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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
#1
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
#2
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
#3
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
#4
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
#5
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
https://www.readbyqxmd.com/read/28302286/viscoelastic-hemostatic-assays-in-the-management-of-the-pediatric-trauma-patient
#6
Christine M Leeper, Barbara A Gaines
Viscoelastic hemostatic assays (VHA), such as TEG and ROTEM, are whole blood tests that depict functional coagulation both numerically and graphically. The development of rapid VHA technology, which allows for the first data points to result within minutes of test initiation, has increased the utility of these tests in the treatment of trauma patients. Both adult and pediatric centers have integrated VHAs into trauma resuscitation and transfusion protocols. Literature regarding the use of VHAs for injured children is limited...
February 2017: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/28296529/computed-tomography-and-clinical-outcome-in-patients-with-severe-traumatic-brain-injury
#7
Maud Stenberg, Lars-Owe D Koskinen, Per Jonasson, Richard Levi, Britt-Marie Stålnacke
OBJECTIVE: To study: (i) acute computed tomography (CT) characteristics and clinical outcome; (ii) clinical course and (iii) Corticosteroid Randomisation after Significant Head Injury acute calculator protocol (CRASH) model and clinical outcome in patients with severe traumatic brain injury (sTBI). METHODS: Initial CT (CTi) and CT 24 hours post-trauma (CT24) were evaluated according to Marshall and Rotterdam classifications. Rancho Los Amigos Cognitive Scale-Revised (RLAS-R) and Glasgow Outcome Scale Extended (GOSE) were assessed at three months and one year post-trauma...
2017: Brain Injury: [BI]
https://www.readbyqxmd.com/read/28286376/high-mobility-group-box-1-protein-and-outcomes-in-critically-ill-surgical-patients-requiring-open-abdominal-management
#8
Michelle S Malig, Craig N Jenne, Chad G Ball, Derek J Roberts, Zhengwen Xiao, Andrew W Kirkpatrick
Background. Previous studies assessing various cytokines in the critically ill/injured have been uninformative in terms of translating to clinical care management. Animal abdominal sepsis work suggests that enhanced intraperitoneal (IP) clearance of Damage-Associated Molecular Patterns (DAMPs) improves outcome. Thus measuring the responses of DAMPs offers alternate potential insights and a representative DAMP, High Mobility Group Box-1 protein (HMGB-1), was considered. While IP biomediators are being recognized in critical illness/trauma, HMGB-1 behaviour has not been examined in open abdomen (OA) management...
2017: Mediators of Inflammation
https://www.readbyqxmd.com/read/28260484/impact-of-a-full-time-donor-management-protocol-on-donors-liver-biopsy-findings-progress-to-date
#9
Meysam Mojtabaee, Alireza Shamsaeefar, Siavash Gholami, Mojtaba Mohsenzadeh, Farahnaz Sadegh Beigee
OBJECTIVES: This study investigated a fixed coordinator-directed donor management strategy's impact on donated liver quality, as determined by definitive biopsy results. MATERIALS AND METHODS: We collected donated liver biopsy results from donations both before and after implementing a fixed coordinator-directed donor management strategy. This strategy involved full-time attendance by a donor coordinator and continued resuscitation of brain-dead donors. All donations took place in a single organ procurement unit...
February 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/28255509/palliative-management-of-nonoperative-femoral-neck-fractures-with-continuous-peripheral-pain-catheters-20-patient-case-series
#10
Christopher H Rashidifard, Nicholas M Romeo, Paul Muccino, Mark Richardson, Thomas G DiPasquale
INTRODUCTION: To identify the success of pain catheters in the management of pain in nonoperatively treated femoral neck fractures (FNFs) in supplement to current multimodal protocols for end-of-life pain management. METHODS: Twenty patients aged older than 50 years with FNFs were selected in a retrospective fashion at a level 1 trauma center. These patients were treated nonoperatively with indwelling continuous peripheral pain catheters to palliate pain. Adjunctive pain control for patients undergoing nonoperative management of FNFs was provided with an indwelling continuous intra-articular/peripheral nerve ropivacaine pain catheters...
