Jurnal Reading 1gdg

8/18/2019 Jurnal Reading 1gdg

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Wu et al. World Journal of Emergency Surgery 2015, 10:4

http://www.wjes.org/content/10/1/4WORLD JOURNAL OF

EMEREN!" #URER"

RE#EAR!$ AR%&!LE Open Access

F'(tor r)s)(o )ntr'per)tone'* +ers',''n -'nper-'r'h'n retroper)tone'* p'-' p's)en tr','t,p* '+-o,en!hn") W #h'ngJ "'ng !h)h"'n F2 !h)en$ng L)'o #h)h!h)ng 3'ng "'o $s5e)ng!h'n L)n 3o!h)ng "'n 'n- #h'ng" W'ng

A+str'ct

&ntro-ct)on: &ntr'per)tone'* 'n- retroper)tone'* he,orrh'ges ,'6 occr s),*t'neos*6 )n +*nt '+-o,)n'* tr',' 75A%8p't)ents. %hese p't)ents n-ergo e,ergenc6 *'p'roto,)es +ec'se o9 conco,)t'nt nst'+*e he,o-6n',)cs 'n- pos)t)esonogr'ph)c e;',)n't)on res*ts. $oweer )9 the 'ssoc)'te- retroper)tone'* he,orrh'ge )s 9on- )ntr'oper't)e*6 'n-c'nnot +e contro**e- srg)c'**6 then the p't)ents re48 h'- conco,)t'nt pe*)c 9r'ctre -)'gnoses. O9 these p't)ents e)ghteen 70@ 1C/B08 n-erwent *'p'roto,6 on*6 wh)*ethe other twe*e p't)ents 740@ 1/B08 re


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W et '*. Wor*- Jorn'* o9 E,ergenc6 #rger6 01 10:4 'ge o9 http://www.wjes.org/content/10/1/4

worldwide, it can only detect intraperitoneal hemorrhageand has limitations regarding retroperitoneal hemorrhagesurveillence [/- &&]. here$ore, it is di$$icult to identi$y

pa-tients with concomitant intraperitoneal and

retroperiton-eal hemorrhages during primary evaluationsover a short time period.

0atients usually undergo emergency laparotomies be-cause o$ concomitant unstable hemodynamics and posi-tive sonographic eamination results [/,&1,&2]. 3owever,i$ associated retroperitoneal hemorrhages are $ound in-traoperatively and cannot be controlled surgically, then

post-laparotomy !" is re+uired. he preparation o$ anangioembolization suite and the gathering o$ personnelare usually time-consuming, which may delay de$initivehemostasis. *urthermore, transporting these patients be-tween the operation and angiographic rooms is risyunder such critical conditions. here$ore, the early iden-ti$ication o$ these patients is important to ensure thatsubse+uent treatments can be initiated in a timely man-ner. !dditionally, more in$ormation may be needed $or

physicians to predict retroperitoneal hemorrhages and$urther hemostatic procedure re+uirements.

In this study, we describe a retrospective observation o$the management o$ patients with concomitant %! andunstable hemodynamics. he di$$erent clinical coursecharacteristics were delineated and compared, and the pa-tients who underwent post-laparotomy !" were investi-

gated and analyzed. e attempted to determine the ris$actors that indicated post-laparotomy !" and analyzedthe critical decision-maing processes that occurred whenonly limited in$ormation was available.

M'ter)'*s 'n- ,etho-s

*rom 6ay 211) to 7ctober 21&', patients with con-comitant%! and unstable hemodynamic were retro-spectivelyanalyzed. hey were evaluated and treated according to ourestablished algorithm, which is based on the !dvancedrauma 8i$e 9upport (!89# guide-lines [&'] (*igure .he 0elvic :-ray was routinely used as an ad;unct to the

primary survey in these patients. in;uries were classi$ied as un-stable

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pelvic $racture (%&A eternal rotational unstable, %2A

internal rotational unstable, >A both rotational and verticalunstable#. he patients who underwent laparot-omy onlyor laparotomy plus post-laparotomy !" were compared.

