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Biomedical subjects

Eric J Kuncir

Publications and source records attributed to Eric J Kuncir.

7 recordsLinked to original sources
PubMed2006

Femoral vessel injuries: analysis of factors predictive of outcomes.

BACKGROUND: Femoral vessel injuries are the most common vascular injuries treated in a Level I trauma center. No studies have identified risk factors for survival and complications. STUDY DESIGN: We performed a retrospective, 132-month study that included univariate and multivariate analyses. RESULTS: We studied 204 patients with 298 vessel injuries: 204 were arterial, 94 were venous. Mean age (+/- SD) was 29+/-13 years and mean Injury Severity Score (+/- SD) was 17+/-8. There were 176 (86%) penetrating injuries and 28 (14%) blunt injuries. Arterial repairs included: reverse saphenous vein graft bypass, 108 (53%); primary repair, 53 (26%); PTFE, 21 (10.2%); ligation, 13 (6.4%); and vein patch, 9 (4.4%). Venous repairs included: ligation, 49 (52%); primary repair, 41 (44%); and bypass, 4 (4%). Fasciotomies included: calf, 56 (27%); thigh, 25 (12%); traumatic amputations, 6 (3%); and delayed amputations, 0. Overall survival rate was 91% (186 of 204), and adjusted survival was 95% (excluding emergency department thoracotomy deaths). There were 1 or more complications in 47 (23%), including wound infection, 31 (15%); venous thrombosis, 6 (3%); bleeding, 5 (2.5%); ARDS, 4 (2%); and arterial thrombosis, 1 (0.5%). Predictors of mortality were age>45 years, Injury Severity Score>25, common femoral artery injury, associated venous and abdominal injury, hypotension, hypothermia, and acidosis; coagulopathy in the operating room and the need for PTFE repair also predicted outcomes. Predictors of postoperative complications were intraoperative hypotension, arterial intimal injury, bony fracture, and thoracic injury. CONCLUSIONS: Although survival and limb salvage rates are high for femoral vessel injuries, these injuries incur high complication rates. Independent predictors for mortality are: Injury Severity Score > 25, Glasgow Coma Scale 28, presence of coagulopathy in the operating room, presence of two or more vascular signs, and age > 45 years.

Adult↗
PubMed2006

Cervical spine injury is highly dependent on the mechanism of injury following blunt and penetrating assault.

BACKGROUND: The mechanism of injury has not been highly regarded as an important variable when evaluating cervical spine injuries. The aim of this study was to determine the incidence of cervical spine fracture (CSF) and cervical spinal cord injury (CSCI) based on mechanism following blunt and penetrating assault to better aid prioritization of management. METHODS: Retrospective analysis from two large urban Level I trauma centers over 87 and 144 months caused by gunshot wounds (GSW), stab wounds (SW) or blunt assault (BA). RESULTS: During the study period, there were 57,532 trauma patients evaluated at the two trauma centers, of which 42.3% were following blunt or penetrating assault. The rates of CSF and CSCI for the various mechanisms were similar between the two centers. The rates for having CSF were significantly different (p < 0.05) for the various mechanisms. GSW (1.35%) was the highest followed by BA (0.41%) and then SW (0.12%). The rates of CSCI for GSW (0.94%) were significantly (p < 0.05) higher than BA (0.14%) and SW (0.11%). For GSW patients, all patients with CSF or CSCI had a point of entry between the ears and the nipple. For SW patients, the wound was directly in the neck below the mandible and above the trapezius muscle. Although many of the SW patients also suffered blunt assault, none of the CSF or CSCI injuries were from blunt forces. In addition, all patients, both blunt and penetrating who had CSCI had neurologic deficit at the time of presentation. Surgical stabilization or tongs were applied in 15.5% (26 of 168) of the GSWs, 27.8% (3 of 11) of the SWs and 31.6% (6 of 19) of the BA patients. There was a BA patient (1 of 4,390) patient with CSF that was neurologically intact that required surgical stabilization and this patient had neck pain on admission. No penetrating injury patients with CSCI regained significant neurologic recovery during the hospitalization. SUMMARY: The rate of CSF or CSCI is low following assault and dependent on mechanism of injury. Thus the concern and extent of evaluation should also be dependent on the mechanism of injury. Neurologic deficits from penetrating assault were established and final at the time of presentation. Concern for protecting the neck should not hinder the evaluation process or life saving procedures.

Adult↗
PubMed2004

Thyroid storm induced by strangulation.

Thyroid storm most often occurs in patients with known thyrotoxicosis. This report discusses a severe case of thyroid storm developing as a direct result of strangulation in a patient without a preexisting history of thyroid disease. Classification and treatment of this entity are discussed.

Adult↗
PubMed2003

The vasculopathic patient: uncommon surgical emergencies.

Recognition of the patient who has an emergent vascular disorder and the early initiation of simple management steps in the ED can significantly impact patient outcome. The vasculopathic patient presents with significant comorbid conditions and a small window of opportunity to alter the prognosis favorably. The critical role of the EP lies in prompt use of this opportunity and appropriate direction of further care.

Axillary Vein↗
PubMed2003

Surgical management and strategies in the treatment of hypothermia and cold injury.

Increased participation in outdoor activities and the epidemic of homelessness have caused the incidence of cold injuries in the civilian population to rise dramatically over the last 20 years. Knowledge of the treatment is crucial for emergency physicians in rural and urban areas. Recent developments have significantly advanced the understanding of the pathophysiology of hypothermic and frostbite injuries. Together with improved rewarming techniques and use of radiological assessment of tissue viability, future advancements should allow for a more aggressive and active approach to the management of these injuries.

Energy Transfer↗
PubMed2003

Necrotizing soft-tissue infections.

It has been more than 130 years since NSTIs were first described. Despite the development of various classification systems and progress in surgical management, these infections continue to have high mortality and pose enormous diagnostic and therapeutic challenges. For optimal outcome, treatment involves rapid institution of appropriate antibiotic coverage and early wide surgical debridement. Recovery requires aggressive resuscitation, postoperative nutritional support and wound care that is similar to the care of burn patients in many respects. The entire therapeutic process requires a well-prepared and coordinated team of health care professionals including EPs, general, orthopedic, and other specialist surgeons, infectious disease consultants, specially trained nursing staff, and physical therapists.

Humans↗