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Management of a trauma patient with alcohol withdrawal who developed neuroleptic malignant syndrome in Korea: a case report. 一例因酒精戒断而出现抗精神病药物恶性综合征的创伤患者的治疗
Pub Date : 2023-09-01 Epub Date: 2022-12-20 DOI: 10.20408/jti.2022.0048
Byungchul Yu, Ji Yeon Lee, Yong Beom Kim, Hee Yeon Park, Junsu Jung, Youn Yi Jo

Neuroleptic malignant syndrome (NMS) is a rare but fatal condition, with a high mortality rate. NMS is characterized by altered mental status, fever, myoclonus, autonomic dysfunctions, and elevated creatinine phosphokinase. The clinical manifestations may be confused with alcohol-related symptoms, trauma, sepsis, postoperative agitation, or malignant hyperthermia. A 69-year-old male patient with alcohol withdrawal was admitted to the operating theatre to rule out septic shock due to mesenteric injury after multiple trauma. He was suspected NMS with abrupt increase body temperature to 41.7°C after haloperidol administration. Active cooling and rapid fluid infusion was done during anesthesia. Delayed diagnosis and treatment of NMS lead to catastrophic result. Therefore, if the patient's past medical history is unknown or clinical symptoms develop that are suggestive of NMS, early treatment must be considered.

抗精神病药物恶性综合征(NMS)是一种罕见但致命的疾病,死亡率很高。NMS的特征是精神状态改变、发烧、肌阵挛、自主神经功能障碍和肌酸酐磷酸激酶升高。临床表现可能与酒精相关症状、创伤、败血症、术后躁动或恶性高热混淆。一名69岁的男性患者因酒精戒断被送入手术室,以排除多重创伤后肠系膜损伤引起的感染性休克。他被怀疑是NMS患者,服用氟哌啶醇后体温突然升高至41.7°C。麻醉期间进行主动冷却和快速输液。NMS的延误诊断和治疗会导致灾难性的结果。因此,如果患者既往病史未知或出现提示NMS的临床症状,则必须考虑早期治疗。
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引用次数: 0
Posttraumatic bilateral thigh Morel-Lavallée lesions without an underlying bone fracture in the United Kingdom: a case report. 无潜在骨折的双侧大腿Morel-Lavallée损伤一例报告
Pub Date : 2023-09-01 Epub Date: 2023-01-11 DOI: 10.20408/jti.2022.0060
Sarah Razaq, James Geffner, Asma Khan, Harry Mee, Cynthia Udensi, Fahim Anwar

A Morel-Lavallée lesion results from a degloving injury between the muscle fascia and the subcutaneous layer. It is most commonly found in the trochanteric area but can occur at other sites. The treatment of the condition varies according to the medical circumstances, as well as the size and chronicity of the condition. A case of large (18×6 and 10×5 cm) bilateral posttraumatic Morel-Lavallée lesions with no underlying bone fracture is presented; the case occurred in a 49-year-old male patient 4 weeks posttrauma. Ultrasound scans showed bilateral large collections of anechoic fluid, which were aspirated under ultrasound guidance and further managed by compression bandages. There were no further complications. The objective of this case report is to present this unique and educational case, as well as to provide an overview of the pathophysiology, diagnosis, and management of Morel-Lavallée lesions. We conclude by discussing the importance of having a high index of suspicion to ensure early detection and prompt treatment of such lesions to avoid complications.

莫雷尔-拉瓦雷病变是由肌肉筋膜和皮下层之间的脱落损伤引起的。这种病最常见于转子部位,但也可能发生在其他部位。治疗方法因病情、大小和慢性程度而异。本文介绍了一例双侧大面积(18×6 和 10×5 厘米)创伤后莫雷尔-拉瓦雷病变,且无潜在骨折的病例;该病例发生在一名 49 岁的男性患者身上,创伤后 4 周。超声扫描显示双侧有大量无回声液体积聚,在超声引导下进行了抽吸,并通过加压包扎进行了进一步处理。没有进一步的并发症。本病例报告旨在介绍这一独特的教育性病例,并概述莫雷尔-拉瓦雷病变的病理生理学、诊断和处理方法。最后,我们讨论了高度怀疑的重要性,以确保早期发现和及时治疗此类病变,避免并发症的发生。
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引用次数: 0
Relationship between sonorheometry parameters and laboratory values in a critical care setting in Italy: a retrospective cohort study. 重症监护环境中声流变学参数与实验室值之间的关系:一项初步回顾性研究
Pub Date : 2023-09-01 Epub Date: 2023-07-04 DOI: 10.20408/jti.2023.0014
Antonio Romanelli, Renato Gammaldi, Alessandro Calicchio, Salvatore Palmese, Antonio Siglioccolo

Purpose: This preliminary retrospective cohort study analyzed the relationship between the parameters provided by sonorheometry device Quantra and the coagulation values obtained from standard venous blood samples in patients admitted in intensive care unit (ICU).