!ll data are presented as patient percentages or meanswith standard deviations. he numerical data were com-

pared using the ilcoon two-sample eact test. Bom-inal data were compared using *isher Ks eact test.6ultivariate logistic regression analysis was per$ormed todetermine the independent ris $actors related to the


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W et '*. Wor*- Jorn'* o9 E,ergenc6 #rger6 01 10:4 'ge B o9 http://www.wjes.org/content/10/1/4

re+uirement $or post-laparotomy !". !ll statisticalanalyses were per$ormed using the 9099 computer so$t-ware pacage (version &'.1, >hicago, I8,


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Unst'+*e 7t)*e 5/!8

47.C@8? 7F0.0@8

%'+*e %he 9'ctors )n-epen-ent*6 'ssoc)'te- w)th post*'p'roto,6 %AE )n the oer'** p't)ent pop*'t)on

'r)'+*eO--s r't)o 7?@ !&8

p/:'*.eP

e*)c 9r'ctreB.4 7A.A Q 11.480.01C

5*oo- tr'ns9s)on≧ 100 ,*C.> 70.> Q 1D.A8

0.B0A

R%# .D.A 70.1 Q 1B.480.A>A

#≧ 1A.A 71.F Q ?.D80.04C

PM*t)'r)'te *og)st)c regress)on.

vs. ))C.' E /'4./ ml, p F 1.12)# (able . 6ultivariatelo-gistic regression analyses revealed that the presence o$a pelvic $racture (odds ratio [7@] F '.4, p F 1.1&)# and anI99≧ & (7@ F 2.2, p F 1.14)# were two signi$icant pre-dictive $actors $or patients re+uiring post-laparotomy !"(able 2#.

In the current study, there were '1 concomitant pelvic$racture diagnoses (41.5D, '1?C4#. 7$ these patients, eighteen(1D, &)?'1# underwent laparotomy only, while the othertwelve patients (41D, &2?'1# re+uired post-laparotomy !".>ompared with the laparotomy-only pa-tients, the post-laparotomy !" patients re+uired more trans$used blood(&542.) E &122.5 ml vs. /&4.5 E 425./ ml, p = 1.11.

!dditionally, there were more patients with type %& pelvic$ractures (5).'D vs. &&.&D, p F 1.1&'# or un-stable pelvic$ractures (C5.1D vs. 22.2D, p F 1.11)# among these patients.*urthermore, the post-laparotomy !" patients alsodemonstrated signi$icantly higher I99s (2.' E &4.& vs. 22.5E 21.C, p F 1.114# and lower @9s (4.&&5 E 2.4'& vs. 5./)& E

'.2&2, p F 1.1& than the

%'+*e B !o,p'r)sons +etween the pe*)c 9r'ctre p't)entswho n-erwent *'p'roto,6 on*6 'n- the p't)ents whore.C@84 7BB.B@8

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tr'ns9s)on 7,*8

Fr'ct.re p'ttern 7N8

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'r)'+*es 're e;presse- 's ,e'ns #D.W)*co;on twos',p*e e;'ct test GF)sherKs e;'ct test.

W et '*. Wor*- Jorn'* o9 E,ergenc6 #rger6 01 10:4http://www.wjes.org/content/10/1/4

%'+*e 4 %he 9'ctors )n-epen-ent*6 'ssoc)'te- w)th post*'p'roto,6 %AE )n pe*)c 9r'ctre p't)ents

'r)'+*eO--s r't)o 7?@ !&8

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%)*e 51 pe*)c 9r'ctreF.4 74.0 Q 1D.180.00A

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other patients (able '#. able 4 shows that a type %&

pelvic $racture (7@ F .4, p F 1.112# and an I99 H & (7@ F 5./, p F 1.112# were two independent ris $actors $or

post-!" laparotomy.

In current study, there were three patients without pel-vic$ractures who re+uired post-laparotomy !". heir

angiographic eaminations revealed that all o$ them hadactive lumbar arterial hemorrhage.

