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5 results

  • Chapter 16 - Epidemiology of Findings Claimed to Be Highly Specific for Shaken Baby Syndrome/Abusive Head Trauma, a Prerequisite to Improve Diagnosis of Child Abuse

  • from Section 3 - Science
  • Edited by Keith A. Findley, University of Wisconsin, Madison, Cyrille Rossant, University College London, Kana Sasakura, Konan University, Japan, Leila Schneps, Sorbonne Université, Paris, Waney Squier, John Radcliffe Hospital, Oxford, Knut Wester, Universitetet i Bergen, Norway
  • Book:
    Shaken Baby Syndrome
    Published online:
    07 June 2023
    Print publication:
    08 June 2023, pp 249-258

  • Summary

    A systematic review by the SBU identified evidence gaps in diagnosing shaken baby syndrome. Population epidemiological studies, and clinical epidemiology, case-series and case-control studies, from Sweden, based on health registers (ICD-codes) and records for infants born 1997 to 2014, and forensic investigation, may add information to improve the diagnostic process of infant abuse. Our findings to date can be summarised as: perinatal exposure; small-for-gestational age, preterm, multiple birth, or male sex, increase the risk for SDH (subdural haemorrhage). Infants with chronic SDH more often had an abnormal increase in head circumference before or at the time of diagnosis. Intra- and inter-country differences in abuse diagnosis, and findings attributed to SBS/AHT indicate different prevailing practices and different interpretation of current understanding of injuries caused by abuse. A false-positive diagnosis of abuse is detrimental to the family. Further research on infant abuse, its circumstances and the specific findings indicative of abuse, is urgently needed to support evidence-based child protection, and to keep false positives and false negatives to a minimum.

  • Profile of Chest Injuries and Oxygen Therapy in Trauma Patients with Acute Respiratory Failure after the Jiangsu Tornado in China: A Retrospective Study

  • Gen hua Mu, Zhong qian Lu, Xing Li, Ping fa Chen, Lei He, Yun hao Sun, Shan shan Hou, Yi jun Deng
  • Journal:
    Prehospital and Disaster Medicine / Volume 35 / Issue 3 / June 2020
    Published online by Cambridge University Press:
    23 March 2020, pp. 335-340
    Print publication:
    June 2020
  • Background:

    The aim of this study was to analyze the profile of chest injuries, oxygen therapy for respiratory failure, and the outcomes of victims after the Jiangsu tornado, which occurred on June 23, 2016 in Yancheng City, Jiangsu Province, China.

    Methods:

    The clinical records of 144 patients referred to Yancheng City No.1 People’s Hospital from June 23 through June 25 were retrospectively investigated. Of those patients, 68 (47.2%) sustained major chest injuries. The demographic details, trauma history, details of injuries and Abbreviated Injury Scores (AIS), therapy for respiratory failure, surgical procedures, length of intensive care unit (ICU) and hospital stay, and mortality were analyzed.

    Results:

    Of the 68 patients, 41 (60.3%) were female and 27 (39.7%) were male. The average age of the injured patients was 57.1 years. Forty-six patients (67.6%) suffered from polytrauma. The mean thoracic AIS of the victims was calculated as 2.85 (SD = 0.76). Rib fracture was the most common chest injury, noted in 56 patients (82.4%). Pulmonary contusion was the next most frequent injury, occurring in 12 patients (17.7%). Ten patients with severe chest trauma were admitted to ICU. The median ICU stay was 11.7 (SD = 8.5) days. Five patients required intubation and ventilation, one patient was treated with noninvasive positive pressure ventilation (NPPV), and four patients were treated with high-flow nasal cannula (HFNC). Three patients died during hospitalization. The hospital mortality was 4.41%.

    Conclusions:

    Chest trauma was a common type of injury after tornado. The most frequent thoracic injuries were rib fractures and pulmonary contusion. Severe chest trauma is usually associated with a high incidence of respiratory support requirements and a long length of stay in the ICU. Early initiation of appropriate oxygen therapy was vital to restoring normal respiratory function and saving lives. Going forward, HFNC might be an effective and well-tolerated therapeutic addition to the management of acute respiratory failure in chest trauma.

  • 32 - CT of the Chest

  • from PART III - COMPUTED TOMOGRAPHY
  • Edited by J. Christian Fox, University of California, Irvine
  • Book:
    Clinical Emergency Radiology
    Published online:
    07 December 2009
    Print publication:
    29 September 2008, pp 457-472

  • Summary

    Chest computed tomography (CT) is extremely useful in the assessment of injuries to the aorta, chest wall, lung parenchyma, airway, pleura, and diaphragm. It is very useful in estimating the extent of contusion, which is important in predicting the degree of posttraumatic respiratory insufficiency. The sensitivity of CT in detecting pulmonary contusions is very high. Pneumothorax succeeds rib fractures as the second most common injury seen in chest trauma. CT is able to detect pneumothoraces missed by initial chest radiograph in 5% to 15% of trauma patients. Empyemas are exudates associated with pulmonary infections. On CT, they usually have a regularly shaped lumen and a smooth inner surface. Traumatic rupture of the aorta (TRA) is rarely visualized on CT because patients expire from exsanguination before reaching medical facilities. Posterior dislocations are more easily diagnosed on CT. Scapular fractures are frequently overlooked on the interpretation of chest radiographs.

  • Gastritis and peptic ulcer disease

  • from Chief complaints and diagnoses
  • Edited by Stephen H. Thomas
  • Book:
    Emergency Department Analgesia
    Published online:
    18 December 2009
    Print publication:
    25 September 2008, pp 213-224

  • Summary

    Thoracic trauma constitutes 10-15% of all injuries, with rib fractures (RF) being common and painful. The intrathecal injection of morphine has been studied for patients with multiple RFs. If conditions are suitable for their use, the local anesthetics are the most efficacious mechanism for managing RF pain. Local anesthetics (sometimes co-administered with opioids) have also been used by the epidural administration route. This approach is associated with decreased pulmonary morbidity and mortality in patients older than 60 years of age with RF. For the majority of patients with RF, the controversy surrounding NSAIDs and delayed bone fracture healing is relevant. Used in patients with chest wall trauma, epidural analgesia produces pain relief that is superior to that produced by systemic opioids or other local anesthetic approaches. Local anesthetic administration via thoracic paravertebral block entails injecting an agent such as bupivacaine alongside the thoracic vertebrae.

  • Rib fractures following minor trauma in older patients: a not-so-benign injury

  • Sam G. Campbell, Margaret A. Dingle
  • Journal:
    Canadian Journal of Emergency Medicine / Volume 2 / Issue 1 / January 2000
    Published online by Cambridge University Press:
    21 May 2015, pp. 32-34
    Print publication:
    January 2000
    • Article
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  • Two older adults presented to the emergency department with rib fractures following minor trauma. Both were discharged on oral analgesics and died within 2 days. Rib fractures more often lead to adverse outcomes in older adults. Emergency physicians should consider admitting any such patient who presents with two or more rib fractures.