ABSTRACT
Mortality and morbidity from head trauma have been substantially reduced by improved prehospital care and aggressive diagnostic and therapeutic management. However, a substantial number of patients will require prolonged periods of hospitalization, intensive care, and ventilator support during their recovery, placing them at risk for infectious complications. Eighty-two such patients were reviewed during a 30-month period at a Level I trauma center. Forty-one patients (50%) developed at least one infectious complication. The most common source was respiratory, occurring in 34 patients relatively early (average, 3.2 days) in their hospital course. The severity of head injury and presence of coexisting thoracic trauma correlated statistically; administration of prophylactic antibiotics and corticosteroids did not in the development of infectious problems. Only three patients died as a result of sepsis, indicating that early recognition and prompt treatment may control the severity of infectious complications.
Subject(s)
Craniocerebral Trauma/complications , Infections/complications , Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Humans , Infection Control , Male , Meningitis/complications , Middle Aged , Respiratory Tract Infections/complications , Retrospective Studies , Sepsis/complications , Skull Fractures/complications , Thoracic Injuries/complicationsABSTRACT
The availability of two-dimensional echocardiography as a clinical tool has led to an interest in its applicability, usefulness, and reliability in the evaluation of blunt cardiac trauma. Forty patients who sustained objective evidence of blunt chest trauma were evaluated at our institution using serial ECGs, creatine phosphokinase (CPK) isoenzyme determinations, and two-dimensional echocardiography. Twenty patients (50%) manifested evidence of cardiac injury as demonstrated by abnormal ECGs, elevated CPK isoenzymes, or abnormal echocardiograms. Nine (23%) patients had abnormal echocardiograms with findings of pericardial effusions in four, chamber enlargement in three, and echodense areas of the right ventricle in two. There was no correlation with ECG changes or the presence of CPK isoenzymes. Based on these observations we believe echocardiography can be used as a noninvasive modality to complement other clinical tools in the detection of blunt cardiac injury.
Subject(s)
Echocardiography/methods , Heart Injuries/diagnosis , Thoracic Injuries/complications , Wounds, Nonpenetrating/complications , Adult , Aged , Creatine Kinase/blood , Electrocardiography , Female , Heart Injuries/etiology , Humans , Isoenzymes , Male , Middle AgedABSTRACT
Retroileal retroperitoneal transplantation of the transverse colon allows additional length for safe colorectostomy after left hemicolectomy in patients with short proximal colonic remnants.
