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https://www.readbyqxmd.com/read/29763388/how-should-trauma-patients-informed-consent-or-refusal-be-regarded-in-a-trauma-bay-or-other-emergency-settings
#1
Ashley Suah, Peter Angelos
The precipitous and unexpected nature of trauma requires training health care practitioners to think and act quickly, according to the best medical interest of the patient. The urgency of treatment for trauma patients, who frequently have temporary alterations in their abilities to make autonomous and competent decisions, often results in presumed consent for medically necessary treatment. Academic trauma centers use protocol-based management of injuries to facilitate their simultaneous evaluation by multiple clinicians and to avoid delays in treatment, ensuring that trauma patients receive the best possible care...
May 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29760852/altered-mental-status-current-evidence-based-recommendations-for-prehospital-care
#2
REVIEW
Ashley Sanello, Marianne Gausche-Hill, William Mulkerin, Karl A Sporer, John F Brown, Kristi L Koenig, Eric M Rudnick, Angelo A Salvucci, Gregory H Gilbert
Introduction: In the United States emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with an acute change in mental status and to compare these recommendations against the current protocols used by the 33 EMS agencies in the State of California. Methods: We performed a literature review of the current evidence in the prehospital treatment of a patient with altered mental status (AMS) and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations...
May 2018: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29751949/platelet-storage-lesions-what-more-do-we-know-now
#3
REVIEW
Monica Suet Ying Ng, John-Paul Tung, John Francis Fraser
Platelet concentrate (PC) transfusions are a lifesaving adjunct to control and prevent bleeding in cancer, hematologic, surgical, and trauma patients. Platelet concentrate availability and safety are limited by the development of platelet storage lesions (PSLs) and risk of bacterial contamination. Platelet storage lesions are a series of biochemical, structural, and functional changes that occur from blood collection to transfusion. Understanding of PSLs is key for devising interventions that prolong PC shelf life to improve PC access and wastage...
April 17, 2018: Transfusion Medicine Reviews
https://www.readbyqxmd.com/read/29742577/surgical-management-of-the-recent-orbital-war-injury
#4
Safaa Riyadh, Saif Saadedeen Abdulrazaq, Ali Mhana Sabeeh Zirjawi
Maxillofacial trauma affects sensitive and essential functions for the human being such as smell, breathing, talking, and the most importantly the sight. Trauma to the orbit may cause a vision loss especially if this trauma yields a high kinetic energy like that encountered during wars. The purpose of the study was to evaluate the surgical outcomes of the orbital war trauma, enriching the literature with the experience of the authors in this field. A total of 16 patients were injured, evacuated, and managed, between June 2014 and June 2017, from the fight between the Iraqi army and the Islamic State of Iraq and Syria (ISIS) in different areas of Iraq...
May 8, 2018: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/29738399/cost-determinants-in-the-90-day-management-of-isolated-ankle-fractures-at-a-large-urban-academic-hospital
#5
Matthew Varacallo, Patrick Mattern, Jonathan Acosta, Nader Toossi, Kevin Denehy, Susan Harding
OBJECTIVES: To determine the independent risk factors associated with increasing costs and unplanned hospital readmissions in the 90-day episode of care (EOC) for isolated operative ankle fractures at our institution. DESIGN: Retrospective cohort study SETTING:: Level I Trauma Center PATIENTS:: Two hundred ninety-nine patients undergoing open reduction internal fixation (ORIF) for the treatment of an acute, isolated ankle fracture between 2010 and 2015. INTERVENTION: none MAIN OUTCOME MEASUREMENTS:: Independent risk factors for increasing 90-day EOC costs and unplanned hospital readmission rates...
May 3, 2018: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/29705730/paediatric-traumatic-cardiac-arrest-a-delphi-study-to-establish-consensus-on-definition-and-management
#6
Annette C Rickard, James Vassallo, Tim Nutbeam, Mark D Lyttle, Ian K Maconochie, Doyo G Enki, Jason E Smith
AIMS: Paediatric traumatic cardiac arrest (TCA) is associated with low survival and poor outcomes. The mechanisms that underlie TCA are different from medical cardiac arrest; the approach to treatment of TCA may therefore also need to differ to optimise outcomes. The aim of this study was to explore the opinion of subject matter experts regarding the diagnosis and treatment of paediatric TCA, and to reach consensus on how best to manage this group of patients. METHODS: An online Delphi study was conducted over three rounds, with the aim of achieving consensus (defined as 70% agreement) on statements related to the diagnosis and management of paediatric TCA...
April 28, 2018: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29699720/getting-inside-the-expert-s-head-an-analysis-of-physician-cognitive-processes-during-trauma-resuscitations
#7
Matthew R White, Heather Braund, Daniel Howes, Rylan Egan, Andreas Gegenfurtner, Jeroen J G van Merrienboer, Adam Szulewski
STUDY OBJECTIVE: Crisis resource management skills are integral to leading the resuscitation of a critically ill patient. Despite their importance, crisis resource management skills (and their associated cognitive processes) have traditionally been difficult to study in the real world. The objective of this study was to derive key cognitive processes underpinning expert performance in resuscitation medicine, using a new eye-tracking-based video capture method during clinical cases. METHODS: During an 18-month period, a sample of 10 trauma resuscitations led by 4 expert trauma team leaders was analyzed...
