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Tucker H, Griggs JE, Gavrilovski M, Rahman S, Simpson C, Lyon RM, Hudson A. Prehospital Management of Penetrating Neck Injuries: An Evaluation of Practice. Air Med J 2024; 43:23-27. [PMID: 38154835 DOI: 10.1016/j.amj.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/02/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE Penetrating neck injuries (PNIs) can occur at multiple anatomic sites and involve airway, nerve, vascular, and gastrointestinal structures. They pose a unique challenge to clinicians, especially in the prehospital setting. Published guidance on the prehospital management of PNIs is limited, and there is no review of the current prehospital practice. METHODS A retrospective electronic case note review of PNIs managed within 1 UK helicopter emergency medical service (HEMS) over a 7-year period was undertaken. Data were collected on the zone of injury, mechanism of injury, prehospital times, patient demographics, prehospital interventions, and on-scene mortality. RESULTS Ninety-eight patients met the study inclusion criteria, 40% of whom had zone 2 neck injuries. Eighty-three percent were male with a mean age of 42 years. The predominant injury mechanism was interpersonal violence (51%) followed by self-harm (47%). Fifteen percent underwent prehospital emergency anesthesia, 17% underwent prehospital blood transfusion, and 30% had a hemostatic dressing applied. No patients underwent cervical spine immobilization. One percent underwent resuscitative thoracotomy. Five percent were pronounced life extinct after HEMS arrival following interventions by the HEMS team. CONCLUSION Time-critical and emergent interventions in this select patient population must be minimal and focus on optimizing care during rapid transfer to the hospital. Airway and hemorrhagic pathologies must be managed, often concomitantly. Targeted injury prevention to reduce interpersonal violence must ensue. The author group intends to devise a national Delphi and derive consensus guidelines for the management of prehospital PNIs.
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Affiliation(s)
- Harriet Tucker
- Air Ambulance Charity Kent Surrey Sussex, Surrey, United Kingdom; St George's Hospital, London, United Kingdom
| | - Joanne E Griggs
- Air Ambulance Charity Kent Surrey Sussex, Surrey, United Kingdom; School of Health Sciences, University of Surrey, Guildford, Surrey, United Kingdom.
| | - Maja Gavrilovski
- Air Ambulance Charity Kent Surrey Sussex, Surrey, United Kingdom; St Thomas' Hospital, London, United Kingdom
| | - Shah Rahman
- Air Ambulance Charity Kent Surrey Sussex, Surrey, United Kingdom
| | | | - Richard M Lyon
- Air Ambulance Charity Kent Surrey Sussex, Surrey, United Kingdom; School of Health Sciences, University of Surrey, Guildford, Surrey, United Kingdom
| | - Anthony Hudson
- Air Ambulance Charity Kent Surrey Sussex, Surrey, United Kingdom; St George's Hospital, London, United Kingdom
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Haupt TL, Harley EH. Targeting safety: Exploring trends and risk factors in pediatric head and neck BB gun injuries and hospitalization. Int J Pediatr Otorhinolaryngol 2024; 176:111783. [PMID: 37995450 DOI: 10.1016/j.ijporl.2023.111783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/15/2023] [Accepted: 11/05/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE To examine head and neck injuries caused by BB (Ball Bearing) guns treated in US emergency departments among children under 18 to identify trends in injury frequency over time and risk factors associated with severe injuries leading to hospital admission. METHODS This retrospective study utilized data from the National Electronic Injury Surveillance System (NEISS), a single database, to analyze head and neck injuries caused by BB guns between 1993 and 2019. The analysis explored demographic characteristics and injury patterns, including sex, age, incidence, injury location, hospital type, and disposition. Linear regression was employed to assess trends in the yearly frequency of injuries, while univariate and multivariate binary logistic regression was used to calculate the odds ratios associated with hospitalization. RESULTS A total of 4041 cases of pediatric head and neck injuries caused by BB guns and treated in US emergency departments were identified. Most patients were male (84 %), with the highest proportion of injuries occurring in the 10-14 age group (49.7 %). The face (35.8 %) and eye (27.4 %) were the most affected injury sites, and 7.5 % of patients required hospital admission. No significant linear trend was observed in injury frequency over the study period. However, children aged four and under had higher odds of hospitalization (OR 2.77, 95 % CI 1.61-4.75) despite a lower incidence of injuries. Injuries to the eye (OR 12.37, 95 % CI 8.31-18.43) and neck (OR 7.58, 95 % CI 4.76-12.06) were strong predictors of hospital admission. CONCLUSION Pediatric BB gun-related head and neck injuries remain a source of emergency room visits nationally. Younger children are at increased risk of admission to the hospital. Eye and neck injuries were the strongest predictors of hospital admission. Implementing safety precautions for younger children is crucial, as injuries might be more severe in this age group.
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Affiliation(s)
- Thomas L Haupt
- Howard University College of Medicine, Washington, DC, United States.
| | - Earl H Harley
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, United States.
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Muzyka L, Bradford JM, Teixeira PG, DuBose J, Cardenas TCP, Bach M, Ali S, Robert M, Brown CVR. Trends in prehospital cervical collar utilization in trauma patients: Closer, but not there yet. Acad Emerg Med 2024; 31:36-41. [PMID: 37828864 DOI: 10.1111/acem.14822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE This study aims to assess the change in cervical spine (C-spine) immobilization frequency in trauma patients over time. We hypothesize that the frequency of unnecessary C-spine immobilization has decreased. METHODS A retrospective chart review of adult trauma patients transported to our American College of Surgeons-verified Level I trauma center from January 1, 2014, to December 31, 2021, was performed. Emergency medical services documentation was manually reviewed to record prehospital physiology and the application of a prehospital cervical collar (c-collar). C-spine injuries were defined as cervical vertebral fractures and/or spinal cord injuries. Univariate and year-by-year trend analyses were used to assess changes in C-spine injury and immobilization frequency. RESULTS Among 2906 patients meeting inclusion criteria, 12% sustained C-spine injuries, while 88% did not. Patients with C-spine injuries were more likely to experience blunt trauma (95% vs. 68%, p < 0.001), were older (46 years vs. 41 years, p < 0.001), and had higher Injury Severity Scores (31 vs. 18, p < 0.001). They also exhibited lower initial systolic blood pressures (108 mm Hg vs. 119 mm Hg, p < 0.001), lower heart rates (92 beats/min vs. 97 beats/min, p < 0.05), and lower Glasgow Coma Scale scores (9 vs. 11, p < 0.001). In blunt trauma, c-collars were applied to 83% of patients with C-spine injuries and 75% without; for penetrating trauma, c-collars were applied to 50% of patients with C-spine injuries and only 8% without. Among penetrating trauma patients with C-spine injury, all patients either arrived quadriplegic or did not require emergent neurosurgical intervention. The proportion of patients receiving a c-collar decreased in both blunt and penetrating traumas from 2014 to 2021 (blunt-82% in 2014 to 68% in 2021; penetrating-24% in 2014 to 6% in 2021). CONCLUSIONS Unnecessary C-spine stabilization has decreased from 2014 to 2021. However, c-collars are still being applied to patients who do not need them, both in blunt and in penetrating trauma cases, while not being applied to patients who would benefit from them.
