RESUMO
Cervical spine instability in the neurologically intact patient following penetrating neck trauma has been considered rare or non-existent. We present a case of a woman with an unstable C5 fracture without spinal cord injury after a gunshot wound to the neck. Considerations regarding the risk of cervical spine instability are discussed, as well as suggestions for a prudent approach to such patients.
Assuntos
Vértebras Cervicais/lesões , Instabilidade Articular/etiologia , Lesões do Pescoço/complicações , Fraturas da Coluna Vertebral/etiologia , Ferimentos por Arma de Fogo/complicações , Tratamento de Emergência/métodos , Feminino , Humanos , Imobilização , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/terapia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Fatores de Risco , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/terapia , Fusão Vertebral , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To establish diagnostic criteria for acute mountain sickness (AMS) in preverbal children. DESIGN: Nonrandomized control trial. SETTING: Ambulatory. PARTICIPANTS: Children aged 3 through 36 months and adults from the Denver, Colo, area (altitude, 1610 m). MAIN OUTCOME MEASURES: The Lake Louise Scoring System was modified, using a fussiness score as the headache equivalent and a pediatric symptom score to assess appetite, vomiting, playfulness, and ability to sleep. Acute mountain sickness was assessed by combining the fussiness and pediatric symptom scores to produce what we termed the Children's Lake Louise AMS Score (CLLS). INTERVENTIONS: Parents recorded the fussiness score at 11 AM, 1, 3, and 5 PM, and the pediatric symptom score at 3:00 PM each day. Each subject traveled twice, with 1 day considered a control. Days 1 and 2 were measurements at home; day 3 reflected travel without altitude change to 1615 m; and 1 week later, day 4 involved travel to 3488 m. On days 3 and 4 the accompanying adults completed the Lake Louise Scoring System. RESULTS: Twenty-three subjects (14 boys; mean+/-SD age, 20.7+/-9.0 months) participated. The mean CLLS demonstrated no differences on days 1, 2, or 3. On day 4, 5 subjects (21.7%) had AMS, established as a CLLS of 7 or higher, and these scores normalized 2 hours after descent. Forty-five adults participated and 9 (20%) had AMS. CONCLUSIONS: We define AMS in preverbal children as a CLLS of 7 or higher with a fussiness score of 4 or higher and a pediatric symptom score of 3 or higher, in the setting of recent altitude gain. The incidence of AMS in preverbal children (21.7%) was similar to that in adults (20%).
Assuntos
Doença da Altitude/diagnóstico , Doença Aguda , Apetite , Comportamento Infantil , Pré-Escolar , Feminino , Humanos , Lactente , Comportamento do Lactente , Masculino , SonoRESUMO
To identify all patients with serious intracranial injury, current treatment strategies include admission and/or computed tomographic evaluation of all patients with head injuries. However, the majority of patients with head injuries who are awake do not require subsequent intervention. A review of 407 consecutive patients with head injuries treated at an adult regional trauma center identified 310 patients with Glasgow Coma Scores of 15 in the emergency department, all of whom were admitted. Five patients with Glasgow Coma Scores of 15 required intervention for intracranial abnormality. All five patients had skull fractures and/or neurologic deficits. Based on this and other studies, criteria for discharge from the emergency department are a Glasgow Coma Score of 15, no deficit except amnesia, no signs of intoxication, and no evidence of basilar fracture on clinical examination or linear fracture on screening skull roentgenography. Safe discharge without universal computed tomographic evaluation or admission is possible and cost-efficient.