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pre hospital trauma

Ellen W Blair, Jyoti Chhabra, Cynthia Belonick, Maria Tackett
Potential for suicide risk can be a safety concern for patients in all health care settings. Inadequate training of nurses in suicide assessment and prevention is a serious patient safety concern. A non-randomized pre-/postintervention research design was used to measure the effects of education on non-psychiatric nurses' perceived self-efficacy in assessment and inquiry about suicide risk and in implementing suicide prevention strategies. The intervention was an educational module about suicide prevention and care delivered to non-psychiatric nurses employed on a neuro-trauma unit in an acute care urban hospital setting...
March 14, 2018: Journal of Psychosocial Nursing and Mental Health Services
Mitchell R Dyer, DaShawn Hickman, Norman Luc, Shannon Haldeman, Patricia Loughran, Christa Pawlwoski, Anirban Sen Gupta, Matthew D Neal
BACKGROUND: Clinical resuscitative treatment of traumatic hemorrhage involves transfusion of RBC, platelets and plasma in controlled ratios. However, use of such blood components, especially platelets, present many challenges including availability, portability, contamination risks, and short shelf-life, which limit the use of platelet transfusions outside of large trauma centers such as remote civilian hospitals and austere pre-hospital settings. This has prompted significant research in platelet substitutes that may resolve the above issues while providing platelet-mimetic hemostatic action...
March 12, 2018: Journal of Trauma and Acute Care Surgery
Tsunehiko Konomi, Kota Suda, Satoko Matsumoto, Miki Komatsu, Masahiko Takahata, Norimasa Iwasaki, Akio Minami
Introduction: There are considerable risks for vertebral artery (VA) injury in case of corrective surgery for a severe and rigid cervical kyphotic deformity. This case report describes a rare case of surgical management for pre-existing traumatic rigid cervical kyphosis associated with unilateral VA occlusion. Case presentation: A 73-year-old male fell down and injured his neck. He was referred to our hospital 10 months after injury because his degree of head drop progressed gradually to a chin-on-chest position such that he could not look straight forward...
2018: Spinal Cord Series and Cases
Karen J Riemenschneider
Prevention of hospital-acquired pressure injuries (HAPIs) remains a crucial clinical challenge especially for those patients undergoing surgery. The purpose of this project was to examine whether a 5-layer silicone foam dressing applied to the sacrum of patients undergoing vascular surgery decreased the occurrence of sacral pressure injuries and to explore participant characteristics associated with the development of operating room (OR)-related pressure injuries. A pre-/postintervention design, quality improvement project in a convenience sample of 81 patients undergoing vascular surgery, in a 700-bed level I trauma acute care setting, in the Northeastern United States...
March 2018: Journal of Wound, Ostomy, and Continence Nursing
Majdi Omri, Halim Bouaouina, Hajer Kraiem, Naoufel Chebili, Mehdi Methamem, Mohamed Aymen Jaouadi, Mounir Naija, Walid Naija, Mohamed Nejib Karoui
BACKGROUND: During primary survey of trauma patients, missed injuries and delayed diagnosis can be a potential source of morbidity and mortality. OBJECTIVE: To assess type and frequency of missed injuries in prehospital care in trauma patients and to analyze their contributing factors and implications. METHODS:   It is a descriptive and analytic prospective study. It was performed over six months which had included 200 trauma patients. The initial assessment made by the out-of hospital team of Sousse was compared to the second survey made in the emergency room and intensive care unit after the radiological assessment...
May 2017: La Tunisie Médicale
Mark Krauthammer, Amir Shuster, Daphna Mezad-Koursh, Benjamin Shlomi, Chaim Stolovitch, Igal Leibovitch
Purpose: To demonstrate an unusual case of orbital trauma due to dental surgery complication. Observations: An elderly patient who underwent dental implantation to the zygomatic bone was hospitalized in the ophthalmology department with impaired abduction of her right eye, also evident on ocular examination. Head computed tomography demonstrated damage to the lateral rectus and to the inferior oblique muscles. Clinical assessment determined these muscles could not be repaired and reattached...
April 2017: American Journal of Ophthalmology Case Reports
Cory Taylor, Jamie C Fertal, Solomon Liao
BACKGROUND: Withdrawal of life-support for an individual with refractory schizophrenia following attempted suicide remains controversial. Discussion regarding prognosis of mental illness and the distinction between somatic and mental illness brings out many ethical issues. This paper will examine the role and weight of severe persistent mental illness in the withdrawal of life support following attempted suicide. CASE DESCRIPTION: A 30-year-old gentleman with deafness and schizophrenia was admitted with multiple self-inflicted visceral stab wounds...
