ABSTRACT
Medical accountability is an essential component of a system for trauma care. The microcomputerized regional trauma registry provides a simple method of providing accountability by integrating medical and system information to evaluate quality of care, adequacy of system criteria, and system compliance. The regional trauma registry is developed by identifying all patients who are suspected or known to have sustained a serious injury, whether or not they received trauma system care, and documenting their course from initial contact through final disposition. The microcomputer provides an inexpensive and readily available method for storing and evaluating the database. Information derived from the regional trauma registry is useful for profiling the nature and extent of trauma and for monitoring and modifying the system to improve patient access and medical care.
Subject(s)
Computers , Medical Audit/methods , Microcomputers , Registries , Wounds and Injuries , California , Humans , Oregon , SoftwareABSTRACT
The technique of placement of a central venous line can be easily mastered by careful adherence to details. It is used for pressure monitoring, hyperalimentation, or administration of medications. Complications are few, easily recognized, and simply treated.
Subject(s)
Catheterization/methods , Catheterization/adverse effects , Humans , Pneumothorax/etiology , Subclavian VeinABSTRACT
The lethal potential of duodenal trauma relates to the severity of the defect, associated injuries, and the adequacy and expedience of treatment. We studied 247 patients whose injuries were managed at a single institution during an 18-year period. Emphasis was placed on complications directly related to the duodenal wound and the selection of operative repair. Repairs consisted of duodenorrhaphy in 190 patients (83%) and more complex procedures in 33 (13%). Death resulted from the duodenal injury in nine patients (4%) and fistula developed in 16 (7%). Factors associated with an increase in the morbid potential of the duodenal wound were (1) missile or blunt injury, or a defect larger than 75% of the circumference; (2) injury of the first or second portion; (3) an injury-operation delay of more than 24 hours; and (4) adjacent common bile duct injury. These factors require consideration in the selection of the operative repair.
Subject(s)
Duodenum/injuries , Wounds, Nonpenetrating/surgery , Wounds, Penetrating/surgery , Adolescent , Adult , Age Factors , Aged , Bile Ducts/injuries , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Resuscitation , Sex Factors , Time Factors , Wounds, Gunshot/surgery , Wounds, Nonpenetrating/mortality , Wounds, Penetrating/mortality , Wounds, Stab/surgeryABSTRACT
Two patients with aortic abdominal aneurysms in association with horseshoe kidney are presented, making a total of 34 cases recorded in the literature. In 29 patients, the aneurysm was resected and five patients were non-resectable. Because of the abnormalities in vascular supply to the abnormal kidney, it is important to diagnose the combination of aneurysm and horseshoe kidney preoperatively. An error in diagnosis should be unusual if an intravenous pyelogram is routinely obtained on all patients. This study may reveal abnormalities which will allow the diagnosis of horseshoe kidney to be made or suspected. If the intravenous pyelogram is abnormal, it should be followed by an aortogram. This may substantiate the diagnosis of aneurysm and horseshoe kidney and provide the necessary detailed information regarding the pattern of blood supply and its relationship to functioning tissue. The amount and disposition of functioning renal parenchyma may be further amplified by renal scan. If this sequence is followed, the unanticipated combination of abdominal aneurysm and horseshoe kidney should be rare.
