Automobile Accident Victims Research Articles

Cranioplasty using poly-methyl-methacrylate: a case report

The objective of this study is to show a case of cranioplasty, treated with acrylic prosthesis. A 36 years-old man, car accident victim, admitted to the Department of Neurosurgery, at Hospital Estadual Adão Pereira Nunes, in the city of Rio de Janeiro, Brazil. Submitted to pterional craniotomy decompressive of emergency due traumatic brain injury. After 01 years of neurological recovery, the patient was referred to the Oral and Maxillofacial Surgery Department, of the same hospital. Presented clinically with a severe bulging in the fronto-orbital on the left side, associated with mechanical impaction ipsilateral upper eyelid, which precluded the full eye opening, without neurological deficit. Cranial CT examination revealed frontal fragment rotated clockwise, with invasion of orbital cone. Front of case, the proposed treatment was cranioplasty, in order to correct the cosmetic defect, aided prototyping courtesy (CTI ProMED) and customized prosthetic poly-methyl-methacrylate. Under general anesthesia and with coronal access, the bone was exposed, the necessary osteotomies were performed and the prosthesis fixed with system 1.5 (MDT®). There were no accident and trans-operative patient progressed well, been discharged on the seventh postoperative day.

The assessment of lens opacity postmortem and its implication in forensics

Visual impairment, mostly due to cataracts, has been demonstrated to be an important factor associated with traffic accidents. Although vision screening is standard procedure during licensing in order to prevent motor vehicle accidents, an eye exam is not typically administered after an accident has already occurred.Postmortem assessment of lens opacity in victims of car accidents would provide helpful information for attesting to the liability of the parties in specific accidents, determining the circumstances of the accident, and developing preventive measures for both drivers and pedestrians alike.In this paper, we explore the use of different methods and their limitations for assessing lens opacity postmortem. We discuss the possible use and benefits of a simple, but as-yet untested method: retrobulbar translucency. The method would be based on the recording of shadows formed by opaque regions of the lens while the eye is illuminated from the back with a rigid source of light. The efficacy and objectivity of the method, its reproducibility, and the inter- and intra-observer error should be tested before implementing such a technique to be regularly used to determine lens opacity in cadavers.

Sentimentos de pais de crianças acidentadas em automóveis sem uso de assento de segurança infantil

doi: 10.5216/ree.v15i2.18111 - http://dx.doi.org/10.5216/ree.v15i2.18111. RESUMO Os acidentes se configuram em um problema de saúde pública no Brasil. O objetivo deste estudo foi compreender a experiência de pais de crianças vítimas de acidentes automobilísticos sem a utilização de Assento de Segurança Infantil (ASI) ocorridos em Londrina, Paraná, de 2008 a 2011. Estudo exploratório de abordagem qualitativa. Os participantes foram 17 pais de crianças de zero a oito anos, atendidas pelo Sistema Integrado de Atendimento ao Trauma de Emergência (SIATE) e encaminhadas a hospitais. A análise dos dados se deu através da análise de conteúdo, resultando em duas categorias: Acidente de trânsito: quem está a salvo?; Sentimentos no momento do acidente. Concluiu-se que as pessoas não acreditam que acidentes possam acontecer consigo ou com pessoas próximas. Sentimentos de nervosismo são os observados no momento do acidente. A educação se mostra como ponto de partida para o uso do ASI, daí a importância do enfermeiro como profissional educador. Descritores: Assentos de Segurança Infantil; Acidentes de Trânsito; Enfermagem; Criança.

