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Trauma care

Caroline M Ruminski, Matthew T Clark, Douglas E Lake, Rebecca R Kitzmiller, Jessica Keim-Malpass, Matthew P Robertson, Theresa R Simons, J Randall Moorman, J Forrest Calland
Predictive analytics monitoring, the use of patient data to provide continuous risk estimation of deterioration, is a promising new application of big data analytical techniques to the care of individual patients. We tested the hypothesis that continuous display of novel electronic risk visualization of respiratory and cardiovascular events would impact intensive care unit (ICU) patient outcomes. In an adult tertiary care surgical trauma ICU, we displayed risk estimation visualizations on a large monitor, but in the medical ICU in the same institution we did not...
August 18, 2018: Journal of Clinical Monitoring and Computing
Quirine M J van der Vliet, Oscar E C van Maarseveen, Diederik P J Smeeing, Roderick M Houwert, Karlijn J P van Wessem, Rogier K J Simmermacher, Geertje A M Govaert, Mirjam B de Jong, Ivar G J de Bruin, Luke P H Leenen, Falco Hietbrink
INTRODUCTION: There is continuous drive to optimize healthcare for the most severely injured patients. Although still under debate, a possible measure is to provide 24/7 in-house (IH) coverage by trauma surgeons. The aim of this study was to compare process-related outcomes for severely injured patients before and after transition of attendance policy from an out-of-hospital (OH) on-call attending trauma surgeon to an in-house attending trauma surgeon. METHODS: Retrospective before-and-after study using prospectively gathered data in a Level 1 Trauma Center in the Netherlands...
August 10, 2018: Injury
Aline B Maddux, Matthew Cox-Martin, Michael Dichiaro, Tellen D Bennett
OBJECTIVES: To determine the association between the Functional Status Scale and Pediatric Functional Independence Measure scores during the rehabilitation stay in children who survive traumatic brain injury. DESIGN: Secondary analysis of a prospective observational cohort study. SETTING: Tertiary care children's hospital with a level 1 trauma center and inpatient rehabilitation service. PATIENTS: Sixty-five children less than 18 years old admitted to an ICU with acute traumatic brain injury and subsequently transferred to the inpatient rehabilitation service...
August 16, 2018: Pediatric Critical Care Medicine
Brian D Sumner, Emily A Grimsley, Niall H Cochrane, Ryan R Keane, Alexis B Sandler, Paul C Mullan, Karen J O'Connell
BACKGROUND: The National Association of EMS Physicians emphasizes the importance of high quality communication between emergency medical services (EMS) providers and emergency department (ED) staff for providing safe, effective care. The Joint Commission has identified ineffective handoff communication as a contributing factor in 80% of serious medical errors. The quality of handoff communication from EMS to ED teams for critically ill pediatric patients needs further exploration. OBJECTIVE: This study assessed the quality of handoff communication between EMS and ED staff during pediatric medical resuscitations...
August 17, 2018: Prehospital Emergency Care
Steven G Schauer, Jason F Naylor, Joseph K Maddry, Carmen Hinojosa-Laborde, Michael D April
BACKGROUND: Tactical Combat Casualty Care (TCCC) guidelines regarding prehospital analgesia agents have evolved. The guidelines stopped recommending intramuscular (IM) morphine in 1996, recommending only intravenous (IV) routes. In 2006, the guidelines recommended oral transmucosal fentanyl citrate (OTFC), and in 2012 it added ketamine via all routes. It remains unclear to what extent prehospital analgesia administered on the battlefield adheres to these guidelines. We seek to describe trends in analgesia administration patterns on the battlefield during 2007-2016...
August 17, 2018: Prehospital Emergency Care
Tracy Shamas, Sarah Gillespie-Heyman
One aspect of palliative medicine that has been underexplored is the perspective of veterans either facing critical life-limiting illness or at the end of life. The needs of veterans differ not only because military culture affects how veterans cope with their illness but also because exposure-related factors (combat and environmental) differ between military branches. In this paper, we describe two cases involving end-of-life care for veterans with combat trauma and describe individualized approaches to their care...
