An experience with upper-extremity vascular trauma

Article Abstract:

Vascular (blood vessel) injuries of the arm and shoulder account for almost half of the vascular injuries in the United States. These are usually penetrating wounds, and most patients are young males. These injuries can have severe social and economic consequences if they result in loss of arm function or amputation. A study was undertaken of 101 upper extremities (100 patients) in order to evaluate these vascular injuries and decrease the rate of disability associated with vascular injury. The majority of patients were male (74 percent) and the average age was 28. The cause of 94 percent of the injuries was a penetrating wound. The patients initially had absent distal pulses (29 patients) and arterial bleeding (29). There were 29 patients who were able to have the pulse palpated, despite having a major vascular injury. The location of the blood vessel injuries was as follows: 65 were in the radial or ulnar arteries (lower arm, below the elbow); 23 were in the brachial arteries (upper arm); and 13 were in the axillary-subclavian arteries (the upper chest and shoulder area). Nerve damage was present in 50 limbs; 29 had tendon laceration and 11 had bone fracture. Artery repair was carried out in 54 injured blood vessels, 26 had vein grafting performed, three had patch angioplasty, and 17 required only ligation of the bleeding artery. There was one amputation, therefore the limb salvage rate was 99 percent. There were 20 patients who only had vascular injuries and none of these had functional impairment at the time of discharge. Sixty-four percent of patients with nerve damage and 25 percent of patients with musculoskeletal injury had functional impairment. It is concluded that rapid diagnosis and surgery can eliminate vascular injury as a factor contributing to loss or disability of an arm following trauma. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Wounds and injuries, Arm, Arteries, Arm injuries

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Utility of the cervical spine radiograph in pediatric trauma

Article Abstract:

In managing pediatric trauma, prompt evaluation of the injury and timely diagnostic studies are essential. It is considered necessary for a cervical spine (neck area) X-ray to be obtained on trauma patients. This recommendation is based on the incidence of cervical spine fractures in adults, which are frequent. However, cervical spine injuries in children under 12 are relatively rare, accounting for about 3 percent of all patients with cervical spine injuries. A study was undertaken to determine the usefulness of routine cervical spine X-rays in pediatric trauma patients. All cervical spine X-rays performed on pediatric trauma patients over a two-and-a-half-year period were reviewed. These X-rays were performed on 187 children with an average age of 6.6 years. There were 46 patients (25 percent) who required more than one X-ray to visualize all of the neck vertebrae. There was only one child with cervical fracture identified in the entire study period. Records of all children admitted with cervical spine injury over a 20-year period were also reviewed; this represented 16 children with an average age of 7.8 years. Children who do have cervical spine injury have a different pattern of injury depending on age. There were three children who had injury below the fourth cervical vertebra; all were above eight years of age. No patient under age eight had injury at or below this level. All patients with cervical injury were either comatose or had symptoms referable to the neck. It is concluded that in pediatric trauma, routine cervical spine X-rays add little information and should be obtained only in children who have indications of neck injury, such as coma, neurologic findings, or symptoms referable to the neck. (Consumer Summary produced by Reliance Medical Information, Inc.)

Children, Pediatric injuries, Vertebrae, Cervical, Cervical vertebrae

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Rural trauma management

Article Abstract:

Injuries which occur in rural areas are a major problem in the United States, with up to 70 percent of trauma-caused fatalities occurring in such areas among only 30 percent of the nation's population. Preventable trauma mortality has been the subject of many studies over the past 30 years. The development of a regional trauma care system in Oregon should decrease the number of preventable deaths from injury. A four-pronged effort to improve the quality of trauma care in a rural Oregon community of 30,000 people with two small rural hospitals is documented. Steps taken to achieve this goal included improving doctor and nurse education, establishing standard procedures for prompt resuscitation and stabilizing the condition of patients, regular reviews of trauma cases, and coordination of prehospital treatment and the activities of emergency medical technicians.

Health aspects, Planning, Case studies, Hospital emergency services, Oregon, Trauma centers, Hospitals, Rural, Rural hospitals, Emergency medicine, Clatsop County, Oregon

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