Comparative anatomical study of the leg's nerves of Cebus (barbed capuchins) with baboons, chimpanzees and modern humans

The anatomical comparative studies among the primates are important for the investigation of ethology, evolution, taxonomy, and comprehension of tools by hominoids. Especially the anatomical knowledge of Cebus contributes to conservation of the species, and to development of surgical procedures and clinical treatments of these animals, as they frequently are victims of automobile accidents. Recent anatomical studies came to a wrong conclusion regarding behavioral traits of Cebus, ascribed to few data available in previous literature. Therefore, to provide anatomical data and to support the other sciences related to anatomy, and to develop surgical and/or clinical procedures, we described the nerves of the legs of Cebus foccusing on their position and trajectory, as wll as innerved muscles, and compared these results with those of humans and other primates. Eight adult capuchin specimens were used for this study. The anatomical comparative study of the leg's nerves of Cebus demonstrated that, in general, structural organization of the nerves is similar among the four primates analyzed here (Cebus, chimpanzees, baboons and humans), which might be attributed to the fact that the all four primates have similar body structures. However, nerve trajectory and muscles innervation in Cebus was more similar to baboons.

The Influence of Seatbelts on the Types of Operated Brachial Plexus Lesions Caused by Car Accidents

To determine whether there is a relationship between seatbelt use and type of brachial plexus injury seen in automobile accidents. Knowledge of such a relationship may help guide the surgical management of these patients. We retrospectively evaluated 43 surgical patients with brachial plexus palsy caused by car accidents. We recorded sex, age, and type of injury for each case. We also obtained data regarding the patients' position in the car at the time of the accident and whether they were wearing a seatbelt. We obtained data on 39 men and 4 women. Of the seatbelted patients, 24 (100%) had upper plexus palsy on the side where the seatbelt crossed the shoulder. Of those who were not wearing seatbelts, 17 (86%) had complete plexus injuries. We also found 1 upper and 1 lower plexus injury in the unbelted group. We found a relationship between the type of brachial plexus injury sustained by the accident victim and the use and position of the seatbelt. Complete plexus injuries were more common in those who were not wearing seatbelts. We saw upper plexus injuries for those wearing seatbelts. Information about seatbelt use may be useful in clinical practice. When treating an unbelted car accident victim with a brachial plexus injury, it is reasonable to anticipate a more serious form of the injury. Prognostic IV.

Using Radio Frequency Identification (RFID) Tags to Store Medical Information Needed by First Responders

In the event of an accident or emergency, a victim’s medical information such as blood type, prescribed drugs, and other pertinent medical history is critical to Emergency Medical Technicians (EMTs) so that the correct treatment can be provided to the victim as quickly as possible. Victims of car accidents, heart attacks, etc., are not always able to answer simple but crucial medical questions. Treatment time is critical in an emergency situation and the EMT must quickly obtain correct medical information to provide treatment until the victim is stabilized or admitted to the hospital. With an unconscious patient, the EMT must perform a number of tests to obtain these details. A Radio Frequency Identification (RFID) tag encoded with this information could provide this information quickly and correctly, while saving the time and expense of the tests to answer these questions. The ability of the RFID tag to communicate through objects can minimize the movement of the victim to obtain the necessary information. This paper presents a standardized format for encoding (storing) this information in the RFID tag for use in the United States. The use of data compression techniques are explored to maximize the amount of information able to be stored in the RFID tag. Privacy and security issues with this application are discussed and a potential solution is presented.

Maxillofacial trauma and seat belt: a 10-year retrospective study

Brazil is among the countries with the highest prevalence of people injured by traffic accidents, showing that in 2008, levels reached 18.3 victims for 100,000 habitants were victims of traffic accidents. This retrospective study involved data collected from treated patients' charts at seven different hospitals located in three different cities all in the state of São Paulo, Brazil. Information was obtained through a standardized form, which was designed to investigate the epidemiologic features of maxillofacial traumas, restricted to victims of car accidents. Three hundred ninety-six patients were victims of car crashes with mean age 29.75 years. The age group 18-30 years showed an association with facial trauma in 96 patients, 41.56 % of whom reported using seat belt. Le Fort I, II and III (70 %) and mandible (63.11 %) were more associated with body traumas and seat belt use. The most common soft tissue lesion was laceration with 189 cases (42.3 %). The treatment way was assessed, 93 (23 %) were treated surgically and 303 (77 %) underwent conservative treatment. Classically, it is known front seat belt use was positively correlated with back seat belt use, healthy diet, dental and general health, regular walking, adequate sleep and no smoking. Accidents involving cars occurred more frequently in age group 18-30 years, suffering more general traumas and representing the nonusers group that wore fewer seat belts, caused, perhaps, by bigger access of the youth to cars, driving in high speed and to an inefficient fiscalization of the traffic laws.

