Retrosternal Percutaneous Tracheostomy: An Approach for Predictably Impossible Classic Tracheostomy

Percutaneous tracheostomy is a routine procedure in intensive care units. In cases of very low position of the larynx, cervical spine deformation, morbid obesity, or neck tumor, performance of the classic tracheostomy is inapplicable. Retrosternal approach to tracheostomy in such 20 patients is herein reported. After preoperative neck computerized tomography to define the neck anatomy, a small suprasternal incision followed by a short retrosternal tissue dissection to expose the trachea was done; the trachea was then catheterized at the level of the 2nd ring in the usual tracheostomy manner. The immediate and late (≥6 months) outcomes were similar to that of the standard tracheostomy. Thus, percutaneous retrosternal tracheostomy is safe in patients with abnormal positioning of the trachea or neck constitution. It is a bedside applicable technique, that, however, requires caution to avoid hazardous vascular complications

ALCOHOL USE AMONG TRAUMA VICTIMS ADMITTED TO A LEVEL I TRAUMA CENTER IN ISRAEL.

מטרה: לקבוע את שיעור מקרי הטראומה שנגרמו כתוצאה משימוש באלכוהול ולבחון את מאפייניהם. שיטה: ניתוח נתונים על 854 מטופלים מתוך 5,529 מטופלים שהופיעו ברישום הטראומה הישראלי בשנים 2001-.2003 מן הממצאים: אצל 170 מהפונים נמצאה רמה גבוהה של אלכוהול בדם. בקרב אלה היה שיעור תאונות הדרכים גבוה מזה שבקרב הנפגעים ללא האלכוהול (35% לעומת 24%) וכך גם לגבי דקירות (29% לעומת 7%). חומרת הפגיעות בקרב קבוצת ה"אלכוהול" הייתה רבה יותר ושיעורי הלא-יהודים, הצעירים, והגברים בקבוצה זו היו גבוהים מהשיעורים אצל שאר הנבדקים. רוב הפגיעות המיוחסות לאלכוהול התרחשו בסופי שבוע ובשעות הערב-לילה

Non-hip fracture-associated trauma in the elderly population

BACKGROUNDThe rate of trauma in the elderly is growing.OBJECTIVESTo evaluate the characteristics of non-hip fracture-associated trauma in elderly patients at a level I trauma center.METHODSThe study database of this retrospective cohort study was the trauma registry of a level I trauma center. Trauma patients admitted from January 2001 to December 2003 were stratified into different age groups. Patients with the diagnosis of hip fracture were excluded.RESULTSThe study group comprised 7629 patients. The non-hip fracture elderly group consisted of 1067 patients, 63.3% women and 36.7% men. The predominant mechanism of injury was falls (70.5%) and most of the injuries were blunt (94.1%). Injury Severity Score was found to increase significantly with age. The average mortality rate among the elderly was 6.1%. Age, ISS, Glasgow Coma Score on admission, and systolic blood pressure on admission were found to be independent predictors of mortality.CONCLUSIONSFalls remain the predominant cause of injury in the elderly. Since risk factors for mortality can be identified, an effective community prevention program can help combat the future expected increase in morbidity and mortality associated with trauma in the elderly

Ultrasonography for the evaluation of abdominal trauma in multiple casualty incidents

Objective: Ultrasound (US) is commonly used for the diagnosis of hemoperitoneum in trauma patients. The use of US in the evaluation of abdominal injury during multiple casualty incidents (MCIs) has been described, but never evaluated. The purpose of this study was to determine the accuracy of US for evaluation of the unique injury patterns associated with MICs. Patients and methods: We conducted a retrospective study of patients admitted to a Level 1 trauma center during MCIs resulting from terrorist attacks in the Tel-Aviv area. Results: During the 4-year study period there were 43 patients who had an US examination as part of their initial assessment. The overall accuracy of the US examination was 77%, with a sensitivity of 40%, and a specificity of 88%. The positive predictive value (PPV) was 50%, and the negative predictive value (NPV) was 83%. Conclusions: Although US examination lacks the sensitivity to be used alone in determining operative intervention in the evaluation of patients admitted in an MCI, a reasonable specificity might justify its use as a screening tool in MCIs