HighlightsTension pneumopericardium is a cause of shock in thoracic trauma.It should be regarded in hemodynamically unstable patients with blunt chest trauma.Immediate pericardium decompression may save the patient’s life.
Intra-arterial calcium gluconate might be considered for finger burns caused by concentrated HF. Complete recovery of wounded fingers can be achieved with this technique even if started 24 hours after the exposure. However, controlled clinical trials are needed to confirm the effectiveness and safety of this intervention.
Background: This report reviews our clinical experience with 55 cases of traumatic diaphragmatic hernia at a Brazilian university hospital. Traumatic diaphragmatic hernia is an uncommon injury and presents diagnostic and therapeutic challenges. Occasionally, it is missed in trauma patients and is usually associated with significant morbidity and mortality. This analysis aimed to improve the diagnostic outcomes of trauma patient care. Methods: Retrospective design analysis of database records of trauma patients at HC-Unicamp were performed to investigate incidence, trauma mechanism, diagnosis, herniated organs, associated injuries, trauma score, morbidity and mortality. Results: Fifty-five patients were analysed. Blunt trauma was two-fold more frequent than penetrating trauma and was associated with high-grade injury; motor vehicle collision was the most common mechanism. Left-sided hernia was four-fold more frequent than that on the right side, although critical injuries were more frequently associated with the right side. The stomach was the most herniated organ in both trauma mechanisms. Preoperative diagnosis was mostly performed using chest radiography (55%). Postoperative diagnosis was mostly performed via laparotomy rather than laparoscopy. Associated injuries were observed in 43 patients (78%) and the mortality rate was 20% for both the sides. Conclusion: Isolated injuries are rare, and the presence of associated injuries increases morbidity and mortality. Chest radiography in the trauma bay is useful as an initial examination, although it is not suitable for use as a definitive method. Despite the use of laparoscopy in a few cases, laparotomy is the most common approach.
Selective non-operative management of hepatic injuries from blunt trauma has become an accepted practice over the past 20 years [1]. The advent of abdominal computed tomography (CT) scanning following blunt abdominal trauma has facilitated the selective nonsurgical management of liver and other intra-abdominal solid organ injuries in stable patients [1,2]. The conservative non-operative approach requires close monitoring in an intensive care unit (ICU) setting with fluid resuscitation and correction of any underlying hypovolemia or coagulopathy. There are only few case reports of isolated hepatic trauma in patients with haemophilia [3][4][5].Trauma patients who are haemodynamically stable and who have no indications for laparotomy are ideal candidates for evaluation by emergency abdominal CT. In this select group, criteria for nonoperative management include (i) simple hepatic parenchymal laceration of intrahepatic haematoma, (ii) absence of active haemorrhage, (iii) haemoperitoneum of less than 500 mL, (iv) limited need for liverrelated blood transfusions, (v) absence of diffuse peritoneal signs in patients not neurologically impaired, and (vi) absence of other peritoneal injuries that would otherwise require an operation [1,2]. In fact, the main indication of the operative approach to the blunt liver injury is haemodynamic instability, not the grading of the injury.Here, we describe the successful non-surgical management of an isolated blunt liver trauma patient with severe haemophilia A. The objective of this report is to present a severe haemophilia A patient with a complex blunt hepatic trauma treated non-operatively to reinforce that this approach is possible in selected situations under established protocol.A 21-year-old carpenter with severe haemophilia A, without history of inhibitors, and treated in on-demand manner, sustained direct blunt trauma to the right upper abdominal quadrant (RUQ) while working up to split a big longitudinal piece of wood into two parts using a circular saw. One of the parts escaped from the saw guide wire and was launched 65 feet away tangentially hitting the carpenter on its initial trajectory. The accident happened in a rural zone located 1.24 mile distant from the referenced regional trauma centre. At the impact moment, the patient felt excruciating abdominal pain and sudden dyspnoea, followed by weakness feeling and dark vision. A haematoma and important swelling appeared to the whole injury topography. The patient immediately received at home the administration of a single dose of 2 000 IU of plasma-derived factor VIII (pdFVIII) concentrate (30 IU kg )1 ), and was referred to the closest emergency hospital. Approximately 40 min after the injury, the patient was admitted to the local rural hospital. The patient arrived conscious, but his physical examination revealed tachypnea, tachycardia, with heart rate of 96 bpm, local pain, pallor and blood pressure of 80/40 mmHg. There was no active external bleeding manifestation. The abdominal examination revealed normal bowel soun...
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