The contribution of threat probability estimates to reexperiencing symptoms: A prospective analog study

Background and objectivesIndividuals with posttraumatic stress disorder (PTSD) are hypothesized to have a “sense of current threat.” Perceived threat from the environment (i.e., external threat), can lead to overestimating the probability of the traumatic event reoccurring (Ehlers & Clark, 2000). However, it is unclear if external threat judgments are a pre-existing vulnerability for PTSD or a consequence of trauma exposure. We used trauma analog methodology to prospectively measure probability estimates of a traumatic event, and investigate how these estimates were related to cognitive processes implicated in PTSD development. Methods151 participants estimated the probability of being in car-accident related situations, watched a movie of a car accident victim, and then completed a measure of data-driven processing during the movie. One week later, participants re-estimated the probabilities, and completed measures of reexperiencing symptoms and symptom appraisals/reactions. ResultsPath analysis revealed that higher pre-existing probability estimates predicted greater data-driven processing which was associated with negative appraisals and responses to intrusions. Furthermore, lower pre-existing probability estimates and negative responses to intrusions were both associated with a greater change in probability estimates. Reexperiencing symptoms were predicted by negative responses to intrusions and, to a lesser degree, by greater changes in probability estimates. LimitationsThe undergraduate student sample may not be representative of the general public. The reexperiencing symptoms are less severe than what would be found in a trauma sample. ConclusionsThreat estimates present both a vulnerability and a consequence of exposure to a distressing event. Furthermore, changes in these estimates are associated with cognitive processes implicated in PTSD.

A Case Report of Isolated Posterior Fracture Dislocation of Anatomical Neck of Humerus

Introduction: Fracture dislocation of anatomical neck of humerus is an extremly rare fracture. So, the best treatment for it and long term results are not well established. It is our duty to report each case of it to make material for a greater study. Material and method: A 27 years old man who is a victim of car accident is presented with shoulder and pelvic pain. In X- ray, there was a hollow glenoid and in CT scan, the fractured anatomical head is rotated and angulated posterior to glenoid (Figure 1). It was treated with hemiarthroplasty of shoulder. Results: By deltopectoral approach, we can remove head fragment and because there was no enough bone in subchondral region, we didn’t fix it and exchange it with cemented hemiarthroplasty of involved shoulder. Discussion: Because of complete dislocation of anatomical head of humerus and no soft tissue attachment to it, avascular necrosis of head of humerus can be highly anticipated. So, we choose hemiarthroplasty for him and we think because tuberosities are not detached, function will be good.

Success rates and endotracheal tube insertion times of experienced emergency physicians using five video laryngoscopes

No randomised controlled trial has yet compared different video laryngoscopes in respect of the success rates and the time taken to achieve endotracheal intubation in trapped car accident victims. The aim of the present study was to evaluate whether five video laryngoscopes facilitate tracheal intubation more quickly or more securely than conventional laryngoscopy. Prospective, controlled, randomised crossover trial. An airway manikin was placed on the driver's seat of a compact car. Access was possible only through the opened driver's door. Twenty-five experienced anaesthetists. Tracheal intubation in a simulated trapped patient using video laryngoscopes in a typical out-of-hospital setting. Times to achievement of a view of the glottis, tracheal intubation, cuff inflation, first ventilation and tracheal tube position were compared using a standard Macintosh laryngoscope or Glidescope Ranger, Storz C-MAC, Ambu-Pentax AWS, Airtraq and McGrath Series 5 video laryngoscopes in a randomised order. Wilcoxon signed-rank test and McNemar test were used for statistical analysis. A P value of less than 0.05 was considered statistically significant. Twenty-five anaesthetists (35.1 ± 7.3 years; 16 male, nine female) with an intubation experience of 374 ± 96 intubations per year and an experience of 9.1 ± 7.3 years participated. Glottic view, tracheal intubation, cuff inflation and first ventilation were achieved most rapidly with the Macintosh laryngoscope, although the Airtraq and Pentax AWS video laryngoscopes were not significantly slower. Times were significantly longer when the Glidescope Ranger, McGrath Series 5 or Storz C-MAC video laryngoscopes were used (P < 0.05), failure to place the endotracheal tube correctly was significantly commoner with the McGrath Series 5 than with the Macintosh (P = 0.031). When attempting to intubate a trapped car accident victim, video laryngoscopes provide a better view of the glottis, but some delay tracheal intubation significantly. The devices with a tube guide (Airtraq and Ambu Pentax AWS) enable tracheal intubation to be achieved significantly faster and with a lower failure rate than devices without a tube guide. No video laryngoscope outperformed direct laryngoscopy with a Macintosh laryngoscope in this simulation study.

