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Spinal cord injuries
427
Injury:
INJURIES OF THE HEAD AND SPINE Cotticosteroids
and infection
All deaths among 177 victims of cerebrospinal injuries with an ISS of 20 or more that occurred 5 or more days after injury were caused by infection and all occurred in patients receiving steroids. Infection occurred in nearly half those receiving steroids as against about 1 in 7 of those who were not, irrespective of the severity of injury of the central nervous system. Demaria E. J., Reichman W., Kenney P. R., Armitage J. M. and Gann D. S. (1985) Septic complications of corticosteroid administration after central nervous system trauma. Ann. Surg. 202, 248. Ventilation
for tetraplegics
Nearly all 21 survivors of 37 tetraplegics who required artificial ventilation were in favour of temporary ventilation should the need arise. The authors stress the need for care in deciding which patients should be untreated. Gardner B. P., Theodeous F., Watt J. W. H. and Krishnan K. R. (1985) Ventilation or dignified death for patients with high tetraplegia. Br. Med. J. 291, 1620. Spinal cord injuries
This article deals with radiological examination, particularly of the neck. Grundy D., Russell J. and Swain A. (1985) The ABC of spinal cord injuries. Br. Med. J. 291, 1702. Spinal cord injury
A useful summary of the causes, complications and difficulties that may arise in first aid (at all levels of skill) after spinal injury. Swain A., Grundy D. and Russell J. (1985) ABC of spinal cord injury. Br. Med. J. 291, 1558. Infection following thoracic injury Two hundred and fifty-four out of 310 victims of serious
injuries of the chest survived long enough to be at risk of septic complications. Twenty-one died later, 15 because of infection; 84 developed infection in the chest, 15 elsewhere. Closed injury, hypotension, unconsciousness on arrival and splenectomy were associated with an increased risk of infection. Tracheostomy was much safer than intubation and antibiotics were beneficial. Walker W. E., Kapelanski D. P., Weiland A. P., Stewart J. D. and Duke J. H. (1985) Patterns of infection to mortality in thoracic trauma. Ann. Surg. 201, 752. Retroperitoneal
haematoma
Two hundred and three cases are reported; 39 died, 12 from uncontrolled retroperitoneal bleeding. Two-thirds followed closed injuries and all but two of these had not broached the peritoneum; such enclosed haematomas that were not expanding were not explored unless they adjoined important retroperitoneal structures. The 27 patients not operated on had fractured pelves as the source of the haematoma. Henas F. and Aldrete J. S. (1985) Retroperitoneal haematomas of traumatic origin. Surg. Gynecol. Obstet. 161, 106. Retroperitoneal
haematoma
Twenty-two central haematomas arose from large blood vessels, pancreas and duodenum and nearly two-thirds of the victims died. Over half of the 73 haematomas in the flank required exploration; 5 died. The 11 pelvic haematomas arose from pelvic vessels; 2 died. The authors favour exploring all central and pelvic bleeding but not all haematomas in the flank. Costa M. and Robbs J. V. (1985) Management of retroperitoneal haematoma following penetrating trauma. Br. J. Surg. 72, 662.
the British Journal
of Accident
Surgery
(1986) Vol. 17/N0. 6
Splenic injury
Forty per cent of 127 ruptured spleens were not removed and 5 per cent were not operated on at all. If suture and packing did not stop the bleeding this was obvious at the time and no patient bled later. More infections occurred after removing the spleen than after keeping it. Chadwick S. J. D., Huizinga W. K. J. and Baker L. W. (1985) Management of splenic trauma: the Durban experience. Br. J. Surg. 72, 634.
BURNS Thermal injury in pregnancy
Of 6573 burned persons admitted, 30 were pregnant. Burned areas ranged from 6 to 92 per cent, with a mean of 40 per cent of the body’s surface. Given adequate treatment of the burn, the outcome for the mother was unaffected by her being pregnant and for the child by the mother’s being burned. Amy B. W., MacManus W. F., Goodwin C. W., Mason H. and Privitt B. A. (1985) Thermal injury in the pregnant patient. Surg. Gynecol. Obstet. 161, 209. Burns casualties following
a disaster
Burned casualties do not figure predominantly in plans for dealing with disasters. Bradford’s experience of 250 casualties of whom 83 required admission to hospital and 5.5 required primary excision of their burns and skin grafting should be taken into account by planners. Sharpe D. T.. Roberts A. H. N., Barday T. L., Dickson W. A., Settle J. H. D., Crockett D. J. and Morsad M. G. (1985) Treatment of burns casualties after fire at Bradford City football ground. Br. Med. 1. 291, 945.