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Affiliation(s)
- Logan Muzyka
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - James M Bradford
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Pedro G Teixeira
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Joseph DuBose
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Tatiana C P Cardenas
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Michelle Bach
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Sadia Ali
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Michelle Robert
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Carlos V R Brown
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
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Lee SJ, Jian L, Liu CY, Tzeng IS, Chien DS, Hou YT, Lin PC, Chen YL, Wu MY, Yiang GT. A Ten-Year Retrospective Cohort Study on Neck Collar Immobilization in Trauma Patients with Head and Neck Injuries. Medicina (Kaunas) 2023; 59:1974. [PMID: 38004023 PMCID: PMC10673496 DOI: 10.3390/medicina59111974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/23/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: In the context of prehospital care, spinal immobilization is commonly employed to maintain cervical stability in head and neck injury patients. However, its use in cases of unclear consciousness or major trauma patients is often precautionary, pending the exclusion of unstable spinal injuries through appropriate diagnostic imaging. The impact of prehospital C-spinal immobilization in these specific patient populations remains uncertain. Materials and Methods: We conducted a retrospective cohort study at Taipei Tzu Chi Hospital from January 2009 to May 2019, focusing on trauma patients suspected of head and neck injuries. The primary outcome assessed was in-hospital mortality. We employed multivariable logistic regression to investigate the relationship between prehospital C-spine immobilization and outcomes, while adjusting for various factors such as age, gender, type of traumatic brain injury, Injury Severity Score (ISS), Revised Trauma Score (RTS), and activation of trauma team. Results: Our analysis encompassed 2733 patients. Among these, patients in the unclear consciousness group (GCS ≤ 8) who underwent C-spine immobilization exhibited a higher mortality rate than those without immobilization. However, there was no statistically significant difference in mortality among patients with alert consciousness (GCS > 8). Multivariable logistic regression analysis revealed that advanced age (age ≥ 65), unclear consciousness (GCS ≤ 8), major traumatic injuries (ISS ≥ 16 and RTS ≤ 7), and the use of neck collars for immobilization (adjusted OR: 1.850, 95% CI: 1.240-2.760, p = 0.003) were significantly associated with an increased risk of mortality. Subgroup analysis indicated that C-spine immobilization was significantly linked to an elevated risk of mortality in older adults (age ≥ 65), patients with unclear consciousness (GCS ≤ 8), those with major traumatic injuries (ISS ≥ 16 and RTS ≤ 7), and individuals in shock (shock index > 1). Conclusions: While our findings do not advocate for the complete abandonment of neck collars in all suspected head and neck injury patients, our study suggests that prehospital cervical and spinal immobilization should be applied more selectively in certain head and neck injury populations. This approach is particularly relevant for older individuals (age ≥ 65), those with unclear consciousness (GCS ≤ 8), individuals experiencing major traumatic injuries (ISS ≥ 16 or RTS ≤ 7), and patients in a state of shock (shock index ≥ 1). Our study employs a retrospective cohort design, which may introduce selection bias. Therefore, in the future, there is a need for confirmation of our results through a two-arm randomized controlled trial (RCT) arises, as this design is considered ideal for addressing this issue.
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Affiliation(s)
- Shu-Jui Lee
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Lin Jian
- Department of Medical Education, Changhua Christian Hospital, Changhua 500, Taiwan
- Department of Medicine, College of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Chi-Yuan Liu
- Department of Orthopedic Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan
- Department of Orthopedics, School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - I-Shiang Tzeng
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan
| | - Da-Sen Chien
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Yueh-Tseng Hou
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Po-Chen Lin
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Yu-Long Chen
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Meng-Yu Wu
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Giou-Teng Yiang
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan
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Paulson MW, Rossetto M, McKay JT, Bebarta VS, Flarity K, Keenan S, Schauer SG. Association of Prehospital Neck Wound Survivability and Battlefield Medical Evacuation Time in Afghanistan. Mil Med 2023; 188:185-191. [PMID: 37948214 DOI: 10.1093/milmed/usad080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/13/2023] [Accepted: 03/03/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION The U.S. Military's Golden Hour policy led to improved warfighter survivability during the Global War on Terror. The policy's success is well-documented, but a categorical evaluation and stratification of medical evacuation (MEDEVAC) times based on combat injury is lacking. METHODS We queried the Department of Defense Joint Trauma System Prehospital Trauma Registry for casualties with documented penetrating neck trauma in Afghanistan requiring battlefield MEDEVAC from June 15, 2009, through February 1, 2021. Casualties were excluded if the time from the point of injury to reach higher level medical care was not documented, listed as zero, or exceeded 4 hours. They were also excluded if demographic data were incomplete or deemed unreliable or if their injuries occurred outside of Afghanistan.We designed a logistic regression model to test for associations in survivability, adjusting for composite injury severity score, patient age group, and type of next higher level of care reached. We then used our model to interpolate MEDEVAC times associated with 0.1%, 1%, and 10% increased risk of death for an incapacitated casualty with penetrating neck trauma. RESULTS Of 1,147 encounters, 444 casualties met inclusion criteria. Of these casualties, 430 (96.9%) survived to discharge. Interpolative analysis of our multivariable logistic regression model showed that MEDEVAC times ≥8 minutes, ≥53 minutes, and ≥196 minutes are associated with a 0.1%, 1%, and 10% increased risk of mortality from baseline, respectively. CONCLUSIONS Our data characterize the maximum MEDEVAC times associated with 0.1%, 1%, and 10% increased risk of death from baseline survivability for penetrating battlefield neck trauma in Afghanistan.
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Affiliation(s)
- Matthew W Paulson
- University of Colorado School of Medicine, Aurora, CO 80045, USA
- University of Colorado Center for COMBAT Research, University of Colorado School of Medicine, Aurora, CO 80045, USA
- Colorado National Guard Medical Detachment, Buckley Space Force Base, Aurora, CO, USA
| | - Marika Rossetto
- University of Colorado School of Medicine, Aurora, CO 80045, USA
- University of Colorado Center for COMBAT Research, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Jerome T McKay
- University of Colorado School of Medicine, Aurora, CO 80045, USA
- Department of Biomedical Informatics, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Vikhyat S Bebarta
- University of Colorado School of Medicine, Aurora, CO 80045, USA
- University of Colorado Center for COMBAT Research, University of Colorado School of Medicine, Aurora, CO 80045, USA
- 59th Medical Wing, JBSA Lackland, TX 78236, USA
| | - Kathleen Flarity
- University of Colorado School of Medicine, Aurora, CO 80045, USA
- University of Colorado Center for COMBAT Research, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Sean Keenan
- University of Colorado Center for COMBAT Research, University of Colorado School of Medicine, Aurora, CO 80045, USA
- Joint Trauma System, Defense Health Agency, JBSA-Fort Sam Houston, TX 78234, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Steven G Schauer
- 59th Medical Wing, JBSA Lackland, TX 78236, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
- U.S. Army Institute of Surgical Research, JBSA-Fort Sam Houston, TX 782347, USA
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Mills RL, Johnston JR, Harter CC. Helmet and Pad Removal for Football Head and Neck Injuries. Am Fam Physician 2023; 108:Online. [PMID: 37725447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
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Hewes HA, Ravindra VM, Ryan S, Russell KW, Soisson S, Brockmeyer DL. The Fate of the Cervical Collar: An Observational Pilot Study Investigating Follow-up Care After Emergency Department Discharge in Children With Mild Traumatic Neck Injuries. Pediatr Emerg Care 2023; 39:274-278. [PMID: 35616540 DOI: 10.1097/pec.0000000000002755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES After evaluation and treatment of minor traumatic cervical spine injury (CSI), many children are discharged home in a rigid cervical orthosis (RCO). This study investigated their adherence to RCO treatment recommendations. The feasibility of telehealth cervical spine clearance was also explored. METHODS This was a prospective observational study of children 3 to 18 years old with mild CSI evaluated at a level I pediatric trauma center from December 1, 2019, through July 31, 2021. Before emergency department discharge, patients received RCO use instructions and recommendation for follow-up with in-person neurosurgery clinic visit, neurosurgery telehealth visit, or in-person primary care provider visit. The family was responsible for arranging follow-up. Primary outcomes included compliance with follow-up and collar use. RESULTS Ninety-eight children (mean age, 11.3 ± 4.1 years) were included. Overall, follow-up contact was available for 51 patients (52%). At 1-week follow-up with 36 children, 64% were collar compliant, 13 had no pain (38% remained in RCO), 14 had mild pain without limitations, 8 had pain with some limitations, and 1 had significant pain. At 2-week follow-up with 31 children, 9 (29%) were collar compliant, 23 had no pain, 7 had mild pain without limitations, and 1 with significant persistent pain was found to have an odontoid fracture requiring C1-2 fusion. Patients/families often discontinued the use of the collar without follow-up (47%). Approximately half utilized a recommended clinical follow-up option for clearance, most often in neurosurgery clinic or using a neurosurgery telehealth visit. The mean time to follow-up was 11.34 ± 4.9 days (range, 3-25 days), and mean collar compliance lasted 9.8 ± 5.7 days (range, 1-25 days). No child experienced any short-term complications related to RCO use. CONCLUSIONS In this pilot study, a substantial portion of children with mild CSIs discharged from the emergency department with an RCO did not adhere to compliance or follow-up recommendations. Persistent pain requires further evaluation.