February 26, 2018: Journal of Pain and Symptom Management
Rebecca Maria Hasler, Sandra Stucky, Heinz Bähler, Aristomenis K Exadaktylos, Frank Neff
OBJECTIVE: Most deaths occur in the pre-hospital setting, whereas mortality in the emergency department (ED) is low (<1%). However, our clinical impression is that some patients are being transported to hospital in devastating conditions with no likelihood of survival, but demanding extensive hospital resources. The decision on whether to transport a dying person to hospital or not is a difficult task for emergency medical services (EMS) personnel. As there is little epidemiological data about these patients, this paper aims to describe this special population...
2018: PloS One
Pengcheng Zhu, Wenzhong Miao, Feng Gu, Chungen Xing
Objective: The objective of this study is to investigate the effects of laparoscopic and open operation on serum and peritoneal inflammatory mediators in patients with right colon carcinoma. Patients and Methods: A total of 100 patients were randomly divided into laparoscopic group (n = 50) and open group (n = 50). The age, sex, operation time, operation blood loss, post-operative Dukes stage, time to first passage of flatus and post-operative hospital stay were recorded...
February 27, 2018: Journal of Minimal Access Surgery
Jesse Whitehead, Matt Roskruge, Colin Tan, Alistair Smith, Grant Christey
AIM: Pre-hospital triage strategies aim to identify the type and extent of patient injuries and ensure that they are transferred to the most appropriate trauma centres. Despite the importance of appropriate pre-hospital transport, there is little evidence base to assist medical staff on optimal destination policy for emergent pre-hospital transport. This paper explores the spatial relationship of patient transfers prior to the implementation of the Midland Pre-Hospital Trauma Destination Matrix in New Zealand, and is a retrospective view of practice against a destination policy that was applied after the study period...
February 23, 2018: New Zealand Medical Journal
Aaron Cunningham, Marc Auerbach, Mark Cicero, Mubeen Jafri
BACKGROUND: Recent mass casualty events in the United States have highlighted the need for public preparedness to prevent death from uncontrolled hemorrhage. The Pediatric Trauma Society (PTS) reviewed the literature regarding pediatric tourniquet usage with the aim to provide recommendations about the utility of this adjunct for hemorrhage control in children. METHODS: Search terms "pediatric" and "tourniquet" were used to query the US National Library of Medicine National Institutes of Health for pertinent literature...
February 17, 2018: Journal of Trauma and Acute Care Surgery
Mohammad Auais, Suzanne N Morin, Lois Finch, Sara Ahmed, Nancy Mayo
OBJECTIVES: To examine the course of recovery and resulting health-related quality of life (HRQL) after low-trauma hip fracture using two different definitions of recovery. DESIGN: Inception cohort with eight assessments over one year. SETTING: Participants were recruited from a tertiary-care hospital and followed in the community. INTERVENTION: Not applicable PARTICIPANTS: 47 (75% of all eligible) community-dwelling hip fracture patients (≥65 years)...
February 14, 2018: Archives of Physical Medicine and Rehabilitation
Stefan Heschl, Ben Meadley, Emily Andrew, Warwick Butt, Stephen Bernard, Karen Smith
INTRODUCTION: Prehospital airway management of the paediatric patient with traumatic brain injury (TBI) is controversial. Endotracheal intubation of children in the field requires specific skills and has potential benefits but also carries potentially serious complications. We aimed to compare mortality and functional outcomes after six months between children with TBI who either underwent prehospital rapid sequence intubation (RSI) by trained Intensive Care paramedics (ICP) or received no intubation...
February 12, 2018: Injury
Lusha Xiang, Harold G Klemcke, Nathan A Wienandt, Kathy L Ryan, Carmen Hinojosa-Laborde
BACKGROUND: Pain management is important in pre-hospital care of patients with extremity trauma (ET). The goal of this study was to establish a rat model of ET for pre-hospital pain research, and validate it using pain behaviors and analgesics. METHODS: Rats were anesthetized using isoflurane and ET was induced in one hindlimb via clamping retrofemoral tissues for 30 sec, followed by closed fibula fracture. Rats regained consciousness after ET. Pain responses in the injured hindlimb to thermal hyperalgesia (paw withdrawal latency, PWL), mechanical allodynia (paw withdrawal pressure, PWP), and weight bearing (WB) were determined before and 90 minutes after ET...
