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Trauma care

Giacomo Lamarão Lima, Jonas Byk
The management of patients, such as Jehovah's Witnesses, who refuse to receive blood transfusions, is often a medical challenge, not only because of the ethical dilemma, but also because it creates a major obstacle to rapid hemorrhage control in a setting of trauma. This article explores the reasons for this conflict between the physician's duty of care and the respect for the patient's autonomy, and draws a panorama of the main understandings of the Judiciary on the subject. Finally, it is concluded that the manifestation of the patient's will, although free, is not enough to release the doctor from his (her) duty of care...
November 29, 2018: Revista do Colégio Brasileiro de Cirurgiões
Sara Reis Teixeira, Fabrício Guimarães Gonçalves, Carolina A Servin, Kshitij Mankad, Giulio Zuccoli
Abusive head trauma (AHT) is a form of inflicted head injury. AHT is more frequent in 2-year-old or younger children. It is an important cause of neurological impairment and the major cause of death from head trauma in this age group. Brain magnetic resonance imaging allows the depiction of retinal hemorrhages, injured bridging veins, and identifying and localizing extra- and intra-axial bleeds, contusions, lacerations, and strokes. The diagnosis of AHT is a multidisciplinary team effort which includes a careful evaluation of social, clinical, laboratory, and radiological findings...
December 2018: Topics in Magnetic Resonance Imaging: TMRI
John Chung-Han Wu, Hsin-Yu Chen, Chien-Hung Liao, Shang-Yu Wang, Chih-Yuan Fu, Chih-Hao Chen, Chien-Tzung Chen
OBJECTIVE: Maxillofacial fractures with concomitant laryngeal injuries put both the quality and maintenance of life in jeopardy. Because of its low incidence, it is often overlooked in the clinical setting. The purpose of this study is to review the incidence, clinical presentations, managements, and outcomes of these patients. METHODS: A retrospective analysis of medical records from 2008 to 2015 was conducted at a single institute. A case series (n = 12, which contributed 22...
December 3, 2018: Annals of Plastic Surgery
D J Hepple, J W Durrand, O Bouamra, P Godfrey
The deployment of physician-led pre-hospital enhanced care teams capable of critical care interventions at the scene of injury may confer a survival benefit to victims of major trauma. However, the evidence base for this widely adopted model is disputed. Failure to identify a clear survival benefit has been attributed to several factors, including an inherently more severely injured patient group who are attended by these teams. We undertook a novel retrospective analysis of the impact of a regional enhanced care team on observed vs...
December 5, 2018: Anaesthesia
Sinan Akay, Mehmet Burak Aşık, Sami Eksert
BACKGROUND: The aim of this study was to investigate the characteristics of shrapnel distribution in the body and a possible relationship to the type of weapon and type of location of the conflict. METHODS: The records of 246 patients admitted to a level-III trauma center with any kind of firearm injury were examined retrospectively. Ninety patients who had at least 1 radiologically-proven piece of shrapnel in their body were included in the study. For the purposes of the study, the body was divided into 5 regions (head/neck, thorax/back, abdomen/pelvis/waist, upper extremities, and lower extremities) and shrapnel distribution was noted according to these divisions...
November 2018: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
Kıvılcım Karadeniz Cerit, Rabia Ergelen, Tural Abdullayev, Halil Tuğtepe, Tolga Emrullah Dağlı, Gürsu Kıyan
BACKGROUND: Although a nonoperative treatment approach is preferred for blunt liver and spleen trauma in childhood, there are significant differences between clinics in the algorithms used. The approach to high-grade liver and spleen injury is still controversial, particularly as grade V liver and spleen injuries are not included in the American Pediatric Surgical Association guideline. The aim of this study was to present experience with a non-operative treatment approach to children with high-grade liver and spleen injuries...
November 2018: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
Carol A Kidron, Laurence J Kirmayer
Efforts to provide culturally appropriate global mental health interventions have included attention to local idioms of distress. This article critically examines the potential gap between lay ethnopsychological understandings of the Cambodian idiom of baksbat (broken courage) on the one hand and clinical conceptualizations of the idiom as a potential indicator of posttraumatic stress disorder. Ethnographic semi-structured interviews with trauma survivors reveal resistance to current clinical translations and hybrid Euro-Western and Khmer treatment interventions...
