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https://www.readbyqxmd.com/read/29441170/management-of-traumatic-brain-injury-patients
#1
REVIEW
Hari Hara Dash, Siddharth Chavali
Traumatic brain injury (TBI) has been called the 'silent epidemic' of modern times, and is the leading cause of mortality and morbidity in children and young adults in both developed and developing nations worldwide. In recent years, the treatment of TBI has undergone a paradigm shift. The management of severe TBI is ideally based on protocol-based guidelines provided by the Brain Trauma Foundation. The aims and objectives of its management are prophylaxis and prompt management of intracranial hypertension and secondary brain injury, maintenance of cerebral perfusion pressure, and ensuring adequate oxygen delivery to injured brain tissue...
February 2018: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/29441123/circulation-first-the-time-has-come-to-question-the-sequencing-of-care-in-the-abcs-of-trauma-an-american-association-for-the-surgery-of-trauma-multicenter-trial
#2
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
https://www.readbyqxmd.com/read/29440320/left-of-bang-interventions-in-trauma-some-legal-implications-of-military-medical-prophylaxis
#3
Rain Liivoja
In the context of military medical care, Eisenstein and colleagues have introduced the notion 'left of bang intervention in trauma', which refers to interventions administered before trauma to reduce morbidity and mortality after injury. This paper responds to Eisenstein and colleagues' ethical analysis of such interventions, highlighting the difficulty in distinguishing between purely prophylactic and enhancing interventions. This response also addresses legal issues that arise from left of bang interventions under human rights law and the law of armed conflict, in particular the questions as to whether the consent of service members would need to be obtained and whether the adversary would as a consequence be authorised to resort to more injurious weapons...
February 13, 2018: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29440235/do-patients-with-blunt-thoracic-aortic-injury-present-to-hospital-with-unstable-vital-signs-a-systematic-review-and-meta-analysis
#4
Jordan Bade-Boon, Joseph K Mathew, Mark C Fitzgerald, Biswadev Mitra
BACKGROUND: Blunt thoracic aortic injury (BTAI) is an uncommon diagnosis, usually developing as a consequence of high-impact acceleration-deceleration mechanisms. Timely diagnosis may enable early resuscitation and reduction of shear forces, essential to prevent worsening of the injury prior to definitive management. Death is commonly due to haemorrhagic shock, but clinical features may be absent until sudden and massive haemorrhage. OBJECTIVES: The aim of this systematic review was to determine the proportion of patients with BTAI who present with unstable vital signs...
February 9, 2018: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29439891/resuscitative-endovascular-balloon-occlusion-of-the-aorta-using-a-low-profile-device-is-easy-and-safe-for-emergency-physicians-in-cases-of-life-threatening-hemorrhage
#5
Takahiro Shoji, Takehiko Tarui, Takashi Igarashi, Yuki Mochida, Hiroyuki Morinaga, Yasuhiko Miyakuni, Yoshitaka Inoue, Yasuhiko Kaita, Hiroshi Miyauchi, Yoshihiro Yamaguchi
BACKGROUND: Bleeding from hemorrhagic shock can be immediately controlled by blocking the proximal part of the hemorrhagic point using either resuscitative thoracotomy for aortic cross-clamping or insertion of a large-caliber (10-14Fr) resuscitative endovascular balloon occlusion of the aorta (REBOA) device via the femoral artery. However, such methods are very invasive and have various complications. With recent progress in endovascular treatment, a low-profile REBOA device (7Fr) has been developed...
February 10, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29439071/ten-year-inhospital-mortality-trends-for-patients-with-trauma-in-japan-a-multicentre-observational-study
#6
Isao Nagata, Toshikazu Abe, Masatoshi Uchida, Daizoh Saitoh, Nanako Tamiya
OBJECTIVES: Trauma is one of the main causes of death in Japan, and treatments and prognoses of these injuries are constantly changing. We therefore aimed to investigate a 10-year trend (2004-2013) in inhospital mortality among patients with trauma in Japan. DESIGN: Multicentre observational study. SETTING: Japanese nationwide trauma registry (the Japan Trauma Data Bank) data. PARTICIPANTS: All patients with trauma whose Injury Severity Score (ISS) were 3 and above, who were aged 15 years or older, and whose mechanisms of injury (MOI) were blunt and penetrating between 2004 and 2013 (n=90 833)...
