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severe trauma

Edda Sveinsdottir, Helga Gottfredsdottir, Anna S Vernhardsdottir, Gudny B Tryggvadottir, Reynir T Geirsson
BACKGROUND: Obstetric anal sphincter injuries lead frequently to short- and long-term consequences for the mother, including perineal pain, genital prolapse, and sexual problems. The aim of the study was to evaluate whether the implementation of an intervention program in the second stage of labor involving altered perineal support techniques reduced severe perineal trauma. METHODS: All women reaching the second stage of labor and giving birth vaginally to singleton babies at Landspítali University Hospital (comprising 76% of births in Iceland in 2013) were enrolled in a cohort study...
November 16, 2018: Birth
Julian D Ford
Trauma memory processing (TMP) is an empirically supported approach to psychotherapy for posttraumatic stress disorder (PTSD). However, TMP is not a single, uniform intervention but instead a paradigm that can be operationalized through a variety of component procedures that have not been systematically elucidated and formally tested. Based on findings from phenomenological/structural and neuroimaging research, a central feature of PTSD is theorized to be the involuntary immersion in trauma memories with diminished awareness or negative appraisals of self and current context...
November 16, 2018: Journal of Traumatic Stress
Mari A Griffioen, Melissa L Ziegler, Robert V O'Toole, Susan G Dorsey, Cynthia L Renn
BACKGROUND: Effective acute pain management following injury is critical to improve short-and long-term patient outcomes. Analgesics can effectively reduce pain intensity, yet half of injury patients report moderate to severe pain during hospitalization. PURPOSE: The primary aim of this study was to identify the analgesic, different analgesic combinations, or analgesic and adjuvant analgesic combination that generated the largest percent change from pre- to post-analgesic pain score...
November 12, 2018: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
Yohei Hirano, Toshikazu Abe, Hiroshi Tanaka
PURPOSE: The beneficial effect of the presence of an emergency physician in prehospital major trauma care is controversial. The aim in this study is to assess whether an emergency physician on scene can improve survival outcome of critical trauma patients. METHODS: This retrospective cohort study was conducted by using nationwide trauma registry data between 2004 and 2013 in Japan. Severe trauma patients (injury severity score (ISS) ≥ 16) who were transported directly to the hospital from the injury site were included in our analysis...
November 9, 2018: American Journal of Emergency Medicine
Christopher David Jones, Weiguang Ho, Eilidh Gunn, Daniel Widdowson, Hilal Bahia
INTRODUCTION: Electronic cigarettes (EC) have been reported to be associated with burns secondary to explosions of the device or battery, or contact from overheating, resulting in flame, contact or chemical burns. In addition to this, there have also been reported cases of soft tissue and bony trauma with or without associated burns. Using collective evidence, this review aims to summarise all reported burns associated with ECs, and its implications on immediate management with a particular focus on surgical treatment...
November 12, 2018: Burns: Journal of the International Society for Burn Injuries
Carlo Giussani, Lelio Guida, Francesco Canonico, Erik P Sganzerla
BACKGROUND: Neurosurgical features of mucopolysaccharidosis (MPS) patients mainly involve the presence of cranio-vertebral junction (CVJ) abnormalities and the development of communicating hydrocephalus. CVJ pathology is a critical aspect that severely influences the morbidity and mortality of MPS patients. Hydrocephalus is slowly progressing; it must be differentiated from cerebral atrophy, and rarely requires treatment. The aim of this paper was to review the literature concerning these conditions, highlighting their clinical, radiological, and surgical aspects to provide a practical point of view for clinicians...
November 16, 2018: Italian Journal of Pediatrics
Reza M Amanipour, Xiaoxia Zhu, Guillaume Duvey, Sylvain Celanire, Joseph P Walton, Robert D Frisina
Acoustic trauma can induce temporary or permanent noise-induced hearing loss (NIHL). Noise exposed animal models allow us to study the effects of various noise trauma insults on the cochlea and auditory pathways. Here we studied the short-term and long-term functional changes occurring in the auditory system following exposure to two different noise traumas. Several measures of hearing function known to change following noise exposure were examined: Temporary (TTS) and permanent (PTS) threshold shifts were measured using auditory brainstem responses (ABR), outer hair cell function was examined using distortion product otoacoustic emissions (DPOAEs), and auditory temporal processing was assessed using a gap-in-noise (GIN) ABR paradigm...
July 2018: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
W Y Zhang, W Y Wang
As a newly developed technique for hemodynamic monitoring, pulse contour cardiac output (PiCCO) monitoring takes great advantages in guiding shock resuscitation and fluid administration. PiCCO has been used more and more in burn patients in recent years, however there is no clinic consensus on how to apply PiCCO monitoring, understand the significance of PiCCO monitored parameters, and guide the treatment using PiCCO monitored parameters in patients with severe burns. Based on the current literatures and the experts' clinical experience, national experts consensus on application of pulse contour cardiac output monitoring technique in severe burn treatment (2018 version ) is now issued by the Burn and Trauma Branch of Chinese Geriatrics Society, aiming to provide practical guidance for its usage in clinic...