December 4, 2018: Culture, Medicine and Psychiatry
Cecily Begley, Natalie Sedlicka, Deirdre Daly
BACKGROUND: Respectful maternity care includes treating women with dignity, consulting them about preferences, gaining consent for treatment, respecting their wishes, and giving care based on evidence, not routines. In the absence of any documented evidence, this study aimed to ascertain maternity care-givers' perceptions of respectful care provided for childbearing women in Czech Republic. METHODS: Following ethical approval, an online quantitative survey with qualitative comments was completed by 52 respondents recruited from workshops on promoting normal birth, followed by snowball sampling...
December 4, 2018: Reproductive Health
Xiao Lu, ChunShuang Wu, YuZhi Gao, Mao Zhang
BACKGROUND: High-flow nasal cannula (HFNC) oxygen therapy has been shown to reduce the need for mechanical ventilation and decrease the duration of hospital and intensive care unit (ICU) stays for patients with a severely compromised respiratory system. This study aims to observe the evolution of lung aeration via lung ultrasound score (LUS) in a chest-injured population who had been treated with HFNC oxygen therapy, and to assess the benefit of the HFNC oxygen therapy in trauma patients...
December 4, 2018: Journal of Intensive Care Medicine
Zhang Hu, Sitong Lu, Yu Cheng, Songzhi Kong, Sidong Li, Chengpeng Li, Lei Yang
Hemorrhea is one of the major problems in war, trauma care, and surgical operation that threaten the life of the injured and patients. As a novel polymeric hemostatic agent, biodegradable chitosan can stop bleeding through a variety of approaches. In this paper, chitosan with various molecular parameters was prepared from chitin as raw material through deacetylation, oxidative degradation, hydrophilic modification, and salt formation reactions. The influence of different polymer parameters on the hemostatic effects of chitosan was investigated by in vitro coagulation time and dynamic coagulation assay...
November 30, 2018: Molecules: a Journal of Synthetic Chemistry and Natural Product Chemistry
Amir Shamshirian, Ali Reza Mohseni, Ali Akbar Pourfathollah, Shirin Mehdipour, Samira Hosseini, Atiyeh Ghorbanpour, Soheil Azizi
BACKGROUND/OBJECTIVES: Blood is a vital resource that its utilization is ever increasing throughout the world and blood wastage is a global challenge that needs to be controlled. Most blood resources are used during complications of pregnancy, trauma, severe childhood anemia, gynecology, cancers, surgery, hematology disorders, and chronic diseases. Units that are expired, broken bags, returning the blood unit after 30 min, blood clotted units, etc., which are due to lack of awareness may result in the wastage of blood products...
December 4, 2018: Acta Clinica Belgica
Sushil A Luis, Nandan S Anavekar, Peter C Spittell, Krishnaswamy Chandrasekaran
We present the case of a 26-year-old female restrained front-seat passenger who presents following a motor vehicle accident, with CT angiogram features suggestive of possible acute aortic injury. However, clinical features including relative hemodynamic stability and absence of typical symptoms were discordant with these imaging findings. This case illustrates that even with ECG-gating, CT angiogram artifact mimicking acute aortic injury may still occur. Careful evaluation and clinical correlation is of vital importance, both to ensure acute aortic injury is not missed and that patients are not erroneously sent for aortic surgery when there is no aortic injury...
December 4, 2018: Echocardiography
Ibinabo Ibiebele, Jennifer R Bowen, Tanya A Nippita, Jonathan M Morris, Jane B Ford
INTRODUCTION: There is debate about optimal management of pregnancies with a large-for-gestational age baby. A recent randomized controlled trial reported that early term induction of labor reduced cesarean section rates and infant morbidity. However, long term childhood outcomes have not been assessed. The aim of this study was to assess maternal, neonatal and child health and education outcomes for large-for-gestational age babies induced at 37-38 weeks gestation. MATERIAL AND METHODS: Population-based record linkage study of term (37+ weeks), cephalic-presenting singleton pregnancies with a large-for-gestational age baby in New South Wales, Australia, 2002-2006...
December 4, 2018: Acta Obstetricia et Gynecologica Scandinavica
Richa Gawande, My Ngoc To, Elizabeth Pine, Todd Griswold, Timothy B Creedon, Alexandra Brunel, Angela Lozada, Eric B Loucks, Zev Schuman-Olivier
BACKGROUND: Self-management of health is important for improving health outcomes among primary care patients with chronic disease. Anxiety and depressive disorders are common and interfere with self-regulation, which is required for disease self-management. An insurance-reimbursable mindfulness intervention integrated within primary care may be effective for enhancing chronic disease self-management behaviors among primary care patients with anxiety, depression, trauma, and stress-related and adjustment disorders compared with the increasingly standard practice of referring patients to outside mindfulness resources...