February 8, 2018: BMJ Open
https://www.readbyqxmd.com/read/29438587/managing-penetrating-renal-trauma-experience-from-two-uk-major-trauma-centres
#7
Marios Hadjipavlou, Edmund Grouse, Robert Gray, Denosshan Sri, Dean Huang, Christian Brown, Davendra Sharma
OBJECTIVES: To present our series of patients with penetrating renal trauma from two urban major trauma centres and discuss contemporary management of these injuries. METHODS: We reviewed prospective urological trauma databases for all patients presenting with penetrating renal trauma between January 2005 and October 2016. Patient demographics, clinical characteristics, imaging, management and follow-up data were analysed. RESULTS: Over the 11 year period, 63 patients presented with penetrating renal injuries...
February 13, 2018: BJU International
https://www.readbyqxmd.com/read/29437746/from-renal-salt-wasting-to-siadh
#8
Tzy Harn Chua, Matin Ly, Senthil Thillainadesan, Katie Wynne
Hyponatraemia is common following major head injury and is associated with significant morbidity and mortality. A 20-year-old man presented with reduced consciousness after head trauma and was found to have a fractured skull base with bilateral frontal contusions. On day 3 of his admission, he developed hyponatraemia with raised urine sodium and osmolality, despite receiving dexamethasone and intravenous fluid therapy. His hyponatraemia worsened after the treatment with fluid restriction and oral salt. He was in negative fluid balance suggesting possible renal salt wasting...
February 5, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29437639/soluble-gpvi-is-elevated-in-injured-patients-shedding-is-mediated-by-fibrin-activation-of-gpvi
#9
Samantha J Montague, Céline Delierneux, Christelle Lecut, Nathalie Layios, Robert J Dinsdale, Christine S-M Lee, Natalie S Poulter, Robert K Andrews, Peter Hampson, Christopher M Wearn, Nathalie Maes, Jonathan Bishop, Amy Bamford, Chris Gardiner, Woei Ming Lee, Tariq Iqbal, Naiem Moiemen, Steve P Watson, Cécile Oury, Paul Harrison, Elizabeth E Gardiner
Soluble glycoprotein VI (sGPVI) is shed from the platelet surface and is a marker of platelet activation in thrombotic conditions. We assessed sGPVI levels together with patient and clinical parameters in acute and chronic inflammatory conditions, including patients with thermal injury and inflammatory bowel disease and patients admitted to the intensive care unit (ICU) for elective cardiac surgery, trauma, acute brain injury, or prolonged ventilation. Plasma sGPVI was measured by enzyme-linked immunosorbent assay and was elevated on day 14 after thermal injury, and was higher in patients who developed sepsis...
February 13, 2018: Blood Advances
https://www.readbyqxmd.com/read/29437067/the-impact-of-external-fixation-on-mortality-in-patients-with-an-unstable-pelvic-ring-fracture-a-propensity-matched-cohort-study
#10
T Ohmori, T Kitamura, T Nishida, T Matsumoto, T Tokioka
AIM: There is not adequate evidence to establish whether external fixation (EF) of pelvic fractures leads to a reduced mortality. We used the Japan Trauma Data Bank database to identify isolated unstable pelvic ring fractures to exclude the possibility of blood loss from other injuries, and analyzed the effectiveness of EF on mortality in this group of patients. PATIENTS AND METHODS: This was a registry-based comparison of 1163 patients who had been treated for an isolated unstable pelvic ring fracture with (386 patients) or without (777 patients) EF...