Methods: We reviewed medical charts of 13 ICU adult patients in whom at least one coagulation study with Quantra was performed. The relationship between Quantra and laboratory data was analyzed with the Spearman rank correlation coefficient (rho). The 95% confidence interval (CI) was computed. A P-value <0.05 was considered statistically significant.

Results: We collected 28 data pairs. Statistically significant moderate correlations were found for the following parameters: clot time (CT) and activated partial thromboplastin time (rho=0.516; 95% CI, 0.123-0.904; P=0.009; clot stiffness (CS) and the international normalized ratio (INR; rho=0.418; 95% CI, 0.042-0.787; P=0.039); INR and platelet contribution to CS (rho=0.459; 95% CI, 0.077-0.836; P=0.022); platelet count and platelet contribution to CS (PCS; rho=0.498; 95% CI, 0.166-0.825; P=0.008); and fibrinogen and fibrinogen contribution to CS (FCS; rho=0.620; 95% CI, 0.081-0.881; P=0.001).

Conclusions: Quantra can provide useful information regarding coagulation status, showing modest correlations with the parameters obtained from laboratory tests. During diffuse bleeding, CT and FCS values can guide the proper administration of clotting factors and fibrinogens. However, the correlation of INR with CS and PCS can cause misinterpretation. Further studies are needed to clarify the relationship between Quantra parameters and laboratory tests in the critical care setting and the role of sonorheometry in guiding targeted therapies and improving outcomes.

目的:本初步回顾性研究分析了重症监护病房(ICU)患者超声测定仪Quantra提供的参数与标准静脉血凝血值的关系。方法:我们回顾了13例ICU成人患者的病历,其中至少有一次使用Quantra进行凝血研究。采用Spearman秩相关系数(rho)分析Quantra与实验室数据之间的关系。计算95%置信区间(CI)。p值<0.05认为有统计学意义。结果:共收集28对数据。以下参数有统计学意义的中度相关性:凝块时间(CT)和活化的部分凝血活素时间(rho=0.516;95% ci, 0.123-0.904;P = 0.009;凝块刚度(CS)和国际归一化比(INR);ρ= 0.418;95% ci, 0.042-0.787;P = 0.039);INR和血小板对CS的贡献(rho=0.459;95% ci, 0.077 - 0.836;P = 0.022);血小板计数及血小板对CS的贡献;ρ= 0.498;95% ci, 0.166 - 0.825;P = 0.008);纤维蛋白原和纤维蛋白原对CS的贡献(FCS);ρ= 0.620;95% ci, 0.081 - 0.881;P = 0.001)。结论:Quantra可以提供关于凝血状态的有用信息,显示出与实验室测试参数的适度相关性。弥漫性出血时,CT和FCS值可以指导凝血因子和纤维蛋白原的正确使用。然而,INR与CS和PCS的相关性可能会引起误解。需要进一步的研究来阐明在重症监护环境中Quantra参数和实验室测试之间的关系,以及超声在指导靶向治疗和改善结果中的作用。
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引用次数: 0
Penetrating right ventricular injury following a single gunshot to the left flank in Iraq: a case report. 右心室损伤后单一枪击左侧:一个不寻常的案例报告穿透心脏损伤
Pub Date : 2023-09-01 Epub Date: 2023-04-19 DOI: 10.20408/jti.2022.0073
Zryan Salar Majeed, Yad N Othman, Razhan K Ali

A century ago, cardiac injuries usually resulted in death. However, despite all the advances in medicine, these injuries still have high mortality and morbidity rates. In the present case, we describe a patient with a bullet injury to the right ventricle who survived at our hospital despite the limitations of our center with regard to modalities and equipment. A 30-year-old man was brought to our emergency department with a bullet wound to his left flank. He was hemodynamically unstable. After only 8 minutes in the hospital and without further investigations he was rushed to the operating room. During laparotomy, a clot was visible in the left diaphragm, which dislodged and caused extensive bleeding. The decision was made to perform a sternotomy in the absence of a sternal saw. An oblique 8-cm injury to the right ventricle was discovered following rapid exploration. It was repaired without the need for cardiopulmonary bypass surgery. After a few days in the hospital, the patient was discharged home. In the event of a penetrating cardiac injury, rapid decision-making is crucial for survival. Whenever possible, the patient should be transferred to the operating room, as emergency department thoracotomies are associated with a high mortality rate.