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Affiliation(s)
- Hilary A Hewes
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics
| | | | - Sydney Ryan
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics
| | - Katie W Russell
- Division of Pediatric Surgery, Department of Surgery, School of Medicine
| | - Sean Soisson
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT
| | - Douglas L Brockmeyer
- Department of Neurosurgery, Clinical Neurosciences Center, School of Medicine, University of Utah, Salt Lake City, UT
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Usman S. Management of Head and Neck Injuries by the Sideline Physician. Am Fam Physician 2022; 106:543-548. [PMID: 36379500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Although rare, sport-related injuries to the head and neck can be life threatening; therefore, timely and appropriate treatment is critical. Preparation is key for the sideline physician and begins well before arriving on the sideline. Knowing the athletic trainer and support staff, establishing a chain of command and emergency action plan, and having all the appropriate equipment readily available are important for game or practice preparedness. At the athletic event, physicians should have a clear line of sight to the field of play and easy access to reach the field when necessary. When performing an on-field assessment of any athlete who is not moving, whether conscious, unconscious, or with decreased consciousness, head and neck injury must be assumed, and the injured athlete should be placed on a spine board with cervical spine stabilization and transported to the emergency department for further evaluation. Generally, helmets and pads are left on while the injured athlete is being transported. Concussion is among the most common head and neck injuries in athletes, and if concussion is suspected, the athlete cannot return to the game on the same day. Nasal fractures do not always require immediate closed reduction; however, orbital, maxillary, or mandibular fractures require transport to the emergency department. For tooth avulsion, time is important; reimplantation should be attempted within 30 minutes of injury.
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Affiliation(s)
- Saif Usman
- Facey Medical Group, Valencia, California
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Vielsmeier V, Hackenberg S, Schelzig H, Knapsis A. [Update on neck trauma]. HNO 2022; 70:724-735. [PMID: 36066623 DOI: 10.1007/s00106-022-01214-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Important organs and structures are located in the cervical region. In case of blunt and penetrating trauma, emergency situations may arise. OBJECTIVE Emergency management as well as diagnostic and therapeutic steps pertaining to neck injuries are presented. CONCLUSION Shock therapy and airway management are essential, fast management of neck injuries highly relevant.
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Affiliation(s)
- V Vielsmeier
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland.
| | - S Hackenberg
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - H Schelzig
- Klinik für Gefäß- und Endovaskularchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - A Knapsis
- Klinik für Gefäß- und Endovaskularchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
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Lind K, Do-Nguyen A. Neck trauma: diagnosis and management in the emergency department. Emerg Med Pract 2021; 23:1-29. [PMID: 33825432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/25/2021] [Indexed: 06/12/2023]
Abstract
Neck trauma is an uncommon but serious presenting complaint in the emergency department. Many vital structures may be affected in a patient with a traumatic neck injury, including the airway, digestive tract, and carotid and vertebral arteries. Emergency clinicians must also be prepared to diagnose and manage occult and delayed presentations of injury related to neck trauma. This supplement reviews advances and best practices in the evaluation and management of patients with neck trauma, with a focus on evidence-based guidelines. A streamlined algorithm is provided as well as discussion of recent changes and controversies in neck trauma management in the prehospital and emergency department settings.
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Affiliation(s)
- Karen Lind
- Attending Physician and Faculty Member, Department of Emergency Medicine, Highland Hospital, Oakland, CA
| | - Amy Do-Nguyen
- Department of Emergency Medicine, Highland Hospital, Oakland, CA
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Wasif M, Dhanani R, Ghaloo SK, Awan MS, Danish MH, Hussain HM, Pasha HA. Management of Laryngotracheal trauma: A review of current trends and future Directions. J PAK MED ASSOC 2020; 70(Suppl 1):S60-S64. [PMID: 31981338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Laryngotracheal trauma is rare but can pose serious threats to one's life. Presenting symptoms vary according to the severity of injury. Immediate Airway control is first step in the management, intubation should be considered by a senior member of the trauma team if the injury is minor while tracheostomy should be reserved for more severe injuries. Evaluation by a fibre-optic laryngoscopy and CT scan should be done whenever possible. Reconstruction is done according to the site involved using suture, titanium miniplates and stents. Tissue engineering has added a new horizon in this management but up till now complete laryngotracheal regeneration is very far-fetched, but tissue regeneration at individual sites have shown some positive results. More work needs to be done in this less explored field including laryngeal transplantation.
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Affiliation(s)
- Muhammad Wasif
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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12
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Hundersmarck D, Reinders Folmer E, de Borst GJ, Leenen LPH, Vriens PWHE, Hietbrink F. Penetrating Neck Injury in Two Dutch Level 1 Trauma Centres: the Non-Existent Problem. Eur J Vasc Endovasc Surg 2019; 58:455-462. [PMID: 31307866 DOI: 10.1016/j.ejvs.2019.04.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 04/16/2019] [Accepted: 04/20/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Penetrating neck injuries (PNIs) have a low incidence in European trauma populations. Selective non-operative management of PNI has been suggested as a safe alternative to standard surgical neck exploration, but evidence is lacking. This clinical scenario evaluates institutional PNI management, specifically the associated carotid artery injury, and compares it with current guidelines. METHODS Retrospectively, PNI patients presenting at two Dutch level 1 trauma centres from 2007 to 2015, were identified. International guidelines on PNI management were reviewed and recommendations were assessed in relation to current institutional management, and considering an illustrative case. RESULTS Two current guidelines on PNI management were reviewed. Both advocate a zone based approach; one recommends a prominent role for computed tomography angiography (CTA) scanning in stable patients, supplemented by endoscopy when indicated. A combined total of 43 PNI patients were identified over a nine year period. Haemodynamically unstable patients and patients with other hard signs (i.e. active bleeding, expanding haematoma, air/saliva leak, massive subcutaneous emphysema) received immediate exploration (n = 9). Haemodynamically stable patients and those responding to resuscitation (transient responders) had a CTA scan (n = 31). Three asymptomatic patients were treated conservatively, and had an uncomplicated clinical course regarding the PNI. In 10 of 14 patients who received surgical exploration, a significant vascular or aerodigestive injury was found and repaired (71%). All patients treated conservatively after CTA scanning had an uncomplicated clinical course regarding the PNI (n = 17). Six patients with penetrating carotid artery injury underwent primary arterial reconstruction, of whom five survived. CONCLUSIONS This clinical scenario evaluates institutional management in two trauma centres for PNI and associated carotid artery injury, and compares it to current guidelines. In comparison with guideline recommendations, CTA scanning and the so called "No zone" approach appears to have assumed a more prominent role in management of PNI.
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Affiliation(s)
- Dennis Hundersmarck
- Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands; Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands.
| | | | - Gert J de Borst
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Luke P H Leenen
- Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Falco Hietbrink
- Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
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Wessels EU, Kong VY, Buitendag J, Moffatt S, Weale R, Ras AB, Ras M, Smith MTD, Laing GL, Bruce JL, Bekker W, Manchev V, Clarke DL. The spectrum of animal related injuries managed at a major trauma centre in South Africa. S AFR J SURG 2019; 57:54. [PMID: 31392866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Humans come into contact and interact with an array of animals in a number of areas and environments. We set out to review our experience with animal-related injuries in Pietermaritzburg, KwaZulu-Natal, South Africa. METHOD All patients who sustained an injury secondary to an interaction with an animal in the period December 2012-December 2017 were identified from the Hybrid Electronic Medical Registry (HEMR). RESULTS There were 104 patients in the study sample. The mean age of patients in the study was 32.8 years, with a range from 1 to 76 years old. 75% (n = 78) were male and 25% (n = 26) female. Out of the 104 animal-related injuries, 67 were blunt trauma, 39 penetrating trauma and 3 a combination of blunt and penetrating trauma. The species causing trauma included dogs (53), horses (29), cows (18), buffalo (1), warthog (1), impala (1) and a single goat (1). The median time from injury to hospitalisation was 46.62 hours (range from 0 to 504 hours). Injuries occurred to the head (n = 32), face (n = 9), neck (n = 32), abdomen (n = 22), urogenital system (n = 6), upper limb (n = 39) and lower limb (n = 39). The Injury Severity Score (ISS) mean for the patients was 8.16, the range 1-4, the median 9 and the standard deviation 6.88. In 49 patients the treatment was non-operative. In the remaining 55 patients, a total of 68 operative procedures were required. Operations included wound debridement/surgical washout (n = 38), laparotomy (n = 9), arterial repair/ligation (n = 8), skin graft (n = 4), craniotomy (n = 5), fasciotomy (n = 2), amputation (n = 1), and placement of an ICP monitor (n = 1). 49 of these operations were for patients with dog bite injuries. The mean hospital stay was 0.13 days with a range of 0-4 days. Four patients were admitted to the Intensive Care Unit (ICU) and two patients died. CONCLUSION Human interactions with animals may result in injuries which require surgical treatment. The most common animal injury is a dog bite but in the case of the larger domestic farm animals, blunt force type injuries and goring can result in significant injuries which require complex surgical interventions.