December 3, 2018: Journal of General Internal Medicine
Brian W Powers, Jiali Yan, Jingsan Zhu, Kristin A Linn, Sachin H Jain, Jennifer L Kowalski, Amol S Navathe
BACKGROUND: There is a growing focus on improving the quality and value of health care delivery for high-cost patients. Compared to fee-for-service Medicare, less is known about the clinical composition of high-cost Medicare Advantage populations. OBJECTIVE: To describe a high-cost Medicare Advantage population and identify clinically and operationally significant subgroups of patients. DESIGN: We used a density-based clustering algorithm to group high-cost patients (top 10% of spending) according to 161 distinct demographic, clinical, and claims-based variables...
December 3, 2018: Journal of General Internal Medicine
Stephen C Haskins, Daniel Feldman, Kara G Fields, Meghan A Kirksey, Cynthia A Lien, Thuyvan H Luu, Jemiel A Nejim, James A Osorio, Elaine I Yang
Background: Point-of-care ultrasonography (PoCUS) provides real-time, dynamic clinical evidence for providers to make potentially lifesaving medical decisions; however, these tools cannot be used effectively without appropriate training. Although there is always the option of traditional didactic methods, there has been a recent trend toward a "reverse classroom" web-based model using online e-learning modules. Our objective was to collect pilot data that would justify a future randomized controlled trial, comparing traditional didactics to an e-learning PoCUS curriculum for lung ultrasonography (LUS) and the focused assessment with sonography in trauma (FAST) exam...
July 2018: Journal of Education in Perioperative Medicine: JEPM
Manon A Boeschoten, Niels Van der Aa, Anne Bakker, F Jackie June Ter Heide, Marthe C Hoofwijk, Ruud A Jongedijk, Agnes Van Minnen, Bernet M Elzinga, Miranda Olff
Background : In 2013, the Clinician-Administered PTSD Scale, the golden standard to assess PTSD, was adapted to the DSM-5 (CAPS-5). Objective : This project aimed to develop a clinically relevant Dutch translation of the CAPS-5 and to investigate its psychometric properties. Method : We conducted a stepped translation including Delphi rounds with a crowd of 44 Dutch psychotrauma experts and five senior psychotrauma experts. Using partial crowd-translations, two professional translations and the official Dutch translation of the DSM-5, each senior expert aggregated one independent translation...
2018: European Journal of Psychotraumatology
Maya G Meentken, Ingrid M van Beynum, Elisabeth W C Aendekerk, Jeroen S Legerstee, Hanan El Marroun, Jan van der Ende, Ramón J L Lindauer, Manon H J Hillegers, Henriette A Moll, Wim A Helbing, Elisabeth M W J Utens
Background : Three in every 10 children and adolescents admitted to a hospital or undergoing medical treatment develop subthreshold symptoms of posttraumatic stress disorder (PTSD). When untreated, subthreshold PTSD can have a serious impact on psychosocial functioning, quality of life and long-term psychopathology. However, research investigating subthreshold PTSD and its treatment following paediatric medical interventions and/or hospitalization is scarce. Eye Movement Desensitization and Reprocessing (EMDR) is a fast and non-invasive psychosocial treatment for posttraumatic stress complaints...
2018: European Journal of Psychotraumatology
C Margarido, J Ferns, V Chin, T Ribeiro, B Nascimento, J Barrett, E Herer, S Halpern, L Andrews, G Ballatyne, M Chapmam, J Gomes, J Callum
BACKGROUND: A structured approach to hemorrhagic emergencies in obstetrics has gained popularity with the implementation of massive hemorrhage protocols. The trauma literature suggests that routine quality reviews should be in place to improve patient outcomes. The aim of this study was to develop quality indicators and assess compliance by the clinical team. METHODS: A multidisciplinary team set the institutional quality indicators for the massive hemorrhage protocol review...
November 3, 2018: International Journal of Obstetric Anesthesia
Daniel J Shubert, Kevin H Shepet, Abigail F Kerns, Michelle A Bramer
HYPOTHESIS/BACKGROUND: Iatrogenic pneumothorax is a rare but serious complication of open reduction and internal fixation (ORIF) of clavicular fractures. Many institutions use postoperative chest radiographs to evaluate for this complication despite a lack of data to support this routine practice. Due to concerns of radiation exposure and health care costs, this practice may not be necessary. This study determined the rate of iatrogenic pneumothorax after clavicular ORIF with plate fixation at a single institution over 8 years...
November 30, 2018: Journal of Shoulder and Elbow Surgery
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