MISCELLANEOUS Alginate
dressings
Alginate dressings reduced the blood lost from the donor sites of Thiersch grafts to half that when the raw surfaces were dressed with gauze. There was no sign of adverse effect. Groves A. R. and Lawrence J. C. (1986) Alginate dressing as a donor site haemostat. Ann. R. Coil. Surg. Engl. 68, 27. Bites by Russell’s viper
Of 123 persons bitten by Vipera Russelli Siamensis, 28 per cent showed no sign of poisoning and 28 per cent had no more than local swelling, but 44 per cent had varying degrees of incoagulability and bleeding, thrombocytopenia, hypotension and oliguria. A locally produced antivenom was rapidly beneficial to the blood but not to the kidneys. Ten of the 123 victims died. Myint-Lwin, Warrell D. A., Phillips R. E., Tin-nu-Swe Tun-pe and Maung-Maung-Lay (1985) Bites by Russell’s viper in Burma. Lancet ii, 1259. Penetrating
neck wounds
One hundred and thirty-four wounds were explored and 69 per cent showed no serious injury; there were equal numbers of gunshot and stab wounds. Of 109 further wounds, 40 were explored and of these, 9 showed no serious injury. None of the other 69 came to any harm. Sixty per cent of these wounds were by stabbing and 40 per cent by gunshot. Yoyao A. M. A., Kadezi Y. L., Parsa M. H. and Freeman H. P. (1985) Penetrating neck wounds. Ann. Surg. 202, 563. Candida septic thrombosis
Six of the eight cases reported survived after treatment with amphotericin B, supplemented in five cases with 5-fluorocytosine. There was good renal function in the survivors. Endocarditis caused by Candida was fatal in all cases. Strinden W. D., Helgerson R. B. and Marki D. G. (1985) Candida septic thrombosis of the great central veins associated with central catheters. A.. Surg. 202, 653.
Injury:
INJURIES OF THE HEAD AND SPINE Cotticosteroids
and infection
All deaths among 177 victims of cerebrospinal injuries with an ISS of 20 or more that occurred 5 or more days after injury were caused by infection and all occurred in patients receiving steroids. Infection occurred in nearly half those receiving steroids as against about 1 in 7 of those who were not, irrespective of the severity of injury of the central nervous system. Demaria E. J., Reichman W., Kenney P. R., Armitage J. M. and Gann D. S. (1985) Septic complications of corticosteroid administration after central nervous system trauma. Ann. Surg. 202, 248. Ventilation
for tetraplegics
Nearly all 21 survivors of 37 tetraplegics who required artificial ventilation were in favour of temporary ventilation should the need arise. The authors stress the need for care in deciding which patients should be untreated. Gardner B. P., Theodeous F., Watt J. W. H. and Krishnan K. R. (1985) Ventilation or dignified death for patients with high tetraplegia. Br. Med. J. 291, 1620. Spinal cord injuries
This article deals with radiological examination, particularly of the neck. Grundy D., Russell J. and Swain A. (1985) The ABC of spinal cord injuries. Br. Med. J. 291, 1702. Spinal cord injury
A useful summary of the causes, complications and difficulties that may arise in first aid (at all levels of skill) after spinal injury. Swain A., Grundy D. and Russell J. (1985) ABC of spinal cord injury. Br. Med. J. 291, 1558. Infection following thoracic injury Two hundred and fifty-four out of 310 victims of serious
injuries of the chest survived long enough to be at risk of septic complications. Twenty-one died later, 15 because of infection; 84 developed infection in the chest, 15 elsewhere. Closed injury, hypotension, unconsciousness on arrival and splenectomy were associated with an increased risk of infection. Tracheostomy was much safer than intubation and antibiotics were beneficial. Walker W. E., Kapelanski D. P., Weiland A. P., Stewart J. D. and Duke J. H. (1985) Patterns of infection to mortality in thoracic trauma. Ann. Surg. 201, 752. Retroperitoneal
haematoma
Two hundred and three cases are reported; 39 died, 12 from uncontrolled retroperitoneal bleeding. Two-thirds followed closed injuries and all but two of these had not broached the peritoneum; such enclosed haematomas that were not expanding were not explored unless they adjoined important retroperitoneal structures. The 27 patients not operated on had fractured pelves as the source of the haematoma. Henas F. and Aldrete J. S. (1985) Retroperitoneal haematomas of traumatic origin. Surg. Gynecol. Obstet. 161, 106. Retroperitoneal
haematoma
Twenty-two central haematomas arose from large blood vessels, pancreas and duodenum and nearly two-thirds of the victims died. Over half of the 73 haematomas in the flank required exploration; 5 died. The 11 pelvic haematomas arose from pelvic vessels; 2 died. The authors favour exploring all central and pelvic bleeding but not all haematomas in the flank. Costa M. and Robbs J. V. (1985) Management of retroperitoneal haematoma following penetrating trauma. Br. J. Surg. 72, 662.