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Affiliation(s)
- E U Wessels
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - V Y Kong
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa and Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - J Buitendag
- Department of Surgery, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - S Moffatt
- Department of Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - R Weale
- Department of Surgery, North West Deanery, Manchester, United Kingdom
| | - A B Ras
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - M Ras
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - M T D Smith
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - G L Laing
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - J L Bruce
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - W Bekker
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - V Manchev
- Department of Surgery, University of KwaZulu-Natal, Durban, South Afric
| | - D L Clarke
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa and Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
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Hundersmarck D, van Koperen PJ, Leenen LPH, de Borst GJ, Houwert RM, Hietbrink F. [Not Available]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 2019; 163:D2879. [PMID: 31424702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Penetrating neck injuries (PNIs) as a result of stabbing or deliberate self-harm are complex and potentially life-threatening. Nowadays, selective non-operative management of PNI has become common practice. Diagnostic and treatment algorithms originating from high-volume trauma centres in South-Africa and North-America are used in Dutch clinical practice. Three patients that sustained a PNI are discussed. Two patients, aged 61 and 37, only had mild signs on physical examination that justified additional diagnostic investigations. In the first patient, a penetrating oesophageal injury was found and repaired. The latter had a partial Horner syndrome as a result of PNI, no underlying injuries were found. One patient, aged 57, was haemodynamically unstable and therefore received immediate surgical exploration of the neck. A penetrating injury of the jugular vein was discovered and repaired. A summary of literature and guidelines is presented for the benefit of Dutch physicians that may be confronted with these complex injuries.
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Affiliation(s)
- Dennis Hundersmarck
- Universitair Medisch Centrum Utrecht, afd. Heelkunde, Utrecht
- Contact: D. Hundersmarck
| | | | - Loek P H Leenen
- Universitair Medisch Centrum Utrecht, afd. Heelkunde, Utrecht
| | - Gert J de Borst
- Universitair Medisch Centrum Utrecht, afd. Heelkunde, Utrecht
| | | | - Falco Hietbrink
- Universitair Medisch Centrum Utrecht, afd. Heelkunde, Utrecht
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van Adrichem DC, Ratering MRHA, Rashid SM, Jusabani MA, Poppe VE, Mwaitele HA, Massawe HH, Howlett WP, Moshi HI, Dekker MCJ. Penetrating spinal cord injury causing paraplegia in a bird hunter in rural Tanzania. Spinal Cord Ser Cases 2019; 5:49. [PMID: 31632707 PMCID: PMC6786419 DOI: 10.1038/s41394-019-0195-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/03/2019] [Accepted: 05/05/2019] [Indexed: 11/08/2022] Open
Abstract
Introduction Cultural and socioeconomic factors influence the risk of sustaining a Traumatic Spinal Cord Injury (TSCI). The standard of management and rehabilitation available to TSCI patients differs greatly between high-income and low-income countries. Case presentation We report a 17-year-old male bird hunter, with no prior medical history, presenting with paraplegia and sensory loss from the xiphoid process down after being struck by an arrow in the left lateral side of the neck. Discussion Penetrating neck injuries are potentially life threatening because of the complex arrangement of vital structures in the neck. Management of spinal cord trauma resulting from such injuries in low-resource settings is challenging.
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Affiliation(s)
| | | | - Sakina Mehboob Rashid
- Department of General Surgery, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Mubashir Alavi Jusabani
- Department of Orthopaedics and Traumatology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | | | - Honest Herman Massawe
- Department of Orthopaedics and Traumatology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | | | - Marieke Cornelia Johanna Dekker
- Department of Orthopaedics and Traumatology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Department of Paediatrics and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Department of Neurology, Radboudumc Nijmegen, Nijmegen, Netherlands
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Berke DM, Helmer SD, Reyes J, Haan JM. Injury Patterns in Near-Hanging Patients: How Much Workup Is Really Needed? Am Surg 2019; 85:549-555. [PMID: 31126370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Survivors of near-hangings suffer anoxic brain injuries, but it remains uncertain whether the incidence of associated injuries warrants extensive workup or trauma activation. An 11-year retrospective review was conducted on adult patients with a hanging mechanism who underwent trauma workup and management. The majority of patients (n = 98) were white (88.8%) males (75.5%) with an average age of 30 ± 12.3 years. Two-hundred fifty-four CT and magnetic resonance scans were performed and eight injuries were uncovered: three thyroid cartilage/hyoid fractures; three vertebral injuries; and two cervical vascular injuries. Anoxic brain injury was diagnosed clinically in 35 patients (35.7%) and was present in all 19 patients (19.4%) who died. Only one patient had intra-abdominal injury requiring surgical intervention. Injuries were more likely in patients with abnormal Glasgow Coma Scale (GCS) versus normal GCS (55% vs 10.5%, respectively). Patients who present after near-hanging have a low incidence of associated injuries. Workup can be restricted to patients with abnormal GCS scores and for specific signs and symptoms or high-risk energy mechanisms. The trauma team can be activated for signs of trauma.
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Boots RJ, Joyce C, Mullany DV, Anstey C, Blackwell N, Garrett PM, Gillis S, Alexander N. Near-Hanging as Presenting to Hospitals in Queensland: Recommendations for Practice. Anaesth Intensive Care 2019; 34:736-45. [PMID: 17183891 DOI: 10.1177/0310057x0603400610] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Near-hanging is an increasing presentation to hospitals in Australasia. We reviewed the clinical management and outcome of these patients as they presented to public hospitals in Queensland. A retrospective clinical record audit was made at five public hospitals between 1991 and 2000. Of 161 patients enrolled, 82% were male, 8% were indigenous and 10% had made a previous hanging attempt. Chronic medical illnesses were documented in 11% and previous psychiatric disorders in 42%. Of the 38 patients with a Glasgow Coma Scale score (GCS) of 3 on arrival at hospital, 32% returned to independent living and 63% died. Fifty-two patients received CPR, of whom 46% had an independent functional outcome. Independent predictors of mortality were a GCS on hospital arrival of 3 (AOR 150, CI 95% 12.4–1818, P<0.001), taking plain X-rays of the cervical spine (AOR 0.06, CI 95% 0.004–0.97, P=0.047) and contact with the ground (AOR 0.03, CI 95% 0.002–0.62, P=0.02). Only 66% had imaging of the cervical spine performed with other imaging performed infrequently. There were three laryngeal, two hyoid bone and three cervical spine injuries and one carotid dissection. The number of cervical spine X-rays required to find a significant cervical spine fracture was 54. Near-hanging presenting to hospital with a poor conscious state or even cardiac arrest can have a favourable clinical outcome. Radiological investigations are infrequently performed despite a low GCS precluding early accurate assessment. Given the general favourable outcome, an aggressive approach to searching for correctable injuries is recommended.
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Affiliation(s)
- R J Boots
- Department of Intensive Care, Royal Brisbane and Women's Hospital, Brisbane
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Freyvert Y, Yong NA, Morikawa E, Zdunowski S, Sarino ME, Gerasimenko Y, Edgerton VR, Lu DC. Engaging cervical spinal circuitry with non-invasive spinal stimulation and buspirone to restore hand function in chronic motor complete patients. Sci Rep 2018; 8:15546. [PMID: 30341390 PMCID: PMC6195617 DOI: 10.1038/s41598-018-33123-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 09/17/2018] [Indexed: 01/01/2023] Open
Abstract
The combined effects of cervical electrical stimulation alone or in combination with the monoaminergic agonist buspirone on upper limb motor function were determined in six subjects with motor complete (AIS B) injury at C5 or above and more than one year from time of injury. Voluntary upper limb function was evaluated through measures of controlled hand contraction, handgrip force production, dexterity measures, and validated clinical assessment batteries. Repeated measure analysis of variance was used to evaluate functional metrics, EMG amplitude, and changes in mean grip strength. In aggregate, mean hand strength increased by greater than 300% with transcutaneous electrical stimulation and buspirone while a corresponding clinically significant improvement was observed in upper extremity motor scores and the action research arm test. Some functional improvements persisted for an extended period after the study interventions were discontinued. We demonstrate that, with these novel interventions, cervical spinal circuitry can be neuromodulated to improve volitional control of hand function in tetraplegic subjects. The potential impact of these findings on individuals with upper limb paralysis could be dramatic functionally, psychologically, and economically.
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Affiliation(s)
- Yevgeniy Freyvert
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, 90095, USA
- Neuromotor Recovery and Rehabilitation Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, 90095, USA
| | - Nicholas Au Yong
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, 90095, USA
- Neuromotor Recovery and Rehabilitation Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, 90095, USA
| | - Erika Morikawa
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, 90095, USA
- Neuromotor Recovery and Rehabilitation Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, 90095, USA
| | - Sharon Zdunowski
- Departments of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, California, 90095, USA
| | - Melanie E Sarino
- Rancho Los Amigos National Rehabilitation Center, Downey, California, 90242, USA
| | - Yury Gerasimenko
- Departments of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, California, 90095, USA
- Pavlov Institute of Physiology, St. Petersburg, Russia
| | - V Reggie Edgerton
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, 90095, USA
- Departments of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, California, 90095, USA
- Neurobiology, University of California, Los Angeles, Los Angeles, California, 90095, USA
- Brain Research Institute, University of California, Los Angeles, Los Angeles, California, 90095, USA
| | - Daniel C Lu
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, 90095, USA.
