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Head trauma,emergency

Tomislav Pavlović, Marina Milošević, Sanja Trtica, Hrvoje Budinčević
BACKGROUND: Vertigo is a common symptom and reason for admission to the emergency department (ED). AIM: This research aimed to determine the incidence of clinically significant findings on computed tomography (CT) in patients with vertigo without focal neurological abnormalities in the ED. MATERIAL AND METHODS: The results of the native CT scans in the ED were retrospectively analysed. Exclusion criteria included: focal neurological abnormalities, underlying malignancy, brain metastasis, previous brain operation, headache, fever, nausea, vomiting, head trauma, coagulopathy...
September 25, 2018: Open Access Macedonian Journal of Medical Sciences
Marcello Covino, Emanuele Gilardi, Alberto Manno, Benedetta Simeoni, Veronica Ojetti, Chiara Cordischi, Evelina Forte, Luigi Carbone, Simona Gaudino, Francesco Franceschi
INTRODUCTION: Well recognized guidelines are available for the use of cranial computed tomography (CCT) in traumatic patients, while no definitely accepted standards exists to for CCT in patients without history of head injury. The aim of this study is to propose an easy clinical score to stratify the need of CCT in emergency department (ED) patients with suspect non-traumatic intracranial pathology. METHODS: We retrospectively evaluated patients presenting to the ED for neurological deficit, postural instability, acute headache, altered mental status, seizures, confusion, dizziness, vertigo, syncope, and pre-syncope...
September 19, 2018: American Journal of Emergency Medicine
Mary Matthews, Peter Richman, Scott Krall, Kimberly Leeson, K Tom Xu, Albert L Gest, Osbert Blow
BACKGROUND: Recurrent CT imaging is believed to significantly increase lifetime malignancy risk. We previously reported that high acuity, admitted trauma patients who received a whole-body CT in the emergency department (ED) had a history of prior CT imaging in 14% of cases. The primary objective of this study was to determine the CT imaging history for trauma patients who received a whole-body CT but were ultimately deemed safe for discharge directly home from the ED. METHODS: This was a retrospective cohort study conducted at an academic ED...
October 16, 2018: BMC Emergency Medicine
Chao Zhang, Li Teng, Jia-Jie Xu, Jian-Jian Lu, Fang Xie, Li-Ya Yang, Shu-Yuan Li, Huan-Huan Wu, Heng Sun, Biao Yang
Ear amputations are common in emergency departments as the auricle's protrusion from the lateral aspect of the head makes it particularly susceptible to trauma. Of the numerous approaches for auricle injuries, the classic methods include microsurgical replantation, primary reattachment, composite graft, retroauricular pocket principle, secondary reconstruction with rib cartilage, and methods using postauricular flap. The success of the operation depends largely on choosing the appropriate surgical procedure since many factors can influence surgical outcome...
October 12, 2018: Journal of Craniofacial Surgery
Xinpu Tang, Hongxu Chen, Chaoyue Chen, Jianguo Xu
INTRODUCTION: Impalement injury is an uncommon presentation, and penetrating chest injuries account for 1% to 13% of thoracic trauma hospital admissions. The vast majority of patients with penetrating thoracic trauma who survive to reach the hospital alive can be managed nonoperatively. Nevertheless, in 10% to 15% of cases, emergency operation is necessary due to the associated hemorrhagic shock and visceral injury. CASE PRESENTATION: Here, we report on a 39-year-old male, a construction worker, who fell down from a height of a construction site, landing ventrally on a clump of iron rods with 4 projecting heavy metallic rods penetrating into his thorax and head (scalp pierced only)...
October 2018: Medicine (Baltimore)
Christopher W Snyder, Jeremy D Kauffman, Etienne E Pracht, Paul D Danielson, David J Ciesla, Nicole M Chandler
BACKGROUND: Effective and sustainable pediatric trauma care requires systems of regionalization and interfacility transfer. Avoidable transfer, also known as secondary overtriage, occurs when a patient is transferred to a regional trauma center after initial evaluation at another facility that is capable of providing definitive care. The purpose of this study was to identify risk factors for avoidable transfer among pediatric trauma patients in southwest Florida. METHODS: All pediatric trauma patients two years and older transferred from outlying hospitals to the emergency department (ED) of a single state-designated pediatric trauma center between 2009 and 2017 were obtained from the institutional registry...
