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Trauma patient critical care

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https://www.readbyqxmd.com/read/28214722/when-high-pressure-system-constraints-and-a-social-justice-mission-collide-a-socio-structural-analysis-of-emergency-department-social-work-services
#1
Megan Moore, Margaret Cristofalo, Danae Dotolo, Nicole Torres, Alexandra Lahdya, Leyna Ho, Mia Vogel, Mollie Forrester, Bonnie Conley, Susan Fouts
The emergency department (ED) can be a critical intervention point for many patients with multifaceted needs. Social workers have long been part of interdisciplinary ED teams. This study aimed to contribute to the limited understanding of social worker-patient interactions and factors influencing social work services in this setting. This paper reports a qualitative content analysis of social work medical record notes (N = 1509) of services provided to trauma patients in an urban, public, level 1 trauma center and an in-depth analysis of semi-structured interviews with ED social workers (N = 10)...
February 11, 2017: Social Science & Medicine
https://www.readbyqxmd.com/read/28213888/transfusion-in-critical-care-a-uk-regional-audit-of-current-practice
#2
J O M Plumb, M G Taylor, E Clissold, M P W Grocott, R Gill
A consistent message within critical care publications has been that a restrictive transfusion strategy is non-inferior, and possibly superior, to a liberal strategy for stable, non-bleeding critically ill patients. Translation into clinical practice has, however, been slow. Here, we describe the degree of adherence to UK best practice guidelines in a regional network of nine intensive care units within Wessex. All transfusions given during a 2-month period were included (n = 444). Those given for active bleeding or within 24 h of major surgery, trauma or gastrointestinal bleeding were excluded (n = 148)...
February 18, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28208022/protein-requirements-for-critically-ill-patients-with-renal-and-liver-failure
#3
Jayshil J Patel, Craig J McClain, Menaka Sarav, Jill Hamilton-Reeves, Ryan T Hurt
Diseases leading to critical illness induce proteolysis resulting in muscle wasting and negative nitrogen balance. Muscle wasting has been associated with poor intensive care unit (ICU)-related outcomes, including an increased risk for mortality. Acute kidney injury (AKI) represents a common organ dysfunction associated with ICU-related disorders, such as sepsis, trauma, and respiratory failure. AKI and renal replacement therapy lead to amino acid loss. Decompensated liver cirrhosis (DLC) and acute liver failure (ALF) represent more severe forms of liver dysfunction leading to ICU admission...
February 1, 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28197049/zinc-supplementation-in-adult-mechanically-ventilated-trauma-patients-is-associated-with-decreased-occurrence-of-ventilator-associated-pneumonia-a-secondary-analysis-of-a-prospective-observational-study
#4
Farshad Hasanzadeh Kiabi, Abbas Alipour, Hadi Darvishi-Khezri, Aily Aliasgharian, Amir Emami Zeydi
BACKGROUND: Ventilator-associated pneumonia (VAP) is a type of lung infection that typically affects critically ill patients undergoing mechanical ventilation (MV) in the Intensive Care Unit (ICU). The aim of this analysis is to determine potential association between zinc supplementation with the occurrence of VAP in adult mechanically ventilated trauma patients. SUBJECTS AND METHODS: This secondary analysis of a prospective observational study was carried out over a period of 1 year in ICUs of one teaching hospital in Iran...
January 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28193322/geographic-distribution-of-trauma-burden-mortality-and-services-in-the-united-states-does-availability-correspond-to-patient-need
#5
Arturo J Rios-Diaz, David Metcalfe, Olubode A Olufajo, Cheryl K Zogg, Brian Yorkgitis, Mansher Singh, Adil H Haider, Ali Salim
BACKGROUND: The association between the need for trauma care and trauma services has not been characterized previously. We compared the distribution of trauma admissions with state-level availability of trauma centers (TCs), surgical critical care (SCC) providers, and SCC fellowships, and assessed the association between trauma care provision and state-level trauma mortality. STUDY DESIGN: We obtained 2013 state-level data on trauma admissions, TCs, SCC providers, SCC fellowship positions, per-capita income, population size, and age-adjusted mortality rates...