一个世纪以前,心脏损伤通常会导致死亡。然而,尽管医学进步,这些伤害仍然有很高的死亡率和发病率。在本病例中,我们描述了一位右心室中弹损伤的患者,尽管我们中心在治疗方式和设备方面存在局限性,但他在我们医院存活了下来。一名30岁的男子被送到我们的急诊科,他的左侧有枪伤。他的血流动力学不稳定。在医院只呆了8分钟,没有进一步的检查,他就被紧急送往手术室。剖腹手术时,发现左侧横膈膜有血块,血块移位导致大量出血。决定在没有胸骨锯的情况下进行胸骨切开术。快速探查后发现右心室斜向8厘米损伤。它的修复不需要体外循环手术。住院几天后,病人出院回家了。在心脏穿透性损伤的情况下,快速决策对生存至关重要。只要有可能,患者应转至手术室,因为急诊开胸手术死亡率高。
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引用次数: 0
Thoraco-laparotomy approach to salvage a life-threatening cardiac box stab injury to the infecrior vena cava in Malaysia: a case report. 经胸腹手术抢救危及生命的下腔静脉心脏箱刺伤1例
Pub Date : 2023-09-01 Epub Date: 2023-05-19 DOI: 10.20408/jti.2022.0071
Ida Arinah Mahadi, Jih Huei Tan, Jin Zhe Teh, Yuzaidi Mohamad, Imran Alwi Rizal

Torso stab injuries near the cardiac box may present unique challenges due to difficulties in hemorrhage control. For a stab injury to the heart, the repair is straightforwardly performed via median sternotomy. In contrast, injuries to the inferior vena cava are challenging to repair, especially when they are close to the diaphragm, and the bleeding can be torrential. Herein, we describe a case of a self-inflicted stab wound within the "cardiac box." The trajectory of the stab injuries went below the diaphragm and injured the infradiaphragmatic inferior vena cava. Successful emergent repair via the thoraco-laparotomy approach revived the young man. In this report, we revisit and discuss previous large series of patients with this rare vena cava injury.

由于出血控制的困难,在心脏箱附近的躯干刺伤可能会带来独特的挑战。对于心脏刺伤,直接通过正中胸骨切开术进行修复。相比之下,下腔静脉的损伤很难修复,特别是当它们靠近膈肌时,出血可能会很严重。在这里,我们描述了一个自我造成的刺伤在“心脏盒”的情况。刺伤的轨迹在横膈膜下面伤到了膈下下腔静脉。通过胸腹开腹手术成功的紧急修复使这名年轻人恢复了生命。在这篇报道中,我们回顾并讨论了以前的大量患者的这种罕见的腔静脉损伤。
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引用次数: 0
Percutaneous screw fixation and external stabilization as definitive surgical intervention for a pelvic ring injury combined with an acetabular fracture in the acute phase of polytrauma in Korea: a case report. 经皮螺钉固定和外固定作为骨盆环损伤合并髋臼骨折急性期的决定性手术干预:1例报告
Pub Date : 2023-09-01 Epub Date: 2023-07-13 DOI: 10.20408/jti.2023.0002
Hohyoung Lee, Myung-Rae Cho, Suk-Kyoon Song, Euisun Yoon, Sungho Lee

Unstable pelvic ring injuries are potentially life-threatening and associated with high mortality and complication rates in polytrauma patients. The most common cause of death in patients with pelvic ring injuries is massive bleeding. With resuscitation, external fixation can be performed as a temporary stabilization procedure for hemostasis in unstable pelvic fractures. Internal fixation following temporary external fixation of the pelvic ring yields superior and more reliable stabilization. However, a time-consuming extended approach to open reduction and internal fixation of the pelvic ring is frequently precluded by an unacceptable physiologic condition and/or concomitant injuries in patients with multiple injuries. Conservative treatment may lead to pelvic ring deformity, which is associated with various functional disabilities such as limb length discrepancy, gait disturbance, and sitting intolerance. Therefore, if the patient is not expected to be suitable for additional surgery due to a poor expected physiologic condition, definitive external fixation in combination with various percutaneous screw fixations to restore the pelvic ring should be considered in the acute phase. Herein, we report a case of unstable pelvic ring injury successfully treated with definitive external fixation and percutaneous screw fixation in the acute phase in a severely injured polytrauma patient.

