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Trauma: Case Presentation

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Trauma: Case Presentation

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    1. Trauma: Case Presentation Ronald Jou 19 March 2007

    2. Ring Down 7?year-old girl Rear passenger Lap belt restraint (shared) Car traveling at freeway speeds Tire blew out Impact on median divider

    3. Trauma Survey 1 survey: Patient vomiting No life-threatening injuries Vitals stable Hx of abd pain and vomiting that AM No medication allergies or PMHx Patient had no complaints

    4. Trauma Survey 2 survey: Abdomen soft, non-tender Abrasion over left iliac crest Repeat survey: Somnolent CT head: negative Patient admitted to PICU

    5. PICU Course Linear bruising across abdomen Abdominal pain and tenderness CT abdomen/pelvis obtained

    13. Operating Theater Diagnostic laparoscopy: Moderate stool Mild blood Sigmoid perforation Conversion to open laparotomy

    14. Operating Theater Exploratory laparotomy: Full thickness sigmoid perforation No other injuries seen Six hours had elapsed since injury

    15. Cornwell EE, Velmahos GC, Berne TV, et al: The fate of colonic suture lines in high-risk trauma patients: a prospective analysis. J Am Coll Surg 187:58, 1998.Cornwell EE, Velmahos GC, Berne TV, et al: The fate of colonic suture lines in high-risk trauma patients: a prospective analysis. J Am Coll Surg 187:58, 1998.

    16. Operating Theater Treatment: Resection of injury Loop sigmoid colostomy

    17. Seatbelts Sir George Cayley, ca. 1800 Implemented in aircraft, 1930s Standard for U.S. automobiles, 1964 Rear belts standard in U.S., 1968

    18. Seatbelt Innovations Three-point belt, 1958 Vehicle sensors Pretensioners, 1981 Webclamps Rip-stitching

    19. U.S. Seatbelt Usage Rates New York first state with seatbelt law. Currently, only New Hampshire does not have a seatbelt law. Massachusetts has only a secondary law. Usage rates increase as you move West.New York first state with seatbelt law. Currently, only New Hampshire does not have a seatbelt law. Massachusetts has only a secondary law. Usage rates increase as you move West.

    20. Please Wear Your Seatbelt No randomized controlled trials Only cohort data is available Seatbelt laws reduce fatality by 7-10%

    21. Patterns of Injury Severe head injury Facial injury Solid organ injury Long-bone fracture Hollow viscus injury Sternal fracture Lumbar spine Denis, et al. Changing Trends with Abdominal Injury in Seatbelt Wearers. J Trauma. 1983, 23(11):1007. University of Montreal. Mandatory seatbelt law in Canada, 1 January 1971. Porter, et al. Patterns of Injury in Belted and Unbelted Individuals Presenting to a Trauma Center After Motor Vehicle Crash: Seat Belt Syndrome Revisited. Denis, et al. Changing Trends with Abdominal Injury in Seatbelt Wearers. J Trauma. 1983, 23(11):1007. University of Montreal. Mandatory seatbelt law in Canada, 1 January 1971. Porter, et al. Patterns of Injury in Belted and Unbelted Individuals Presenting to a Trauma Center After Motor Vehicle Crash: Seat Belt Syndrome Revisited.

    22. Seatbelt Sign Linear ecchymosis of the abdominal wall

    24. Seatbelt Sign Seen in 60% of 112 adults in MVC 64% v. 9% had abdominal injury 36% v. 4% required operation 35% v. 3% had hollow viscus injury Chandler CF, Lane JS, Waxman KS. Seatbelt sign following blunt trauma is associated with increased incidence of abdominal injury. Am Surg. 1997 Oct;63(10):885-8. 117 adult MVC patients. Chandler CF, Lane JS, Waxman KS. Seatbelt sign following blunt trauma is associated with increased incidence of abdominal injury. Am Surg. 1997 Oct;63(10):885-8. 117 adult MVC patients.

    25. Seatbelt Sign MVCs in EAST multi-institutional study 4.7-fold increase in small bowel perforation in MVCs.

    26. Problem Seatbelt injuries are difficult to diagnose No ideal diagnostic test Delays in diagnosis lead to morbidity

    27. Solution Patients with seatbelt sign need workup CT abdomen/pelvis Serial examinations DPL

    28. Questions Chest seatbelt sign? Does an abrasion count? Safer seatbelts? Increasing usage in high-risk groups?

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