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Polytrauma

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https://www.readbyqxmd.com/read/28933334/-damage-control-surgery-in-polytrauma-patients-with-pelvic-fractures-is-it-possible-to-use-internal-fixation
#1
L Havlůj, V Džupa, R Gürlich
Current polytrauma management is multidisciplinary, with Damage Control Surgery (DCS), Damage Control Orthopaedics (DCO) and Damage Control Resuscitation (DCR) being applied in the first few hours after injury. The most severe group of polytrauma patients are those with circulatory instability and massive blood loss as a consequence of unstable pelvic fractures. In treating these patients, of crucial importance is the speed and quality of stabilisation of pelvic fracture fragments. The authors present two case reports of polytrauma patients with unstable pelvic fractures, in whom open reduction and internal fixation was performed on the anterior fracture segment through extended laparotomy in order to stop bleeding into the abdominopelvic cavity as part of the DCS approach...
2017: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
https://www.readbyqxmd.com/read/28928953/treatment-of-femoral-shaft-fractures-with-monoaxial-external-fixation-in-polytrauma-patients
#2
Gianluca Testa, Domenico Aloj, Alessandro Ghirri, Eraclite Petruccelli, Vito Pavone, Alessandro Massé
Background: Femoral shaft fractures, typical in younger people, are often associated with polytrauma followed by traumatic shock. In these situations, despite intramedullary nailing being the treatment of choice, external fixation could be used as the definitive treatment. The aim of this study is to report evidence regarding definitive treatment of femoral shaft fractures with monoaxial external fixation. Methods: Between January 2006 and December 2015, 83 patients with 87 fractures were treated at the Department of Orthopaedics and Traumatology CTO of Turin, with a monoaxial external fixation device...
2017: F1000Research
https://www.readbyqxmd.com/read/28926486/comorbid-posttraumatic-stress-disorder-and-traumatic-brain-injury-generalization-of-prolonged-exposure-ptsd-treatment-outcomes-to-postconcussive-symptoms-cognition-and-self-efficacy-in-veterans-and-active-duty-service-members
#3
Gregory K Wolf, Gregory J Mauntel, Tracy Kretzmer, Eric Crawford, Christina Thors, Thad Q Strom, Rodney D Vanderploeg
OBJECTIVES: To examine (a) generalization of the effectiveness of prolonged exposure (PE) therapy for posttraumatic stress disorder (PTSD) in improving postconcussive symptoms (PCSs) and other outcomes in military service members and Veterans (VA) with histories of mild to severe traumatic brain injury (TBI), and (b) factors associated with PCS reduction. SETTING: VA polytrauma medical center. PARTICIPANTS: Consecutive referrals for PTSD treatment of Active Duty (n = 17) or Veterans (n = 27) diagnosed with PTSD and TBI (N = 44)...
September 18, 2017: Journal of Head Trauma Rehabilitation
https://www.readbyqxmd.com/read/28921846/improvement-of-polytrauma-management-quality-inspection-of-a-newly-introduced-course-concept
#4
Ingo Gräff, Shahab Ghamari, Sylvia Schacher, Procula Glien, Rolf Fimmers, Torsten Baehner, Se-Chan Kim
RATIONALE, AIMS, AND OBJECTIVES: A systematic literature search for training course concepts for care of severely injured and severely ill patients respecting improvement of process and outcome yielded little data. For several years, the University Hospital of Bonn has hosted a shock-room management course which, on the one hand, communicates human factor aspects and, on the other hand, pursues interdisciplinary and interprofessional team training. The Bonn shock-room management course (BSM-course®) differs from other courses in both format and principles...
September 17, 2017: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/28916848/interleukin-17-as-a-predictor-of-sepsis-in-polytrauma-patients-a-prospective-cohort-study
#5
M Ahmed Ali, E S Mikhael, A Abdelkader, L Mansour, R El Essawy, R El Sayed, A Eladawy, A Mukhtar
Sepsis is one of the most serious complications after major trauma, and may be associated with increased mortality. We sought to determine whether there is an association between serum levels of interleukin-17 (IL-17) at the time of admission to the intensive care unit (ICU) and the development of sepsis. We evaluated 100 adult patients with major trauma admitted to the surgical ICU over a 6-month period. Serum levels of IL-17, IL-6, and TNF-α were determined by enzyme-linked immunosorbent assays (ELISA). The IL-17 rs1974226 genotype was determined by real-time PCR...