April 23, 2018: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29696505/intracranial-pressure-monitoring-in-diffuse-brain-injury-why-the-developing-world-needs-it-more
#8
Tarang K Vora, Sudish Karunakaran, Ajay Kumar, Anil Chiluka, Harish Srinivasan, Kanishk Parmar, Srivatsan Thirumalai Vasu, Rahul Srinivasan, H A Chandan, P S Vishnu, Lakshay Raheja
BACKGROUND: Use of ICP monitoring is considered to be part of "standard of care" in management of severe traumatic brain injury, but it is rarely used in developing countries. The authors present a study which evaluates the efficacy and outcomes of ICP monitoring at a high-volume trauma center in India. METHODS: Data on management and outcomes for 126 patients who were admitted with diffuse traumatic brain injury (GCS 3-8) were studied prospectively over an 18-month period...
June 2018: Acta Neurochirurgica
https://www.readbyqxmd.com/read/29690930/simple-modification-of-trauma-mechanism-alarm-criteria-published-for-the-traumanetwork-dgu-%C3%A2-may-significantly-improve-overtriage-a-cross-sectional-study
#9
Philipp Braken, Felix Amsler, Thomas Gross
BACKGROUND: No consensus exists in the literature on the use of uniform emergency room trauma team activation criteria (ERTTAC). Today excessive over- or undertriage rates continue to be a challenge for most trauma centres. Application of ERTTAC, published for use in the German TraumaNetwork DGU® , at a Swiss trauma centre resulted in a high overtriage rate. The aim of the investigation was to analyse the ERTTAC in detail with the intention of possible improvement. METHODS: The investigation included consecutive adult (age > 15 years) trauma patients treated at the emergency department of a level II trauma centre from 01...
April 24, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29664527/-perioperative-nutrition-in-eras-protocols
#10
Andrés Sánchez C, Karin Papapietro V
The trauma involved in any surgical procedure, even if elective, causes a metabolic stress response characterized by postoperative insulin resistance (PIR). PIR is considered a surgical stress marker and is associated with increased morbidity and postoperative length of stay. PIR worsens when the patient is operated in a state of prolonged preoperative fasting or when postoperative feeding is delayed. The ERAS Protocols (Enhanced Recovery After Surgery) includes anesthetic, surgical, kinesiology, nutritional and nursing interventions aimed to modulate PIR...
November 2017: Revista Médica de Chile
https://www.readbyqxmd.com/read/29664514/-damage-control-resuscitation-in-pediatric-severe-trauma
#11
Adriana Wegner Araya
INTRODUCTION: Trauma is an important cause of morbidity and mortality in the pediatric population. It has the first place in mortality in our country without considering perinatal pathologies and congenital malformations. An important percentage of early and late deaths secondary to this cau se, as well as its sequelae, could be prevented with optimal and timely resuscitation. OBJECTIVE: To review the applicability of damage control resuscitation (DCR) in severe pediatric trauma, with emphasis on medical management...
February 2018: Revista Chilena de Pediatría
https://www.readbyqxmd.com/read/29662732/institutional-review-of-hemorrhagic-pelvic-emergencies-effectively-managed-with-percutaneous-arterial-embolization
#12
Muhammad Azeemuddin, Raza Sayani, Nauman Turab, Syed M Mustahsan, Mohammad Hasan, Dawar B Khan, Fatima Mubarak
OBJECTIVE: Our aim was to review the results of pelvic arterial embolization (PAE) performed in the interventional radiology suite. METHOD: The data of all patients in whom pelvic angioembolization was performed was collected from July 2011 to June 2017. Procedures were performed by an experienced interventional radiologist. The clinical and laboratory data, as well as the outcome data, were obtained from the medical records of our hospital. The following parameters were collected for each patient, including the age, gender, presenting symptoms, site of bleeding, catheters used for embolization, material used for embolization, previous computed tomography (CT) scan and/or focused assessment with sonography for trauma (FAST) ultrasound, average hemoglobin before the procedure, and patient clinical status on discharge...
February 15, 2018: Curēus
https://www.readbyqxmd.com/read/29651626/current-topics-in-the-management-of-acute-traumatic-spinal-cord-injury
#13
Christopher D Shank, Beverly C Walters, Mark N Hadley
Acute traumatic spinal cord injury (SCI) affects more than 250,000 people in the USA, with approximately 17,000 new cases each year. It continues to be one of the most significant causes of trauma-related morbidity and mortality. Despite the introduction of primary injury prevention education and vehicle safety devices, such as airbags and passive restraint systems, traumatic SCI continues to have a substantial impact on the healthcare system. Over the last three decades, there have been considerable advancements in the management of patients with traumatic SCI...