D)scss)on

%lunt abdominal trauma may result in intraperitoneal orretroperitoneal hemorrhages, which are both potentially li$e-threatening and re+uire organized rapid evaluation andtreatment [&- ']. !n emergency laparotomy is usuallyindicated $or an intraperitoneal hemorrhage that presents asintra-abdominal $ree $luid during sonography. In themanagement o$ the associated retroperitoneal hemorrhage,the 0>> and even the etraperitoneal pacing are re-+uired

to decrease the retroperitoneal hemorrhage be$ore thelaparotomy. hen the $urther !" could be per$ormed $or thede$initive hemostasis. 3owever, in these patients, it isdi$$icult to consider the re+uirement o$ !" until per-sistentepansion o$ a retroperitoneal hematoma was de-tectedintraoperatively. !t that time, the !" preparation would beinitiated. !$ter a damage-control laparotomy, withintraperitoneal?retroperitoneal pacing, the patients

'ge 4 o9

would be sent to an angiographic room. here$ore, theywould remain in critical condition with an ongoinghemorrhage while waiting $or an angioembolization suiteto be prepared and $or personnel to be gathered.

In the current study, C4 patients underwent emergencylaparotomy because o$ concomitant unstable hemodynamicsand positive sonographic eamination results. @etroperiton-eal hemorrhage was $ound intraoperatively in &5 o$ these patients (21.'D# thus, they underwent post-laparotomy!". he percentage o$ these patients with concomitant pelvic $racture was signi$icantly greater than that o$ the pa-

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tients who underwent laparotomy only ()1.1D vs. '1.5D, p= 1.11. *urthermore, multivariate logistic regression ana-lyses revealed that the presence o$ a pelvic $racture was asigni$icant $actor in predicting the need $or post-laparotomy!" in such patients (7@ F '.4, p F 1.1&)# (able 2#. 0elvic$ractures usually stem $rom high-inetic-energy blunt traumaand can result in retroperitoneal hemorrhage. !sso-ciatedhemodynamic instability was reported in 5 S21D o$ these patients, and the subse+uent reported mortality rate was &) S41D [&- 21]. here$ore, in addition to intraperito-neal

hemorrhage, an associated retroperitoneal hemorrhage shouldalso be considered when managing patients with %! andunstable hemodynamics with concomitant pelvic $ractures.

0revious reports have proposed that unstable pelvic$ractures indicate ma;or ligamentous disruptions that areo$ten associated with li$e threatening arterial bleeding[&4,&5,2&]. !dditionally, pelvic $racture patterns wereclassi$ied into three main groups according to the integ-rity o$ the posterior sacroiliac comple by ile [&4,&5]. he $ocused analysis o$ pelvic $racture patients in thecurrent study revealed that the patients who re+uired post-

laparotomy !" had a signi$icantly greater percent-age o$ unstable pelvises (C5.1D vs. 22.2D, p F 1.11)# and type

%& (eternal rotational unstable# pelvic $ractures

F)gre *')n e;tern'* rot't)on'* t6pe pe*)c 9 r'ctre 9)*,s. %he *'rge 'rrows )n-)c'te the -)srpt)e 9orce -)rect)on 'n- s)-e o9 the),p'ct 'n- the s,'** 'rrows )n-)c'te the sp*'6)ng o9 the p+)c s6,ph6s)s 7A8 'n- 9rther e;tern'* )*)'c w)ng rot't)on 758.

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(5).'D vs. &&.&D, p F 1.1&'# compared with the patientswho underwent laparotomy only (able '#. *urthermore,multiple logistic regression analyses in the current study

also revealed that type %& pelvic $ractures were an inde-

pendent ris $actor $or concomitant intraperitoneal andretroperitoneal hemorrhages, with approimately an eight-$old increased ris o$ re+uiring post-laparotomy !" (7@ F .4, p F 1.112# (able 4#.

SC.%6+rs() J W)*son RF Dente ! #te99es ! !'r*)n AM. F'ctors'99ect)ng ,ort'*)t6 r'tes )n p't)ents w)th '+-o,)n'* 'sc*'r )njr)es. J

%r','. 0010:100S. NOM.

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R'=' M A++'s " De) r's'- 3 R)=( 3N N')r . Non oper't)e,'n'ge,ent o9 '+-o,)n'* tr',' ' 10 6e'rs re)ew. Wor*- J E,erg#rg. 01BC:14.

