ABDOMINAL TRAUMA AND BRAIN INJURY– DIFFICULT CONDITION, FREQUENT ASSOCIATION, SPECIFIC CONSEQUENCES FOR EMERGENCY MEDICAL PREHOSPITAL TEAM

  • Luciana Rotaru Associate Professor, Department of Emergency Medicine and First Aid – University of Medicine and Pharmacy Craiova, ED - SMURD County Clinical Hospital Craiova, Romania
  • Cristian Boeriu Associate Professor, Department of Emergency Medicine and First Aid – University of Medicine and Pharmacy Tirgu – Mures, ED - SMURD County Clinical Hospital Tirgu, Mures, Romania
Keywords: multiple trauma, abdominal trauma, head trauma, traumatic brain injury, hemorrhagic shock, neurogenic shock, golden hour

Abstract

Background: Brain injury provides a significant percentage of, preventable deaths '' in trauma, makes threaten in the highest degree the survival chance leads to definitive impairment of the brain functions, generates traumatic disability and concomitant lesion associations.

Purpose of the paper is to highlight specific diagnosis but also management and evolution medical issues that each of the two lesion types generates and which can lead to misdiagnosis symptoms and signs. We focused on the specific ways trough abdominal and brain injury interacts each other to produce a traumatic complex evolving and adding secondary traumatic effects In the same time we aimed to distinguish very particular emergency approach standards to minimize the risks of worsening evolution

The method of study: We analyzed 398 patients assisted by the prehospital teams related to ED County Hospital Craiova (2009 – 2012) with different association of multiple trauma lesions but significant abdominal and brain trauma association

Conclusions:
1. Clinical examination data are difficult to analyze in the presence of altered mental status and paraclinically resources must be widespread or systematic used.
2. Cervical spine lesions or spinal shock hide most significantly clinical abdominal signs.
3. Neurogenic shock can create confusion in the hemorrhagic shock interpretation.
4. Secondary brain injury is maintained or worsening by the presence of shock, but overcorrection of those to.
5. General anesthesia should be early considered in tactics, techniques and means custom, which has undeniable benefits in combating shock and brain protection
6. Temperature control should be considered