Categorical and dimensional study of the predictive factors of the development of a psychotrauma in victims of car accidents

Objective This study aimed to evaluate the predictive factors of the emergence of complete PTSD and subsyndromal PTSD (defined as individuals exposed to a traumatic event with at least one psychopathological impact, such as hyperarousal, avoidance or persistent re-experiencing) following a motor vehicle accident (MVA). Methods We recruited 155 adult MVA patients, physically injured and admitted to trauma service, over two years. In the week following the accident, patients were asked to complete questionnaires assessing their social situation (sex, age, marital and employment status, prior MVA or trauma), comorbidity (MINI), distress (PDI) and dissociation (PDEQ) experienced during and immediately after the trauma. An evaluation using the CAPS was conducted six months after the trauma to assess a possible PTSD. Results At six months, 25.8% of the participants developed subsyndromal symptoms and 7.74% developed complete PTSD. The three symptoms that best discriminated the groups were dysphoric emotion, perceived life threat and dissociation. Logistic regression results showed that the strongest predictor of PTSD was the perceived life threat. In addition, a dimensional approach to the results revealed significant correlations between (1) peritraumatic distress and persistent re-experiencing or hyperarousal and (2) dissociation score and avoidance strategy. The presence of a prior traumatic event reinforces avoidance strategies. Conclusions Our results stress that peritraumatic factors (especially the perception of a life threat) are good predictors of PTSD development. A dimensional perspective allows better identification of psychological complications following an MVA.

Video laryngoscopes in emergency medicine - a comparison using a simulated entrapped car accident victim

Video laryngoscopes in emergency medicine - a comparison using a simulated entrapped car accident victim

Late Sequelae of Whiplash Injury with Dissection of Cervical Arteries

Background/Aims: The objective of our study was to estimate the incidence of posttraumatic dissections of cervical arteries in patients with whiplash injury acquired in a car accident. Methods and Patients: We performed a retrospective analysis of medical records of 500 patients with whiplash injury acquired in car accidents between 1996 and 2005 and searched for dissections of cervical arteries occurring within 12 months after injury. Results: Eight cases of cervical arterial dissection occurred within 12 months following whiplash injury. In 7 cases (87.5%), the dissection was complicated by brain infarction. The incidence of posttraumatic dissections after whiplash injuries was much higher than the overall incidence of cervical arterial dissections in the general population (1.6 vs. 0.0041%). The risk of cerebrovascular events was still increased 4–12 months after whiplash injury (0.6 vs. 0.003075% in the general population). Conclusions: There is an increased risk of posttraumatic dissection and cerebrovascular events within 12 months after whiplash injury. Car accident is an important risk factor for arterial dissections. The victims of car accidents should be screened for arterial dissections. The results of this study should be more thoroughly investigated in a prospective trial of car accident victims as a risk factor for arterial dissections.