#r)ss'-'porn # '('rt R %h'r'ej ! #)r)ch)n-'(* 5

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$'sch)*- O Agh'6e E on $e6-en J #troh, ! !*e,'nn Uoh*e,'nn % et '*. Ang)oe,+o*)='t)on 9or pe*)c he,orrh'ge contro*:res*ts 9ro, the er,'n pe*)c )njr6 reg)ster. J %r',' Acte !'re#rg. 01>B:>?SC4.

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Jes(e $! L'rn-or9er R 3r'pp)nger D Att'* R 3*)ngens,)th MLotters+erger ! et '*. M'n'ge,ent o9 he,orrh'ge )n seere pe*)c)njr)es. J %r','. 010C:41S0.

M)**er R Moore # M'nse** E Mere-)th JW !h'ng M!. E;tern'* 9);'t)on or'rter)ogr', )n +*ee-)ng pe*)c 9r'ctre: )n)t)'* ther'p6 g)-e- +6 ,'r(ers o9'rter)'* he,orrh'ge. J %r','. 00B4:4B>S4B.

er+ee( DO )j*str' &A 'n -er Le)j ! onsen 3J 'n De*-en OMos*)ngs J!. %he t)*)t6 o9 FA#% 9or )n)t)'* '+-o,)n'* screen)ng o9 ,'jorpe*)c 9r'ctre p't)ents. Wor*- J #rg. 014BC:1>1?S.W'*cher F We)n*)ch M !onr'- #chwe)g(o9*er U 5re)t(ret= R3)rschn)ng % et '*. rehosp)t'* *tr'son- ),'g)ng ),proes

,'n'ge,ent o9 '+-o,)n'* tr','. 5r J #rg. 00?B:BCS4.

%'6'* # N)e*sen A Jones AE %ho,'son M$ 3e**', J Norton $J. Accr'c6 o9tr',' *tr'son- )n ,'jor pe*)c )njr6. J %r','. 001:14BS>.

!*'r(e JR %roos()n # Dosh) J reenw'*- L Mo-e !J. %),e to*'p'roto,6 9or )ntr''+-o,)n'* +*ee-)ng 9ro, tr',' -oes '99ectsr)'* 9or -e*'6s p to ?0 ,)n. J %r','. 00:40S.

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enn'* F %)*e M W'--e** J 'rs)-e $. e*)c -)srpt)on: 'ssess,ent 'n-c*'ss)9)c't)on. !*)n Orthop Re*'t Res. 1?C011:1S1.McMrtr6 R W'*ton D D)c()nson D 3e**', J %)*e M. e*)c -)srpt)on)n the po*6tr','t)=e- p't)ent: ' ,'n'ge,ent protoco*. !*)n Orthop

Re*'t Res. 1?C011:SB0.

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!r6er $M M)**er F5 Eers 5M Ro+en LR #e*)gson DL. e*)c 9r'ctre c*'ss)9)c't)on:corre*'t)on w)th he,orrh'ge. J %r','. 1?CCC:?>BSC0.5rn J )**ot # 5o='t 5ro; ! %hon6 F ent6 ! et '*. Detect)ng 'ct)epe*)c 'rter)'* h'e,orrh'ge on '-,)ss)on 9o**ow)ng ser)os pe*)c 9r'ctre )n,*t)p*e tr',' p't)ents. &njr6. 0144:101S.

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o9 ' ,*t)-)sc)p*)n'r6 c*)n)c'* p'thw'6 9or the ,'n'ge,ent o9 nst'+*e p't)ents w)thpe*)c 9r'ctre. Ann #rg. 001BB:C4BS0.

F !" W #! !hen RJ W'ng "! !hng 3 "eh !! et '*. E'*'t)on o9 pe*)c9r'ctre st'+)*)t6 'n- the nee- 9or 'ng)oe,+o*)='t)on: pe*)c )nst'+)*)t)es on p*')n 9)*,h'e 'n )ncre'se- pro+'+)*)t6 o9 re:>?S.D'*'* #A 5rgess AR #)ege* J$ "ong JW 5r,+'c( RJ o(' A et '*. e*)c9r'ctre )n ,*t)p*e tr',': c*'ss)9)c't)on +6 ,ech'n)s, )s (e6 to p'ttern o9 org'n)njr6 ressc)t't)e re


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