April 12, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29629983/impact-of-icu-structure-and-processes-of-care-on-outcomes-after-severe-traumatic-brain-injury-a-multicenter-cohort-study
#14
Victoria A McCredie, Aziz S Alali, Damon C Scales, Gordon D Rubenfeld, Brian H Cuthbertson, Avery B Nathens
OBJECTIVES: It is uncertain whether dedicated neurocritical care units are associated with improved outcomes for critically ill neurologically injured patients in the era of collaborative protocol-driven care. We examined the association between dedicated neurocritical care units and mortality and the effects of standardized management protocols for severe traumatic brain injury. DESIGN: We surveyed trauma medical directors from centers participating in the American College of Surgeons Trauma Quality Improvement Program to obtain information about ICU structure and processes of care...
April 6, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29628810/rehabilitation-of-tibial-plateau-fracture-following-anterior-cruciate-ligament-reconstruction-a-case-report
#15
Ali Rabatsky, John D Lockenour
Objective: The purpose of this case report was to describe the management of a tibial plateau fracture in a patient who had undergone anterior cruciate ligament (ACL) reconstruction 3.5 years earlier. Clinical Features: A 36-year-old man presented with pain and edema following a fall from a height of approximately 2 m while skateboarding. The patient reported having undergone arthroscopic ACL reconstruction with allograft and bioabsorbable screws 3.5 years earlier...
March 2018: Journal of Chiropractic Medicine
https://www.readbyqxmd.com/read/29619644/road-traffic-accidents-a-pictorial-review
#16
Sanaa Kissi, L Fournier, N How Kit
Road traffic accidents are still a major cause of morbidity and mortality. With well-established whole-body CT protocols in trauma, radiologists are an integral part of trauma diagnosis and management teams. Five well-recognized traumatic syndromes (seat belt syndrome, handlebar syndrome, scapulothoracic dissociation, dashboard syndrome, and brake pedal injury) with their frequent associated complications should be diagnosed precociously according to the accident mechanism to avoid diagnostic delays and poor prognosis even if the circumstances seem minor...
April 4, 2018: Emergency Radiology
https://www.readbyqxmd.com/read/29605431/combination-of-blood-lactate-level-with-assessment-of-blood-consumption-abc-scoring-system-a-more-accurate-predictor-of-massive-transfusion-requirement
#17
Wongsakorn Chaochankit, Osaree Akaraborworn, Burapat Sangthong, Komet Thongkhao
PURPOSE: Exsanguination is the most common leading cause of death in trauma patients. The massive transfusion (MT) protocol may influence therapeutic strategies and help provide blood components in timely manner. The assessment of blood consumption (ABC) score is a popular MT protocol but has low predictability. The lactate level is a good parameter to reflect poor tissue perfusion or shock states that can guide the management. This study aimed to modify the ABC scoring system by adding the lactate level for better prediction of MT...
March 3, 2018: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
https://www.readbyqxmd.com/read/29602468/do-the-key-prognostic-factors-for-non-specific-neck-pain-have-moderation-effects-a-study-protocol
#18
Arun Prasad Balasundaram, Hilde Stendal Robinson, Nina Køpke Vøllestad
Neck pain is one of the common musculoskeletal conditions prevalent in the general population in Norway. Patients with neck pain, seek treatment from different health professionals such as general practitioners, physiotherapists, chiropractors and alternative medicine practitioners. The interventions for neck pain are typically provided in a primary care or specialised healthcare setting depending on the general practitioners' referral patterns. Clinicians are interested to know the various prognostic factors that can explain the recovery from neck pain...
May 2018: Medical Hypotheses
https://www.readbyqxmd.com/read/29589039/blunt-traumatic-injury-during-pregnancy-a-descriptive-analysis-from-a-level-1-trauma-center
#19
Hassan Al-Thani, Ayman El-Menyar, Brijesh Sathian, Ahammed Mekkodathil, Sam Thomas, Monira Mollazehi, Maryam Al-Sulaiti, Husham Abdelrahman
PURPOSE: The precise incidence of trauma in pregnancy is not well-known, but trauma is estimated to complicate nearly 1 in 12 pregnancies and it is the leading non-obstetrical cause of maternal death. METHODS: A retrospective study of all pregnant women presented to national level 1 trauma center from July 2013 to June 2015 was conducted. Descriptive and inferential statistics applied for data analysis. RESULTS: Across the study period, a total of 95 pregnant women were presented to the trauma center...
March 27, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29569680/successful-non-operative-management-of-blunt-abdominal-trauma-in-highly-selective-cases-a-safe-and-effective-choice
#20
Georgios Theodoros Liagkos, Charalampos Spyropoulos, Gerasimos Tsourouflis, Aris Papadopoulos, Paulos Ioannides, Constantine Vagianos
BACKGROUND: The non-operative management (NOM) of abdominal injuries has gained wide acceptance over the last few decades. The present study evaluated the efficacy of NOM in blunt abdominal trauma (BAT) at a regional Hellenic hospital. METHODS: We analyzed the results of a pre-decided treatment protocol, which was applied to all patients hospitalized for BAT, from 2008 to 2015. The protocol proposed NOM in hemodynamically stable patients with no signs of peritonitis...
March 2018: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
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