PubMed Health⌕ Search

Biomedical subjects

R N Townsend

Publications and source records attributed to R N Townsend.

At least 19 recordsLinked to original sources
PubMed1997

Impact of skull fracture on neuropsychological functioning following closed head injury.

The role of skull fracture in affecting morbidity following closed head injury (CHI) has received a significant amount of attention from researchers. While there is fairly widespread agreement that skull fractures increase the risk of complications such as haematoma, it us unclear whether the presence of skull fracture has predictive value in terms of the neuropsychological sequelae of CHI. The purpose of the current study was to further investigate the role of skull fracture in predicting neuropsychological dysfunction following CHI. Subjects included patients admitted to the trauma service of a large teaching hospital who were suspected of having suffered CHI. All patients completed neuropsychological testing and had normal computerized tomography (CT) scans. Patients who had suffered skull fracture were compared to those who had not suffered skull fracture on selected neuropsychological measures. Groups did not differ in terms of CHI severity as assessed by the Glasgow Coma Scale (GCS). Multivariate analysis of variance revealed that the groups did differ in terms of neuropsychological functioning. Results are interpreted as suggesting that the presence of a skull fracture is predictive of additional neuropsychological dysfunction, even in the absence of intracranial pathology or more severe disturbance of consciousness on the GCS.

Adult↗
PubMed1996

Early tracheostomy in trauma patients.

A retrospective analysis of 118 trauma patients who underwent tracheostomy for airway and pulmonary management was undertaken. Timing of the procedure was defined as early (0-3 days), intermediate (4-7 days), and late (> 7 days). Head injury patients received tracheostomy early (p < 0.00003). Aspiration evaluated by modified bedside aspiration test was a frequent occurrence in all three groups with no difference in incidence (p < 0.34). Pneumonia was less frequent in the early group compared with the intermediate and late groups (p < 0.0034). The incidence of pneumonia in the early group was not different from that observed in early extubated patients (n = 282; p < 0.23). Our study suggests that early tracheostomy may decrease pulmonary septic complications in trauma patients. Although no change in length of stay can be attributed to the early performance of tracheostomy, preventing pneumonia in the intensive care unit setting with its resulting high expense is beneficial.

Adult↗
PubMed1994

Blunt vascular injury associated with closed mid-shaft femur fracture: a plea for concern.

During a period of six years, 765 consecutive patients were treated by the trauma service at Allegheny General Hospital for closed mid-shaft femur fractures that were a component of their injury complex. Thirty-one patients underwent angiography of the involved extremity for indications including loss of pulses in eleven and large hematomas or deformities of the thigh in the remainder. Ten patients (1.3%) were found to have acute vascular injuries. In nine patients there was an intimal flap of the superficial femoral artery (SFA), and in one, a pseudoaneurysm. Two patients had injuries of the femoral nerve. Three patients had no other associated major injuries (Injury Severity Score range, 10-19). Twelve months after the initial injury, one patient developed an arteriovenous fistula of the SFA. Detailed, repeated physical examinations, early utilization of angiography, and intensive follow-up by the trauma surgeon or orthopedic surgeon of patients with closed mid-shaft femur fractures should lead to early recognition of this potentially serious association.

Adolescent↗
PubMed1994

Enhanced rim around infarcted, traumatized spleen on computed tomographic scans: case report.

Computed tomography is considered a reliable imaging technique when determining the extent of splenic injury. We present the case of a patient with a traumatic infarct of the spleen detected by computed tomographic scanning of the abdomen. During laparotomy there was an infarction of the spleen from a hilar injury in addition to bleeding from the splenic vein. We conclude that ongoing bleeding from the splenic hilar vessel can lead to a rim of enhancement around the spleen from contrast material. This should be taken into account when a decision is made for nonsurgical management.

Abdominal Injuries↗
PubMed1994

Diving injuries: a preventable catastrophe.