October 11, 2018: Journal of Trauma and Acute Care Surgery
Erdem Değirmenci, Yasin Emre Kaya, Kutay Engin Özturan
Hip is a stabilized joint due to the surrounding ligaments, and muscles, which can dislocate as a result of high energy trauma, high-level falls, and motor vehicle accidents. Traumatic hip dislocations can either be isolated or simultaneously with acetabular and proximal femur fractures. At the same time injury of sciatic, femoral or obturator nerves can be seen. However, avascular necrosis of femoral head, posttraumatic osteoarthritis, and heterotopic ossifications can be seen as prolonged complications. The period prior to the reduction, severity of the trauma, and performing open or close reductions are the major contributors of the prognosis...
October 2018: Trauma Case Reports
Omar Damji, Patricia Lee-Nobbee, David Borkenhagen, Adam Cheng
ABSTRACTEye-tracking devices are able to capture eye movements, which are further characterized by fixations. The application of eye tracking in a trauma setting has not been explored. Visual fixation can be utilized as a surrogate measure of attention during the management of a trauma patient. We aimed to determine the feasibility of using eye tracking and to characterize eye tracking behaviours of pediatric emergency medicine physicians during management of a simulated pediatric trauma patient. Each participant was equipped with a head-mounted eye-tracking device during a standardized simulated pediatric trauma scenario...
October 8, 2018: CJEM
Alain Cunqueiro, Alejandra Durango, Daniel M Fein, Kenny Ye, Meir H Scheinfeld
BACKGROUND: Children presenting to the emergency department with acute psychosis or hallucinations sometimes undergo a head CT to evaluate for a causative lesion. The diagnostic yield of head CT in this scenario has not been reported. OBJECTIVE: To determine the yield for head CT in children with acute psychosis or hallucinations. MATERIALS AND METHODS: We retrospectively searched the radiology report database over a 7.5-year period for head CT reports for pediatric emergency department patients using the following keywords: hallucination, psychosis, psychotic or "hearing voices...
October 5, 2018: Pediatric Radiology
Foscarina Della Rocca, Miranda Zoleo, Francesca Pignatiello, Fabia De Lazzari, Anna Chiara Frigo, Gianna Vettore, Donata Favretto, Rossella Snenghi
INTRODUCTION: Driving under the influence of alcohol and/or psychoactive substances increases the risk of road accidents, but it is controversial whether this affects site and severity of injuries. MATERIAL AND METHODS: We search for alcohol, cannabinoids, cocaine, benzodiazepines, opioids, methadone, amphetamines and barbiturates in biological fluids of 1764 traumatized drivers admitted to the Emergency Department (ED) of Padua between 2010 and 2014. RESULTS: We note correlation between alcohol and benzodiazepines and admission in ICU and between all the intoxications and the reserved prognosis...
July 2018: Annali Dell'Istituto Superiore di Sanità
R Q Long, D S Yu, Z H Liu, J Yang, C H Zhang, F F Jia, J Y Gao
Objective: To explore the feasibility of intercricothyrotomy in emergency airway management. Method: Characteristics of 27 cases underwent surgical cricothyrotomy were analyzed. Result: The main causes of emergency were severe trauma of head and neck, larynx stenosis, interspaces infection of the floor of the mouth and submaxillary space, etc; all the patients were divided into 2 groups : surgical cricothyrotomy as the first choice (group A,16/27) and surgical cricothyrotomy after conventional tracheotomy (group B,11/27); The average time of opening airway for group A was much shorter than group B [(58...
August 2018: Journal of Clinical Otorhinolaryngology, Head, and Neck Surgery
Kwesi Dawson-Amoah, Jesse Raszewski, Neil Duplantier, Bradford Sutton Waddell
Background: Dislocation of the hip is a well-described event that occurs in conjunction with high-energy trauma or postoperatively after total hip replacement. Methods: In this review, the types, causes, and treatment modalities of hip dislocation are discussed and illustrated, with particular emphasis on the assessment, treatment, and complications of dislocations following total hip replacement. Results: Hip dislocations are commonly classified according to the direction of dislocation of the femoral head, either anterior or posterior, and are treated with specific techniques for reduction...
2018: Ochsner Journal
Felicia Chow
PURPOSE OF REVIEW: Brain abscesses and spinal epidural abscesses are serious, potentially life-threatening infections of the central nervous system. This article outlines the clinical presentation, evaluation, and management of brain abscesses and spinal epidural abscesses, with a specific focus on bacterial infections. RECENT FINDINGS: The overall incidence of brain abscesses has declined, in part because of fewer brain abscesses associated with otogenic infections...