- Neuromotor Recovery and Rehabilitation Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, 90095, USA.
- Brain Research Institute, University of California, Los Angeles, Los Angeles, California, 90095, USA.
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Lee HY, Youk H, Ii Lee J, Kang CY, Kong JS, Sung S, Kang IH, Lee JH, Kim OH, Jung WJ, Lee KH, Youn YH, Park JC. Injury analysis of patients according to impact patterns involved in pedestrian traffic crashes. Traffic Inj Prev 2018; 19:S153-S157. [PMID: 29584483 DOI: 10.1080/15389588.2017.1365142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 08/04/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES In cases of car-to-person pedestrian traffic crashes (PTCs), the principal issue is determining at what point the car collided with the pedestrian. Accordingly, the objective of the present study was to use the medical records of patients injured in PTCs to investigate the characteristics of crash types and the areas and injury severity and to determine whether there are differences in injuries due to the angle, motion, and position at the point of impact. METHODS The present study examined 231 PTC patients admitted to the emergency room (ER) between January and December 2014. Electronic medical records from the hospital were used to divide the patient data according to Abbreviated Injury Scale (AIS) codes for injured areas based on sex, age, time of the crash, outcomes after ER treatment, and major symptoms. Among 231 patients, police reports on 67 crash cases, involving 70 people, were obtained with the help of local police departments, and these reports were used to reconstruct details of the actual crash. For statistical analysis, a chi-square test and a one-way analysis of variance calculation were used to compare the Injury Severity Score (ISS) based on groups and stages, with a statistical significance level set to P < .05. RESULTS With respect to patients who were admitted for PTC, 52.4% were females and 47.6% were males. The frequency of crashes was high in middle-aged and elderly groups, as well as for youths between 10 and 19 years old. With respect to outcomes after ER treatment, discharge to home after symptom improvement was the most common outcome (24.6%). Admissions to the intensive care unit (25.1%) and to the general ward (23.8%) were also high. In terms of major symptoms, the most common injuries were to the head, resulting from a rotatory motion post impact (35.9%), and injuries to the legs, resulting from the impact of a direct collision with an object (25.1%). CONCLUSIONS This study demonstrated that injuries to the chest and abdomen were the most severe in the fender vault group and head and neck injuries were the most severe in the roof vault group. In particular, the Injury Severity Score was highest in the roof vault group.
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Affiliation(s)
- Hee Young Lee
- a Department of Emergency Medicine , Yonsei University Wonju College of Medicine , Wonju, Gangwon , Republic of Korea
| | - Hyun Youk
- a Department of Emergency Medicine , Yonsei University Wonju College of Medicine , Wonju, Gangwon , Republic of Korea
| | - Jeong Ii Lee
- a Department of Emergency Medicine , Yonsei University Wonju College of Medicine , Wonju, Gangwon , Republic of Korea
| | - Chan Young Kang
- a Department of Emergency Medicine , Yonsei University Wonju College of Medicine , Wonju, Gangwon , Republic of Korea
| | - Joon Seok Kong
- a Department of Emergency Medicine , Yonsei University Wonju College of Medicine , Wonju, Gangwon , Republic of Korea
| | - Sil Sung
- a Department of Emergency Medicine , Yonsei University Wonju College of Medicine , Wonju, Gangwon , Republic of Korea
| | - In Hye Kang
- a Department of Emergency Medicine , Yonsei University Wonju College of Medicine , Wonju, Gangwon , Republic of Korea
| | - Jung Hun Lee
- a Department of Emergency Medicine , Yonsei University Wonju College of Medicine , Wonju, Gangwon , Republic of Korea
| | - Oh Hyun Kim
- a Department of Emergency Medicine , Yonsei University Wonju College of Medicine , Wonju, Gangwon , Republic of Korea
| | - Woo Jin Jung
- a Department of Emergency Medicine , Yonsei University Wonju College of Medicine , Wonju, Gangwon , Republic of Korea
| | - Kang Hyun Lee
- a Department of Emergency Medicine , Yonsei University Wonju College of Medicine , Wonju, Gangwon , Republic of Korea
| | - Young Han Youn
- b School of Mechatronics, Korea University of Technology and Education , Cheonan , Republic of Korea
| | - Jong Chan Park
- c Division of Traffic Accident, National Forensic Service , Wonju, Gangwon , Republic of Korea
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Davis S, McIntyre R, Cribari C, Dunn J. Thyroid Storm Induced by Trauma: A Challenging Combination. Am Surg 2018; 84:e44-e46. [PMID: 30454474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Stephanie Davis
- Division of GI, Tumor, and Endocrine Surgery, Department of Surgery, University of Colorado, Aurora, Colorado, USA
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Choi AR, Shin JS, Lee J, Lee YJ, Kim MR, Oh MS, Lee EJ, Kim S, Kim M, Ha IH. Current practice and usual care of major cervical disorders in Korea: A cross-sectional study of Korean health insurance review and assessment service national patient sample data. Medicine (Baltimore) 2017; 96:e8751. [PMID: 29145327 PMCID: PMC5704872 DOI: 10.1097/md.0000000000008751] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Neck pain is a highly common condition and is the 4th major cause of years lived with disability. Previous literature has focused on the effect of specific treatments, and observations of actual practice are lacking to date. This study examined Korean health insurance review and assessment service (HIRA) claims data to the aim of assessing prevalence and comparing current medical practice and costs of cervical disorders in Korea.Current practice trends were determined through assessment of prevalence, total expenses, per-patient expense, average days in care, average days of visits, sociodemographic characteristics, distribution of medical costs, and frequency of treatment types of high frequency cervical disorders (cervical sprain/strain, cervical intervertebral disc displacement [IDD], and cervicalgia).Although the number of cervical IDD patients was few, total expenses, per-patient expense, average days in care, and average days of visits were highest. The proportion of women was higher than men in all 3 groups with highest prevalence in the ≥50s middle-aged population for IDD compared to sprain/strain. Primary care settings were commonly used for ambulatory care, of which approximately 70% chose orthopedic specialist treatment. In analysis of medical expenditure distribution, costs of visit (consultation) (22%-34%) and physical therapy (14%-16%) were in the top 3 for all 3 disorders. Although heat and electrical therapies were the most frequently used physical therapies, traction use was high in the cervical IDD group. In nonnarcotics, aceclofenac and diclofenac were the most commonly used NSAIDs, and pethidine was their counterpart in narcotics.This study investigated practice trends and cost distribution of treatment regimens for major cervical disorders, providing current usage patterns to healthcare policy decision makers, and the detailed treatment reports are expected to be of use to clinicians and researchers in understanding current usual care.
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Affiliation(s)
- A Ryeon Choi
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul
| | - Joon-Shik Shin
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul
| | - Jinho Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul
| | - Me-riong Kim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul
| | - Min-seok Oh
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Dae-Jeon University, Daejeon
| | - Eun-Jung Lee
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Dae-Jeon University, Daejeon
| | - Sungchul Kim
- ALS & MND Center at Wonkwang University Korean Medicine Hospital in Gwangju, Gwangju
| | - Mia Kim
- Department of Cardiovascular and Neurological Diseases (Stroke Center), College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul
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Tilney PVR, Turcotte J, Stuart G. An 89-Year-Old Man Hanging in a Remote Location. Air Med J 2017; 36:93-94. [PMID: 28499689 DOI: 10.1016/j.amj.2017.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 02/28/2017] [Indexed: 06/07/2023]
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Qadeer M, Sharif S. Management of cervical trauma: A Brief review. J PAK MED ASSOC 2017; 67:760-766. [PMID: 28507367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Cervical injury is not uncommon in any trauma, especially in road traffic accident. A standard approach, towards, transport, workup, and management is required for best outcomes, and decrease morbidity. We tried to review the recent literature and briefly discuss the management protocols concluded that in our setting, emergency ambulance personnel and Emergency Room doctors should be trained in dealing with all kinds of cervical spine trauma, they should be aware of recent guidelines and should refrain from using steroids routinely. By following guidelines, large numbers of cervical spine injury patients can benefit.