September 15, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/28913489/cerebral-salt-wasting-syndrome-in-patients-with-minor-head-trauma-two-case-reports
#6
Gabriela Csipak, Natalia Hagau
We describe two polytrauma patients without severe head trauma who developed Cerebral Salt Wasting Syndrome (CSWS) during their stay in our ICU with natriuresis, hyponatremia and hypovolemia. Hyponatremia encountered in CSWS and the syndrome of inadequate antidiuretic hormone secretion (SIADH) is a common electrolyte finding in patients with severe head trauma, subarachnoid hemorrhage, malignancy and infections of the central nervous system. CSWS was an unexpected electrolyte finding in our patients with minor head trauma without neurological or neurosurgical problems...
October 2016: Rom J Anaesth Intensive Care
https://www.readbyqxmd.com/read/28904652/-role-of-trauma-damage-control-orthopaedic-in-polytraumas-a-case-of-pelvic-disjunction-associated-with-hip-dislocation-with-vascular-injury
#7
Tarik Madani, El Mehdi El Alouani, Younes Mhammdi, Mohammed Kharmaz, Mohamed El Ouadghiri, Abdou Lahlou, Lamrani Moulay Omar, Ahmed El Bardouni, Mustapha Mahfoud, Mohamed Saleh Berrada
The knowledge of the pathophysiology of patients with severe trauma and the hemodynamic and inflammatory consequences of initial surgical management has led many surgeons to change their approach to the treatment of patients with severe polytraumas associated with lesions of the pelvis or of limbs by integrating the principles of sequential treatment or Trauma Damage Control Orthopaedic (TDCO). We report the case of a patient involved in a public road accident, admitted to hospital in a state of shock with pelvic disjunction and hip dislocation complicated by vascular injury in the same limb...
2017: Pan African Medical Journal
https://www.readbyqxmd.com/read/28898793/displaced-acromion-fracture-a-rare-injury-case-report
#8
Özgür Çiçekli, Abdülhalim Akar, Hüseyin Nevzat Topçu
INTRODUCTION: Acromion fractures are extremely rare. There are no common accepted treatment schemes and fixation methods We aimed to present a case which may contribute to the diagnosis and treatment of acromion fracture in a patient with polytrauma. PRESENTATION OF CASE: Acromion fracture associated with scapula and clavicle fractures was diagnosed in 40 years old patient and treated with open reduction and cannulated screw fixation. The fracture healing was completed without causing subacromial impingement...
September 1, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28891977/polytrauma-defined-by-the-new-berlin-definition-a-validation-test-based-on-propensity-score-matching-approach
#9
Cheng-Shyuan Rau, Shao-Chun Wu, Pao-Jen Kuo, Yi-Chun Chen, Peng-Chen Chien, Hsiao-Yun Hsieh, Ching-Hua Hsieh
Background: Polytrauma patients are expected to have a higher risk of mortality than that obtained by the summation of expected mortality owing to their individual injuries. This study was designed to investigate the outcome of patients with polytrauma, which was defined using the new Berlin definition, as cases with an Abbreviated Injury Scale (AIS) ≥ 3 for two or more different body regions and one or more additional variables from five physiologic parameters (hypotension [systolic blood pressure ≤ 90 mmHg], unconsciousness [Glasgow Coma Scale score ≤ 8], acidosis [base excess ≤ -6...
September 11, 2017: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/28891913/the-assignment-of-american-society-of-anesthesiologists-physical-status-classification-for-adult-polytrauma-patients-results-from-a-survey-and-future-considerations
#10
Catherine M Kuza, George Hatzakis, Jeffry T Nahmias
BACKGROUND: The American Society of Anesthesiologists (ASA) physical status (PS) classification system assesses the preoperative health of patients. Previous studies demonstrated poor interrater reliability and variable ASA PS scores, especially in trauma scenarios. There are few studies that evaluated the assignment of ASA PS scores in trauma patients and no studies that evaluated ASA PS assignment in severely injured adult polytrauma patients. Our objective was to assess interrater reliability and identify sources of discrepancy among anesthesiologists and trauma surgeons in designating ASA PS scores to adult polytrauma patients...
