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Biomedical subjects

Yoram Klein

Publications and source records attributed to Yoram Klein.

8 recordsLinked to original sources
PubMed2006

Suicide bombers form a new injury profile.

BACKGROUND: Recent explosions of suicide bombers introduced new and unique profiles of injury. Explosives frequently included small metal parts, increasing severity of injuries, challenging both physicians and healthcare systems. Timely detonation in crowded and confined spaces further increased explosion effect. METHODS: Israel National Trauma Registry data on hospitalized terror casualties between October 1, 2000 and December 31, 2004 were analyzed. RESULTS: A total of 1155 patients injured by explosion were studied. Nearly 30% suffered severe to critical injuries (ISS > or = 16); severe injuries (AIS > or = 3) were more prevalent than in other trauma. Triage has changed as metal parts contained in bombs penetrate the human body with great force and may result in tiny entry wounds easily concealed by hair, clothes etc. A total of 36.6% had a computed tomography (CT), 26.8% had ultrasound scanning, and 53.2% had an x-ray in the emergency department. From the emergency department, 28.3% went directly to the operating room, 10.1% to the intensive care unit, and 58.4% directly to the ward. Injuries were mostly internal, open wounds, and burns, with an excess of injuries to nerves and to blood vessels compared with other trauma mechanisms. A high rate of surgical procedures was recorded, including thoracotomies, laparotomies, craniotomies, and vascular surgery. In certain cases, there were simultaneous multiple injuries that required competing forms of treatment, such as burns and blast lung. CONCLUSIONS: Bombs containing metal fragments detonated by suicide bombers in crowded locations change patterns and severity of injury in a civil population. Specific injuries will require tailored approaches, an open mind, and close collaboration and cooperation between trauma surgeons to share experience, opinions, and ideas. Findings presented have implications for triage, diagnosis, treatment, hospital organization, and the definition of surge capacity.

Adolescent↗
PubMed2005

Spine injuries are common among asymptomatic patients after gunshot wounds.

BACKGROUND: Spine injuries after gunshot wounds are thought to be rare among asymptomatic patients. The occurrence of spine injuries among asymptomatic patients with gunshot wounds was studied to determine the necessity for mandatory spine immobilization and radiographic imaging. METHODS: In this retrospective cohort study, initial physical examination, radiographic findings, and final diagnosis and treatment were reviewed. Patients were included if they were admitted to the authors' level 1 trauma center with gunshot wounds to the head, neck, or trunk during a 10-year period. Spine injuries were considered "significant" if the injury was associated with spinal cord injury or required spine-related surgical procedures or prolonged spine immobilization. Spine injuries were defined as "unsuspected" if there were no neurologic findings at admission. RESULTS: During the study period, 2,450 patients who survived more than 24 hours were admitted with gunshot wounds to the trunk, neck, or head. Of these patients, 244 (approximately 10%) had spine injuries, and 228 of them had complete records. Two thirds of the spine injuries were found to be significant, requiring surgery or prolonged immobilization, and 13% were unsuspected. CONCLUSIONS: Spine injuries without neurologic signs are not uncommon among patients with gunshot wounds. Complete radiographic spine imaging is therefore recommended to ensure that spine injuries are not missed in this population.

Abdominal Injuries↗
PubMed2003

Diagnostic peritoneal lavage through an abdominal stab wound.

Diagnostic peritoneal lavage (DPL) is one of the most useful tools in the diagnosis of intraperitoneal injuries secondary to stab wounds. The lavage catheter is inserted into the peritoneal cavity through a surgical incision or a blind puncture. Complications related to the catheter insertion were previously reported in both techniques. We describe 2 cases in which the lavage catheter was inserted through the stab wound itself after local wound exploration clearly demonstrated violation of the peritoneum. We suggest that in anterior abdominal stab wounds, the DPL can be safely and effectively performed through the stab wound if penetration to the peritoneum is diagnosed.

Abdominal Injuries↗
PubMed2002

CT diagnosis of traumatic bronchial rupture in children.

Bronchial rupture is a rare and serious complication of blunt chest trauma in children. The diagnosis of this injury is challenging and requires a high degree of clinical suspicion. It is frequently associated with other severe injuries that may draw the focus of attention away from this potentially catastrophic but treatable injury. The radiographic findings of bronchial rupture have been reported in very few series. We report the findings in two children with bronchial rupture diagnosed by CT, in whom CT resulted in a significant change in patient management.

Accidents, Traffic↗
PubMed2002

Updates in the management of severe coagulopathy in trauma patients.

Coagulopathy is the major cause of bleeding-related mortality in patients who survive the operating room. Its association with hypothermia and metabolic acidosis is common and constitutes a vicious cycle. Usually, post-traumatic coagulopathy is an early event and may be present during surgery. The pathogenesis of severe post-traumatic coagulopathy is complex and multifactorial. Virtually every aspect of the normal coagulation cascade is affected in the cold, acidotic, exsanguinating trauma patient. In the last decade many surgeons have emphasized the role of prevention or early treatment of this vicious cycle. Damage control surgery with planned re-operations has demonstrated superiority over the traditional approach in cases where the patients' condition is deteriorating. Early control of surgical bleeding and significant contamination, together with vigorous correction of hypothermia and continuous resuscitation, has improved the survival of these patients. Recently, a new adjunct to the treatment of coagulopathy in trauma patients has been reported and is undergoing controlled animal trials. Recombinant activated factor VII (rFVIIa) was originally developed as a pro-hemostatic agent for the treatment of bleeding episodes in hemophilia patients. rFVIIa has been successfully used in moribund trauma patients in whom standard procedures had failed to correct bleeding. Preliminary preclinical and clinical studies are under way.

Blood Loss, Surgical↗
PubMed2002

Lung contusion: pathophysiology and management.

Management of severe pulmonary contusion is a challenge for clinicians. The incidence of adult respiratory distress syndrome (5-20%), pneumonia (5-50%), and mortality (5-10%) associated with traumatic lung injury has changed little in the past three decades. Therapeutic options are limited to basic supportive measures such as mechanical ventilation, positive end expiratory pressure, invasive cardiopulmonary monitoring, analgesics and aggressive pulmonary hygiene. Presently, no pharmacological agents can prevent the progressive respiratory embarrassment that is associated with the natural history of the disease, but several drugs have been tested in the laboratory. The purpose of this brief review is to summarize information published since January 2000 related to the clinical management and pathophysiology of lung contusion.

Journal Article↗