Air and water powered tools are employed increasingly in industry and involve new possibilities for occupational casualties. A new mechanism of trauma is described where the cause of death was an injury to the head, similar to a firearm wound. The "missile" was the water beam from the victim's own high pressure cleansing device, which was able to produce water pressure up to 900 atmospheres resulting in high water velocity of 300 meters/second. As prophylaxis, new legislations, as a result of understandings between employers and employees in the member states of the Common Market, are under preparation at present.
42 patients with epidural haematoma were operated upon in the surgical department of the regional hospital, TromsÃ¸, in the years 1967-1985. Clinical evaluation showed that 17 of these patients (40.5%) were intoxicated by alcohol at the time of trauma. 14 of the intoxicated (82.4%) but only 7 (28%) of the sober patients, had been injured either in the evening or at night. 13 in the intoxicated group (76.5%) and 10 in the sober group (40%) were hurt by falling or as a result of violence. 15 of the sober group (60%) and 4 intoxicated patients (23.5%) arrived less than 4 hours after the accident. We found a significant difference between the two groups as regards the time lag between accident and arrival at TromsÃ¸ hospital.
A total of 625 patients who sustained acute cervical spine fractures were evaluated by the Spinal Cord Injury Service at Barrow Neurological Institute, Phoenix, Arizona, between January 1976 and January 1984. Of them, 107 had fractures of the second cervical vertebra. In a retrospective review, motor vehicle accidents were found to be the most common mechanism of injury, resulting in 73 (68%) of the 107 axis fractures. All axis fracture types were encountered in this subgroup: hangman's (27%), Odontoid Type II (39%), Odontoid Type III (15%), and miscellaneous fractures (19%). Only one of the 30 patients with complete medical records and detailed information about the accident was wearing a seat belt. Equally remarkable is that 15 of the 30 accidents were single car mishaps, where occupant restraints might theoretically provide the most protection. Sixteen of the 30 patients were thrown from their vehicles, another five were found in the backseat, which leads to the conclusion that a significant of the driving population does not wear seat belts or shoulder restraints. Patients with axis fractures from an automobile accident had a high rate of associated severe head injuries or other cervical spine fractures, three times that of patients with C-2 fractures from other causes. Motorists who are thrown from their vehicles suffer the most severe trauma and have the highest rates of morbidity and mortality. As many as 25% to 40% of individuals who sustain high cervical fractures in motor vehicle accidents die as a result of their injuries.
In a retrospective study on 456 women hospitalized at the Departments of Surgery and Oto-rhinolaryngology of Huddinge Hospital for emergency injuries during the years 1978 and 1979, the injuries were found to have been caused by battering in 29%. The majority of the women had been physically abused by their husbands, fiancés or cohabitees. As women seldom seek social or psychiatric assistance for this problem spontaneously, it is an important task of the responsible accident surgeon both to detect battering as the cause of the injuries and to act as mediator in contacting a women's refuge or other social assistance agency.
The number of bicycle-related injuries has risen significantly with the increased popularity of bicycle riding in Canada. The risk of injury is highest among children. To assess the magnitude of the problem and to identify the contributing factors we used a questionnaire, injury reports and patient charts to survey bicycle-related injuries among children brought to the emergency department of the Children's Hospital of Eastern Ontario, Ottawa, between May 1 and Sept. 30, 1988. The questionnaire was completed for 517 (91%) of the 568 children; 70% were boys, and the mean age was 9.4 years. Only 2% of the patients had been wearing a helmet at the time of injury, although 13% claimed to own one for cycling. Over 60% of the accidents were attributable to carelessness or poor bicycle control; mechanical failure and environmental hazards were minor factors. Over 80% of the injuries occurred within a kilometre of the child's home. Of the 97 children admitted to hospital 49% had head and skull injuries and 40% had limb fractures. Bicycle-related injuries represented 14.8% of all nonwinter (Apr. 1 to Oct. 31) trauma admissions among children 5 years or older. Our results further document bicycle-related injuries as an important childhood problem and underscore the need for improved safety measures.
Cites: Br Med J (Clin Res Ed). 1987 May 16;294(6582):1267-93109611
Cites: Am J Dis Child. 1987 Feb;141(2):140-43812380
Motor vehicle crashes are a leading cause of death and serious injury for children. Emergency nurses can play a key role in encouraging parents and caregivers to use child restraints consistently and correctly. This article will discuss a case scenario where a young child is seriously injured in a motor vehicle crash where his child car seat was not used correctly. Injury prevention strategies for emergency nurses will be reviewed.
This is a study of medical care when road accident incidents result in traumatic brain injury (TBI). We investigated the personal perceptions of those involved in acute care episodes and subsequent rehabilitation. We conducted simultaneous semi-structured interviews with individuals who had sustained a TBI (8) and their families (8). We then conducted semi-structured individual interviews with the professionals (22) and physicians (9) who attended them. Results reveal the difficulties encountered by the different people involved, from the standpoint of the rehabilitation of both the person who with the TBI and their families, the relationships among the various actors, and the continuity of care. The results disclose the importance of including the family and the TBI casualty in the care process by endorsing their participation and by setting up suitable structures that prioritize a meaningful partnership among the individuals, families, physicians, professionals and health care organizations and in which each person can play a role as an agent in the care of the person with the TBI. An important element, which came out again in our results, is that the shortage of information provided to the families can jeopardize establishing a relationship of trust among the actors. Furthermore, many of the family members were upset that the health intervention was entirely focussed on the TBI casualty: none of the professionals were concerned with what the families were going through, either during the acute care or rehabilitation. Another major problem is lack of communication, not just amongst the professionals, but also between institutions which seem to function in isolation. Lack of resources, the limited availability of those that are offered, and social policies are also detrimental to the reintegration of the TBI individual into the community. Finally, many of the professionals reported that they had not been trained to assist families in this situation.