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trauma management protocol

Naomi B Fine, Michal Achituv, Amit Etkin, Ofer Merin, Arieh Y Shalev
Background : The immediate aftermath of traumatic events is a period of enhanced neural plasticity, following which some survivors remain with post-traumatic stress disorder (PTSD) whereas others recover. Evidence points to impairments in emotional reactivity, emotion regulation, and broader executive functions as critically contributing to PTSD. Emerging evidence further suggests that the neural mechanisms underlying these functions remain plastic in adulthood and that targeted retraining of these systems may enhance their efficiency and could reduce the likelihood of developing PTSD...
2018: European Journal of Psychotraumatology
Yuqing Zhang, Xinyu Zhou, Lining Yang, Sarah E Hetrick, John R Weisz, Pim Cuijpers, Jürgen Barth, Cinzia Del Giovane, Shuai Yuan, David Cohen, Donna Gillies, Xiaofeng Jiang, Teng Teng, Peng Xie
INTRODUCTION: Post-traumatic stress disorder (PTSD) is common among children and adolescents who are exposed to trauma, and it is often associated with significant negative impacts on their psychosocial functioning and quality of life. Many types of psychotherapies have been found to be effective for PTSD in children and adolescents. However, due to the lack of direct comparisons between different psychotherapies, the hierarchy of treatment efficacy is still unclear. Therefore, we plan to conduct a systematic review and network meta-analysis to evaluate the efficacy and acceptability of various types of psychotherapies for PTSD in children and adolescents...
March 12, 2018: BMJ Open
Saumita Ghosh Biswal, Rajesh Datt Mehta
Background: The diagnosis of cutaneous adversities in the cancer patient is especially difficult, given the complexity of their illness and combination protocols used for the treatment. The present study was undertaken to know the spectrum of cutaneous adversities in patients undergoing chemotherapy and the drug(s) most commonly associated with it. Materials and Methods: A total of 1000 patients with malignancies under chemotherapy in the oncology ward and outpatient department were screened in this observational study from January 2013 to February 2015...
January 2018: Indian Journal of Dermatology
Sharon Wacht, Kristin Salottolo, Amy Atnip, Michelle Hooks, Mary Bailie, Matthew Carrick
Head strikes can be fatal for patients taking blood thinners (anticoagulants or antiplatelets). Our trauma center instituted the "head strike protocol" to provide uniform and expedited care for adult trauma patients taking preinjury anticoagulants and antiplatelet medications with suspected head injury. The purpose of this article is to describe the development and implementation of the head strike protocol and compare time metrics and outcomes before and after implementing the protocol. Per the head strike protocol, patients with suspected traumatic intracranial hemorrhage (tICH) were screened for anticoagulants or antiplatelet medications by emergency medical service personnel/at first contact, activated as a Level II trauma and received a computed tomographic scan of the head within 30 min of arrival, and started reversal of blood products within 30 min of tICH confirmation...
March 2018: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
Shannon Broxton, Regina Medeiros, Adel Abuzeid, Corey Peterson, Autumn Schumacher
Massive transfusion protocols (MTPs) allow practitioners to follow a prescribed algorithm for the rapid replacement of blood products during a massive hemorrhage. They function as an established protocol to provide consistent treatment. Once implemented, the MTP must be evaluated to ensure best practice. The purpose of this clinical improvement project was to formally evaluate the use and efficacy of an MTP during its first year of implementation. The specific aims were to (1) determine whether MTP activations were missed; (2) compare outcomes between those patients managed by the MTP and those who were not; and (3) provide recommendations to the institution's stakeholders...
March 2018: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
Nicholas R Phillips, Derek E Kunz
While overall sports participation continues at high rates, chest injuries occur relatively infrequently. Many conditions of chest injury are benign, related to simple contusions and strains, but the more rare, severe injuries carry a much higher risk of morbidity and mortality than the typical issues encountered in athletic medicine. Missed or delayed diagnosis can prove to be catastrophic. Sports medicine providers must be prepared to encounter a wide range of traumatic conditions relating to the torso, varying from the benign chest wall contusion to the life-threatening tension pneumothorax...
