Hemorrhage is the second most common cause of death among trauma patients and almost half of the deaths occur within 24 hours after arrival. Damage control resuscitation is a new paradigm for patients with massive ble...Hemorrhage is the second most common cause of death among trauma patients and almost half of the deaths occur within 24 hours after arrival. Damage control resuscitation is a new paradigm for patients with massive bleeding. It consists of permissive hypotension, hemostatic resuscitation and transfusion strategies, and damage control surgery. Permissive hypotension seems to have better results before the bleeding is controlled. The strategy of fluid resuscitation is minimizing crystalloid infusion and increasing early transfusion with a high ratio of flesh frozen plasma to packed red cells. Damage control surgery is done when the patient＇s condition is unfit for definitive surgery. Hemorrhage and contamination control with temporary abdominal closure is performed before transferring the patients to intensive care unit and the operating room for a permanent laparotomy.展开更多
Objective： The association of scapular fractures with other life-threatening injuries including blunt thoracic aortic injury is widely recognized. Few studies have investigated this presumed association. In this stud...Objective： The association of scapular fractures with other life-threatening injuries including blunt thoracic aortic injury is widely recognized. Few studies have investigated this presumed association. In this study, we investigated the incidence of significant associated injuries with scapular fracture and their outcomes. Methods： A retrospective study was conducted from 2005 to 2009 in a level I trauma center in Thailand. All blunt trauma patients were identified. Patients＇ demographics, injury mechanism, associated injuries, Injury Severity Score （ISS）, and survival outcomes were recorded. The manage- ment of associated injuries with scapular fracture was reviewed, and the risk factors for mortality were identified. Results： Among the 7 345 trauma patients admitted, scapular fractures occurred in 84 cases （1.1%）. The mean age was （37.98±15.21） years. Motorcycle crash was the most frequent mechanism of injury, occurring in 51 cases （60.7%）.Seventyour patients （88.1%） suffering from scapular fractures had associated injuries： 5 （6.0%） had significant chest injuries, but none of them had blunt thoracic aortic injury. Two patients （2.4%） with scapular fractures died. Factors determining the likelihood of mortality were： （1） ISS〉25 （LR=8.5, P〈0.05）; （2） significant associated chest injury （AIS〉3, LR=5.3, P〈0.05） and （3） significant associated abdominal injury （AIS〉3, LR=5.3, P〈0.05）. Conclusion： A blunt scapular fracture may not accompany a blunt thoracic aortic injury but it is strongly related to other injuries like chest injury, extremity injury, head injury, etc. If a scapular fracture is found with a high ISS score, high chest or abdomen AIS score, the patient would have a high risk of mortality.展开更多
文摘Hemorrhage is the second most common cause of death among trauma patients and almost half of the deaths occur within 24 hours after arrival. Damage control resuscitation is a new paradigm for patients with massive bleeding. It consists of permissive hypotension, hemostatic resuscitation and transfusion strategies, and damage control surgery. Permissive hypotension seems to have better results before the bleeding is controlled. The strategy of fluid resuscitation is minimizing crystalloid infusion and increasing early transfusion with a high ratio of flesh frozen plasma to packed red cells. Damage control surgery is done when the patient＇s condition is unfit for definitive surgery. Hemorrhage and contamination control with temporary abdominal closure is performed before transferring the patients to intensive care unit and the operating room for a permanent laparotomy.
文摘Objective： The association of scapular fractures with other life-threatening injuries including blunt thoracic aortic injury is widely recognized. Few studies have investigated this presumed association. In this study, we investigated the incidence of significant associated injuries with scapular fracture and their outcomes. Methods： A retrospective study was conducted from 2005 to 2009 in a level I trauma center in Thailand. All blunt trauma patients were identified. Patients＇ demographics, injury mechanism, associated injuries, Injury Severity Score （ISS）, and survival outcomes were recorded. The manage- ment of associated injuries with scapular fracture was reviewed, and the risk factors for mortality were identified. Results： Among the 7 345 trauma patients admitted, scapular fractures occurred in 84 cases （1.1%）. The mean age was （37.98±15.21） years. Motorcycle crash was the most frequent mechanism of injury, occurring in 51 cases （60.7%）.Seventyour patients （88.1%） suffering from scapular fractures had associated injuries： 5 （6.0%） had significant chest injuries, but none of them had blunt thoracic aortic injury. Two patients （2.4%） with scapular fractures died. Factors determining the likelihood of mortality were： （1） ISS〉25 （LR=8.5, P〈0.05）; （2） significant associated chest injury （AIS〉3, LR=5.3, P〈0.05） and （3） significant associated abdominal injury （AIS〉3, LR=5.3, P〈0.05）. Conclusion： A blunt scapular fracture may not accompany a blunt thoracic aortic injury but it is strongly related to other injuries like chest injury, extremity injury, head injury, etc. If a scapular fracture is found with a high ISS score, high chest or abdomen AIS score, the patient would have a high risk of mortality.
