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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Sympathetic hyperactivity syndrome following cerebral fat embolization

Abstract

To date, there have been no reports of paroxysmal sympathetic hyperactivity syndrome (PSHS) associated with cerebral fat embolization. We describe the case of a young male who developed acute brain injury and acute hypoxemic respiratory failure secondary to significant fat embolization following a traumatic femur injury. Our patient demonstrated episodes of significant hypertension, tachycardia, fever and extensor posturing. Extensive evaluation lead to the diagnosis and appropriate treatment for PSHS. Ultimately, the patient went on to have a good neurologic recovery after a prolonged hospitalization. We will discuss PSHS diagnostic criteria, pathophysiology and treatment options. This diagnosis should be considered in all brain-injured patients with paroxysms of autonomic instability and abnormal movements.

Key words: acute brain injury, myoclonic encephalopathy, fat embolism, autonomic nervous system diseases, adult respiratory distress syndrome,wound, injuries

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Child Victims of U.S. Motor Vehicle Crashes: Time from Crash to Hospital Arrival Among Cases Documented in the 2003 Fatality Analysis Reporting System (FARS) Database

Abstract

There have been recent proposals to enhance organization and funding of emergency care in the U.S. because of perceived deficiencies – especially in services for children.   Motor vehicle crashes are among the leading causes of death and disability for both adults and children in the United States and place a heavy burden on emergency and trauma care.  This study uses the Fatality Accident Reporting System (FARS) to examine the length of time between vehicle crash and hospital arrival for crashes involving seriously injured children transported to hospital in 2003.  Only about 1/3 (1868) of  5436 crashes had data for hospital arrival time.  For those cases that could be evaluated, median transport time was 46 minutes (52 minutes for rural crashes, 35 minutes for those in urban areas).   There was substantial delay in a minority of crashes.  Delays occurred both between crash and emergency services (EMS) notification and between EMS contact and hospital arrival and were more common in rural crashes.  Other research has shown that prolonged transport times are associated with worsened trauma outcomes.  Since states vary in the extent and sophistication of their trauma services we sought, but failed to find,  correlation between number of trauma centers (Level I and II or all-level) per million population and median arrival time calculated for each U.S. state. Integrated trauma care begins at the site of injury and continues through post-hospital care. Time between injury and hospital admission is one important indicator of trauma system performance.

Keywords: Accidents, Traffic; Emergency Medical Services; Children; Transportation of Patients; Trauma Centers; Injuries

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