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https://www.readbyqxmd.com/read/28507367/management-of-cervical-trauma-a-brief-review
#1
Mohsin Qadeer, Salman Sharif
Cervical injury is not uncommon in any trauma, especially in road traffic accident. A standard approach, towards, transport, workup, and management is required for best outcomes, and decrease morbidity. We tried to review the recent literature and briefly discuss the management protocols concluded that in our setting, emergency ambulance personnel and Emergency Room doctors should be trained in dealing with all kinds of cervical spine trauma, they should be aware of recent guidelines and should refrain from using steroids routinely...
May 2017: JPMA. the Journal of the Pakistan Medical Association
https://www.readbyqxmd.com/read/28501121/validation-of-a-field-spinal-motion-restriction-protocol-in-a-level-i-trauma-center
#2
James M Tatum, Nicolas Melo, Ara Ko, Navpreet K Dhillon, Eric J T Smith, Dorothy A Yim, Galinos Barmparas, Eric J Ley
BACKGROUND: Spinal motion restriction (SMR) after traumatic injury has been a mainstay of prehospital trauma care for more than 3 decades. Recent guidelines recommend a selective approach with cervical spine clearance in the field when criteria are met. MATERIALS AND METHODS: In January 2014, the Department of Health Services of the City of Los Angeles, California, implemented revised guidelines for cervical SMR after blunt mechanism trauma. Adult patients (aged ≥18 y) with an initial Glasgow Coma Scale (GCS) score of ≥13 presented to a single level I trauma center after blunt mechanism trauma over the following 1-y period were retrospectively reviewed...
May 1, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28473995/concussion-management-plan-compliance-a-study-of-ncaa-power-5-conference-schools
#3
Thomas A Buckley, Christine M Baugh, William P Meehan, Melissa S DiFabio
BACKGROUND: In response to concerns over concussions and repeated head impacts that occur during sports, the National Collegiate Athletic Association (NCAA) mandated that all member institutions enact a concussion management plan (CMP). Although institutional and health care provider self-reports have been investigated, compliance with NCAA protocol recommendations has not been examined. PURPOSE: To examine the CMPs from the 65 institutions within the NCAA Power 5 conferences for compliance with the NCAA 2015 concussion guidelines...
April 2017: Orthopaedic Journal of Sports Medicine
https://www.readbyqxmd.com/read/28461962/anticoagulation-therapy-and-proximal-femoral-fracture-treatment-an-update
#4
Ioannis Ktistakis, Vasileios Giannoudis, Peter V Giannoudis
Hip fractures in the elderly population have become a 'disease' with increasing incidence.Most of the geriatric patients are affected by a number of comorbidities.Coagulopathies continue to be a special point of interest for the orthopaedic trauma surgeon, with the management of this high-risk group of patients a hot topic of debate among the orthopaedic community.While a universal consensus on how to manage thromboprophylaxis for this special cohort of patients has not been reached, multiple attempts to define a widely accepted protocol have been published...
August 2016: EFORT Open Rev
https://www.readbyqxmd.com/read/28457980/reversal-of-trauma-induced-coagulopathy-using-first-line-coagulation-factor-concentrates-or-fresh-frozen-plasma-retic-a-single-centre-parallel-group-open-label-randomised-trial
#5
Petra Innerhofer, Dietmar Fries, Markus Mittermayr, Nicole Innerhofer, Daniel von Langen, Tobias Hell, Gottfried Gruber, Stefan Schmid, Barbara Friesenecker, Ingo H Lorenz, Mathias Ströhle, Verena Rastner, Susanne Trübsbach, Helmut Raab, Benedikt Treml, Dieter Wally, Benjamin Treichl, Agnes Mayer, Christof Kranewitter, Elgar Oswald
BACKGROUND: Effective treatment of trauma-induced coagulopathy is important; however, the optimal therapy is still not known. We aimed to compare the efficacy of first-line therapy using fresh frozen plasma (FFP) or coagulation factor concentrates (CFC) for the reversal of trauma-induced coagulopathy, the arising transfusion requirements, and consequently the development of multiple organ failure. METHODS: This single-centre, parallel-group, open-label, randomised trial was done at the Level 1 Trauma Center in Innsbruck Medical University Hospital (Innsbruck, Austria)...