December 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28187816/multimodal-neurologic-monitoring
#6
G Korbakis, P M Vespa
Neurocritical care has two main objectives. Initially, the emphasis is on treatment of patients with acute damage to the central nervous system whether through infection, trauma, or hemorrhagic or ischemic stroke. Thereafter, attention shifts to the identification of secondary processes that may lead to further brain injury, including fever, seizures, and ischemia, among others. Multimodal monitoring is the concept of using various tools and data integration to understand brain physiology and guide therapeutic interventions to prevent secondary brain injury...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28187248/emergency-department-telemedicine-is-used-for-more-severely-injured-rural-trauma-patients-but-does-not-decrease-transfer-a-cohort-study
#7
Nicholas M Mohr, Karisa K Harland, Elizabeth A Chrischilles, Amanda Bell, Dan M Shane, Marcia M Ward
OBJECTIVES: Traumatic injury is a leading cause of death in the United States, and rural populations are at increased risk of injury and death. Rural residents have limited access to trauma care, and telemedicine has been proposed as one strategy to improve the provision of trauma care locally. The objective of this study was to describe patient-level factors associated with telemedicine consultation in North Dakota critical-access hospital (CAH) emergency departments (EDs) and to measure the association between telemedicine consultation and interhospital transfer...
February 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28187026/an-algorithmic-approach-to-the-suspected-septic-wrist
#8
Jeffrey R Claiborne, Leslie G Branch, Michael Reynolds, Anthony J Defranzo
An acutely painful, erythematous wrist can be due to a variety of pathologic processes, including crystalline arthropathy, infection, trauma, osteoarthritis, and systemic disease. The broad differential diagnosis of the inflamed wrist and nonspecific clinical findings make accurate diagnosis challenging. There is no published clinical or laboratory criterion that reliably differentiates septic wrist arthritis from a sterile inflammatory arthropathy. For septic joint patients, long-term results are notably poorer in patients with a delay in treatment, therefore establishing evidenced-based guidelines deserves attention...
February 10, 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28185977/the-central-role-of-relationships-to-trauma-informed-integrated-care-for-children-and-youth
#9
Jonathan D Brown, Melissa A King, Lawrence S Wissow
OBJECTIVE: Primary care plays an essential role in the primary and secondary prevention of children's mental health problems. A growing series of trials have demonstrated the capacity of primary care providers to deliver care that specifically addresses risks to healthy social and emotional development by incorporating mental health services into their routines and integrating their work with the mental health care system. This paper describes elements common to various integration schemes that seem essential to their success...
February 6, 2017: Academic Pediatrics
https://www.readbyqxmd.com/read/28183742/preventable-injury-deaths-identifying-opportunities-to-improve-timeliness-and-reach-of-emergency-healthcare-services-in-new-zealand
#10
Rebbecca Lilley, Bridget Kool, Gabrielle Davie, Brandon de Graaf, Shanthi N Ameratunga, Pararangi Reid, Ian Civil, Bridget Dicker, Charles C Branas
BACKGROUND: Traumatic injury is a leading cause of premature death and health loss in New Zealand. Outcomes following injury are very time sensitive, and timely access of critically injured patients to advanced hospital trauma care services can improve injury survival. OBJECTIVE: This cross-sectional study will investigate the epidemiology and geographic location of prehospital fatal injury deaths in relation to access to prehospital emergency services for the first time in New Zealand...
February 9, 2017: Injury Prevention: Journal of the International Society for Child and Adolescent Injury Prevention
https://www.readbyqxmd.com/read/28164614/using-circulating-mirnas-as-biomarkers-for-the-evaluation-and-monitoring-of-the-mitochondrial-damage-in-the-critically-ill-polytrauma-patients
#11
REVIEW
Ovidiu H Bedreag, Marius Papurica, Alexandru F Rogobete, Dorel Sandesc, Raluca Dumache, Carmen A Cradigati, Mirela Sarandan, Lavinia M Bratu, Sonia E Popovici, Laurentiu V Sima
BACKGROUND: The multiple-traumatic critical patient presents a variety of pathophysiological, cellular, and molecular dysfunctions. One of the most important is represented by mitochondrial damage which afterwards is responsible for the augmentation and worsening of a series of pathologies that lead to the worsening of the clinical status of the patient. The severe inflammatory response, sepsis, and the redox imbalance are other pathologies that together with the multiple traumas are responsible for the mitochondrial dysfunctions...
