Deep Trauma

Tisherman, S.A., Safar, P., Radovsky, A., Peirzman, A., Marrone, G., Kuboyama, K., Weinrauch, V. (1991). Profound hypothermia (< 10 °C) compared to deep hypothermia (15 °C) improves neurologic outcome in dogs after two hours circulatory arrest induced to enable resuscitative surgery. J. Trauma 31, 1051-1062. 

Tetanus occurs when Cl. tetani, ubiquitous in the soil and faeces, contaminates wounds, especially deep puncture-type lesions. These might be minor traumas such as a splinter, or major ones such as battle injury. At these sites, tissue necrosis and possibly microbial growth reduce the oxygen tension to allow this anaerobe to multiply. Its growth is accompanied by the production of a highly potent toxin which passes up peripheral nerves and diSuses locally within the central nervous system. It acts like strychnine by affecting normal function at the synapses. Since the motor nerves of the brain stem are the shortest, the cranial nerves are the first affected, with twitches of the eyes and spasms of the jaw (lockjaw). 

Recommendations in this section may change based on the results from the recent EPO-3 trial (epoetin alfa versus placebo). A difference in red blood cell transfusion rates was not observed between groups. Epoetin alpha therapy improved survival in trauma patients. Epoetin alfa did not have a measurable clinical benefit in medical/surgical non-trauma patients. Epoetin alpha therapy was associated with an increased thrombotic event rate, particularly in patients not receiving pharmacological deep vein thrombosis prophylaxis. 

Venous thromboembolism (VTE) is one of the most common cardiovascular disorders in the United States. VTE is manifested as deep vein thrombosis (DVT) and pulmonary embolism (PE) resulting from thrombus formation in the venous circulation (Fig. 7-1).1 It is often provoked by prolonged immobility and vascular injury and is most frequently seen in patients who have been hospitalized for a serious medical illness, trauma, or major surgery. VTE can also occur with little or no provocation in patients who have an underlying hypercoagulable disorder. 

NF typically erupts after an initial trauma, which can range from a small abrasion to a deep penetrating wound. The infection begins in the fascia, where bacteria replicate and release toxins that facilitate their spread.21... 

The structure of trauma injuries is given in Table 20.1. There were on average 1.5 injuries per injured person. The most common localization of injuries was in the lower limbs - 59.4%, of which shin - 47.4%, upper limbs and head - 25.0% each. The injuries with high lethality included injuries of the chest and abdominal cavities, and also pelvis, which were accompanied by a deep shock condition. 

Before commencing the sessions the patients were assessed by physical examination and full medical history including age, sex, occupation, residence, special habits of medical importance with particular emphasis on the history of the underlying disease including duration of ulcer, mode of onset, ulcer pain, history of deep vein thrombosis or varicose veins, trauma, lump, varicosities, contact dermatitis and symptoms suggestive of ischaemia. Photographic reference of ulcer and ulcer area measurements were carried out at the commencement of treatment and during the follow up laser therapy, which continued for 6 months. 

People become overwhelmed when they give up in the face of enormous stress, conflict, disappointment, or trauma. Psychosis and other deep disturbances are personal surrenders. The failing individuals succumb to... 

Berguer R, Staerkel RL, Moore EE, Moore FA, Galloway WB, Mockus MB. Warning fatal reaction to the use of fibrin glue in deep hepatic wounds. Case reports. J Trauma 1991 31(3) 408-11. 

Kim J, Gearhart MM, Zurick A, et al. Preliminary report on the safety of heparin for deep venous thrombosis prophylaxis after severe head injury. J Trauma 2002 53 38 2. 

Three major types of foot infections are seen in diabetic patients deep abscesses, cellulitis of the dorsum, and mal perforans ulcers. Most deep abscesses involve the central plantar space (arch) and are caused by minor penetrating trauma or by an extension of infection of a nail or web space of the toes. Skin infections of the dorsal area generally arise from infections in the toes that are related to routine care of the nails, nailbeds, and calluses of the toes. Mal perforans ulcer is a chronic ulcer of the sole of the foot. The ulcer develops on thickened, hardened calluses over the first or fifth metatarsal. Mal perforans ulcers are associated with neuropathy, which is responsible for the misalignment of the weight-bearing bones of the foot. Osteomyelitis is one of the most serious complications of foot problems in diabetic patients and may occur in 30% to 40% of infections. ... 

THROMBATE III (Bayer) is a plasma-derived product that is used to treat AT-III deficiency, the first inherited trait discovered which was identified in 1965. The condition is associated with thrombophilia caused by low levels of AT-III or the presence of altered AT-III activity. Both conditions can result in excessive blood clotting. Acquired AT-III deficiency is another condition that occurs in situations with high risk of thrombosis such as trauma, burns, and sepsis. GTG Biotherapeutics conducted chnical trials with ATryn in high-risk situations such as surgery or child de-Hvery to prevent deep-vein thrombosis in hereditary AT-III-deficient patients and heparin-resistant patients with acquired AT-III deficiency undergoing coronary bypass. A pharmacokinetic study in patients with hereditary AT-III deficiency indicated that the administration of the recombinant product resulted in an increase in blood... 

Venous thromboembolism (VTE) is a complicating condition responsible for high morbidity and mortality in North America and Europe. This disease commonly is linked to advanced age but has both hereditary and acquired risk factors, such as surgery, any form of trauma, and childbirth, associated with it. It encompasses the conditions of deep vein thrombosis (DVT) and pulmonary embolism. In excess of 60,000 deaths annually are attributed to pulmonary embolism. Preventative therapy consists of the use of two different classes of antithrombotic agents, namely anticoagulants and antiplatelet drugs (1,2). 

Eamshaw studied the neural scan of Skibbow s brain, the huge electrical surge at the mention of Lalonde. "That is one very deep-seated trauma. The associations are hotwired into almost every neural pathway."... 

Contaminated surgery Long operative procedure Trauma with delayed treatment Necrotic tissue or foreign body s Necrotic tissue or foreign body Prolonged duration Large in size and/or deep Anatomically situated near a site of potential contamination, e.g. anal area... 

The tooth pulp can become exposed by a variety of processes, including deep caries, trauma or accidentally during cavity preparation in the dental chair [60]. The consequences can be severe, and include pain, infection and necrosis. When the pulp is exposed, steps need to be taken to manage the situation, and these involve either pulp capping with an appropriate material [60,61] or removal of the pulp followed by sealing of the tooth roots. In the present section of the chapter, we consider briefly materials for the first of these options, pulp capping. 

Safecity is a small town in Utah, the United States. It is located on a rapidly flowing mountain creek. The creek brings beauty (and tourists) to the town, but it is also dangerous for small children playing on its banks. They occasionally fall into the water and must be rescued by the local fire department, which must respond immediately, otherwise the strong current will take the child away. Unfortunately, that happens two or three times each year, and children are drawn into the pools of deep water or die as a result of serious head injuries and trauma when they are taken by the creek to the rapids located just outside the town. 

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