RESUMO
Penetrating injuries of the visceral compartment of the neck are uncommon but potentially life threatening. A retrospective review of patients who sustained penetrating trauma to the laryngotracheal complex was conducted at the Level I trauma center of the University of Louisville Hospital in Kentucky. Sixteen patients were identified and their records reviewed for type of injuries, treatment, complications, and 1-year follow-up. The majority of patients were men who sustained injuries that were violent in nature. Zone II of the anterior neck was the most commonly injured area, with the trachea (69%), esophagus (38%), and larynx (31 %) the most commonly injured structures. Although 31% underwent angiograms, only 13% showed vascular injuries. Eighty-one percent of the patients had injuries involving more than 1 major structure of the neck. Neck exploration was performed in 81% of the patients and tracheotomies in 75% as well as repair of the trachea (50%), larynx (31%), and esophagus (38%). There is significant mortality associated with these injuries (13% in our study), and many of the patients have long-term sequelae such as dysphagia, hoarseness, and prolonged tracheotomy.
Assuntos
Lesões das Artérias Carótidas/complicações , Veias Jugulares/lesões , Traumatismos do Nervo Laríngeo , Lesões do Pescoço/complicações , Lesões do Pescoço/diagnóstico , Ferimentos Penetrantes/complicações , Ferimentos Penetrantes/diagnóstico , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/cirurgia , Estudos Retrospectivos , Ferimentos Penetrantes/cirurgiaRESUMO
Although treatment teams have been examined often in the mental health literature, this literature seldom addresses the crucial property of "teamness"--the key set of intangible phenomena that allow a team to function synergistically as more than the sum of its parts, and with a sense of team identity. In this paper, the concept of the work group is used to develop a framework for understanding the factors contributing to effective team functioning and identity, an their implications for the tasks of team leadership and sociotherapy: "the art of maintaining a social system in which the treatment of an individual patient can best occur" (Edelson 1970). Leadership activities that promote team cohesiveness and boundary maintenance are discussed, and suggestions are provided for ways in which the subjective experiences and emotional reactions of the leader and team members can be used to promote improved task performance and clinical care.