August 1, 2016: Clinical Laboratory
https://www.readbyqxmd.com/read/28163912/the-benefits-of-youth-are-lost-on-the-young-cardiac-arrest-patient
#12
REVIEW
Brian Griffith, Patrick Kochanek, Cameron Dezfulian
Children and young adults tend to have reduced mortality and disability after acquired brain injuries such as trauma or stroke and across other disease processes seen in critical care medicine. However, after out-of-hospital cardiac arrest (OHCA), outcomes are remarkably similar across age groups. The consistent lack of witnessed arrests and a high incidence of asphyxial or respiratory etiology arrests among pediatric and young adult patients with OHCA account for a substantial portion of the difference in outcomes...
2017: F1000Research
https://www.readbyqxmd.com/read/28153385/video-review-as-a-tool-to-improve-orthopedic-residents-performance-of-closed-manipulative-reductions
#13
Nickul S Jain, Ran Schwarzkopf, John A Scolaro
OBJECTIVE: Orthopedic residents commonly perform closed manipulative reductions as a part of their training. Traditionally, this skill is taught early in training but difficult to simulate. Proficiency is achieved through repetition and experience; faculty observation and instruction is unfortunately often limited. Direct resident teaching has been shown to increase competency, comfort, and long-term skill retention. We hypothesize that video review of closed fracture reductions will provide an inexpensive and valuable tool for resident education and improve skill performance...
January 30, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28151802/erythropoietin-to-reduce-mortality-in-traumatic-brain-injury-a-post-hoc-dose-effect-analysis
#14
Dashiell C Gantner, Michael Bailey, Jeffrey Presneill, Craig J French, Alistair Nichol, Lorraine Little, Rinaldo Bellomo
OBJECTIVE: We aimed to assess whether the dosing regimen of erythropoietin shows a relationship to mortality in critically ill patients with traumatic brain injury (TBI). BACKGROUND: Erythropoietin may decrease mortality in patients with TBI; however, the optimal dosing regimen remains uncertain. METHODS: We conducted a post-hoc analysis of a multicenter, randomized trial of weekly erythropoietin versus placebo in patients with moderate and severe TBI admitted to intensive care...
February 1, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28148274/severity-dependent-differences-in-early-management-of-thoracic-trauma-in-severely-injured-patients%C3%A2-analysis-based-on-the-traumaregister-dgu%C3%A2
#15
J Bayer, R Lefering, S Reinhardt, J Kühle, N P Südkamp, T Hammer
BACKGROUND: Major trauma is associated with chest injuries in nearly 50% of multiple injuries. Thoracic trauma is a relevant source of comorbidity throughout the period of multiply-injured patient care and may require swift and well-thought-out interventions in order to avert a deleterious outcome. In this epidemiological study we seek to characterize groups of different thoracic trauma severity in severely injured patients and identify related differences in prehospital and early clinical management...
February 2, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28135807/special-population-child-and-adolescent-psychotherapy
#16
George Halasz
OBJECTIVES: First, to outline the paradigm change of the past 20 years that has transformed the theory and practice of child and adolescent psychodynamic psychotherapy; second, to update aspects of the current Practice Parameters for Psychodynamic Psychotherapy with Children to align with the paradigm change driven by the principles of regulation theory, relational trauma and repair, and the critical need for clinicians' self-care in trauma informed psychotherapy. CONCLUSION: The emerging neuroscience-driven paradigm of psychotherapy poses challenges for the child and adolescent psychotherapist: to embrace the new conceptual reference points as organising principles leads to an urgent need to rethink traditional diagnostic formulations and time-honoured techniques for intervention...