March 2018: Current Sports Medicine Reports
Anne-Claire Pierrefeu-Lagrange, Karine Mari, Caroline Hoss, Breda Cullen, Lorraine Nisbet
INTRODUCTION: Dressings are a mainstay for wound management; however, dressing adherence to the wound or periwound area can cause pain and trauma at removal. Dressing-related trauma includes skin reactions, adherence to the wound, and skin stripping. The development of atraumatic wound contact layer dressings has been a major advancement in reducing trauma. OBJECTIVE: This study compares the benefits of a cellulose acetate mesh (CAM) coated with soft silicone versus a flexible polyamide net (FPN) coated with soft silicone...
January 26, 2018: Wounds: a Compendium of Clinical Research and Practice
Sarah B Cairo, Malachi Fisher, Brian Clemency, Charlotte Cipparone, Evelyn Quist, Kathryn D Bass
PURPOSE: Patient triage to the appropriate destination is critical to prehospital trauma care. Triage decisions are challenging in a region without collocated pediatric and adult trauma centers. METHODS: A regional survey was administered to emergency medical response units identifying variability and confusion regarding factors influencing patient disposition. A course was developed to guide the triage of pediatric and pregnant trauma patients. Pre- and posttests were administered to address course principles, including decision making and triage...
February 11, 2018: Journal of Pediatric Surgery
David A Carver, Alexsander K Bressan, Colin Schieman, Sean C Grondin, Andrew W Kirkpatrick, Rohan Lall, Paul B McBeth, Michael B Dunham, Chad G Ball
INTRODUCTION: Haemothorax following blunt thoracic trauma is a common source of morbidity and mortality. The optimal management of moderate to large haemothoraces has yet to be defined. Observational data have suggested that expectant management may be an appropriate strategy in stable patients. This study aims to compare the outcomes of patients with haemothoraces following blunt thoracic trauma treated with either chest drainage or expectant management. METHODS AND ANALYSIS: This is a single-centre, dual-arm randomised controlled trial...
March 3, 2018: BMJ Open
Nikolaos Mamas, Konstantinos Andreanos, Dimitrios Brouzas, Andreas Diagourtas, Andreas Droulias, Ilias Georgalas, Dimitrios Papaconstantinou
PURPOSE: To report the case of a 65-year-old metalworker with no known history of ocular trauma, who suffered from intense ocular pain during magnetic resonance imaging (MRI) of the brain, due to a retained intraocular metallic foreign body (IOFB). CASE REPORT: Meticulous ophthalmological examination was inconclusive. An IOFB was confirmed with X-ray scan, whereas its exact localization was enabled by means of ultrasonography and ultrasound biomicroscopy (UBM). CONCLUSIONS: Despite appropriate screening protocols, MRI-related ocular complications might occur in the presence of a hidden metallic IOFB...
March 2, 2018: Journal of Ultrasound
Agata Marta Plonczak, Gordon J McArthur, Nicola Goldsmith, Maxim Horwitz
BACKGROUND: Most hand injuries in children can be managed non-operatively and are associated with excellent outcomes. Whilst the majority of our patients are discharged to the care of hand therapists, there is no literature to support this protocol. Our aim was to ensure this is safe and effective practice. MATERIAL AND METHODS: We conducted a retrospective analysis of all patients referred to our paediatric hand trauma clinic for closed injuries over a four month period between December 2014 and March 2015...
December 30, 2017: Ortopedia, Traumatologia, Rehabilitacja
Alberta Sj Van der Watt, Alexandra Psp Suryapranata, Soraya Seedat
Objectives: Our primary objective was to assess the feasibility of interepisodal telephonic mood monitoring in patients with affective disorders in a low-resource setting. Secondary objectives included gathering data on longitudinal mood trajectories and assessing patient acceptance of mood monitoring. Methods: Inpatients with a primary mood or anxiety disorder were recruited predischarge. Assessment at intake included demographic information, the Life Events Checklist, and the Childhood Trauma Questionnaire...
2018: Neuropsychiatric Disease and Treatment
Mina Cheng, Kin-Yan Lee, Annice-M L Chang, Hiu-Fai Ho, Lily-P S Chan, Kin-Bong Lee, Philip-C H Kwok, Alexander-C W Lee, Kevin-Y K Wong, Chak-Wah Kam, Gilberto-K K Leung, John-K S Wong, Nai-Kwong Cheung, Janice-H H Yeung, Ning Tang, Shing-Hing Choi, Tak-Wing Lau, Heidi-H T Wong, Ming Leung
PURPOSE: The mortality rate in patients with haemodynamically unstable pelvic fractures is as high as 40-60%. Despite the new advances in trauma care which are in phase in trauma centres in Hong Kong, the management of haemodynamically unstable pelvic fracture is still heterogeneous. The aim of this study is to review the results of management of haemodynamically unstable pelvic fracture patients in Hong Kong over a five year period. METHODS: This is a retrospective multi-centred cohort study of patients with haemodynamic and mechanically unstable pelvic fractures from 1 January 2010 to 31 December 2014...