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Affiliation(s)
- Mohsin Qadeer
- Department of Neurosurgery, Liaquat National Hospital, Karachi, Pakistan
| | - Salman Sharif
- Department of Neurosurgery, Liaquat National Hospital, Karachi, Pakistan
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Fang LN, Ma WJ, Huang X. [Treatment of laryngeal trauma (report of 38 cases)]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2017; 31:392-394. [PMID: 29871270 DOI: 10.13201/j.issn.1001-1781.2017.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Indexed: 06/08/2023]
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Popkin CA, Nelson BJ, Park CN, Brooks SE, Lynch TS, Levine WN, Ahmad CS. Head, Neck, and Shoulder Injuries in Ice Hockey: Current Concepts. Am J Orthop (Belle Mead NJ) 2017; 46:123-134. [PMID: 28666035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Ice hockey is a fast-paced contact sport that is becoming increasingly popular in North America. More than 1 million men, women, and juniors are playing hockey in the United States and Canada. With players colliding forcefully with one another and with the boards surrounding the ice, injury rates are among the highest in all of competitive sports. Physicians caring for a hockey team should be aware of the more common injuries, involving the head, the neck, and the shoulder. In this review, we discuss evaluation and treatment of these hockey injuries, return to play, and, where applicable, prevention strategies.
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Uriell ML, Allen JW, Lovasik BP, Benayoun MD, Spandorfer RM, Holder CA. Yield of computed tomography of the cervical spine in cases of simple assault. Injury 2017; 48:133-136. [PMID: 27842904 DOI: 10.1016/j.injury.2016.10.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/13/2016] [Accepted: 10/26/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Computed tomography (CT) of the cervical spine (C-spine) is routinely ordered for low-impact, non-penetrating or "simple" assault at our institution and others. Common clinical decision tools for C-spine imaging in the setting of trauma include the National Emergency X-Radiography Utilization Study (NEXUS) and the Canadian Cervical Spine Rule for Radiography (CCR). While NEXUS and CCR have served to decrease the amount of unnecessary imaging of the C-spine, overutilization of CT is still of concern. METHODS A retrospective, cross-sectional study was performed of the electronic medical record (EMR) database at an urban, Level I Trauma Center over a 6-month period for patients receiving a C-spine CT. The primary outcome of interest was prevalence of cervical spine fracture. Secondary outcomes of interest included appropriateness of C-spine imaging after retrospective application of NEXUS and CCR. The hypothesis was that fracture rates within this patient population would be extremely low. RESULTS No C-spine fractures were identified in the 460 patients who met inclusion criteria. Approximately 29% of patients did not warrant imaging by CCR, and 25% by NEXUS. Of note, approximately 44% of patients were indeterminate for whether imaging was warranted by CCR, with the most common reason being lack of assessment for active neck rotation. CONCLUSIONS Cervical spine CT is overutilized in the setting of simple assault, despite established clinical decision rules. With no fractures identified regardless of other factors, the likelihood that a CT of the cervical spine will identify clinically significant findings in the setting of "simple" assault is extremely low, approaching zero. At minimum, adherence to CCR and NEXUS within this patient population would serve to reduce both imaging costs and population radiation dose exposure.
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Affiliation(s)
- Matthew L Uriell
- Emory University School of Medicine, Atlanta, GA, United States; Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States.
| | - Jason W Allen
- Emory University School of Medicine, Atlanta, GA, United States; Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States; Department of Neurology, Emory University, Atlanta, GA, United States.
| | - Brendan P Lovasik
- Emory University School of Medicine, Atlanta, GA, United States; Department of Surgery, Emory University, Atlanta, GA, United States.
| | - Marc D Benayoun
- Emory University School of Medicine, Atlanta, GA, United States; Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States.
| | | | - Chad A Holder
- Emory University School of Medicine, Atlanta, GA, United States; Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States.
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Jitpakdee P, Steele T, Bhuskute A, Setabutr D. Pediatric laryngotracheal separation following a go-cart injury. Int J Pediatr Otorhinolaryngol 2016; 85:166-9. [PMID: 27240517 DOI: 10.1016/j.ijporl.2016.03.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 03/19/2016] [Accepted: 03/19/2016] [Indexed: 11/18/2022]
Abstract
Less than one percent of trauma admission cases are categorized as pediatric neck trauma [13]. Nevertheless, due to an increasingly mobile society, there has been an increasing frequency of pediatric neck trauma with motor vehicle accidents being the most common mechanism of injury [8]. We present a case of laryngotracheal separation from a blunt, clothesline injury to the neck in a pediatric patient. We also review the literature and discuss the benefit of balloon airway dilation and its assistance in the management of laryngeal trauma and its resultant effects.
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Affiliation(s)
- Polpatt Jitpakdee
- Chulabhorn International College of Medicine, Thammasat University, Department of Otolaryngology-Head and Neck Surgery, Pathum Thani, Thailand
| | - Toby Steele
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, CA USA
| | - Aditi Bhuskute
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, CA USA
| | - Dhave Setabutr
- Cohen's Children's Medical Center, Hofstra University School of Medicine | Northwell Health, Division of Pediatric Otolaryngology, New Hyde Park, NY, USA.
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Xydakis MS, Fravell MD, Nasser KE, Casler JD. Analysis of Battlefield Head and Neck Injuries in Iraq and Afghanistan. Otolaryngol Head Neck Surg 2016; 133:497-504. [PMID: 16213918 DOI: 10.1016/j.otohns.2005.07.003] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2004] [Indexed: 11/26/2022]
Abstract
OBJECTIVE: At the time of this study, the 1st place that an injured or ill American soldier in Iraq or Afghanistan would have been evaluated by an ENT–head and neck surgeon was at a tertiary care medical center as a result of air evacuation out of theater: Landstuhl Regional Medical Center (LRMC), Ramstein, Germany. By examining the ENT-related diagnoses of all air evacuations from downrange, we were able to match the patients classified as having battle injuries to determine the percentage with head and neck trauma. STUDY DESIGN: A prospective review of 11,287 soldiers air-evacuated from Afghanistan and Iraq, representing the 1st year of combat operations. A new, computerized patient-tracking system was created by our team to merge several disparate databases to generate and compile our data. RESULTS: The ENT–head and neck surgery department evaluated and primarily managed 8.7% of all patients evacuated out of theater by air to Germany. Other medical and surgical services managed 7.3% of all patients evacuated out of theater with overlapping ENT diagnoses. The number of potential ENT patients increased to 16% when one looked at all head and neck pathology instances seen by all medical and surgical departments hospital-wide. Of all patients air-evacuated and classified as having battle injuries, 21% presented with at least 1 head and neck trauma code. CONCLUSIONS: This is the 1st paper focusing on the role of the ENT–head and neck surgeon in treating a combat population and also the patterns of illness and head and neck injuries in a deployed force in our modern military. Improved soldier body armor has resulted in distinctly new patterns of combat injuries. Unprotected areas of the body account for the majority of injuries. SIGNIFICANCE: These findings should be used to improve the planning and delivery of combat medical care.
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Affiliation(s)
- Michael S Xydakis
- 435 Medical Group at Landstuhl Regional Medical Center of the US Air Force, MacDill AFB, Tampa, Florida, USA.
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Dixon A. Cervical Spinal Injury In Pediatric Blunt Trauma Patients: Management In The Emergency Department. Pediatr Emerg Med Pract 2016; 13:1-24. [PMID: 26894868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 12/10/2015] [Indexed: 06/05/2023]
Abstract
Spinal injuries from blunt trauma are uncommon in pediatric patients, representing only about 1.5% of all blunt trauma patients. However, the potentially fatal consequences of spinal injuries make them of great concern to emergency clinicians. Clinical goals in the emergency department are to identify all injuries using selective imaging and to minimize further harm from spinal cord injury. Achieving these goals requires an understanding of the age-related physiologic differences that affect patterns of injury and radiologic interpretation in children, as well as an appreciation of high-risk clinical clues and mechanisms. This issue reviews current approaches to prehospital immobilization, identification of low-risk patients who may be clinically cleared from immobilization, a rational approach to the use of radiologic imaging, and the existing evidence for medical management of spinal cord injuries.
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Affiliation(s)
- Andrew Dixon
- Associate Professor, Division of Emergency Medicine, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Sinikumpu JJ, Salokorpi N, Suo-Palosaari M, Pesälä J, Serlo W. [Severe trampoline injuries and their risk factors among children and the young]. Duodecim 2016; 132:1061-1068. [PMID: 27400592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Although the majority of trampoline injuries in children are minor, severe injuries occur as well. METHODS We have analyzed the risk factors, treatment and outcome of severe trampoline injuries treated in the Oulu University Hospital in children and the young between April and November 2105. RESULTS There was a total of eight severe injuries. Five injuries involved a danger of death. Almost all severe trampoline injuries resulted from an unsuccessful trick. A safety net was in use in half of the cases. CONCLUSIONS All cervical spine injuries would have been avoided provided that the children would have refrained from doing a somersault on the trampoline.
