ABSTRACT
The coexistence of myocardial contusion and thoracic aortic injury is probably more common than recognized following rapid deceleration multisystem trauma. This report describes the successful application of intra-aortic balloon counterpulsation in a critically injured patient requiring emergent repair of a thoracic aortic tear complicated by ventricular failure due to cardiac contusion.
Subject(s)
Aortic Rupture/surgery , Counterpulsation , Heart Injuries/therapy , Intra-Aortic Balloon Pumping , Aorta, Thoracic/surgery , Aortic Rupture/complications , Aortic Rupture/therapy , Blood Vessel Prosthesis , Contusions , Female , Heart Injuries/complications , Heart Injuries/surgery , Humans , Middle Aged , Postoperative CareABSTRACT
On December 14, 1985, the Teller chairlift at the Keystone, Colorado, ski area collapsed, throwing 60 of the 372 people aboard to the ground from heights up to 50 feet. Initial triage and management of the victims was carried out by the local ski patrol, the on-duty physician at the area's Snake River Health Services Clinic, and by volunteer physicians and nurses present at the scene. Thirty-three people required immediate evacuation to hospitals, most of them being transported 75 miles by helicopter air ambulance to level I and II trauma centers in the Denver metropolitan area. Eighteen of these air-evacuated patients were in serious or critical condition. Less seriously injured victims were treated at local medical facilities. The scene evacuation was carried out by helicopter and ground vehicles in accordance with an existing disaster plan coordinated by the Colorado Trauma Institute (CTI). The unique problems posed by a mass casualty incident in a remote mountain location are emphasized by this tragedy. Patient salvage due to the efficacy of a regionally organized trauma system is clearly demonstrated.
Subject(s)
Disasters , Emergency Medical Services , Regional Medical Programs , Trauma Centers , Adolescent , Adult , Colorado , Female , Humans , Male , Middle Aged , Skiing , Wounds and Injuries/therapyABSTRACT
Pneumatosis cystoides intestinalis has been detected in 3/103 kidney transplant patients (3%) treated with CsA and prednisone, in contrast to less than 1% of kidney transplant patients treated with Aza and prednisone. In these three patients, the diagnosis of PCI was made by plain x-rays, 10 to 25 days after transplantation. PCI may be more likely to occur in patients with CsA trough blood levels above the recommended therapeutic range. There was associated pneumoperitoneum in all three patients, but none were subjected to exploratory laparotomy. PCI and associated pneumoperitoneum were not associated with adverse effects in any of our three patients. Antibiotics and exploratory laparotomy appear to be unnecessary.
Subject(s)
Cyclosporins/adverse effects , Kidney Transplantation , Pneumatosis Cystoides Intestinalis/chemically induced , Pneumoperitoneum/chemically induced , Prednisone/adverse effects , Adolescent , Adult , Female , Humans , MaleABSTRACT
Use of the observation unit in the management of 150 consecutive patients sustaining blunt or penetrating thoracic trauma, and initially presenting with stable vital signs, normal physical examination findings, and normal chest x-ray studies, was reviewed. All patients requiring admission declared themselves within six hours, with the exception of one asymptomatic patient whose repeat x-ray study was slightly delayed. Of the 150 patients, 129 (86%) were spared hospital admission, and no increased morbidity or mortality could be associated with our policy of selective hospital admission.