不稳定骨盆环损伤可能危及生命,并与多发创伤患者的高死亡率和并发症发生率相关。骨盆环损伤患者最常见的死亡原因是大出血。在复苏的情况下,外固定可以作为不稳定骨盆骨折止血的临时稳定措施。盆腔环临时外固定后的内固定可获得更好、更可靠的稳定。然而,由于无法接受的生理状况和/或多发损伤,骨盆环切开复位内固定的延长入路常常被排除在外。保守治疗可能导致盆腔环畸形,这与各种功能障碍有关,如肢体长度差异、步态障碍和坐姿不耐受。因此,如果患者因预期生理状况不佳而不适合进行额外手术,则应考虑在急性期采用明确的外固定联合各种经皮螺钉固定来恢复骨盆环。在此,我们报告一例不稳定骨盆环损伤患者在急性期成功地采用明确的外固定和经皮螺钉固定。
{"title":"Percutaneous screw fixation and external stabilization as definitive surgical intervention for a pelvic ring injury combined with an acetabular fracture in the acute phase of polytrauma in Korea: a case report.","authors":"Hohyoung Lee, Myung-Rae Cho, Suk-Kyoon Song, Euisun Yoon, Sungho Lee","doi":"10.20408/jti.2023.0002","DOIUrl":"10.20408/jti.2023.0002","url":null,"abstract":"<p><p>Unstable pelvic ring injuries are potentially life-threatening and associated with high mortality and complication rates in polytrauma patients. The most common cause of death in patients with pelvic ring injuries is massive bleeding. With resuscitation, external fixation can be performed as a temporary stabilization procedure for hemostasis in unstable pelvic fractures. Internal fixation following temporary external fixation of the pelvic ring yields superior and more reliable stabilization. However, a time-consuming extended approach to open reduction and internal fixation of the pelvic ring is frequently precluded by an unacceptable physiologic condition and/or concomitant injuries in patients with multiple injuries. Conservative treatment may lead to pelvic ring deformity, which is associated with various functional disabilities such as limb length discrepancy, gait disturbance, and sitting intolerance. Therefore, if the patient is not expected to be suitable for additional surgery due to a poor expected physiologic condition, definitive external fixation in combination with various percutaneous screw fixations to restore the pelvic ring should be considered in the acute phase. Herein, we report a case of unstable pelvic ring injury successfully treated with definitive external fixation and percutaneous screw fixation in the acute phase in a severely injured polytrauma patient.</p>","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11309269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45018747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pancreaticoduodenectomy as an option for treating a hemodynamically unstable traumatic pancreatic head injury with a pelvic bone fracture in Korea: a case report. 胰十二指肠切除术治疗血流动力学不稳定的创伤性胰头损伤合并骨盆骨折一例报告
Pub Date : 2023-09-01 Epub Date: 2022-12-07 DOI: 10.20408/jti.2022.0059
Sung Yub Jeong, Yoonhyun Lee, Hojun Lee

Pancreatic trauma occurs in 0.2% of patients with blunt trauma and 5% of severe abdominal injuries, which are associated with high mortality rates (up to 60%). Traumatic pancreatoduodenectomy (PD) has significant morbidity and appreciable mortality owing to complicating factors, associated injuries, and shock. The initial reconstruction in patients with severe pancreatic injuries aggravates their status by causing hypothermia, coagulopathy, and acidosis, which increase the risk for early mortality. A staging operation in which PD follows damage control surgery is a good option for hemodynamically unstable patients. We report the case of a patient who was treated by staging PD for an injured pancreatic head.

钝性创伤患者中有0.2%发生胰腺损伤,严重腹部损伤患者中有5%发生胰腺损伤,这与高死亡率(高达60%)相关。外伤性胰十二指肠切除术(PD)由于并发症、相关损伤和休克,具有显著的发病率和明显的死亡率。严重胰腺损伤患者的初始重建会导致体温过低、凝血功能障碍和酸中毒,从而加重病情,增加早期死亡的风险。对于血流动力学不稳定的患者,在损害控制手术后进行PD分期手术是一个很好的选择。我们报告的情况下,病人谁是分期PD治疗损伤的胰头。
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引用次数: 0
Rare complication of skin necrosis after endoscopic debridement and cutaneo-fascial suture for a massive Morel-Lavallée lesion in Korea: a case report. 韩国大面积morel - lavallsade病变内镜清创及皮筋膜缝合后皮肤坏死的罕见并发症:1例报告
Pub Date : 2023-09-01 Epub Date: 2023-08-25 DOI: 10.20408/jti.2023.0007
Youngmin Kim, Jayun Cho, Myung Jin Jang, Kang Kook Choi