April 27, 2017: Lancet Haematology
https://www.readbyqxmd.com/read/28452281/assessment-prevention-and-management-of-skin-tears
#6
Maureen Benbow
Skin tears are common in older people. They are acute wounds that are at high risk of becoming complex, chronic wounds due to the interplay between the physiological changes in the skin and trauma from the external environment. Skin tears have been reported to have prevalence rates equal to, or greater than, those for pressure ulcers. A comprehensive risk assessment should include assessment of the individual's general health (chronic/critical disease, polypharmacy and cognitive, sensory and nutritional status); mobility (history of falls, impaired mobility, dependent activities of daily living, and mechanical trauma); and skin (extremes of age, fragile skin and previous skin tears)...
April 28, 2017: Nursing Older People
https://www.readbyqxmd.com/read/28439613/the-role-of-delayed-head-ct-in-evaluation-of-elderly-blunt-head-trauma-victims-taking-antithrombotic-therapy
#7
D Scantling, C Fischer, R Gruner, A Teichman, B McCracken, J Eakins
INTRODUCTION: Increasing active longevity has created an increasing surge of elderly trauma patients. The majority of these patients suffer blunt trauma and many are taking antithrombotic agents. The literature is mixed regarding the utility of routine repeat head CT in patients taking antithrombotic medications with a GCS of 15 and initial negative head CT. We hypothesized that scheduled delayed CT head 12 h after admission (D-CTH) in elderly blunt trauma victims would not identify clinically significant new hemorrhages or change management...
April 24, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/28437224/structure-process-and-culture-of-intensive-care-units-treating-patients-with-severe-traumatic-brain-injury-survey-of-centers-participating-in-the-american-college-of-surgeons-trauma-quality-improvement-program
#8
Aziz S Alali, Victoria A McCredie, Todd G Mainprize, David Gomez, Avery B Nathens
Outcome after severe traumatic brain injury (TBI) differs substantially between hospitals. Explaining this variation begins with understanding the differences in structures and processes of care, particularly at intensive care units (ICUs) where acute TBI care takes place. We invited trauma medical directors (TMDs) from 187 centers participating in the American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) to complete a survey. The survey domains included ICU model, type, availability of specialized units, staff, training programs, standard protocols and order sets, approach to withdrawal of life support, and perceived level of neurosurgeons' engagement in the ICU management of TBI...
May 17, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28430540/demystifying-orbital-emergencies-a-pictorial-review
#9
Viet D Nguyen, Achint K Singh, Wilson B Altmeyer, Bundhit Tantiwongkosi
Imaging of the orbit plays an important role in the workup of orbital emergencies. Orbital imaging is particularly useful in the emergency department, where clinical history and physical examination may be limited or delayed until the exclusion or treatment of more life-threatening conditions. Cross-sectional orbital imaging with multidetector computed tomography (CT) and magnetic resonance (MR) imaging is commonly performed in addition to ultrasonography. In an emergent setting, CT is the preferred modality when evaluating for intraorbital foreign bodies, fractures, or calcifications within a mass lesion...
May 2017: Radiographics: a Review Publication of the Radiological Society of North America, Inc
https://www.readbyqxmd.com/read/28409600/postpartum-hemorrhage-prevention-and-treatment
#10
Ann Evensen, Janice M Anderson, Patricia Fontaine
Postpartum hemorrhage is common and can occur in patients without risk factors for hemorrhage. Active management of the third stage of labor should be used routinely to reduce its incidence. Use of oxytocin after delivery of the anterior shoulder is the most important and effective component of this practice. Oxytocin is more effective than misoprostol for prevention and treatment of uterine atony and has fewer adverse effects. Routine episiotomy should be avoided to decrease blood loss and the risk of anal laceration...