Tratamento endovascular de pseudoaneurisma de aorta torácica: relato de caso

Paciente de 31 anos vítima de acidente automobilístico apresentou falta de ar inspiratória progressiva acompanhada de dor dissecante no tórax, de forte intensidade, sem irradiação; Glasgow 15 e ISS 26 (16 + 9 + 1); exames laboratoriais e radiográficos compatíveis com a normalidade. Foi operado de fratura de tíbia 1 dia depois, tendo recebido alta 3 dias depois da entrada no serviço. No entanto, foi piorando da falta de ar e da dor torácica, retornando para nova consulta 2 dias após a alta hospitalar. Foi realizada tomografia computadorizada helicoidal que revelou pseudoaneurisma de aorta torácica. Optou-se por tratamento endovascular com implante de endoprótese.

Impact of Driver Characteristics on the Severity of Injuries and Final Outcome of Four-Wheeler Automobile Accident Victims

Background: Globally, injuries are responsible for about 5% of the total mortalities and a large proportion out of them is due to road traffic accidents. One of the most important factors for these accidents is the driver himself and his driving characterstics. Aim and Objective: To evaluate the impact of driver characteristics on the severity of injuries and final outcome of the victims of four-wheeler automobile accidents.

Road traffic accidents and the elderly

To identify and evaluate the causes and characteristics of road traffic accidents (RTA) and to analyze injury patterns in elderly road traffic victims in order to apply appropriate measures for the prevention of RTA in the elderly. Two hundred and fifty-eight elderly road traffic victims admitted to the Emergency and Traumatology Departments of our institution were enrolled. Complete data about the circumstances surrounding the accident, mechanism of injury, specific injury, comorbid conditions and drug history were recorded. All subjects underwent a physical and mental function examination. The majority of road traffic victims were pedestrians. Most elderly pedestrian accidents were due to falls. Accidents by elderly car drivers occurred frequently at intersections. Craniocerebral and extremity injuries formed the majority of the injuries in pedestrian and cyclist victims whereas chest injuries were commoner in car accident victims. Medical problems and medication usage was common among RTA victims. The fragility of elderly car occupants and pedestrians should be taken into consideration and strategies aimed at the road-user safety including periodic medical screening, improvement of road structure and facilities, and the improved design of motor vehicles should be implemented.

Toxin A-producing Clostridium difficile as an aetiological factor of post-traumatic wound infection

Clostridium difficile is a well-known cause of hospital-acquired infection such as antibiotic associated diarrhoea or pseudomembranous colitis. Extraintestinal infections caused by this pathogen are described rarely. A case of post-traumatic wound infection caused by C. difficile in an immunocompetent, young and otherwise healthy trauma patient is reported. A 31-year-old female, a car accident victim, was admitted to hospital because of polytrauma. After open reduction and internal fixation of a supracondylar femoral fracture by means of the dynamic condylar screw (DCS) system, a purulent fistula occurred. Microbiological examination of the pus revealed C. difficile as the single aetiological factor of this infection. Empirical antibiotic treatment with cefazoline and metronidazole had been administered right after the surgery, but was found to be ineffective. The strain isolated from the patient was sensitive to most antimicrobials except for clindamycin, and amoxicillin/clavulanic acid was chosen for the guided therapy. Such treatment combined with the removal of the DCS system produced a desirable effect.

Chin-sternum-heart syndrome type of injury observed in a pedestrian victim of car traffic accident

We report an autopsy case of a pedestrian victim of car traffic accident with the chin-sternum-heart syndrome type of injury. A drunken man who lay on the road was run over by a car. He died immediately at the scene. The autopsy findings were as follows: large scalp lacerations, abrasions in the chin and the sternal region, a transverse fracture of the sternum, ruptures of the heart, ruptures of the ascending and descending aortae, rupture and hemorrhage of the nuchal muscle, ring fracture of the base of the skull, subarachnoid hemorrhage at the base of the brain, multiple rib fractures, anterior compression fracture of the 11th thoracic vertebra, and small lacerations of the liver. Blood ethanol level was 2.92 mg/g. These findings indicate that there was hyperflexion of the neck and then the victim’s heart was strongly compressed and ruptured by the collision of the chin with the sternal region of the chest.

