesized that outcome of TSAH caused by motor vehicle crash (MVC) or fall from height (FFH) varies based on the MOI. METHODS: Data were collected retrospectively from a prospectively created database registry in the section of Trauma Surgery at Hamad General Hospital between January 2008 and July 2012...
November 2014: World Neurosurgery
Jonathan A Messing, Victor Gall, Babak Sarani
A review on the role of open reduction and internal fixation of flail chest injuries is presented. A 37-year-old woman involved in a motorcycle crash sustained comminuted rib fractures on her right 3rd through 12th ribs. On postinjury day 2, the patient's fifth through ninth ribs were surgically reduced and plated. Later that same day, the patient was successfully weaned from mechanical ventilation and experienced a rapid improvement in incentive spirometry volumes. Further studies are needed to definitively determine the benefits of rib plating versus conventional treatment...
March 2014: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
Alistair J Chapman, Rachel Titus, Hannah Ferenchick, Alan Davis, Carlos Rodriguez
BACKGROUND: Michigan repealed a 35-year mandatory helmet law on April 13, 2012. We examined the early clinical impacts at a level 1 trauma center in West Michigan. METHODS: Retrospective cohort study comparing outcomes among motorcycle crash victims in a 7-month period before and after the helmet law repeal. RESULTS: One hundred ninety-two patients were included. After the repeal, nonhelmeted motorcyclists rose from 7% to 29% (P < .01)...
March 2014: American Journal of Surgery
D Dante Yeh, John O Hwabejire, Marc A DeMoya, Hasan B Alam, David R King, George C Velmahos
BACKGROUND: The clinical significance of sternal fractures (SFs) after blunt trauma is heavily debated. We aimed to test the hypothesis that isolated SF is not associated with significant morbidity or mortality. MATERIALS AND METHODS: The National Trauma Data Bank (NTDB) sets for 2007-2010 were retrospectively examined. Adult subjects with SF were identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes. Data collected included demographics, mechanisms of injury, clinical variables, and in-hospital mortality...
January 2014: Journal of Surgical Research
Andrew F Philip, William Fangman, Junlin Liao, Michele Lilienthal, Kent Choi
OBJECTIVE: The number of registered motorcycles in the United States has been steadily increasing, as have the number of motorcycle injuries and fatalities. The Midwest has the lowest incidence of helmet use in the country. Iowa in particular has no helmet law. MATERIALS AND METHODS: We conducted a retrospective study of the motorcycle crash victims treated at our level 1 trauma center between 2002 and 2008. Data from 713 motorcycle trauma victims were analyzed for correlations between helmet use and multiple outcome measures...
2013: Traffic Injury Prevention
Sven M Almdahl, Terje Veel, Per Halvorsen, Stein E Rynning
OBJECTIVES: Although rare, life-threatening complications requiring emergency cardiac surgery do occur after diagnostic and therapeutic cardiac catheterization procedures. The operative mortality has been persistently reported to remain high. The purpose of this observational study was to evaluate and report the outcomes, with particular emphasis on early mortality, of these risky operations that were performed in a single highly specialized cardiac centre. METHODS: Between June 1997 and August 2007, 100 consecutive patients, 13 after diagnostic complicated cardiac catheterization (0...
August 2013: Interactive Cardiovascular and Thoracic Surgery
Katherine A Heldt, Catherine Hackett Renner, David J Boarini, James R Swegle
OBJECTIVE: The relationship between injuries sustained in a motorcycle crash (MCC) by unhelmeted motorcyclists and the multitude of costs associated with those injuries has been a decades-long debate. Results from research addressing injuries and mortality due to helmet use in MCCs demonstrates that unhelmeted motorcyclists experience more severe injuries, resulting in higher health care costs and an increased likelihood of requiring care beyond the hospital in other facilities. However, a link between injury severity and hospital costs has not been established with its spillover effect onto health insurance providers...
2012: Traffic Injury Prevention
Marcello Fonseca Salgado Filho, Arthur Siciliano, Alexandre Siciliano, Andrey José de Oliveira, Júlia Salgado, Izabela Palitot
BACKGROUND AND OBJECTIVES: The use of transesophageal echocardiography (TEE) during heart harvesting for transplantation can guide the heart assessment, as harvesting a marginal heart can jeopardize the cardiac transplantation. CASE REPORT: Male, 30 years old, suffered a car crash that resulted in a severe traumatic brain injury (TBI) that evolved to brain death. The patient was intubated and ventilated with a fraction of inspired oxygen of 0.6, presetting Vt 500 mL, RR 14 bpm, PEEP of 3 mm Hg, 99% O(2) saturation, and normal blood gases...
March 2012: Revista Brasileira de Anestesiologia
Sang-Won Hwang, Han-Yong Kim, Jung Hun Byun
BACKGROUND: Traumatic rupture of the diaphragm is an unusual type of trauma. In addition, it is difficult to diagnose because it can be accompanied by injuries to other organs. If it is not detected early, the mortality rate can increase due to serious complications. Diaphragmatic rupture is an important indicator of the severity of the trauma. The aim of this study was to investigate the factors affecting the incidence of complications and mortality in patients who had surgery to treat traumatic rupture of the diaphragm...
October 2011: Korean Journal of Thoracic and Cardiovascular Surgery
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