the British Journal
of Accident
Surgery
(1986) Vol. 17/N0. 6
Splenic injury
Forty per cent of 127 ruptured spleens were not removed and 5 per cent were not operated on at all. If suture and packing did not stop the bleeding this was obvious at the time and no patient bled later. More infections occurred after removing the spleen than after keeping it. Chadwick S. J. D., Huizinga W. K. J. and Baker L. W. (1985) Management of splenic trauma: the Durban experience. Br. J. Surg. 72, 634.
BURNS Thermal injury in pregnancy
Of 6573 burned persons admitted, 30 were pregnant. Burned areas ranged from 6 to 92 per cent, with a mean of 40 per cent of the body’s surface. Given adequate treatment of the burn, the outcome for the mother was unaffected by her being pregnant and for the child by the mother’s being burned. Amy B. W., MacManus W. F., Goodwin C. W., Mason H. and Privitt B. A. (1985) Thermal injury in the pregnant patient. Surg. Gynecol. Obstet. 161, 209. Burns casualties following
a disaster
Burned casualties do not figure predominantly in plans for dealing with disasters. Bradford’s experience of 250 casualties of whom 83 required admission to hospital and 5.5 required primary excision of their burns and skin grafting should be taken into account by planners. Sharpe D. T.. Roberts A. H. N., Barday T. L., Dickson W. A., Settle J. H. D., Crockett D. J. and Morsad M. G. (1985) Treatment of burns casualties after fire at Bradford City football ground. Br. Med. 1. 291, 945.
MISCELLANEOUS Alginate
dressings
Alginate dressings reduced the blood lost from the donor sites of Thiersch grafts to half that when the raw surfaces were dressed with gauze. There was no sign of adverse effect. Groves A. R. and Lawrence J. C. (1986) Alginate dressing as a donor site haemostat. Ann. R. Coil. Surg. Engl. 68, 27. Bites by Russell’s viper
Of 123 persons bitten by Vipera Russelli Siamensis, 28 per cent showed no sign of poisoning and 28 per cent had no more than local swelling, but 44 per cent had varying degrees of incoagulability and bleeding, thrombocytopenia, hypotension and oliguria. A locally produced antivenom was rapidly beneficial to the blood but not to the kidneys. Ten of the 123 victims died. Myint-Lwin, Warrell D. A., Phillips R. E., Tin-nu-Swe Tun-pe and Maung-Maung-Lay (1985) Bites by Russell’s viper in Burma. Lancet ii, 1259. Penetrating
neck wounds
One hundred and thirty-four wounds were explored and 69 per cent showed no serious injury; there were equal numbers of gunshot and stab wounds. Of 109 further wounds, 40 were explored and of these, 9 showed no serious injury. None of the other 69 came to any harm. Sixty per cent of these wounds were by stabbing and 40 per cent by gunshot. Yoyao A. M. A., Kadezi Y. L., Parsa M. H. and Freeman H. P. (1985) Penetrating neck wounds. Ann. Surg. 202, 563. Candida septic thrombosis
Six of the eight cases reported survived after treatment with amphotericin B, supplemented in five cases with 5-fluorocytosine. There was good renal function in the survivors. Endocarditis caused by Candida was fatal in all cases. Strinden W. D., Helgerson R. B. and Marki D. G. (1985) Candida septic thrombosis of the great central veins associated with central catheters. A.. Surg. 202, 653.