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Verdonck P, de Schoutheete JC, Monsieurs KG, Van Laer C, Vander Poorten V, Vanderveken O. Penetrating and blunt trauma to the neck: clinical presentation, assessment and emergency management. B-ENT 2016; Suppl 26:69-85. [PMID: 29558578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Penetrating and blunt trauma to the neck: clinical presentation, assessment ana emergency management. In Belgium, and even in Western Europe, penetrating and blunt injury to the neck is relatively uncommon in both the civilian and military populations. Pre-hospital and emergency assessment and management will therefore always prove challenging, as individual exposure to this specific type of injury remains low. Historically, the neck has been divided into three anatomical zones with specific landmarks to guide the diagnostic and therapeutic approach to penetrating neck injuries. Most penetrating injuries need to be explored surgically, although with the advent of multi-detector computed tomographic angiography (MDCTA), which yields high diagnostic sensitivity, this inflexible approach has recently changed to a more targeted management, based on clinical, radiographic and, if deemed necessary, endoscopic findings. However, some authors have addressed their concern about this novel, 'no-zone' approach, since the risk of missing less apparent aerodigestive tract injuries may increase. It is recommended, therefore, that all patients with penetrating neck injuries be closely observed, irrespective of the initial findings. The incidence of blunt neck injury is much lower, and this makes risk assessment and management even more difficult in comparison with penetrating injuries. Again, MDCTA is most often the first diagnostic tool if a blunt neck injury is suspected, due to its good sensitivity for blunt cerebrovascular injuries (BCVI) as well as for aerodigestive tract injuries. Specific patterns of injury and unexpected neurological and neuro-radiological findings in trauma patients should always warrant further investigation. Despite ongoing debate, systemic anticoagulation is recommended for most BCVI, sometimes combined with endovascular treatment. Aerodigestive tract injuries may present dramatically, but are often more subtle, making the diagnosis more difficult than other types of neck injuries. Treatment may be conservative if damage is minimal, but surgery is warranted in all other cases.
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Jennes S, Hanchart B, Keersebilck E, Rose T, Soete O, François PM, Engel H, Van Trimpont F, Davin C, Trippaerts M, Vanderheyden B, Etienne L, Lacroix C, Teodorescu S, Mashaekhi S, Persoons P, Baekelandt D, Hachimi Idrissil S, Watelet JB. Management of burn wounds of the head and neck region. B-ENT 2016; Suppl 26:107-126. [PMID: 29461737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Management of burn wounds of the head and neck region. Management of the severely burned patient is ery often a challenge, not only due to major disturbances in anatomy and physiological processes, but also because the relatively low incidence of this pathology in both civilian and military practice results in care providers'lack of experience. The purpose of this educational document is to provide doctors confronted with these formidable trauma patients with basic management guidelines as well as some practical tips. In summary, and most importantly, these patients should be reated as any other multitrauma patient. First aid is essential and can be provided by non-medical staff. Initial medical nanagement should focus on the usual, familiar trauma algorithms of ABCDEF from the emergency management of evere burns (EMSB) manual' or the ABCDEs of the manual of advanced trauma life support (ATLS)2 or advanced burn life support (ABLS). Medical care should proceed through the following steps - Step one: establish a reliable intravenous nfusion; step two: protect the airway; step three: establish and maintain a haemodynamic state compatible with sufficient organ perfusion in order to reduce aggravation of the burn wounds and increase overall survival likelihood; step four: provide analgesia with adequate sedation and provide anaesthesia for escharotomy, fasciotomy or other surgical injuries; step five: maintain normothermia; step six: feed the patient by starting enteral nutrition as early as possible; step seven: prevent infection using antiseptic wound management, systemic antibiotics and tetanus prophylaxis. All of these intricate steps require continuous reassessment and adjustment, but the existence of other wounds (blast injuries, penetrating and blunt trauma) even further complicates the management of burn casualties.
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Cui N, Sun Y, Zhu D, Zheng J, Sha J, Meng C. [Percutaneous endovascular interventional treatment for vertebral artery injuries: a case report]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2015; 50:63-64. [PMID: 25764932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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34
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Yu B, Yu Y. [Acupuncture combined with excercise for 41 cases of stiff neck]. Zhongguo Zhen Jiu 2015; 35:71. [PMID: 25906575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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35
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Huang Z, Hou Y, Peng Y. [Care experience of acute neck injuries]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2014; 28:1990-1992. [PMID: 25895325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Prokakis C, Koletsis EN, Dedeilias P, Fligou F, Filos K, Dougenis D. Airway trauma: a review on epidemiology, mechanisms of injury, diagnosis and treatment. J Cardiothorac Surg 2014; 9:117. [PMID: 24980209 PMCID: PMC4104740 DOI: 10.1186/1749-8090-9-117] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 06/23/2014] [Indexed: 12/17/2022] Open
Abstract
Airway injuries are life threatening conditions. A very little number of patients suffering air injuries are transferred live at the hospital. The diagnosis requires a high index of suspicion based on the presence of non-specific for these injuries symptoms and signs and a thorough knowledge of the mechanisms of injury. Bronchoscopy and chest computed tomography with MPR and 3D reconstruction of the airway represent the procedures of choice for the definitive diagnosis. Endotracheal intubation under bronchoscopic guidance is the key point to gain airway control and appropriate ventilation. Primary repair with direct suture or resection and an end to end anastomosis is the treatment of choice for patients suffering from tracheobronchial injuries (TBI). The surgical approach to the injured airway depends on its location. Selected patients, mainly with iatrogenic injuries, can be treated conservatively as long as the injury is small (<2 cm), a secure and patent airway and adequate ventilation are achieved, and there are no signs of sepsis. Patients with delayed presentation airway injuries should be referred for surgical treatment. Intraoperative evaluation of the viability of the lung parenchyma beyond the site of stenosis/obstruction is mandatory to avoid unnecessary lung resection.
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Affiliation(s)
- Christos Prokakis
- Department of Cardiothoracic Surgery, University of Patras, School of Medicine, Patras, Greece
| | - Efstratios N Koletsis
- Department of Cardiothoracic Surgery, University of Patras, School of Medicine, Patras, Greece
| | | | - Fotini Fligou
- Department of Anesthesiology and Intensive Care, University of Patras, School of Medicine, Patras, Greece
| | - Kriton Filos
- Department of Anesthesiology and Intensive Care, University of Patras, School of Medicine, Patras, Greece
| | - Dimitrios Dougenis
- Department of Cardiothoracic Surgery, University of Patras, School of Medicine, Patras, Greece
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Ernest E, Burnett A, Frascone RJ. High index of suspicion. Recognizing & managing traumatic neck injuries. JEMS 2014; 39:50-54. [PMID: 24779100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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38
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Hamel MG. Discriminate spinal immobilization: How Lee County (Fla.) EMS implemented a new paradigm of cervical spine management. JEMS 2014; 39:62-64. [PMID: 24640631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Kato H, Nishiwaki Y, Hosoi K, Shiomi N, Hirata M. [Helicopter transportation of a sedated, mechanically ventilated patient with cervical cord injury]. Masui 2013; 62:1127-1131. [PMID: 24063142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We report helicopter transportation of a sedated, mechanically ventilated patient with cervical cord injury. A 20-year-old male sustained traumatic injury to the cervical spinal cord during extracurricular activities in a college. On arrival at the hospital, a halo vest was placed on the patient and tracheostomy was performed. On the 38th hospital day, he was transported a distance of 520km by helicopter to a specialized hospital in Fukuoka for medical repatriation. Cabin space was narrow. Since power supply and carrying capacity were limited, battery-driven and portable medical devices were used. In consideration for patient's psychological stress, he was sedated with propofol. RSS (Ramsay sedation scale) scores were recorded to evaluate whether the patient was adequately sedated during helicopter transportation. Prior to transport, we rehearsed the sedation using bispectral index monitoring (BIS) in the hospital to further ensure the patient's safety during the transport.
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Affiliation(s)
- Hideya Kato
- Department of Anesthesiology, Saiseikai Shiga Hospital, Ritto 520-3046
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40
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Popov VL, Egorova OA. [Peculiarities of the assessment of harm to human health from maxillofacial and neck injuries accompanied by the infectious process]. Sud Med Ekspert 2013; 56:53-54. [PMID: 23888507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The objective of the present study was to elucidate the peculiarities of the assessment of harm to human health from maxillofacial and neck injuries accompanied by the infectious process. The case report described in this paper demonstrates that the unfavourable outcome of an injury is not infrequently attributable to the inadequacy and drawbacks of the existing schemes for the provision of medical aid. However, the health status of the victim depends on the life-threatening character of the primary injury and its naturally developing infectious complications.
