ABSTRACT
BACKGROUND: The mechanism for clearing the cervical spine in patients with altered mental status remains controversial. Recommendations have ranged from removal of the cervical collar after 24 hours in patients with normal radiographs, to indefinite immobilization in a cervical collar, and recently cervical flexion-extension examinations using dynamic fluoroscopy. The purpose of this study was to evaluate the efficacy and safety of dynamic fluoroscopy flexion-extension examinations in identifying ligamentous cervical spine injury and clearing the cervical spine in patients with altered mental status after trauma. METHODS: Patients with a Glasgow Coma Scale score < 13 for greater than 48 hours after admission and normal cervical spine radiographs were candidates for fluoroscopic evaluation. The protocol required visualization of the entire cervical spine, through T1, through full extension and flexion under the direct supervision of a radiologist. Oblique fluoroscopic views were obtained, as necessary, to visualize the cervicothoracic junction. Demographic data, fluoroscopy time, total time per study, true and false positives and negatives, and complications were recorded. RESULTS: From July 1992 through December 1999, fluoroscopic examinations were performed on 301 patients. There were 297 true-negative examinations, 2 true-positive examinations (stable injuries), 1 false-negative examination, and 1 false-positive examination. The incidence of ligamentous injury identified by fluoroscopy in this study was 2 of 301 (0.7%). Unstable cervical spine ligamentous injuries were identified in only 0.02% of all trauma patients. One patient developed quadriplegia when fluoroscopic evaluation was performed after two protocol violations. CONCLUSION: Unstable cervical spine ligamentous injury without fracture is a rare occurrence. The cervical spine may be cleared after a normal cervical spine series (plain radiograph and computed tomographic scan) as recommended in the 1998 Eastern Association for the Surgery of Trauma guidelines. If dynamic fluoroscopy is to be used, adherence to the protocol, including review of the cervical spine radiographs before fluoroscopy and visualization of the entire cervical spine, C1-T1, is mandatory to ensure patient safety.
Subject(s)
Cervical Vertebrae/diagnostic imaging , Cervical Vertebrae/injuries , Fluoroscopy , Head Injuries, Closed/diagnostic imaging , Adult , Chi-Square Distribution , Female , Glasgow Coma Scale , Humans , MaleABSTRACT
A 45-year-old male returned 17 years after a gunshot wound to the chest with intermittent hemoptysis that progressed to frank pulmonary hemorrhage. The complications of retained intrathoracic foreign bodies are briefly reviewed.
Subject(s)
Foreign Bodies/diagnostic imaging , Hemorrhage/diagnostic imaging , Lung Injury , Tomography, X-Ray Computed , Wounds, Gunshot/diagnostic imaging , Diagnosis, Differential , Follow-Up Studies , Foreign Bodies/surgery , Hemorrhage/surgery , Humans , Lung/diagnostic imaging , Lung/surgery , Male , Middle Aged , Wounds, Gunshot/surgerySubject(s)
Autonomic Nervous System Diseases/etiology , Neck Injuries/diagnosis , Vertebral Artery/injuries , Vertebrobasilar Insufficiency/diagnostic imaging , Wounds, Nonpenetrating/diagnosis , Adult , Brain Infarction/diagnosis , Brain Infarction/etiology , Cerebral Angiography , Craniocerebral Trauma/diagnosis , Humans , Magnetic Resonance Imaging , Male , Quadriplegia , Vertebral Artery/diagnostic imaging , Vertebrobasilar Insufficiency/complications , Wounds, Nonpenetrating/complicationsABSTRACT
Laparoscopic cholecystectomy (LC) has been widely used in recent years because of short postoperative hospital stays and low morbidity. In this study, 24 patients were prospectively evaluated with preoperative and postoperative spirometry, arterial blood gas determinations, and chest radiographs to quantitate the magnitude of postoperative pulmonary changes after LC. Statistically significant reductions were noted in forced vital capacity (FVC) (mean decrease, 810 mL) and forced expired volume in 1 second (FEV1) (mean decrease, 420 mL). Clinically important changes in arterial blood gas values did not occur. Of 20 postoperative chest films, 7 showed the development of atelectasis or effusion and 9 showed persistence of subdiaphragmatic free air 24 hours after LC. In summary, LC caused mean decreases of 23% in FVC and 16% in FEV1 24 hours after surgery. The physiologic derangements that follow LC are sufficiently small that all but the most severely impaired patients with pulmonary disease should be able to tolerate this operation.
Subject(s)
Cholecystectomy, Laparoscopic/adverse effects , Lung/physiology , Blood Gas Analysis , Forced Expiratory Volume , Humans , Postoperative Complications , Prospective Studies , Pulmonary Atelectasis/etiology , Vital CapacityABSTRACT
Intraosseous infusion has been advocated as an emergency route in sick infants and children when intravenous access is not readily obtainable. Dobutamine hydrochloride and isoproterenol hydrochloride are useful emergency drugs that have not been studied when administered into the bone marrow. In a swine model, we compared the physiologic responses (heart rate, arterial pressure, and cardiac output) of dobutamine and isoproterenol infusions delivered intravenously and intraosseously during 20-minute intervals. We observed statistically significant effects of both dobutamine and isoproterenol delivered by the intraosseous route. In addition, the effects resulting from intraosseous infusion were statistically similar to those resulting from intravenous administration of these drugs. We conclude that the intraosseous infusion of dobutamine and isoproterenol is an effective and useful method for emergency administration of these medications.