A Morel-Lavallée lesion (MLL) is a pathologic fluid collection within an abnormally formed space, resulting from an internal degloving injury between the muscle fascia and subcutaneous fat layer. Due to its resistance to conservative treatments such as drainage or compression dressing, various therapeutic methods have been developed for MLL. However, no standardized guidelines currently exist. Recently, endoscopic debridement and cutaneo-fascial suture (EDCS) has been introduced for the treatment of MLL, particularly for large lesions resistant to conservative approaches. While this procedure is known to be effective, limited reports are available on potential complications. The authors present a case of skin necrosis following EDCS for a massive MLL.

three
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引用次数: 0
Traumatic tension enterothorax in New Zealand: a case report. 外伤性肠胸紧张性1例
Pub Date : 2023-09-01 Epub Date: 2023-02-27 DOI: 10.20408/jti.2022.0062
Monique Mahadik, Ashok Gunawardene, Aleisha Sutherland, Damien Ah Yen

Traumatic rupture of the right hemidiaphragm occurred following a high-velocity motor vehicle collision in the case presented herein. The resulting herniation of small bowel loops into the thorax resulted in hemodynamic and respiratory compromise due to pressure effects on the right heart and major vessels. The patient's hemodynamic status improved with reduction of enterothorax, and the diaphragmatic defect was repaired. We discuss the available literature and learning points from this rare case.

在本病例中,右半膈在高速机动车碰撞后发生创伤性破裂。由于右侧心脏和大血管受到压力影响,小肠襻疝入胸腔,导致血液动力学和呼吸系统受损。患者的血液动力学状况随着肠胸的缩小而得到改善,膈肌缺损也得到了修复。我们讨论了这一罕见病例的现有文献和学习要点。
{"title":"Traumatic tension enterothorax in New Zealand: a case report.","authors":"Monique Mahadik, Ashok Gunawardene, Aleisha Sutherland, Damien Ah Yen","doi":"10.20408/jti.2022.0062","DOIUrl":"10.20408/jti.2022.0062","url":null,"abstract":"<p><p>Traumatic rupture of the right hemidiaphragm occurred following a high-velocity motor vehicle collision in the case presented herein. The resulting herniation of small bowel loops into the thorax resulted in hemodynamic and respiratory compromise due to pressure effects on the right heart and major vessels. The patient's hemodynamic status improved with reduction of enterothorax, and the diaphragmatic defect was repaired. We discuss the available literature and learning points from this rare case.</p>","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11309275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47520071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Penetrating gallbladder injury in a pediatric patient in the United States: a case report. 小儿穿透性胆囊损伤1例报告
Pub Date : 2023-09-01 Epub Date: 2023-07-05 DOI: 10.20408/jti.2023.0008
Nelimar Cruz-Centeno, Shai Stewart, Derek R Marlor, Charlene Dekonenko, Richard J Hendrickson

Penetrating gallbladder injuries are uncommon in the pediatric population. The treatment varies according to the severity of the injury and the patient's hemodynamics. We present the case of an 11-year-old male with an accidental pellet gunshot wound to the right upper abdomen that resulted in a grade III liver laceration and damage to the anterior gallbladder wall. The patient underwent laparoscopic cholecystectomy with drain placement. Postoperative radiography of the surgical specimen confirmed the presence of the pellet in the gallbladder. The patient recovered uneventfully and was discharged home on postoperative day 3. Laparoscopic cholecystectomy is a feasible treatment option for penetrating gallbladder injuries in hemodynamically stable patients.

穿透性胆囊损伤在儿童中并不常见。治疗方法因损伤的严重程度和患者的血液动力学而异。我们介绍了一例 11 岁男性患者的病例,患者右上腹意外受到弹丸枪伤,导致肝脏 III 级裂伤和胆囊前壁损伤。患者接受了腹腔镜胆囊切除术,并放置了引流管。术后对手术标本进行放射检查,证实胆囊内有颗粒存在。患者恢复顺利,术后第 3 天出院回家。对于血流动力学稳定的穿透性胆囊损伤患者,腹腔镜胆囊切除术是一种可行的治疗方案。
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引用次数: 0
期刊
Journal of Trauma and Injury
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