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Huang P, Zhang S, Li Z, Song S, Chen X, Wang H. [Analysis of diagnosis and treatment for blunt trauma in the neck]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2013; 27:131-133. [PMID: 23700805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To explore the organ damage character and complications of blunt trauma in the neck, and the advantage and disadvantage of CT and ultrasound for blunt trauma in the neck. METHOD The data of 7 neck blunt trauma cases was analyzed. Cricoarytenoid joint reduction, tracheotomy, exploratory surgery of neck were performed respectively for these cases. RESULT Of the 2 cases with vocal cord paralysis, one had his vocal cords fixed in the the para-median position. one had his vocal cords move freely. 2 cases of epiglottis edema had been cured. Among the 2 cases of thyroid area swelling and congestion, one died from respiratory failure, one was cured. One case died of carotid artery embolism. CONCLUSION Circulation of the head should be noticed as well as keeping respiratory tract clear and anti-shock treatment. Some patient with negative laryngeal examinations might get worse in the following hours, and swelling of the neck, dyspnea, obnubilation may appear in these cases. Dynamic monitoring could be helpful for the diagnosis and treatment of neck blunt trauma.
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Affiliation(s)
- Peng Huang
- Department of Otolaryngology of Binzhou Centre Hospital, Binzhou 251700, China
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Bouchareb N, Abada RL, Rouadi S, Mahtar M, Roubal M, Janah A, Essaadi M, Kadiri F. [Epidemiology of paediatric emergencies in ENT]. Rev Laryngol Otol Rhinol (Bord) 2013; 134:95-99. [PMID: 24683819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To assess the prevalence and severity of pediatric emergencies in ENT in Casablanca. MATERIAL AND METHODS This is a retrospective study over two years from January 1st 2010 to December 31, 2011, covering 2220 pediatric othorhinolaryngology emergencies observed in the emergency department of the "20 August Casablanca" hospital. RESULTS Males predominate and account for 72.25% compared to 27.74% of girls. The mean age was 7.5 years ranging from 03 months to 15 years. Five pathologies top the list; head and neck wounds (28.11%), foreign bodies (21.62%), infectious emergencies (21.57%), blunt trauma (16.39%), and finally hemorrhages from natural orifices (11.22%). CONCLUSION This study assessed the prevalence and severity of ENT emergencies in children in Casablanca.
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Abakumov MM, Zubareva OV, Radchenko IA. [Treatment of patients with suicidal and autoagressive neck, thorax and abdomen injuries]. Khirurgiia (Mosk) 2013:4-8. [PMID: 23715386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The issue is devoted to the analysis of case reports of 305 patients with suicidal and autoagressive neck, thorax and abdomen injuries. The objective prevalence of penetrating injuries of the abdomen among men with depressive disorders was registered. The most complicated, both for surgeon and psychiatrist, were cases of combined neck, thorax and abdomen injuries in elderly patients.
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Cohn RM, Alaia MJ, Strauss EJ, Feldman AF. Rink-side management of ice hockey related injuries to the face, neck, and chest. Bull Hosp Jt Dis (2013) 2013; 71:253-256. [PMID: 24344616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Ice hockey is a fast paced sport with unique injury potential. A covering physician must be prepared to acutely manage injuries to the face, neck, and chest that are not common in orthopedic practice. Injuries about the face seen in ice hockey include facial fractures, lacerations, and eye and dental injuries. Neck trauma can result in lacerations and neurologic injury. Commotio cordis and sudden cardiac death are potentially fatal conditions seen in ice hockey. This review details the appropriate acute management of these conditions for the physician covering an ice hockey game. Knowledge of these conditions and appropriate rink-side management can be potentially life-saving.
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Hudson A. Cricoid pressure in penetrating neck trauma: time for a rethink? Emerg Med J 2012; 29:781. [PMID: 22736721 DOI: 10.1136/emermed-2012-201591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Järvholm B, Andersen JH, Veiersted B. [On diseases in the neck and upper musculoskeletal system: Too low scientific quality in the SBU report]. Lakartidningen 2012; 109:1235-1236. [PMID: 22838114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Bengt Järvholm
- Institutionen för folkhälsa och klinisk medicin, Umeå universitet.
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Harris R, Olding C, Lacey C, Bentley R, Schulte KM, Lewis D, Kandasamy N, Oakley R. Changing incidence and management of penetrating neck injuries in the South East London trauma centre. Ann R Coll Surg Engl 2012; 94:240-4. [PMID: 22613301 PMCID: PMC3957502 DOI: 10.1308/003588412x13171221590052] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2012] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION A total of 17 cases of penetrating neck injury were managed by the otolaryngology team at King's College Hospital over a 3-year period in the 1980s. In April 2010 King's College Hospital became the major trauma centre for South East London. This prospective cohort study compares the incidence, changing demographic features and treatment outcomes of penetrating neck trauma in South East London over the previous 23 years. METHODS Data were collected over a 12-month period (April 2010 to March 2011) and a selective management protocol was introduced to standardise initial investigations and further treatment. RESULTS The past 23 years have seen a 550% increase in the incidence of penetrating neck injuries in South East London, with a marked increase in gun crime. Only 38% of cases underwent negative neck exploration in 2011 compared with 65% in 1987. Selective conservative management based on the absence of haemodynamic instability or radiological findings reduces length of hospital stay, lightens surgical workload and cuts costs without affecting morbidity or mortality. CONCLUSIONS The increased incidence of penetrating neck injury is a reflection of more interpersonal violence rather than a consequence of the larger South East London trauma centre catchment area. Tackling this problem requires focus on wider issues of community prevention. Sharing of data between the four London trauma centres and the police is needed to help prevent interpersonal violence and develop a universal treatment algorithm for other institutions to follow.
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Affiliation(s)
- R Harris
- ENT Department, Whipps Cross University Hospital NHS Foundation Trust, London, UK.
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Simmons JD, Ahmed N, Donnellan KA, Schmieg RE, Porter JM, Mitchell ME. Management of traumatic vascular injuries to the neck: a 7-year experience at a Level I trauma center. Am Surg 2012; 78:335-338. [PMID: 22524773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Injury to the carotid artery results in significant mortality and morbidity. The general consensus is to repair all injuries to the common and internal carotid arteries. Ligation is usually reserved for neurologic or hemodynamic instability. We report our experience at a Level I trauma center with vascular injuries to the neck. Retrospective chart review of all patients with vascular injuries in the neck resulting from either blunt or penetrating trauma treated at a Level I trauma center between January 2000 and February 2007. Demographics and outcomes were collected from a chart review. Twenty-five patients with vascular injuries to the neck were identified. There were 13 carotid artery injuries (CAI), five internal jugular vein (IJV) injuries, and 13 external jugular vein (EJV) injuries. Of the carotid artery injuries, six (50%) underwent operative repair (4 primary repairs and 2 bypasses), five (38%) were managed nonoperatively, and one was treated using endovascular techniques. No patient had a postoperative decrease in Glasgow Coma Scale score. There were five isolated IJV injuries (3 primary repair and 2 ligations). Four of the venous injuries (all internal jugular veins) were repaired and the remaining 13 were ligated. Vascular injuries to the neck have significant mortality and morbidity. Treatment of these injuries must be individualized. All CAI in noncomatose patients should be repaired if hemodynamically stable. All IJV injuries should be repaired but may be ligated if hemodynamically unstable. All EJV injuries can be ligated without reservation regardless of neurological status.
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Affiliation(s)
- Jon D Simmons
- Division of Trauma and Surgical Critical Care, University of South Alabama, Mobile, Alabama 36617-2293, USA.
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Abstract
The overall incidence of severe head, face and neck injuries as seen from the German Trauma Registry of the National Association of German Trauma Surgeons is 81.3%. The leading causes of death among these patients are hemorrhage and severe traumatic brain injury. The aim of prehospital emergency medical care is to stabilize vital functions in order to ensure primary survival and to reduce morbidity with appropriate prehospital treatment of the individual injuries within the overall injury pattern. In this review, special aspects as well as pitfalls of the prehospital management of patients with head, face and neck injuries are demonstrated. Prehospital airway management concepts as well as concepts for stopping bleeding in the head, face and neck region are discussed in detail.
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Affiliation(s)
- M Helm
- Sektion Notfallmedizin, Abteilung für Anästhesiologie und Intensivmedizin, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89070 Ulm, Deutschland.
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Zhou J, Sun GL, Wu W. [Clinical analysis of 30 patients with severe facial and neck cut wound treatment]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2012; 47:152-153. [PMID: 22455818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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