During a 5-year period from January 1987 through January 1992, 58 patients were admitted to the Allegheny General Hospital trauma center for non-scuba, non-suicidal diving injuries. There were 46 men and 12 women (mean age, 23 years). Forty-five patients were injured in swimming pools. Twenty-two patients had blood alcohol levels > 100 mg/dL. Cervical spine injury was the most common pathologic entity encountered in this group of patients. Closed head injury, pelvic fracture, thoracic vertebral fracture, and rib fractures were other injuries identified. Some patients had multiple organ failure syndrome. Aquatic recreational activities carry a risk for injury that is preventable. The mechanism, clinical data, and complications of 58 patients are presented and the importance of prevention is discussed.

Adolescent↗
PubMed1994

Delayed rupture of the spleen--myths, facts, and their importance: case reports and literature review.

Over a 1-year period, three patients were seen in our trauma service with delayed bleeding (> or = 7 days) from an initially inapparent splenic injury. This entity was defined as a late occurrence of signs and symptoms attributed to splenic injury not detected by diagnostic computed tomographic (CT) scanning during the initial examination. We believe that this represents an "injury in evolution" minor enough to go undetected on initial CT scans of the abdomen. A high index of suspicion and liberal utilization of imaging techniques are essential for the identification of delayed splenic rupture. Further multicenter studies are required to delineate the true incidence of its occurrence and its clinical significance. We conclude that "delayed rupture" of the spleen is a true clinical entity. The occurrence of a delayed rupture may prove hazardous to patients discharged early from the hospital after blunt abdominal injury. A classification system to assess this type of injury is suggested.

Accidents, Traffic↗
PubMed1993

Hypoxemia after blunt chest injury: right-to-left intracardiac shunt managed non-operatively.

A case of patent foramen ovale with right-to-left intracardiac shunt after blunt chest injury is presented. The association of pulmonary contusion, pulmonary hypertension, and patent foramen ovale in a previously healthy subject is discussed. In such a case reduction of the afterload on the right ventricle is the suggested modality of treatment for hypoxemia due to the right-to-left shunt.

Adult↗
PubMed1993

ATLS-based videotape trauma resuscitation review: education and outcome.

Trauma resuscitations (TRs) can be improved with ongoing videotape review. Unrecognized errors, delays, and system problems can be identified and corrected. Previous studies have demonstrated the importance of a short TR on survival and that videotape education can shorten TR time. Trauma resuscitation efficiency depends on details of TR including timing, organization, and appropriateness of care. Videotape education review monitors TR detail and improves TR efficiency by eliminating wasted time and treatment errors. Eight hundred eighty-three patients were evaluated. Group I included a control group prior to the incorporation of an ATLS based videotape review process. Group II included patients who were resuscitated after the educational review process was established. Subgroups based on ISS, direct OR transfer, DPL, and CT scan were also compared. Time and outcome were compared. Videotape educational review based on ATLS guidelines has improved TR efficiency. The benefits of ongoing videotape review include more efficient time utilization, correction of conceptual and technical errors, elimination of "wasted time," and improved survival.

Audiovisual Aids↗
PubMed1993

Acute obstructive uropathy secondary to pelvic hematoma compressing the bladder: report of two cases.

Two patients with traumatic retroperitoneal hematomas causing obstructive uropathy required surgical evacuation of the hematoma to relieve the obstruction. Fast recovery of renal function and an instant increase in urine output resulted. The obstruction to the urine outflow by the retroperitoneal hematoma caused near total collapse of the bladder in these patients, which was corrected by angiographic embolization and surgical removal of the hematoma.

Acute Disease↗
PubMed1993

Geriatric trauma.

Elderly individuals not only live longer but are also more active than in the past. Accompanying this increase in activity is the number of older trauma victims. The effect of aging on response to injury is reviewed, and the initial evaluation and treatment of geriatric trauma are delineated in this article. Specific injuries of note include head and chest wall injury; pulmonary and cardiac contusion; abdominal trauma; and aortic, spinal, and musculoskeletal injury.