February 2018: Bone & Joint Journal
https://www.readbyqxmd.com/read/29435313/comparison-of-the-efficacy-of-intravenous-tranexamic-acid-with-and-without-topical-administration-versus-placebo-in-urgent-endoscopy-rate-for-acute-gastrointestinal-bleeding-a-double-blind-randomized-controlled-trial
#11
Nader Tavakoli, Marjan Mokhtare, Shahram Agah, Ali Azizi, Mohsen Masoodi, Hassan Amiri, Mehrdad Sheikhvatan, Bahare Syedsalehi, Behdad Behnam, Mehran Arabahmadi, Maryam Mehrazi
Background: Tranexamic acid (TXA), a synthetic antifibrinolytic drug, is effective as a treatment for serious hemorrhage, including bleeding arising from major trauma and post-operative interventions. Significant acute gastrointestinal bleeding may have a poor outcome despite routine medical and endoscopic treatments. The aim of this study was to assess whether early intravenous and/or intravenous plus topical administration of TXA reduces the need for urgent endoscopy for acute gastrointestinal bleeding...
February 2018: United European Gastroenterology Journal
https://www.readbyqxmd.com/read/29433888/trauma-registry-implementation-in-low-and-middle-income-countries-challenges-and-opportunities
#12
REVIEW
Krishna Bommakanti, Isabelle Feldhaus, Girish Motwani, Rochelle A Dicker, Catherine Juillard
BACKGROUND: Trauma registries are an essential part of trauma quality improvement programs aimed at decreasing morbidity and mortality in high-income countries. In low- and middle-income countries (LMICs), where the burden of injury is disproportionately high, hospitals have faced challenges in adapting trauma registry models implemented in high-income countries. We analyze the barriers to trauma registry implementation in LMICs to inform development of sustainable models in resource-constrained settings...
March 2018: Journal of Surgical Research
https://www.readbyqxmd.com/read/29433366/mode-of-birth-in-twins-data-and-reflections
#13
A Reitter, B A Daviss, M J Krimphove, K C Johnson, R Schlößer, F Louwen, A Bisits
Our primary objective was to compare neonatal and maternal outcomes in women with twin pregnancies, beyond 32 weeks, having a planned vaginal birth or a planned caesarean section (CS). This was a retrospective cohort study from a single tertiary centre over nine years. 534 sets of twins ≥32 + 0 weeks of gestation were included. 401 sets were planned vaginally and 133 sets were planned by CS. We compared a composite adverse perinatal outcome (perinatal mortality or serious neonatal morbidity; five minute APGAR score ≤4, neurological abnormality and need for intubation) and a composite maternal adverse outcome (major haemorrhage, trauma or infection) between the groups...
February 12, 2018: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/29433342/promoting-resilience-breaking-the-intergenerational-cycle-of-adverse-childhood-experiences
#14
Briana A Woods-Jaeger, Bridget Cho, Chris C Sexton, Lauren Slagel, Kathy Goggin
Adverse childhood experiences (ACEs), including trauma exposure, parent mental health problems, and family dysfunction, put children at risk for disrupted brain development and increased risk for later health problems and mortality. These negative effects may be prevented by resilience promoting environments that include protective caregiving relationships. We sought to understand (1) parents' experiences of ACEs, (2) the perceived impact on parenting, (3) protective factors that buffer ACEs potential negative impact, and (4) supports and services that can reduce the number and severity of ACEs and promote resilience among children exposed to early adversity...
February 1, 2018: Health Education & Behavior: the Official Publication of the Society for Public Health Education
https://www.readbyqxmd.com/read/29432563/traumatic-injury-induces-stress-granule-formation-and-enhances-motor-dysfunctions-in-als-ftd-models
#15
Eric N Anderson, Lauren Gochenaur, Aditi Singh, Rogan Grant, Krishani Patel, Simon Watkins, Jane Y Wu, Udai Bhan Pandey
Traumatic brain injury (TBI) has been predicted to be a predisposing factor for Amyotrophic lateral sclerosis (ALS) and other neurological disorders. Despite the importance of TBI in ALS progression, the underlying cellular and molecular mechanisms are still an enigma. Here, we examined the contribution of TBI as an extrinsic factor and investigated if TBI influences the susceptibility of developing neurodegenerative symptoms. To evaluate the effects of TBI in vivo, we applied mild to severe trauma to Drosophila and found that TBI leads to the induction of stress granules (SGs) in the brain...