October 2018: Continuum: Lifelong Learning in Neurology
Hansen Deng, John K Yue, Beata Durcanova, Javid Sadjadi
Alcohol intoxication is a common risk factor of traumatic brain injury (TBI) and carries a significant health-care burden on underserved patients. Patients with chronic alcohol use may suffer a spectrum of bleeding diatheses from hepatic dysfunction not well studied in the context of TBI. A feared sequela of TBI is the development of coagulopathy resulting in worsened intracranial bleeding. We report the clinical course of an intoxicated patient found down with blunt head trauma and concurrent alcoholic cirrhosis who was awake and responsive in the field...
October 2018: Journal of Neurosciences in Rural Practice
S Adam, D H Sama, T Mouzou, A Akakpovi, K Tomta, M Bellier
The management of patients in emergency departments is an important indicator of the quality of a healthcare system. In sub-Saharan Africa, emergency care is characterized by human and material difficulties. The purpose of this work was to assess the difficulties in managing emergencies at the surgical emergency admissions unit of Sylvanus Olympio teaching hospital of Lomé. This descriptive prospective study took place during the last 6 months of 2013. Epidemiological, clinical, and therapeutic data were collected...
August 1, 2018: Médecine et Santé Tropicales
Noam Gerber, Kelley Sookraj, Swapna Munnangi, L D George Angus, Vineet Lamba, Krishan Kumar, Brinda Doraiswamy
PURPOSE: To evaluate whether the emergency department usage of head computed tomography (CT) on pediatric patients with minor head trauma changed after publication of the Pediatric Emergency Care Applied Research Network (PECARN) head CT guidelines and to identify risk factors associated with performing head CT on patients without a PECARN guideline indication. METHODS: This retrospective study included 484 patients 18 years of age or younger who presented to the emergency department with head injury and a total Glasgow Coma Scale score ≥ 14 between September 2005 and July 2014...
September 27, 2018: Emergency Radiology
John Ogunlade, Chris Elia, Jason Duong, Paulino J Yanez, Fanglong Dong, Margaret R Wacker, Rosalinda Menoni, Todd Goldenberg, Dan E Miulli
INTRODUCTION: Severe traumatic brain injury (TBI) is a leading cause of morbidity and mortality among young adults. The clinical outcome may also be difficult to predict. We aim to identify the factors predictive of favorable and unfavorable clinical outcomes for youthful patients with severe TBI who have the option of surgical craniotomy or surgical craniectomy. METHODS: A retrospective review at a single Level II trauma center was conducted, identifying patients aged 18 to 30 years with isolated severe TBI with a mass-occupying lesion requiring emergent (< 6 hours from time of arrival) surgical decompression...
July 24, 2018: Curēus
William T O'Brien, Marguerite M Caré, James L Leach
Pediatric head trauma is an important cause of morbidity and mortality in children and may be seen in the setting of accidental or abusive injuries. Although many of the patterns of head injury are similar to adults, the imaging manifestations of head injury in children are more complex due to the developing brain and calvarium. Additionally, there are unique considerations for mechanisms of injury in children, to include abusive head trauma and birth-related injuries. The primary role of the radiologist is to identify and characterize the type and severity of head injury to help guide appropriate patient management...
October 2018: Seminars in Ultrasound, CT, and MR
Courtney Frey, J Michael Hazenfield
Head trauma is a common indication for neuroimaging in the emergency room. CT is the modality of first choice, as it is quick, safe, and effective in evaluating for life-threatening intracranial hemorrhage and mass effect. CT is also best for evaluating for skull fractures, which may alter management and lead to further imaging studies. MRI is reserved for selected patients, particularly when the clinical exam does not match the CT imaging findings, such as in diffuse axonal injury. Emergency room physicians and radiologists, particularly those in training, would benefit from a consistent approach and search pattern for evaluating head trauma...
October 2018: Seminars in Ultrasound, CT, and MR
Nirmal Raj Gopinathan, Vibhu Krishnan Viswanathan, Alvin H Crawford
The clinical presentation and diagnostic workup in pediatric cervical spine injuries (CSI) are different from adults owing to the unique anatomy and relative immaturity. The current article reviews the existing literature regarding the uniqueness of these injuries and discusses the current guidelines of radiological evaluation. A PubMed search was conducted using keywords "paediatric cervical spine injuries" or "paediatric cervical spine trauma." Six hundred and ninety two articles were available in total...
September 2018: Indian Journal of Orthopaedics
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