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References

1. Smith J., Caldwell E., Sugrue M. Difference in trauma team activation criteria between hospitals within the same region. Emergency Medicine Australasia. 2005.17:5-6:480-7
2. Ponsford J, Willmott C, Rothwell A, Cameron P, Kelly AM, Nelms R, et al Factors influencing outcome following mild traumatic brain injury in adults. J Int Neuropsychol Soc. 6, 568–579 as cited by Vanderploeg RD, Curtiss G, Luis CA, Salazar AM (2007) Long-term morbidities following self-reported mild traumatic brain injury. J Clin Exp Neuropsychol. 2000. 29:585–59
3. Meares M, Shores AE, Taylor AJ, Batchelor J, Bryant RA, Baguley IJ, Chapman J, Gurka J, Marosszeky JK The prospective course of postconcussion syndrome: The role of mild traumatic brain injury. Neuropsychology. 2011. 25: 454-465
4. McCrea M Mild traumatic brain injury and postconcussion syndrome: the new evidence base for diagnosis and treatment. Oxford University Press, New York.2008;159-63
5. Jagoda AS, et al. Clinical Policy: Neuroimaging and decisionmaking in adult mild traumatic brain injury in the acute setting. Ann Emerg Med. 2008. 52:714-748
6. Ruff, R. Two decades of advances in understanding of mild traumatic brain injury. J Head Trauma Rehabil. 2005. 20:5-18
7. Moore E., Feliciano D., Mattox K. Trauma - 5th edition. ISBN 0-07- 137069-2.By McGraw-Hill Professional. 2004.1081 -90
8. Smith, DH, Meaney, DF, Shull, WH. Diffuse axonal injury in head trauma. J Head Trauma Rehabil. 2003.18:307-16
9. Lee H, Wintermark M, Gean AD, Ghajar I, Manley G, Mukherjee P.Focal lesions in acute mild traumatic brain injury and neurocognitive outcome: CT versus 3T MRI. J. Neurotrauma. 2008. 25:1049–1056. doi:10.1089/neu.2008.0566
10. Haacke EM, Duhaime AC, Gean AD, Riedy G, Wintermark M, Mukherjee P, Brody DL, DeGraba T, Duncan TD, Elovic E, Hurley R, Latour L, Smirniotopoulos JG, Smith DH. Common data elements in radiologic imaging of traumatic brain injury. J Magn Reson Imaging. 2010. 32:516-43
11. Wang H.E., Yealy DM. Out-of-hospital rapid sequence intubation: is this really the "success" we envisioned? Ann Emerg Med; 40(2): 2002 (Aug);168-71
12. Yang Fan, Bai Xiang-Jun, Li Zhan-Fei. Analysis of misdiagnosis in patients with multiple trauma Chin J Traumatol 2011; 14(1):20-24
13. Janjua K.J., Sugrue M., Deane S.A. Prospective evaluation of early missed injuries and the role of tertiary trauma survey. J Trauma; 1998 (Jun), 44(6): 1000-6; discussion 1006-7
14. Orlinsky M, Shoemaker W, Reis ED, et al. Current controversies in shock and resuscitation. Surg Clin North Am. 2001 Dec. 81(6):1217-62, xi-xii. [Medline].
15. Rhea J.T., Garza D.H., Novelline R.A. Controversies in emergency radiology. CT versus ultrasound in the evaluation of blunt abdominal trauma. Emerg Radiol. 2004 (Jul)10(6): 289-95
16. Krausz MM. Initial resuscitation of hemorrhagic shock. World J Emerg Surg. 2006 Apr 27. 1(1):14.
17. Pryor J.P., Pryor R.J., Stafford P. Initial phase of trauma management and fluid resuscitation. Trauma Reports. 2002. 3(3): 1-12
18. Kramer GC, Kinsky MP, Prough DS, et al. Closed-loop control of fluid therapy for treatment of hypovolemia.J Trauma. 2008 Apr. 64(4 Suppl):S333-41. [Medline].
19. Lai CC, Wang CY, Lin HI, Wang JY. Pulmonary contusion associated with chest compressions. Resuscitation. 2010; 81:133. doi: 10.1016/j.resuscitation.2009.10.001
20. Hamrick MC, Duhn RD, Ochsner MG. Critical evaluation of pulmonary contusion in the early post-traumatic period: risk of assisted ventilation. Am Surg. 2009;75:1054–1058
21. Vinson D.R, Bradbury D.R. Etomidate for procedural sedation in emergency medicine. Ann Emerg Med. 2002. (Jun)39(6): 592-8
22. Wilcox SR, Bittner EA, Elmer J, Seigel TA, Nguyen NT, Dhillon A, et al. Neuromuscular blocking agent administration for emergent tracheal intubation is associated with decreased prevalence of procedure-related complications*. Crit Care Med. 2012 Jun. 40(6):1808-1813. [Medline].
23. Cudnik MT, Newgard CD, Daya M, Jui J. The impact of rapid sequence intubation on trauma patient mortality in attempted prehospital intubation. J Emerg Med. 2010 Feb. 38(2):175-81. [Medline].
24. Davis DP, Dunford JV, Poste JC, Ochs M, Holbrook T, Fortlage D, et al. The impact of hypoxia and hyperventilation on outcome after paramedic rapid sequence intubation of severely headinjured patients. J Trauma. 2004 Jul. 57(1):1-8; discussion 8-10. [Medline]
25. Lowe GJ, Ferguson ND. Lung-protective ventilation in neurosurgical patients Curr Opin Crit Care. 2006 Feb; 12(1):3-7.
26. Rotaru L, Armega V, Bojin L, Cimpoesu D. The impact of telemedicine video vs. data on the cardiorespiratory arrest outcome–In pre-hospital care system in
Romania. Resuscitation. 2015 Jan11;96:80.
27. Hachimi Idrissi S., Corne L., Ebinger G., Michotte Y., Huyghens L. Mild hypothermia inducet by a helmet device: a clinical feasibility study. Resuscitation. 2001. 51: 275 – 81
28. Rotaru L, Calotã F. The management in “the golden hour” and the survival rate of the polytraumatized patient. Medicochirurgicale. Jmed .ro. 2010.
How to Cite
1.
Luciana Rotaru, Cristian Boeriu. ABDOMINAL TRAUMA AND BRAIN INJURY– DIFFICULT CONDITION, FREQUENT ASSOCIATION, SPECIFIC CONSEQUENCES FOR EMERGENCY MEDICAL PREHOSPITAL TEAM. Med. res. chronicles [Internet]. 2016Feb.29 [cited 2024May4];3(1):40-1. Available from: https://medrech.com/index.php/medrech/article/view/143
Issue
Vol. 3 No. 1 (2016): Jan-Feb
Section
Review Article