September 7, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28891043/treamed-locked-intramedullary-nailing-for-studying-femur-fracture-and-its-complications
#11
O Yoshino, J Brady, K Young, B Hardy, R Matthys, T Buxton, R Appleyard, J Tomka, D Dabirrahmani, P Woodford, M Fadia, R Steck, A Quail, R G Richards, Z J Balogh
Morbidity associated with femur fractures in polytrauma patients is known to be high. The many unsolved clinical questions include the immunological effect of the fracture and its fixation, timing of fracture fixation, management of fracture non-union, effect of infection and critical size of bone defects. The aim of this study was to establish a clinically-relevant and reproducible animal model with regards to histological, biomechanical and radiological changes during bone healing. A custom-designed intramedullary nail with interlocking system (RabbitNail, RISystem AG, Davos Platz, Switzerland) was used for fixation, following femur fracture...
September 11, 2017: European Cells & Materials
https://www.readbyqxmd.com/read/28866009/long-term-functional-outcomes-in-military-service-members-and-veterans-after-traumatic-brain-injury-polytrauma-inpatient-rehabilitation
#12
Max Gray, Joyce Chung, Fatima Aguila, T Gavin Williams, Jeffrey K Teraoka, Odette A Harris
OBJECTIVE: To determine the impact of the established Polytrauma/TBI infrastructure on immediate post-treatment functional gains, the long-term sustainability of any gains and participation-related community reintegration outcomes in a baseline cohort of patients eight years post-admission. DESIGN: Retrospective review and prospective repeated measures of an inception cohort. SETTING: Veterans Affairs Palo Alto, Polytrauma Rehabilitation Center (PRC) PARTICIPANTS: 44 patients consecutively admitted to the PRC inpatient rehabilitation unit during its first full Fiscal Year, 2006...
August 30, 2017: Archives of Physical Medicine and Rehabilitation
https://www.readbyqxmd.com/read/28864336/analysis-of-transfusion-related-acute-lung-injury-and-possible-transfusion-related-acute-lung-injury-reported-to-the-french-hemovigilance-network-from-2007-to-2013
#13
REVIEW
Georges Andreu, Karim Boudjedir, Jean-Yves Muller, Elodie Pouchol, Yves Ozier, Guillaume Fevre, Chantal Gautreau, Jean-François Quaranta, Christian Drouet, Claire Rieux, Paul-Michel Mertes, Benoit Clavier, Monique Carlier, Imad Sandid
Using the French Hemovigilance Network database from 2007 to 2013, we provide information on demographics, incidence, and risk factors of reported transfusion-related acute lung injury (TRALI) and possible TRALI, analyze TRALI mitigation efforts for fresh frozen plasma and platelet concentrates, and consider the impact of platelet additive solutions on TRALI incidence. We applied the Toronto consensus conference definitions for TRALI and possible TRALI. Two TRALI subgroups were considered: "antibody positive" when a donor has human leukocyte antigen (class I or II) and/or human neutrophil antigen antibodies and the recipient has cognate antigen, and "antibody negative" when immunological investigation is negative or not done...
July 15, 2017: Transfusion Medicine Reviews
https://www.readbyqxmd.com/read/28859678/does-the-applied-polytrauma-definition-notably-influence-outcome-and-patient-population-a-retrospective-analysis
#14
Stephan Frenzel, Philipp Krenn, Thomas Heinz, Lukas Leopold Negrin
BACKGROUND: Although the term "polytrauma" has been in use for decades, no generally accepted definition exists. The aim of this study was to demonstrate that different polytrauma definitions applied to a specific patient population result in diverse subgroups of individuals, who in turn present a varying outcome. METHODS: All patients (≥18 years) treated at our level I trauma center within a time period of three years were classified according to 11 selected polytrauma definitions and included in our study, if they were rated "polytraumatized" by at least one of these definitions...
August 31, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28857806/reversing-dabigatran-anticoagulation-with-prothrombin-complex-concentrate-versus-idarucizumab-as-part-of-multimodal-hemostatic-intervention-in-an-animal-model-of-polytrauma
#15
Markus Honickel, Till Braunschweig, Rolf Rossaint, Christian Stoppe, Hugo Ten Cate, Oliver Grottke
BACKGROUND: Although idarucizumab is the preferred treatment for urgent dabigatran reversal, it is not always available. Prothrombin complex concentrate (PCC) may be an alternative and, with bleeding in trauma, additional hemostatic therapy may be required. The authors investigated multimodal treatment in a preclinical polytrauma model. METHODS: Dabigatran etexilate (30 mg/kg twice daily) was given orally to 45 male pigs for 3 days. On day 4, animals received a dabigatran infusion before blunt liver injury and bilateral femur fractures...