March 2017: Geriatric Orthopaedic Surgery & Rehabilitation
https://www.readbyqxmd.com/read/28242408/a-rare-entity-traumatic-thoracic-aortic-injury-in-a-patient-with-aberrant-right-subclavian-artery
#11
Hiten Mohanbhai Patel, Shubhabrata Banerjee, Shahzad Bulsara, Tapish Sahu, Virender K Sheorain, Tarun Grover, Rajiv Parakh
BACKGROUND: Aberrant right subclavian artery is an uncommon entity incidence ranging from 0.5-2.5%. Management of thoracic aortic injury in the presence of such anomalies can be a challenge. We present here a case of traumatic aortic injury which was incidentally found to have an asymptomatic aberrant right subclavian artery. The patient was managed by an endovascular repair of thoracic aortic injury with an endograft and a right carotid to subclavian artery bypass as a hybrid procedure...
February 24, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28225743/damage-control-resuscitation-in-patients-with-severe-traumatic-hemorrhage-a-practice-management-guideline-from-the-eastern-association-for-the-surgery-of-trauma
#12
Jeremy W Cannon, Mansoor A Khan, Ali S Raja, Mitchell J Cohen, John J Como, Bryan A Cotton, Joseph J Dubose, Erin E Fox, Kenji Inaba, Carlos J Rodriguez, John B Holcomb, Juan C Duchesne
BACKGROUND: The resuscitation of severely injured bleeding patients has evolved into a multi-modal strategy termed damage control resuscitation (DCR). This guideline evaluates several aspects of DCR including the role of massive transfusion (MT) protocols, the optimal target ratio of plasma (PLAS) and platelets (PLT) to red blood cells (RBC) during DCR, and the role of recombinant activated factor VII (rVIIa) and tranexamic acid (TXA). METHODS: Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, a subcommittee of the Practice Management Guidelines (PMG) Section of EAST conducted a systematic review using MEDLINE and EMBASE...
March 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28215195/tetanus-a-potential-public-health-threat-in-times-of-disaster
#13
Paige Finkelstein, Laura Teisch, Casey J Allen, Gabriel Ruiz
BACKGROUND: Tetanus is a potentially fatal condition that is rare in urban environments but is seen in developing countries and post-natural-disaster. Therefore, the purpose of this report was to review the epidemiology, pathogenesis, and management of tetanus in the trauma patient. METHODS: A thorough literature review was conducted to look for the most current and thorough guidelines on the prophylaxis and treatment of tetanus. PUBMED (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA), MEDLINE (US National Library of Medicine, National Institutes of Health; Bethesda, Maryland USA), and Cochrane Library (The Cochrane Collaboration; Oxford, United Kingdom) databases were searched for articles in English, published from 2005 to 2015, using the keywords "Tetanus," "Trauma/Surgery," and "Disaster...
February 20, 2017: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/28209192/learning-from-2523-trauma-deaths-in-india-opportunities-to-prevent-in-hospital-deaths
#14
Nobhojit Roy, Deepa Kizhakke Veetil, Monty Uttam Khajanchi, Vineet Kumar, Harris Solomon, Jyoti Kamble, Debojit Basak, Göran Tomson, Johan von Schreeb
BACKGROUND: A systematic analysis of trauma deaths is a step towards trauma quality improvement in Indian hospitals. This study estimates the magnitude of preventable trauma deaths in five Indian hospitals, and uses a peer-review process to identify opportunities for improvement (OFI) in trauma care delivery. METHODS: All trauma deaths that occurred within 30 days of hospitalization in five urban university hospitals in India were retrospectively abstracted for demography, mechanism of injury, transfer status, injury description by clinical, investigation and operative findings...
February 16, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28193544/current-approach-to-liver-traumas
#15
Levent Kaptanoglu, Necmi Kurt, Hasan Ediz Sikar
INTRODUCTION: Liver injuries remain major obstacle for successful treatment, due to size and location of the liver. Requirement for surgery should be determined by clinical factors, most notably hemodynamical state. In this present study we tried to declare our approach to liver traumas. We also tried to emphasize the importance of conservative treatment, since surgeries for liver traumas carry high mortality rates. PRESENTATION OF CASE: Patients admitted to the Department of Emergency Surgery at Kartal Research and Education Hospital, due to liver trauma were retrospectively analyzed between 2003 and 2013...
