Articles Tagged with emergency room

Fingertip accidents are commonplace amputations at home or on the job. Fingertips can slam in doors, in car doors, while chopping food or when clearing out a lawnmower or snowblower. These types of injuries can involve crushing of the fingertip, tearing of the fingertip or cutting off of the fingertip, including the thumb. The nailbed, soft tissue and bone (phalanx) can be involved in the injury. The tips of the fingers are injured more commonly than the rest of the finger because they are the least likely to escape harm’s way.

These types of amputations are very painful because there are a lot of nerves in the area. They also tend to bleed quite a lot due to a rich blood supply. When an amputation happens, you should elevate the stump and cover the wound with a sterile dry dressing. Apply pressure if needed. If there is a part of the finger that is cut off, it should be wrapped in a moist sterile gauze and placed in a baggie. You should then place the baggie in some ice water. Don’t put the amputated part directly on ice and do not use dry ice to keep the amputated part cold.

Approximately every 115 minutes, someone or something is struck by a train; almost 50 % of all collisions happen at railroad crossings when the automatic warning lights and automatic warning gates are working correctly. The big problem is that people think that even if their car gets stuck on the tracks, the train will be able to stop. In reality, a 150-car train going at fifty miles per hour will need at least a mile to stop.

The fact of the matter is that a car weighs only about 3000 pounds and it must come up against a several hundred ton train. The car almost always loses. These types of accidents cause about 600 deaths per year and injure about 2300 people per year in the US. About 75 percent of automobile/train crashes involve the train hitting the car in the daytime. At night, half of the collisions happen when the car does not see the train at a poorly lit intersection and strikes the train.

Traumatic hemipelvectomies are rare traumatic injuries with a forty percent mortality rate. It happens when half of the pelvis from the pubic symphysis to the sacroiliac joint is pulled away from the rest of the body in an open or closed injury. Because this is a situation that often results in death, it is important for the trauma team to do angiography to assess the circulation to the area, x-rays to determine the extent of the fracture and possibly a CT scan of the pelvis to determine what the injury looks like in three dimensions. Only aggressive surgical treatment can save the person’s life.

Because prehospital care has gotten so good, more and more people are arriving to the trauma centers alive rather than dead. This is a very unstable fracture with ligamentous injury and bony injury with external bleeding in some cases. The pelvic neurovascular bundle is usually destroyed, affecting sensation to the affected, partially-amputated leg.

Motor vehicle rollover accidents are accidents in which the motor vehicle ends up on its side or on its back. In other words, there is no contact between the wheels of the vehicle and the ground. Unfortunately, 2.7 percent of occupants of a motor vehicle were killed in a rollover compared to 0.2 percent of occupants in non-rollover accidents. A total of 33 percent of all fatalities that are related to motor vehicle collisions occurred in rollover accidents as opposed to those accidents where the vehicle does not roll over.

Rollover rates seem to be higher in light trucks and SUVs. Rollovers are less common for the average passenger vehicle and/or minivan. More than any other demographic, male young drivers were the cause of the majority of these type of accidents. Vehicles that roll also tended to be older vehicles carrying multiple occupants. Sadly, many of the rollover accidents were noted to often contain unbelted passengers. Besides the age, sex and type of vehicle demographic, high speed rates at the time of the incident was another component contributing to these accidents.

Finger amputations may sound small but they really cause a lot of changes in the way the patient performs certain activities, such as punching the buttons on a phone or using a keyboard. This is why the surgeon will attempt to put the finger back on if it is severed from the hand.

When a finger is initially severed, the bystander should wrap the amputated finger in moist, cool gauze. The finger should not be immersed in water because it can become waterlogged. Simply use a paper towel if you have no medical gauze. Put the finger on ice with a Ziploc bag. Do not use dry ice for this part of the process. If there will be an attempt to reimplant the finger, there should be immediate medical attention with a surgeon who can put arteries, veins and nerves back together. The time from amputation to reimplantation should be less than 12 hours.

Subway accidents can have devastating consequences for those involved. In fact, many people do not survive pedestrian versus subway collisions. While the subway system is designed with the intent to be safe, they are not immune to issues. When things do go wrong, people suffer from permanent severe injury and death.

One study conducted a retrospective review using information between 1989 and 2003. In the study, they found 41 patients who were involved in a subway accident and that had presented to Bellevue Hospital in New York City for treatment. The researchers collected pertinent information such as the patient’s age, gender, Injury Severity Score, the time of the accident, and the mechanism by which the accident happened.

Above the elbow amputations are also called trans-humeral amputations and are more difficult than below the elbow amputations to fit with prostheses that are comfortable and functional. When the injury happens at the level of the elbow or above, the person must have a transhumeral amputation with the attempt made to have the stump as long as possible. Longer stumps can help the individual use the prosthesis more effectively.

Another above the elbow amputation that is more severe is through the shoulder with shoulder disarticulation. These are the hardest to place with a prosthesis that the patient can easily use and tend to be unwieldy and more for aesthetics than for functionality. The more joints that have to be replaced, the harder it is to have a functional prosthetic.

Motorcyclists are in a unique position as riders on the road. They ride on two wheels, which is an inherently unstable position. They ride without the benefit of any protective metal around them, which makes direct vehicle to patient contact likely. Road to victim contact is almost inevitable and these riders often suffer from significant injuries. Many motorcyclists use performance enhancing equipment, which makes the chances of severe injury or death quite likely.

One recent review study looked at the patterns of injury, particularly major ones, seen in motorcycle riders following their injuries. There are unique aspects of their care, including airway management, circulatory status and the management of the spine.

Some patients with traumatic brain injury secondary to a motor vehicle accident will recover to the point where they wish to drive again. It is the job of doctors and other health practitioners to make challenging decisions as to whether or not the individual should be able to drive again. In order to do this, doctors need to perform reliable psychometric testing batteries so that unreliable and unsafe drivers can be detected.

Some researchers have looked into five different driving-associated personality traits that predict whether or not a driver can resume driving after a traumatic brain injury. It also helps when evaluating the post-stroke patient who wants to drive again. About 178 patients who suffered from traumatic brain injury or stroke were evaluated for their ability to drive after their medical incident. Each participant took a standardized psychometric test battery and also took a specific standardized driving test. The two tests were combined to see how the individual fared in being able to drive again.

Car surfing is the dangerous practice of standing on the hood or top of a car, “surfing” the car as if it were a surfboard. Some youths consider this a ‘sport.’ It is a practice usually performed by teenagers, some of whom are intoxicated and have poor coordination. Obviously, this is a practice that is fraught with the potential for injury and death.

Trauma from car surfing includes head and spine injuries. A recent study has looked at the neurological injuries resulting from car surfing. The study also addressed why this is a growing ‘trend’ in the nation. For starters, it is portrayed in the media as a “cool thing” to do. Additionally, many teens do not seem to think it is dangerous.

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