1 / 39

Death in the Context of Traffic Accidents

Karina Arrieta Posada Georgina Penagos Hollmann Manuel David Torres Guzmán. Death in the Context of Traffic Accidents. TABLE OF CONTENTS. Introduction Materials and Methods Results Discussion Conclusions Questions. INTRODUCTION.

sal
Download Presentation

Death in the Context of Traffic Accidents

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Karina Arrieta Posada Georgina PenagosHollmann Manuel David Torres Guzmán Death in theContext of TrafficAccidents

  2. TABLE OF CONTENTS • Introduction • Materials and Methods • Results • Discussion • Conclusions • Questions

  3. INTRODUCTION • Introduced to complement the protection provided by safety belts. • This protective feature can be detrimental to infants and children: • 49 deaths in the United States as of November 1, 1997. • Reported 73 pediatric fatalities resulting from airbag deployment (15 were infants).

  4. Establish if unrestrained children in the front passenger seat were at greater risk of airbag deployment trauma than unrestrained children.

  5. MATERIALS AND METHODS • The records of all children evaluated and treated at: • Rainhow Babies & Children’s Hospital (Cleveland). • Children’s Hospital (Columbus). - Children’s Hospital Medical Center (Cincinnati).

  6. MATERIALS AND METHODS • Demographic: injury, and crash data were obtained from: • Medical Emergency Services • Hospital Records • Coroners´ Reports.

  7. RESULTS • 27 children. • Age: 1 month - 12 years M A: 5.1 SD:3.34 • Airbag injuries: 1 of 3 regional pediatric trauma centers • 61% Girls • ISS: M 10 SD: 14.5 • Speed: < 45 mph

  8. RESULTS

  9. RESULTS

  10. RESULTS

  11. RESULTS

  12. DISCUSSION • Airbags reduce the morbidity in adults. • Passenger side airbag increases airbag-related injuries in children. • The severity of injury depends on the proximity to the point of explosive airbag impact. • Thepattern and severitywithin injury classifications differed with age and size of thechildren.

  13. DISCUSSION • The abdominal organ injuries were exclusive to the restrainedgroup. • We encountered an overall mortality rate of 7.4%. Of which, one half were restrained properly. • Isolating small children from the path of an airbag can be problematic when they are transported in vehicles withoutrear-seatingcapability.

  14. The National Highway Trafic Safety Administration recommends that children 12 years of age or younger be properly restrained in the rear seat of a motor vehicle.

  15. INTRODUCTION • Nonpenetrating chest trauma with injury to the heart and aorta has become increasingly common • high-speed vehicular accidents, Airplane crashes, falls from height, and other severe crushing injuries of the tórax Cardiac Injuries byBlunt Trauma

  16. INTRODUCTION • Incidence of cardiac injury is 20% after blunt chest trauma in postmortem studies • Pediatric age group, incidence is slightly lower and previous studies suggested that cardiac injury was found in 15–20% • Incidence for all age groups might be as low as 0.5–0.8% in clinical studies

  17. INTRODUCTION • The majority of patients die before they arrive at the emergency department • The great majority of cardiac injuries are still diagnosed by systemic autopsy • Male:female ratio 3.5:1

  18. MATERIALS AND METHODS • Retrospective analysis of 1597 autopsies of fatalities associated with blunt trauma in Itanbul form 2001 to 2003

  19. RESULTS • 11.9% (190) had cardiac injuries • 45.2% (85) cardiac injuries were cause of death • 56% (106) injuredbyvehicleaccidents • 38% (72) injuredbyfall • 13% (25) were alive on arrival to the emergency department • Survival time less than 24h: 56% (14) • Survival time greater than 24h: 44% (11)

  20. RESULTS • 11.9% (190) had cardiac injuries • Accompanied by: • Pulmonary contusions 44.2% (84) • Sternal fractures 62% (32.6%) • Serious head injuries 41.6% (79)

  21. Injury of great vessels 28.8% (15) • Pericardial Tearing 27.3% (52) Atrial and/or ventricular rupture 38.5% (20)

  22. Myocardial Ruptures and Contusions Left atrium Rupture 11.1% (21) Right atrium Rupture 15.8% (30) Right Wall Contusions 12.1% (23) Left Wall Contusions 8.9% (17) Right ventricle Rupture 22.6% (43) Left Ventricle Rupture 23.2% (44)

  23. Heart valve injuries 3.6% (7), predominantly tricuspid and aortic Coronary artery injuries 2.6% (5) Heart completely torn off at the base 5.2% (10) Other Injuries

  24. DISCUSSION • Mechanism: direct impact to the chest wall with transmission of the kinetic force to the patient, causing compression of the heart between the sternum and the spine • ‘‘Hydraulic Ram Effect’’ • Atria and ventricles appear to be more vulnerable to these compressive forces

  25. DISCUSSION • A number of factors affect the spectrum of cardiac injury: • force applied to the chest • compliance of the chest wall • exact timing of the application of force during the cardiac cycle • Pericardial injuries are the most common findings of blunt cardiac trauma

  26. DISCUSSION • Higher impact traumas, such as motor vehicle accidents, falls, and explosions might be responsible for injuries such as transmural ruptures

  27. CONCLUSIONS • Airbags are an efficacious safety feature in automobiles, but are the cause of injuries to children regardless of whether the child is properly restrained • Injury prevention strategies should focus on the proper use of child restraints coupled with placing children in the rear seat

  28. CONCLUSIONS • Closed Chest trauma must make physicians consider traumatic cardiac lesion • Possibility of concomitant injuries (lung, heart, trachea, bronchus, and esophagus)

  29. CONCLUSIONS • A close clinical evaluation, ECG monitoring, transthoracic, and transesophageal echo examinations, even cardiac enzyme analysis (CKMB, Tn T, Tn I levels) are mandatory • Traffic events =Spectre of deathpossibilities; driver responsabilityisadviced

  30. THANK you!! ANY QUESTIONS?

More Related