The relationship between religiosity and subjective well-being: A case of Kuwaiti car accident victims.

Researchers have long recognized the influence of religion on a person's health and well-being. This study explores the influence of religion on the well-being of traumatized people. The study population included people who had experienced significant trauma in their lives from a severe car accident. The study sample included individuals who had been traumatized through severe injury in car accidents, families of those who have been badly injured, and families of those who were killed in car accidents. Demographic and socioeconomic variables served as independent factors in measuring subjective well-being. Descriptive, bivariate, and multiple regression analyses were used to measure the relationship between religiosity and subjective well-being of a traumatized person. Results showed that there was a positive relationship between religiosity and well-being, that income of the traumatized affected well-being positively, and that age of the traumatized affected well-being negatively. There was no effect of group difference (severely injured, family of severely injured, and family of a killed one) on well-being.

Introduction to the special issue on culture and international contributions.

Following Torture: An Interview Study of Tibetan Torture Survivors’ Use of Coping Mechanisms and How These Were Supported by Western Counseling” by Peter Elsass and Kalsang Phuntsok is a good illustration of the process by which traumatologists first attempt to understand a culture, in this case Tibet, the challenges of adaptation of traumatized Tibetans’, and how best to introduce and modify traditional counseling approaches to best support their adaptation. The next two articles discuss the role of faith, “Disillusionment, Faith, and Cultural Traumatization on a Northern Plains Reservation” written by Lori L. Jervis and “The Relationship Between Religiosity and Subjective Well-being: A Case of Kuwaiti Car Accident Victims” by Hadi Ridha Ashkanani. The former is about the transformation of a culture that has been traumatized for generations and the latter is about the role of faith and traditional beliefs play a role in individuals’ coping with the trauma of car accidents. The next article is also from Kuwait but discusses the consequences of working with a distress population and its effects on job satisfaction in Job Satisfaction Among Counselors Working at Stress Center—Social Development Office—in Kuwait by Humoud Fahad Alqashan and Ali Alzubi. The final two articles in this special issue are written by the same two authors, Jenifer Gregory and David G. Embrey. Their first article, “Companion Recovery Model to Reduce the Effects of Profound Catastrophic Trauma for Former Child Soldiers in Ganta, Liberia,” summarizes an innovative study of former Liberian child soldiers. The final article is an equally innovative model that helps account for and provide direction to recovery by the same Liberian child soldiers. Their companion recovery model draws on the traditional beliefs and cultural norms of Liberia. However, the model provides some useful directors for others work with traumatized children The Society for Traumatic Stress Studies was established 24 years ago at a breakfast meeting at the hotel that was hosting the 15th annual meeting of the National Organization for Victim Assistance (NOVA). Several founding members were attending NOVA and several others lived in the Washington, DC area where the conference was being held. The Society Founders were interested in establishing a learned society of scholars who would establish the knowledge-based, theories, and research methods by which all traumatized people could be understood, studied, and helped. The United States, only 10 years after ending the Vietnam War and long before the trend toward globalization and international collaboration, was composed of professional and scholarly mental health organizations with members and conference attendees who were primarily American. The Society Founders were intent on not only studying and helping all traumatized people worldwide but also collaborating with scholars worldwide. To make this mission crystal clear, the Society inserted “International” in its name and has made considerable efforts to reach out to their colleagues as members and conference presenters. But the percentage of papers presented by and about Americans has remained the same over the years. Participation by non-Americans, particularly at associated “chapters” outside the United States, is far greater than most other mental health–oriented organizations. However, the Society’s journal that was established by this author, though a premier journal, primarily publishes articles by and about Americans. It is with considerable pride, therefore, that Traumatology welcomes this “Special Issue on Culture and International Contributions.” Collectively, these six articles contribute to more of a worldview of trauma manifestation, adaptation, and treatment. The lead article, “Tibetans’ Coping Mechanisms Traumatology Volume 15 Number 1 March 2009 1-2 © 2009 SAGE Publications 10.1177/1534765609333573 http://tmt.sagepub.com hosted at http://online.sagepub.com