Journal of Trauma and Injury最新文献

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.