Abdominal Injuries↗
PubMed1992

Small-bowel obstruction from an extruded Greenfield filter strut: an unusual late complication.

Recently interest has been shown in liberalizing the indications for insertion of vena caval filters. The convenience of percutaneous insertion by radiologists may further perpetuate this trend. However, filter placement is not without morbidity. We report a unique late complication in which a small-bowel obstruction occurred as a result of volvulus around an extruded filter strut.

Adult↗
PubMed1992

The use of transesophageal echocardiography in the evaluation of chest trauma.

Transesophageal echocardiography (TEE) has been used over the last 10 years (1982-1992) to study the heart and thoracic aorta. We set out to evaluate the diagnostic applications of TEE in patients with thoracic trauma. Specifically, TEE was performed on patients suspected of having either a cardiac contusion or an injury of the thoracic aorta. Fifty-eight patients admitted with thoracic trauma underwent TEE. Fifty of those patients suspected of having a cardiac contusion also underwent transthoracic echocardiography (TTE). The two diagnostic modalities were compared. In 21 of these patients a wide mediastinum was apparent on admission chest x-ray films. Nineteen of this latter group underwent thoracic angiography in addition to TEE. Two patients underwent post-mortem examination. Of the 50 patients undergoing both TEE and TTE, a cardiac contusion was detected by TEE in 26 patients. Transthoracic echocardiography detected only six contusions in this group. Of the 21 patients with a wide mediastinum, TEE detected three obvious aortic disruptions. These findings were confirmed in each case by angiography. In 16 cases TEE showed the aorta to be normal. This was confirmed on the angiogram in 14 cases and by autopsy in two cases. Transesophageal echocardiography revealed an aortic intimal irregularity distal to the left subclavian artery in two cases. The results of aortography were normal in these last two cases. As a diagnostic modality, TEE more accurately detected cardiac contusions than TTE (p less than 0.001) and was a very sensitive screening tool in the early evaluation of patients with a wide mediastinum.

Adolescent↗
PubMed1991

Transesophageal echocardiographic examination of a patient with traumatic aortic transection from blunt chest trauma: a case report.

Traumatic aortic disruption is an injury associated with high mortality. Early recognition, diagnosis, and surgical repair are important in order to salvage patients with this injury. We report a case in which transesophageal echocardiography, a rapid, minimally invasive diagnostic technique, was used to identify an acute disruption of the proximal descending aorta in a patient with blunt chest trauma.

Adult↗
PubMed1990

Traumatic rupture of the aorta--critical decisions for trauma surgeons.

The diagnosis and initial stabilization of patients with traumatic rupture of the aorta (TRA) is performed by trauma surgeons. The resuscitations of 54 TRA patients at a Level I trauma center are reviewed. Although the survival of patients who underwent attempted repair was good (75%), 21/27 (78%) deaths occurred during phases of treatment controlled by a trauma surgeon. The techniques and sequencing of resuscitation can affect outcome. Pneumatic antishock garments were not beneficial in the prehospital setting for patients with TRA. In fact, PASG were on and inflated in all patients who presented in cardiac arrest. Awake, unanesthetized intubation caused fatal aortic rupture in three patients. Pharmacologic control of blood pressure during intubation is necessary. The amount of fluid, blood transfusion, and changes in blood pressure secondary to therapy did not statistically affect outcome. The average time from arrival in the ER to angiogram was 64.7 minutes. The average time ER to operating room was 159.7 minutes. Seven cases of TRA had delayed diagnosis usually for a misinterpreted CXR (5/7). Delay in diagnosis did not directly contribute to any deaths. Associated abdominal injuries are a common cause of preventable deaths. Fourteen patients with combined abdominal injuries and TRA were identified. Four of six deaths occurred with potentially reparable injuries. Operative and diagnostic sequences must be adjusted to allow rapid control of all potentially fatal injuries.

Adolescent↗