August 1, 2018: AMA Journal of Ethics
Charles-Henri Houzé-Cerfon, Vincent Bounes, Johanna Guemon, Thibault Le Gourrierec, Thomas Geeraerts
OBJECTIVE: In Trauma brain injury (TBI) patients, early detection and subsequent prompt treatment of elevated intracranial pressure (ICP) is a challenge in the pre-hospital setting, as physical examination is limited in comatose patients, and invasive device placement not possible. The aim of this study was to evaluate the quality and feasibility of Optic Nerve Sheath Diameter (ONSD) measurements obtained during the prehospital management of TBI patients. METHODS: Prospective, observational study of 23 moderate and severe TBI patients during pre-hospital medical care...
August 17, 2018: Prehospital Emergency Care
A F Santoro, S M Shear, A Haber
BACKGROUND: Associations between childhood adversity and negative health outcomes are well documented within the general population; however, this relationship has yet to be confirmed in adults with intellectual and developmental disabilities (I/DD). Bridging the gap between public health and I/DD research is critical in order to better understand the ways in which the health of people with I/DD are compromised by adversity and social disadvantage and to develop preventative care frameworks and health-promoting practices specifically for adults with I/DD...
August 17, 2018: Journal of Intellectual Disability Research: JIDR
Robin A Hanks, Lisa Rapport, Katharine Seagly, Scott Millis, Carolyn Scott, Claire Pearson
This study examined the hypothesis that people who receive concussion recovery education would have better outcomes than those who received usual discharge paperwork from the emergency department, and to determine if participants who were in litigation or seeking disability compensation had more symptoms than individuals not engaged in these activities. 255 persons diagnosed with concussion were randomly assigned to a brief education group, longer education group, and usual care (standard ED discharge instructions)...
August 17, 2018: Journal of Neurotrauma
Yuki Ikeno, Yoshikatsu Nomura, Masamichi Matsumori, Yasuko Gotake, Hidekazu Nakai, Takashi Matsueda, Katsuhiro Yamanaka, Takeshi Inoue, Hiroshi Tanaka, Yutaka Okita
Despite advances in emergency care and the emergent transportation system, cardiac and aortic ruptures after blunt trauma are associated with high mortality and morbidity. We present a rare case of a 70-year-old man with a ruptured left atrial basal appendage and distal aortic arch after sustaining blunt trauma to the chest during a motor vehicle accident. The patient was transported to our hospital in a state of shock and taken directly to the operating room. Hybrid treatment was performed, including surgical repair of the left atrium under cardiopulmonary bypass and thoracic endovascular aortic repair, was performed...
August 16, 2018: General Thoracic and Cardiovascular Surgery
Joji Inamasu, Msasato Nakaya, Dai Kujirai, Keita Mayanagi, Masashi Nakatsukasa
BACKGROUND: While seatbelt is an important device protecting drivers from traumatic brain injury (TBI), it has rarely been reported how often and in what circumstances restrained drivers sustain TBI after road traffic accident (RTA). Whole-body computed tomography (WBCT) for blunt trauma patients may provide a unique opportunity to investigate the frequency and characteristics of TBI sustained by restrained drivers. METHODS: A single-center, retrospective observational study was conducted using prospectively acquired data...
August 17, 2018: Acta Neurochirurgica
Michela Starace, Aurora Alessandrini, Emi Dika, Bianca Maria Piraccini
Squamous cell carcinoma (SCC) of the nail apparatus is a rare malignant tumor that usually originates underneath the nail plate and grows slowly with possible bone invasion. The etiology remains unknown, although a strong association with different conditions, such as high-risk human papillomavirus (HPVs), trauma, or radiation exposure has been demonstrated. Nail SCC is called "the great mimicker nail tumor" because different clinical presentations may coexist, resembling benign or malignant nail lesions...
July 2018: Dermatology Practical & Conceptual
M Marshall, C Shannon, C Meenagh, N Mc Corry, C Mulholland
OBJECTIVES: This study explores rates of a history of childhood trauma in adult patients with bipolar disorder and depression and the impact of such trauma and parental bonding patterns on depressive mood and interpersonal functioning at the time of assessment. METHODS: A cross-sectional design was used and a sample of 49 participants was recruited from a mental health outpatient service in Northern Ireland. Data were subject to correlations, one-way analysis of variance and hierarchal regression analyses...