November 9, 2018: Zhonghua Shao Shang za Zhi, Zhonghua Shaoshang Zazhi, Chinese Journal of Burns
Loren K Liebrecht, Jason Newton, Erika J Martin, Nina Wickramaratne, Sudha Jayaraman, Jinfeng Han, Michel Aboutanos, Donald F Brophy, Martin J Mangino
BACKGROUND: Low volume resuscitation (LVR) in shock prevents deleterious effects of crystalloid loading in pre-hospital settings. Polyethylene glycol 20,000 (PEG-20k) based LVR solutions are 20-fold more effective at maintaining perfusion and survival in shock compared to conventional crystalloids. The aim of this study was to determine coagulation and platelet function of whole blood treated with 10% PEG-20k. METHODS: Citrated blood from volunteers (n = 25) or early admission severely injured trauma patients (n = 9) were diluted 10% with various LVR solutions in a matched design with a paired volume control (saline), and studied using thromboelastography (TEG)...
2018: PloS One
Xingjie Li, Jing Yu, Wenjuan Huang, Qi Huang, Jun Yan, Huaping Liang, Yu Sun
OBJECTIVE: To investigate the risk factors of acute respiratory distress syndrome (ARDS) occurrence in intensive care unit (ICU) traumatic patients. METHODS: Clinical data of traumatic patients in ICU of the People's Hospital of Liangping in Chongqing from January 1st, 2012 to June 30th, 2018 were retrospectively analyzed. According to the outcomes, the patients were divided into ARDS group and non-ARDS group. The differences of demographic indexes (gender, age), time of admission, type of injury, atrial fibrillation, trachea cannula, multiple injury, open injury, shock, surgery, blood transfusion, central venous indwelling catheter, infection, and blood routine indexes [white blood cell count (WBC), red blood cell count (RBC), platelet count (PLT), plateletcytocrit (PCT), hematocrit (Hct)], biochemical indexes [total bilirubin (TBil), albumin (Alb), serum creatinine (SCr), blood sodium, blood calcium, blood potassium, blood glucose], arterial blood gas analysis indexes [partial pressure of carbon dioxide (PaCO2 ), partial pressure of oxygen (PaO2 ), oxygenation index (PaO2 /FiO2 ), blood pH], coagulation indicators [activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), international normalized ratio (INR), fibrinogen (Fib)], injury severity score (ISS), new injury severity score (NISS), acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), Glasgow coma scale (GCS) within 24 hours of admission, and the length of ICU stay between the two groups were analyzed, and the possible influencing factors were screened out...
October 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Yuanyuan Xu, Danqun Jin, Wenjia Tong, Yuanyuan Duan
OBJECTIVE: To analyze the etiology and prognosis of children with thrombocytopenia (TP) in pediatric intensive care unit (PICU). METHODS: The data of children with TP (exclusion of congenital and unknown TP) admitted to PICU of Anhui Provincial Children's Hospital from January 2008 to December 2017 was analyzed retrospectively. According to the age of onset, the children were divided into infantile group (29 days to less than 1 year), early childhood group (1 to less than 3 years), preschool group (3 to less than 6 years), school age group (6 to less than 10 years) and puberty group (more than 10 years)...
October 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Michael Caspers, Marc Maegele, Matthias Fröhlich
Despite advances in the treatment of severely injured patients that have resulted in overall improved outcomes, uncontrolled hemorrhage still represents the most common cause of preventable death following major injury. While addressing both endo- and exogenous factors that lead to an acute trauma-induced coagulopathy, massive transfusion plays a key role in managing bleeding trauma patients. However, the best practice for hemostatic control including massive transfusion in these patients is still under debate...
November 15, 2018: Expert Review of Hematology
Pin-Han Wang, Kuan-Ting Liu, Yen-Hung Wu, I-Jeng Yeh
RATIONALE: Thyrotoxic periodic paralysis is characterized by a sudden onset of hypokalemia and paralysis. This condition mainly affects the lower extremities and is secondary to thyrotoxicosis. The underlying hyperthyroidism is often subtle without typical symptoms such as palpitations, tremors, anxiety, and weight loss; this causes a difficulty in early diagnosis. Here, we reported a case of periodic paralysis in a patient with hyperthyroidism whose potassium level was within the normal range...