August 30, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28856631/implications-of-entropy-and-surgical-pleth-index-guided-general-anaesthesia-on-clinical-outcomes-in-critically-ill-polytrauma-patients-a-prospective-observational-non-randomized-single-centre-study
#16
Alexandru Florin Rogobete, Dorel Sandesc, Carmen Alina Cradigati, Mirela Sarandan, Marius Papurica, Sonia Elena Popovici, Corina Vernic, Ovidiu Horea Bedreag
Being highly unstable, the critically ill polytrauma patient represents a challenge for the anaesthesia team. The aim of this study was to compare the Entropy and Surgical Pleth Index (SPI)-guided general anaesthesia with standard haemodynamic monitoring methods used in the critically ill polytrauma patients and to evaluate the incidence of hemodynamic events, as well as the opioid and vasopressor demand. 72 patients were included in this prospective observational study, divided in two groups, the ESPI Group (N = 37, patients that benefited from Entropy and SPI monitoring) and the STDR Group (N = 35 patients that benefited from standard hemodynamic monitoring)...
August 30, 2017: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/28854479/-special-urological-traumatology-in-children-and-adolescents
#17
P Faé, A Schröder, W H Rösch, R Stein
Isolated injuries of the genitourinary tract are rare, with the kidney being the most frequently affected organ, especially in situations of polytrauma. Overall, the genitourinary tract is involved in approximately 3 % of all children suffering polytrauma accidents. The literature and international guidelines provide clear therapeutic concepts with a consensus on the diagnosis and treatment of renal trauma, both for the treatment of adults and for children and adolescents. However, the most common injuries to the external genitalia in children and adolescents are caused by blunt trauma, abrasion, bruising, and piling...
September 2017: Aktuelle Urologie
https://www.readbyqxmd.com/read/28838026/-acute-care-rehabilitation-is-the-first-link-in-a-chain-of-rehabilitation-interventions
#18
Joachim Beyer, Egbert J Seidel
An early, intensive rehabilitative therapy accelerates the recovery of the functions of patients. It contributes to a reduction in the complication rate as well as an improvement in physical and social functioning/participation in the long-term follow-up. Early rehabilitation must be strengthened on the basis of the existing structures: the creation and maintenance of adequately qualified early-stage rehabilitation facilities, at least in hospitals with priority and maximum supply contracts. Patients with long-term intensive care and polytrauma must be rehabilitated as soon as possible (intensive medical rehabilitation)...
August 2017: Die Rehabilitation
https://www.readbyqxmd.com/read/28838021/-management-of-thoracic-trauma
#19
Bassam Redwan, Christian Biancosino, Katina Nikolova, Thorsten Greve, Servet Bölükbas
Patients with a thoracic trauma are commonly treated by large bore chest tube thoracostomy and appropriate analgesia. The initial treatment is determined by the assessment of the emergency doctor and/or trauma surgeon. Severe intrathoracic lesions in polytrauma patients are rare. However, such injuries may be acutely life-threating. After primary stabilisation of the patients, imaging studies should be performed to assess the extent of the injuries and determine the treatment of choice. Assessment of such injuries should always be performed in a multidisciplinary team of anaesthesiologists, general surgeons, trauma surgeons and thoracic surgeons...
August 2017: Zentralblatt Für Chirurgie
https://www.readbyqxmd.com/read/28836750/emergency-management-of-renal-and-genitourinary-trauma-best-practices-update-digest
#20
Whitney K Bryant, Sanjay Shewakramani, Milana Zaurova
In up to 10% of patients who experience abdominal trauma, renal and urogenital systems will be involved. In polytrauma patients with other potentially life-threatening injuries, renal and genitourinary trauma may be overlooked initially, but a delayed or missed diagnosis of these injuries may result in preventable complications. This review provides a best-practice approach to the diagnosis and management of renal and genitourinary injuries, with an emphasis on the systematic approach needed to identify subtle injuries and avoid long-term urinary sequelae such as hypertension, incontinence, erectile dysfunction, chronic kidney disease, and nephrectomy...
August 22, 2017: Emergency Medicine Practice
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