April 1, 2017: American Family Physician
https://www.readbyqxmd.com/read/28400668/nontuberculous-mycobacterial-infection-of-the-musculoskeletal-system-in-immunocompetent-hosts
#11
Manit K Gundavda, Hitendra G Patil, Vikas M Agashe, Rajeev Soman, Camilla Rodriques, Ramesh B Deshpande
BACKGROUND: Nontuberculous mycobacteria (NTM) were considered saprophytic organisms for many years but now are recognized as human pathogens. Although humans are routinely exposed to NTM, the rate of clinical infection is low. Such infections usually occur in the elderly and in patients who are immunocompromised. However, there has been an increasing incidence in recent years of infections in immunocompetent hosts. NTM infections in immunocompetent individuals are secondary to direct inoculation either contamination from surgical procedures or penetrating injuries rather than hematogenous dissemination...
March 2017: Indian Journal of Orthopaedics
https://www.readbyqxmd.com/read/28385940/the-evolution-of-fracture-clinic-design-the-activity-and-safety-of-the-edinburgh-trauma-triage-clinic-with-one-year-follow-up
#12
T O White, S P Mackenzie, T H Carter, J G Jefferies, O R Prescott, A D Duckworth, J F Keating
AIMS: Fracture clinics are often characterised by the referral of large numbers of unselected patients with minor injuries not requiring investigation or intervention, long waiting times and recurrent unnecessary reviews. Our experience had been of an unsustainable system and we implemented a 'Trauma Triage Clinic' (TTC) in order to rationalise and regulate access to our fracture service. The British Orthopaedic Association's guidelines have required a prospective evaluation of this change of practice, and we report our experience and results...
April 2017: Bone & Joint Journal
https://www.readbyqxmd.com/read/28384963/effect-of-pneumoperitoneum-and-lateral-position-on-oropharyngeal-seal-pressures-of-proseal-lma-in-laparoscopic-urological-procedures
#13
Preeti Rustagi, Geeta A Patkar, Anil Kumar Ourasang, Bharati A Tendolkar
INTRODUCTION: A sustained and effective oropharyngeal sealing with supraglottic airway is required to maintain the ventilation during laparoscopic surgery. Previous studies have observed the Oropharyngeal Seal Pressure (OSP) for Proseal Laryngeal Mask Airway (PLMA) after pneumoperitoneum in supine and trendelenburg position, where PLMA was found to be an effective airway device. This study was conducted with ProSeal LMA, for laparoscopic Urologic procedures done in lateral position. AIM: To measure OSP in supine and lateral position and to observe the effect of pneumoperitoneum in lateral position on OSP...
February 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28378236/a-new-low-dose-multi-phase-trauma-ct-protocol-and-its-impact-on-diagnostic-assessment-and-radiation-dose-in-multi-trauma-patients
#14
Zlatan Alagic, Andreas Eriksson, Erika Drageryd, Sara Rezaei Motamed, Marius C Wick
PURPOSE: Computed tomography (CT) examinations, often using high-radiation dosages, are increasingly used in the acute management of polytrauma patients. This study compares a low-dose polytrauma multi-phase whole-body CT (WBCT) protocol on a latest generation of 16-cm detector 258-slice multi-detector CT (MDCT) scanner with advanced dose reduction techniques to a single-phase polytrauma WBCT protocol on a 64-slice MDCT scanner. METHODS: Between March and September 2015, 109 polytrauma patients (group A) underwent acute WBCT with a low-dose multi-phase WBCT protocol on a 258-slice MDCT whereas 110 polytrauma patients (group B) underwent single-phase trauma CT on a 64-slice MDCT...
April 5, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/28351547/the-road-to-union-protocol-for-the-reconstruction-of-isolated-complex-high-energy-tibial-trauma
#15
Erik Hohmann, Franz Birkholtz, Vaida Glatt, Kevin Tetsworth
INTRODUCTION: The purpose of this study was to describe a standardized staged approach, "The Road to Union", for the reconstruction of isolated complex tibial trauma, both acute and chronic in nature. METHODS: This retrospective study included all patients treated for complex tibial trauma at a specialized limb reconstruction centre, including acute open fracture as well as infected and aseptic non-unions. This standardized approach includes eight specific steps, employed in sequence...