February 8, 2018: Human Molecular Genetics
https://www.readbyqxmd.com/read/29432381/systematic-review-of-prehospital-tourniquet-use-in-civilian-limb-trauma
#16
David S Kauvar, Michael A Dubick, Thomas J Walters, John F Kragh
BACKGROUND: Military enthusiasm for limb tourniquet use in combat casualty care has resulted in acceptance by the trauma community for use in the prehospital care of civilian limb injuries. To date there has been no report synthesizing the published data on civilian tourniquet use. The objective of this systematic review was to compile and analyze the content and quality of published data on the civilian use of tourniquets in limb trauma. METHODS: The MEDLINE database was searched for studies on civilian limb tourniquet use in adults published between 2001 and 2017...
February 9, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29431496/penetrating-neck-injuries
#17
A M Khan, J C Fleming, J P Jeannon
Penetrating neck injuries are becoming more common because of the increasing prevalence of knife and gun crimes. The immediate and long-term consequences of injury to the neck can be significant because of the close relationship of important anatomical structures in a confined space. Delayed recognition of major injury and inadequate treatment results in high morbidity and mortality. Developing a clear understanding of the underlying anatomy, common mechanisms of injury and principles of management will provide first responders, emergency doctors and trauma surgeons with confidence in appropriate evidence-based management...
February 2, 2018: British Journal of Hospital Medicine
https://www.readbyqxmd.com/read/29431096/introduction-of-pediatric-physiological-and-anatomical-triage-score-in-mass-casualty-incident
#18
Chiaki Toida, Takashi Muguruma, Takeru Abe, Mafumi Shinohara, Masayasu Gakumazawa, Naoki Yogo, Aya Shirasawa, Naoto Morimura
BACKGROUND: Triage has an important role in providing suitable care to the largest number of casualties in a disaster setting, but there are no secondary triage methods suitable for children. This study developed a new secondary triage method named the Pediatric Physiological and Anatomical Triage Score (PPATS) and compared its accuracy with current triage methods. METHODS: A retrospective chart review of pediatric patients under 16 years old transferred to an emergency center from 2014 to 2016 was performed...
February 12, 2018: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/29430606/epidemiology-of-acetabular-fractures-in-qatar
#19
Malik Ahmed, Yousef Abuodeh, AbdulJabbar Alhammoud, Motasem Salameh, Khalid Hasan, Ghalib Ahmed
OBJECTIVES: This study aimed to review the epidemiological aspects of acetabular fractures treated at Hamad Medical Corporation in Qatar. The study is the first orthopaedic trauma epidemiological study in Qatar and will provide a platform to advance high-level clinical research. METHODS: We obtained data for 103 patients who presented to our level I trauma centre from 2008 to 2010 with a diagnosis of acetabular fracture. Age, sex, the cause of injury, fracture classification, mode of treatment, associated nerve injuries, and other complications were analyzed...
February 11, 2018: International Orthopaedics
https://www.readbyqxmd.com/read/29429776/interventional-treatment-experience-in-multiple-injury-with-major-abdominal-or-pelvic-injuries-160-cases-analysis
#20
Tian-Xi Zhang, Mei Han, Peng Ye, Quan Hu, Jia-Lin Li, Ling Yin, An-Yong Yu
PURPOSE: To observe the therapeutic effect of interventional embolization and haemorrhage control in multiple trauma patients with a major abdominal or pelvic injury. METHODS: Data of 160 multiple trauma patients with a major abdominal or pelvic injury were retrospectively analyzed. They were admitted into the Department of Emergency of the First Affiliated Hospital of Zunyi Medical College from October 2013 to April 2016. Eighty-seven patients who received emergent intervention for embolization and haemorrhage control were set as group A, including 72 males and 15 females, with an average age of (39...
January 31, 2018: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
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