February 14, 2018: Journal of Trauma and Acute Care Surgery
Paula Ferrada, Rachael A Callcut, David J Skarupa, Therese M Duane, Alberto Garcia, Kenji Inaba, Desmond Khor, Vincent Anto, Jason Sperry, David Turay, Rachel M Nygaard, Martin A Schreiber, Toby Enniss, Michelle McNutt, Herb Phelan, Kira Smith, Forrest O Moore, Irene Tabas, Joseph Dubose
Background: The traditional sequence of trauma care: Airway, Breathing, Circulation (ABC) has been practiced for many years. It became the standard of care despite the lack of scientific evidence. We hypothesized that patients in hypovolemic shock would have comparable outcomes with initiation of bleeding treatment (transfusion) prior to intubation (CAB), compared to those patients treated with the traditional ABC sequence. Methods: This study was sponsored by the American Association for the Surgery of Trauma multicenter trials committee...
2018: World Journal of Emergency Surgery: WJES
Yonas Abebe, Tolesa Dida, Engida Yisma, David M Silvestri
BACKGROUND: Africa accounts for one sixth of global road traffic deaths-most in the pre-hospital setting. Ambulance transport is expensive relative to other modes of pre-hospital transport, but has advantages in time-sensitive, high-acuity scenarios. Many countries, including Ethiopia, are expanding ambulance fleets, but clinical characteristics of patients using ambulances remain ill-defined. METHODS: This is a cross-sectional study of 662 road traffic collisions (RTC) patients arriving to a single trauma referral center in Addis Ababa, Ethiopia, over 7 months...
February 13, 2018: BMC Emergency Medicine
Nathan A Franklin, Ashley Ali, Richard K Hurley, Hassan R Mir, Michael J Beltran
OBJECTIVE: Evaluate the pre-hospital use of Direct Oral Anticoagulant (DOAC) agents on the outcomes of early surgical fixation of a geriatric hip fracture. DESIGN: Case-Control. SETTING: Two academic level 1 trauma centers. INTERVENTION: Early (<48h) surgical fixation of a geriatric proximal femur fracture. PATIENTS: 19 patients receiving Pradaxa (Dabigatran), Eliquis (Apixaban), or Xarelto (Rivaroxaban) who underwent surgery between 2010 and 2015 and 74 control patients...
February 9, 2018: Journal of Orthopaedic Trauma
Megan Brenner, Kenji Inaba, Alberto Aiolfi, Joseph DuBose, Timothy Fabian, Tiffany Bee, John B Holcomb, Laura Moore, David Skarupa, Thomas M Scalea
BACKGROUND: Aortic occlusion (AO) is a potentially valuable tool for early resuscitation in patients nearing extremis or in arrest from severe hemorrhage. STUDY DESIGN: AAST AORTA registry identified trauma patients without penetrating thoracic injury undergoing AO at the level of the descending thoracic aorta (RT or Zone 1 REBOA) in the Emergency Department (ED). Survival outcomes relative to the timing of CPR need and admission hemodynamic status were examined...
February 5, 2018: Journal of the American College of Surgeons
S Grassin-Delyle, O M Theusinger, R Albrecht, S Mueller, D R Spahn, S Urien, P Stein
Tranexamic acid is used both pre-hospital and in-hospital as an antifibrinolytic drug to treat or prevent hyperfibrinolysis in trauma patients; dosing, however, remains empirical. We aimed to measure plasma levels of tranexamic acid in patients receiving pre-hospital anti-hyperfibrinolytic therapy and to build a population pharmacokinetic model to propose an optimised dosing regimen. Seventy-three trauma patients were enrolled and each received tranexamic acid 1 g intravenously pre-hospital. A blood sample was drawn after arrival in the emergency department, and we measured the plasma tranexamic acid concentration using liquid chromatography-mass spectrometry, and modelled the data using non-linear mixed effect modelling...
February 7, 2018: Anaesthesia
Lesley Armstrong, John Jackson, Andrew Riddick
BACKGROUND: Gustilo-Anderson grade 3B open ankle fracture-dislocations requiring stable fixation and soft tissue coverage are increasingly common in frail populations. METHODS: We identified all patients with open ankle fracture-dislocations treated with a tibiotalocalcaneal nail and soft tissue coverage over a five-year period. We retrospectively recorded pre-morbid status, fracture and soft tissue injury pattern, surgical details, post-operative mobility, length of hospital stay, complication and re-operation rate and survival...
April 13, 2017: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
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