Sledding injuries in the southeastern United States.

BACKGROUND: Heavy ice and snow accumulation combined with record low temperatures in Chattanooga, Tennessee, from February 2-6, 1996, contributed to many sledding injuries. METHODS: We retrospectively reviewed medical records of emergency visits to seven area hospitals from February 2-6, 1996. We further reviewed sledding injury records. Sledding was defined as sliding on snow or ice using any device except skis. RESULTS: Of 2,134 emergency room visits, 241 patients had 310 sledding injuries. Ages of patients ranged from 3 to 53 years (mean, 18.9; median, 16). One hundred twenty-eight injuries were severe. These included extremity injuries (65), head injuries (28), chest injuries (10), intra-abdominal injuries (10), vertebral column fractures (11), and pelvic fractures (4). Thirty-six patients required inpatient hospitalization; 18 had surgery. The minimum healthcare costs associated with these injuries were estimated at $220,000. CONCLUSIONS: Major trauma potential is associated with sledding, especially where significant winter storms are uncommon. Level I trauma centers should seasonally incorporate sledding safety into community-wide injury prevention programs.

Postoperative pulmonary complications and morbidity after abdominal aneurysmectomy: a comparison of postoperative epidural versus parenteral opioid analgesia.

Patients undergoing aortic aneurysm repair have a high prevalence of coexisting cardiac and pulmonary disease, and the postoperative recovery is especially delayed by pulmonary complications. A review of all elective abdominal aneurysm repairs over a 29-month period was undertaken to evaluate the effectiveness of postoperative epidural analgesia in decreasing morbidity and mortality, and specifically pulmonary complications. Patients were placed into two groups; Group 1 (34 patients) used an epidural catheter for postoperative pain control, and Group II (31 patients) used standard parenteral opioid analgesia. The two groups were similar in preoperative combined factors including known risk factors for atherosclerotic cardiovascular disease, preexisting cardiac or pulmonary disease, and preexisting renal insufficiency. A statistically significant decrease (P = < 0.05) was found in both cardiac (P = 0.0002) and pulmonary (P = 0.019) complications in comparison, favoring Group I patients. A significant decrease was also seen in the time to liquid intake (P = 0.044), time out of bed to a chair (P = 0.002), length of stay in the Intensive Care Unit (P = 0.024), and overall hospital charges (P = 0.046) in favor of Group I patients. Although no significant difference (P = > 0.05) was seen in decreasing time to ambulation (P = 0.054), average time required on the ventilator (P = 0.053), or hospital days (P = 0.181), all of these did show a trend in favor of epidural catheter utilization. There were no complications or infections related to the use of the epidural catheter during this study period. In conclusion, the use of an epidural catheter for postoperative pain control has been shown to decrease time of intubation, time in the ICU, number of cardiac and pulmonary complications, which should lead to an overall decrease in hospital charges after elective repair of abdominal aortic aneurysms.

Traumatic disruption of the cervical trachea.

Treatment of a case of traumatic disruption of the cervical trachea has been described. This injury is not common but must be suspected in blunt chest trauma patients, with evidence of possible tracheal obstruction as in this patient. Massive subcutaneous emphysema, large air leaks, and persistent pneumothorax are more common signs of tracheobronchial disruption. Diagnosis can be made with fiberoptic bronchoscopy, and primary repair is the treatment of choice.