March 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28192378/analysis-and-management-of-complications-in-a-cohort-of-1-065-minimally-invasive-cochlear-implantations
#16
Yi Jiang, Ping Gu, Beicheng Li, Xue Gao, Baochun Sun, Yueshuai Song, Guojian Wang, Yongyi Yuan, Cuicui Wang, Miao Liu, Dongyi Han, Pu Dai
OBJECTIVES: To analyze complications associated with minimally invasive cochlear implantation by comparing data from different centers, to discuss major reasons for complications, and to refine implantation techniques to decrease them. PATIENTS: Patients who underwent cochlear implantation at our center by the same surgeon (the corresponding author of this article) from March 2006 to March 2015 were enrolled. INTERVENTION: First, a retrospective analysis of the complications associated with minimally invasive cochlear implantation at our center was performed...
March 2017: Otology & Neurotology
https://www.readbyqxmd.com/read/28190515/early-experience-with-a-split-bolus-single-pass-ct-protocol-in-paediatric-trauma
#17
V J Leung, M Grima, N Khan, H R Jones
AIM: To determine the adequacy of the split-bolus computed tomography (CT) technique in terms of vascular enhancement and solid-organ injury assessment in paediatric trauma. MATERIALS AND METHODS: A retrospective review was undertaken of all split-bolus trauma CT examinations performed in patients <16 years during the period from 1 January 2015 to 31 January 2016. Twelve examinations were performed in this time on patients with an age range of 2-15 years (mean 10...
February 9, 2017: Clinical Radiology
https://www.readbyqxmd.com/read/28188036/outcomes-of-an-accelerated-care-pathway-for-pediatric-blunt-solid-organ-injuries-in-a-public-healthcare-system
#18
Oluwatomilayo Daodu, Mary Brindle, Carlos R Alvarez-Allende, Lisette Lockyer, Bryce Weber, Steven R Lopushinsky
PURPOSE: An accelerated clinical care pathway for solid organ abdominal injuries was implemented at a level one pediatric trauma center. The impact on resource utilization and demonstration of protocol safety was assessed. METHODS: Data were collected retrospectively on patients admitted with blunt abdominal solid organ injuries from 2012 to 2015. Patients were subdivided into pre- and post-protocol groups. Length of hospital stay (LOS) and failure of non-operative treatment were the primary outcomes of interest...
January 29, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28187803/management-of-acute-traumatic-spinal-cord-injuries
#19
REVIEW
C D Shank, B C Walters, M N Hadley
Acute traumatic spinal cord injury (SCI) is a devastating disease process affecting tens of thousands of people across the USA each year. Despite the increase in primary prevention measures, such as educational programs, motor vehicle speed limits, automobile running lights, and safety technology that includes automobile passive restraint systems and airbags, SCIs continue to carry substantial permanent morbidity and mortality. Medical measures implemented following the initial injury are designed to limit secondary insult to the spinal cord and to stabilize the spinal column in an attempt to decrease devastating sequelae...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28186700/retrospective-study-of-mortality-in-asiatic-lions-panthera-leo-persica-in-the-european-breeding-population-between-2000-and-2014
#20
Olivia Metz, Jonathan Williams, Rikke Kruse Nielsen, Nic Masters
Although the European population of Asiatic lions (Panthera leo persica) has been managed under the European Endangered Species Program (EEP) since 1990, little is known about the health status of the population. This study was designed to characterize mortality for this population through examination of the studbook and other records on 392 Asiatic lions living in the EEP between 2000 and 2014. A total of 270 animals died during the period with 80% of them being under 1 year old. The mortality rate for under 1 year olds was 54%, while the odds of survival of cubs within a litter increased if the dam had had litters previously...
January 2017: Zoo Biology
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