February 27, 2018: International Orthopaedics
Nathan K Wool, Shannon Wilson, Alexander Cm Chong, Bradley R Dart
Introduction: Metabolic bone disease is a malady that causes significant morbidity and mortality to a patient who has sustained a fragility fracture. There is currently no protocol to prevent secondary fragility fracture at our institution. The objective of this study was to create an appropriate protocol for implementing clinical pathways for physicians to diagnose and treat osteoporosis and fragility fractures by educating patients. Methods: A multidisciplinary team created an appropriate protocol that could be implemented in an inpatient setting...
August 2017: Kansas Journal of Medicine
Rein Ketelaars, Christian Beekers, Geert-Jan Van Geffen, Gert Jan Scheffer, Nico Hoogerwerf
BACKGROUND: Patients in cardiac arrest must receive algorithm-based management such as basic life support and advanced (cardiac) life support. International guidelines dictate diagnosing and treating any factor that may have caused the arrest or may be complicating the resuscitation. Ultrasound may be of potential value in this process and can be used in a prehospital setting. The objective is to evaluate the use of prehospital ultrasound during traumatic and non-traumatic CPR and determine its impact on prehospital treatment decisions in a Dutch helicopter emergency medical service (HEMS)...
February 22, 2018: Prehospital Emergency Care
Benjamin D Johansen, Rebecca S Blue, Tarah L Castleberry, Erik L Antonsen, James M Vanderploeg
INTRODUCTION: With the development of the commercial space industry, growing numbers of spaceflight participants will engage in activities with a risk for pulmonary injuries, including pneumothorax, ebullism, and decompression sickness, as well as other concomitant trauma. Medical triage capabilities for mishaps involving pulmonary conditions have not been systematically reviewed. Recent studies have advocated the use of point-of-care ultrasound to screen for lung injury or illness. The operational utility of portable ultrasound systems in disaster relief and other austere settings may be relevant to commercial spaceflight...
February 1, 2018: Aerospace Medicine and Human Performance
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
Ashwath Kumar, Anthony Alvarado, Kushal Shah, Paul M Arnold
BACKGROUND: The standard of care for isolated mild traumatic subarachnoid hemorrhage (itSAH) involves serial head CT examinations at dedicated time-intervals to monitor neurologic status and hemorrhagic progression. Considering recent evidence questioning such an aggressive monitoring protocol, this study aimed to assess the necessity of repeat head CT imaging in managing itSAH. METHODS: All patients who presented to our academic institution with mild traumatic brain injury were evaluated...
February 10, 2018: World Neurosurgery
Sandro Hodel, Björn-Christian Link, Reto Babst, W H Mallee, Philippe Posso, Frank J P Beeres
INTRODUCTION: Despite the frequent use of external fixation, various regimes of antibiotic prophylaxis, surgical technique and postoperative pin care exist and underline the lack of current evidence. The aim of the study was to assess the variability or consensus in perioperative protocols to prevent implant-associated infections for temporary external fixation in closed fractures of the extremities. MATERIALS AND METHODS: A 26-question survey was sent to 170 members of the Traumaplatform...
February 7, 2018: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Christian David Weber, Frank Hildebrand, Philipp Kobbe, Rolf Lefering, Richard M Sellei, Hans-Christoph Pape
BACKGROUND: Open tibia fractures usually occur in high-energy mechanisms and are commonly associated with multiple traumas. The purposes of this study were to define the epidemiology of open tibia fractures in severely injured patients and to evaluate risk factors for major complications. METHODS: A cohort from a nationwide population-based prospective database was analyzed (TraumaRegister DGU®). Inclusion criteria were: (1) open or closed tibia fracture, (2) Injury Severity Score (ISS) ≥ 16 points, (3) age ≥ 16 years, and (4) survival until primary admission...
February 2, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
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