November 2018: Medicine (Baltimore)
Lisa H Jaycox, Lynsay Ayer, Pamela Vona, Chris Hehman, Bradley D Stein, Ammarah Mahmud, Melissa Woolley, Erika Meza, Elizabeth Thornton, Brinda Venkatesh
Implementation issues often interfere with delivery of evidence-based interventions for students exposed to trauma. To improve uptake of evidence-based techniques for such students, a partnership of interventionist scientists, research and development experts, and students created a self-paced, confidential, online curriculum. This article describes the program and results of an open trial in 5 schools that serve primarily ethnic minority youth in urban settings. Fifty-one middle and high school students completed surveys before and after the program, as well as within the program, to assess emotional and behavioral symptoms (depressive, anxiety, posttraumatic stress disorder [PTSD] symptoms and behavior) and purported mechanisms of action (coping, cognitions, emotional self-efficacy)...
November 15, 2018: Psychological Services
Nurit Dagon, Sigalit Blumer, Benjamin Peretz, Tal Ratson
OBJECTIVES: The Special Olympics Special Smiles (SOSS) Program provides oral health screening and data collection for athletes with intellectual disabilities who participate in Special Olympics events. AIM: This study evaluated the prevalence and severity of dental trauma among Special Olympics athletes with intellectual disabilities who participated in the 2016 Israeli Special Olympics games. METHODS: A free voluntary dental examination was offered to all participating athletes...
November 15, 2018: Special Care in Dentistry
Melissa A Smigelsky, Jesse D Malott, Katherine Veazey Morris, Kristoffer S Berlin, Robert A Neimeyer
OBJECTIVES: Theoretical support for the moral injury (MI) construct is mounting, yet empirical support has lagged behind. A conceptual model has been proposed, but studies have not yet explored the constellation of symptoms within treatment-seeking Veterans. METHODS: Veterans (N = 212) seeking trauma recovery services completed measures of potential MI symptoms that functioned as indicators in person-centered Latent Profile Analysis. Differences in exposure to potentially morally injurious experiences (pMIEs) were compared across profiles using logistic regression...
November 15, 2018: Journal of Clinical Psychology
Chee Foong Chong, Charles Nj McGhee, Shuan H Dai
IMPORTANCE: This is the first national study on childhood visual impairment in a developed nation, New Zealand; describing prevalence, aetiology and preventable causes of low vision and blindness in children. BACKGROUND: Causes of childhood blindness varies between regions. This study aimed to present region-specific data on epidemiology of childhood blindness affecting a developed nation, New Zealand. DESIGN: Retrospective data analysis PARTICIPANTS: All children enrolled with the Blind and Low Vision Education Network (BLENNZ) with best corrected visual acuity =<6/18, or binocular visual field <10 degrees...
November 14, 2018: Clinical & Experimental Ophthalmology
Michael M Neeki, Fanglong Dong, Jake Toy, Reza Vaezazizi, Joe Powell, David Wong, Michael Mousselli, Massoud Rabiei, Alex Jabourian, Nichole Niknafs, Michelle Burgett-Moreno, Richard Vara, Shanna Kissel, Xian Luo-Owen, Karen R O'Bosky, Daniel Ludi, Karl Sporer, Troy Pennington, Tommy Lee, Rodney Borger, Eugene Kwong
Introduction: Hemorrhage is one of the leading causes of death in trauma victims. Historically, paramedics have not had access to medications that specifically target the reversal of trauma-induced coagulopathies. The California Prehospital Antifibrinolytic Therapy (Cal-PAT) study seeks to evaluate the safety and efficacy of tranexamic acid (TXA) use in the civilian prehospital setting in cases of traumatic hemorrhagic shock. Methods: The Cal-PAT study is a multi-centered, prospective, observational cohort study with a retrospective comparison...
November 2018: Western Journal of Emergency Medicine
Irma T Ugalde, Mary K Claiborne, Marylou Cardenas-Turanzas, Manish N Shah, James R Langabeer, Rajan Patel
Introduction: Computed tomography angiography (CTA) is used to screen patients for cerebrovascular injury after blunt trauma, but risk factors are not clearly defined in children. This modality has inherent radiation exposure. We set out to better delineate the risk factors associated with blunt cervical vascular injury (BCVI) in children with attention to the predictive value of seatbelt sign of the neck. Methods: We collected demographic, clinical and radiographic data from the electronic medical record and a trauma registry for patients less than age 18 years who underwent CTA of the neck in their evaluation at a Level I trauma center from November 2002 to December 2014 (12 years)...
November 2018: Western Journal of Emergency Medicine
Kapil Dev Soni, Gaurav Kaushik, Amit Gupta, Vishwajeet Singh, Subodh Kumar, Sushma Sagar
Introduction: Emergency department (ED) overcrowding with critically ill trauma patients has been a major concern globally. It has been shown that longer stays in the hospital before Intensive Care Unit (ICU) admission have a higher mortality rate. Objective: The objective of this study was to find whether the delay in ICU admission from ED is associated with significant mortality in a trauma patient. Methods: A prospective trauma registry data of 232 patients collected from the ED of JPNATC trauma center between September 2015 and March 2016 were used in the study...
July 2018: Journal of Emergencies, Trauma, and Shock
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