The morbidity and mortality of rib fractures.

The incidence of rib fractures secondary to trauma has not been clearly reported. Of the 7147 patients seen by our trauma service from January 1987 to June 1992, 711 (10%) had rib fractures. Among the patients with rib fractures, 84 (12%) died, 670 (94%) had associated injuries, 274 (32%) had a hemothorax or pneumothorax, and 187 (26%) had a lung contusion. Fifty-five percent of the patients required an immediate operation or admission to the intensive care unit. Thirty-five percent of the patients required discharge to an extended care facility and 35% developed a pulmonary complication. We conclude that rib fractures are a marker of severe injury in which (1) 12% will die because of their injuries, (2) more than 90% will have associated injuries, (3) one half will require operative and ICU care, (4) one third will develop pulmonary complications, and (5) one third will require discharge to an extended care facility.

Variability of blood gases, pulse oximeter saturation, and end-tidal carbon dioxide pressure in stable, mechanically ventilated trauma patients.

We evaluated the short-term variability of PaO2, PaCO2, pulse oximeter saturation (SpO2), and end-tidal PCO2 (PETCO2) in mechanically ventilated trauma patients. All patients were stable and undisturbed during the evaluation periods. Blood gases were obtained from an arterial catheter 4 times at 20-minute intervals. SpO2 and PETCO2 were recorded when the blood gases were obtained. Fifty evaluations were made in 26 patients; 24 patients were evaluated twice, with greater than or equal to 24 hours between evaluation periods. Variability was expressed as coefficient of variation (%CV) for each evaluation period. The median %CVs were 3.6% for PaO2 (95th percentile = 9.8%), 0.5% for SpO2 (95th percentile = 1.4%), 2.8% for PaCO2 (95th percentile = 7.4%), and 2.4% for PETCO2 (95th percentile = 7.1%). The overall correlation between PaCO2 and PETCO2 was r = 0.80, and the mean difference between PaCO2 and PETCO2 was 0.9 +/- 3.6 mm Hg. The variability of PETCO2 was similar to the variability of PaCO2. However, the variability of PaO2 was considerably greater than that of SpO2, which was probably related to the shape of the oxyhemoglobin dissociation curve and the relatively high saturations of the patients in this study. Variability of blood gases, SpO2, and PETCO2 should be considered when these values are clinically interpreted.

Pediatric trauma triage: review of 1,307 cases.

To assess patterns of pediatric trauma triage and patient transfer to the pediatric trauma centers, the records of 1,307 patients 14 years old or less who were admitted or died during resuscitation at eight Level II Trauma Centers from January 1987 through December 1988 were reviewed retrospectively. Cases were analyzed according to the following criteria: age, diagnosis, mechanism of injury, admitting service, pediatric trauma score (PTS), length of stay in the intensive care unit (ICU) and in the hospital, and outcome. Forty-three patients were transferred to pediatric trauma centers based on local criteria. Of the remaining 1,264 patients kept at the Level II Trauma Centers, the average patient age was 8.34 year; PTS, 9.74; and length of stay, 4.46 days. Two hundred fifty-eight patients (19.7%) required ICU care for an average length of stay of 2.86 days. Twenty-four patients (1.8%) died; all 24 had a PTS less than or equal to 8. In comparing the data to the guidelines in Appendix J of the American College of Surgeons' Hospital and Prehospital Resources for Optimal Trauma Care of the Injured Patient for transfer to a Level I Pediatric Trauma Center, we found that children with a PTS greater than 8 and who either require ICU care and/or have altered states of consciousness can safely be treated in the adult ICU of a Level II Trauma Center.

Neuroleptic malignant syndrome in a trauma patient: case report.

Presented is a case report of a multiple trauma patient whose post-traumatic course was complicated by neuroleptic malignant syndrome triggered by therapeutic haloperidol treatments. Once the syndrome was recognized and treated, a dramatic recovery was achieved.

Applications of a hand-held computer in critical care medicine.

Hand-held computers provide a reasonable alternative to desk-top computers in critical care units because of their size and affordability. The applications described include specific examples of software to perform hemodynamic calculations, intravenous flow rate calculations, and respiratory calculations. This software has been used for several years and has been found to be very useful.

Early recognition of diaphragmatic injuries from blunt trauma.

Rupture of the diaphragm from blunt trauma was identified in 42 patients in four years. The contribution of peritoneal lavage in identifying these injuries was examined. More than 93% of the ruptured diaphragms were identified within 24 hours. Peritoneal lavage was positive in 89% of patients who had no other source of intraabdominal hemorrhage. Chest radiography alone identified 41% of the patients who had diaphragm injury. If the peritoneal lavage is negative and the best radiograph is not diagnostic but suspicion of diaphragm injury remains, the lavage catheter can still be used to instill contrast into the peritoneum. Peritoneal lavage, when used in combination with chest radiography, is a reliable, rapid, and simple aid in identifying ruptured diaphragms from blunt trauma.