January 1, 2017: Australasian Psychiatry: Bulletin of Royal Australian and New Zealand College of Psychiatrists
https://www.readbyqxmd.com/read/28129265/parenteral-and-enteral-nutrition-in-surgical-critical-care-plasma-metabolomics-demonstrates-divergent-effects-on-nitrogen-fatty-acid-ribonucleotide-and-oxidative-metabolism
#17
Brodie A Parent, Max Seaton, Danijel Djukovic, Haiwei Gu, Brittany Wheelock, Daniel Raftery, Grant E O'Keefe
BACKGROUND: Artificial nutrition support is central to the care of critically ill patients and is primarily provided enterally (EN). There are circumstances when parenteral nutrition (PN) is considered necessary. We are uncertain how each of these approaches confer clinical benefits beyond simply providing calories. We sought to better understand how each of these techniques influence metabolism in critically-ill patients using a broad-based metabolomics approach. Metabolic responses to EN and PN may differ in ways that could help us understand how to optimize use of these therapies...
January 26, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28126035/an-unusual-presentation-of-a-stroke-in-a-developing-country-a-case-report
#18
N D B Ehelepola, T I D M Ranasinghe, B Prashanthi, H M P A G S Bandara
BACKGROUND: Patients often, but not always, present with features that allow easy differentiation between traumatic brain injury and a stroke. Early diagnosis and appropriate treatment are crucial for a good outcome in both. Millions of people worldwide climb coconut and other trees without any protective gear. We present a case of a coconut tree climber found unconscious after a fall, initially misdiagnosed as a traumatic brain injury but later proven to be a hemorrhagic stroke. We discuss how to prevent such incidents and why that deserves more attention...
January 26, 2017: BMC Research Notes
https://www.readbyqxmd.com/read/28122682/fibrinogen-level-on-admission-is-a-predictor-for-massive-transfusion-in-patients-with-severe-blunt-trauma-analyses-of-a-retrospective-multicentre-observational-study
#19
Yoshihiko Nakamura, Hiroyasu Ishikura, Shigeki Kushimoto, Fumiaki Kiyomi, Hiroshi Kato, Junichi Sasaki, Hiroshi Ogura, Tetsuya Matsuoka, Toshifumi Uejima, Naoto Morimura, Mineji Hayakawa, Akiyoshi Hagiwara, Munekazu Takeda, Naoyuki Kaneko, Daizoh Saitoh, Daisuke Kudo, Kunihiko Maekawa, Takashi Kanemura, Takayuki Shibusawa, Yasushi Hagihara, Shintaro Furugori, Atsushi Shiraishi, Kiyoshi Murata, Gou Mayama, Arino Yaguchi, Shiei Kim, Osamu Takasu, Kazutaka Nishiyama
INTRODUCTION: In the early phase of trauma, fibrinogen (Fbg) plays an important role in clot formation. However, to the best of our knowledge, few studies have analysed methods of predicting the need for massive transfusion (MT) based on Fbg levels using multiple logistic regression. Therefore, the present study aimed to evaluate whether Fbg levels on admission can be used to predict the need for MT in patients with trauma. METHODS: We conducted a retrospective multicentre observational study...
January 16, 2017: Injury
https://www.readbyqxmd.com/read/28116225/hyperbaric-oxygen-therapy-for-the-compromised-graft-or-flap
#20
REVIEW
Ashish Francis, Richard C Baynosa
Significance: Tissue grafts and flaps are used to reconstruct wounds from trauma, chronic disease, tumor extirpation, burns, and infection. Despite careful surgical planning and execution, reconstructive failure can occur due to poor wound beds, radiation, random flap necrosis, vascular insufficiency, or ischemia-reperfusion (IR). Traumatic avulsions and amputated composite tissues-compromised tissue-may fail from crush injury and excessively large sizes. While never intended, these complications result in tissue loss, additional surgery, accrued costs, and negative psychosocial patient effects...
January 1, 2017: Advances in Wound Care
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