March 18, 2017: Injury
https://www.readbyqxmd.com/read/28334590/a-prospective-emergency-department-quality-improvement-project-to-improve-the-treatment-of-vaso-occlusive-crisis-in-sickle-cell-disease-lessons-learned
#16
Paula Tanabe, Caroline E Freiermuth, David M Cline, Susan Silva
BACKGROUND: Guidelines recommend rapid, aggressive management of vaso-occlusive crisis (VOC) for patients with sickle cell disease (SCD). A large prospective research and quality improvement (QI) project was conducted to measure changes in clinical outcomes in two EDs-academic medical centers with emergency medicine residency programs and Level 1 trauma centers-during a 2.5-year time period (October 2011-March 2014). METHODS: A QI team used a Plan-Do-Study-Act approach to modify and implement changes to opioid analgesic protocols for the emergency department (ED) treatment of VOC...
March 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28331952/diagnostic-strategies-for-posttraumatic-osteomyelitis-a-survey-amongst-dutch-medical-specialists-demonstrates-the-need-for-a-consensus-protocol
#17
G A M Govaert, A W J M Glaudemans, J J W Ploegmakers, A R Viddeleer, K W Wendt, I H F Reininga
INTRODUCTION: Posttraumatic osteomyelitis (PTO) is a feared complication after surgical fracture care. Late diagnosis can result in interrupted and prolonged rehabilitation programmes, inability to work, medical dependency, unnecessary hospital admissions, and high medical and non-medical costs. Primary aim of this study was to assess preferred diagnostic imaging strategies for diagnosing PTO amongst orthopaedic and trauma surgeons, radiologists, and nuclear medicine physicians. Secondary aims were to determine the preferred serum inflammatory marker for diagnosing PTO and the existence of a local hospital protocol to diagnose and manage PTO...
March 22, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/28325461/neurocritical-care-of-acute-subdural-hemorrhage
#18
REVIEW
Fawaz Al-Mufti, Stephan A Mayer
Although urgent surgical hematoma evacuation is necessary for most patients with subdural hematoma (SDH), well-orchestrated, evidenced-based, multidisciplinary, postoperative critical care is essential to achieve the best possible outcome. Acute SDH complicates approximately 11% of mild to moderate traumatic brain injuries (TBIs) that require hospitalization, and approximately 20% of severe TBIs. Acute SDH usually is related to a clear traumatic event, but in some cases can occur spontaneously. Management of SDH in the setting of TBI typically conforms to the Advanced Trauma Life Support protocol with airway taking priority, and management breathing and circulation occurring in parallel rather than sequence...
April 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28318439/focused-assessment-with-sonography-in-trauma-fast-in-2017-what-radiologists-can-learn
#19
John R Richards, John P McGahan
Focused assessment with sonography in trauma (FAST) has been extensively utilized and studied in blunt and penetrating trauma for the past 3 decades. Prior to FAST, invasive procedures such as diagnostic peritoneal lavage and exploratory laparotomy were commonly utilized to diagnose intraabdominal injury. Today the FAST examination has evolved into a more comprehensive study of the abdomen, heart, chest, and inferior vena cava, and many variations in technique, protocols, and interpretation exist. Trauma management strategies such as laparotomy, laparoscopy, endoscopy, computed tomographic angiography, angiographic intervention, serial imaging, and clinical observation have also changed over the years...
April 2017: Radiology
https://www.readbyqxmd.com/read/28314465/data-capture-and-communication-during-transfers-to-definitive-care-in-an-inclusive-trauma-system
#20
Nori L Bradley, Naisan Garraway, Nathaniel Bell, Nasira Lakha, S Morad Hameed
INTRODUCTION: Background trauma survivors in rural areas transferred to urban centers have higher mortality than trauma patients admitted directly to urban centers. Transfer data in trauma registries is important for injury control. Prehospital and early physiologic data may reflect processes of pre-hospital care. British Columbia currently has no standardized process for trauma patient data transfer. PATIENTS AND METHODS: We performed a retrospective data analysis for major trauma patients (ISS>15) transferred to a Level I trauma center over a 1year period (n=243)...
November 5, 2016: Injury
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