March 2018: Irish Journal of Psychological Medicine
Jinlin Liu, Xiaocheng Luo, Wenjian Wang, Sujie Zheng, Huijun Lin, Juping Zeng, Mao Wu
To systemically analyze megakaryocytes in pleural and peritoneal fluids and their clinical significance. We retrospectively examined 10,846 pleural, peritoneal, and pericardial fluid samples obtained from 3 hospitals over a 20-year period. Megakaryocytes were observed in the pleural fluid samples from 7 patients and peritoneal fluid samples from 2 patients, and the incidence was 0.83%. The clinical diagnoses of these 9 patients included myeloproliferative disorders, trauma, and tumors. The serous effusions in all 9 patients were bloody, and the megakaryocytes could be associated with trauma, bone marrow pollution, extramedullary hematopoiesis, or cancer...
August 2018: Medicine (Baltimore)
Scott Nathan Loewenstein, Stephen P Duquette, Joshua M Adkinson
BACKGROUND: Hand surgery dogma suggests that simultaneous surgical treatment of carpal tunnel syndrome (CTS) and Dupuytren's contracture (DC) results in an increased incidence of Complex Regional Pain Syndrome (CRPS). As a result, many surgeons do not perform surgery for the two conditions concurrently. Our goal was to determine the extent of this association. METHODS: We identified all patients undergoing surgical treatment for CTS, DC, or both between April 1982 and March 2017 using the Indiana Network for Patient Care (INPC), a large, multi-institutional, statewide information exchange...
August 11, 2018: Plastic and Reconstructive Surgery
Guntaragorn Hongrattana, Potipong Reungjui, Panaya Tumsatan, Chulee Ubolsakka-Jones
AIM: The aim of the study was to obtain information about the incidence and risk factors for pulmonary atelectasis in mechanically ventilated patients in the trauma ICU (TMICU). Pulmonary atelectasis is a common complication leading to serious lung dysfunction in patients in the TMICU and early identification of patients at risk is important for their effective management. METHODS: All trauma patients admitted to the TMICU with mechanical ventilation for more than 1 day were included in a prospective 12-month study...
August 14, 2018: International Journal of Evidence-based Healthcare
P Roy, R Mukherjee, M Parik
Over the past three decades, management of blunt splenic trauma has changed radically. Use of improved diagnostic techniques and proper understanding of disease pathology has led to nonoperative management being chosen as the standard of care in patients who are haemodynamically stable. This review was undertaken to assess available literature regarding changing trends of management of blunt splenic trauma, and to identify the existing lacunae in nonoperative management. The PubMed database was searched for studies published between January 1987 and August 2017, using the keywords 'blunt splenic trauma' and 'nonoperative management'...
August 16, 2018: Annals of the Royal College of Surgeons of England
Makini Chisolm-Straker
Human trafficking was defined in the United States in 2000, with the Trafficking Victims Protection Act (TVPA). Studies demonstrate that clinicians are seeing trafficked persons and emergency departments (ED) are among their most frequented healthcare sites.,, These studies were of survivors reporting their healthcare experiences while being trafficked, some of which occurred before the TVPA; EDs have been serving trafficked persons as patients long before the government named the problem. This is not surprising...
August 16, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Nidhi Bhardwaj, Surbhi Khurana, Subodh Kumar, Sushma Sagar, Amit Gupta, Biplap Mishra, Kapil Dev Soni, Purva Mathur
Introduction: Trauma is one of the leading causes of mortality worldwide. Trauma patients, who presented to the hospital casualty department within 24 h of injury, further admitted to the Surgical Intensive Care Unit were enrolled in this study. Materials and Methods: The aim was to study the peripheral blood monocyte activity to produce tumor necrosis factor (TNF-α), interleukin-1 (IL-1) β, IL-6, and IL-8 in severely injured patients after trauma. Result: A total of 28 polytrauma patients were enrolled and observed that the levels of TNF-α, IL-1 β, IL-6, and IL-8 were significantly decreased and levels of IL-8 were increased in the fatal patients compared to the healthy controls...
July 2018: Indian Journal of Critical Care Medicine
Lesley Gotlib Conn, Avery B Nathens, Charlene Soobiah, Homer Tien, Barbara Haas
OBJECTIVE: Quality improvement (QI) training is an essential component of postgraduate surgical education and can occur through formal and informal education programs. Informal QI education requires that faculty take advantage of learning opportunities in the hospital setting. Trauma rotations appear ideal opportunities for informal QI learning given that performance improvement is a mandatory component of care at verified trauma centers. It is unclear, however, whether QI initiatives within trauma programs are well integrated into trainee education...
August 12, 2018: Journal of Surgical Education
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