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Trauma critical care

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https://www.readbyqxmd.com/read/28228127/a-review-of-enhanced-paramedic-roles-during-and-after-hospital-handover-of-stroke-myocardial-infarction-and-trauma-patients
#1
Darren Flynn, Richard Francis, Shannon Robalino, Joanne Lally, Helen Snooks, Helen Rodgers, Graham McClelland, Gary A Ford, Christopher Price
BACKGROUND: Ambulance paramedics play a critical role expediting patient access to emergency treatments. Standardised handover communication frameworks have led to improvements in accuracy and speed of information transfer but their impact upon time-critical scenarios is unclear. Patient outcomes might be improved by paramedics staying for a limited time after handover to assist with shared patient care. We aimed to categorize and synthesise data from studies describing development/extension of the ambulance-based paramedic role during and after handover for time-critical conditions (trauma, stroke and myocardial infarction)...
February 23, 2017: BMC Emergency Medicine
https://www.readbyqxmd.com/read/28222811/recurring-septic-shock-in-a-patient-with-blunt-abdominal-and-pelvic-trauma-how-mandatory-is-source-control-surgery-a-case-report
#2
Antonella Frattari, Giustino Parruti, Rocco Erasmo, Luigi Guerra, Ennio Polilli, Rosamaria Zocaro, Giuliano Iervese, Paolo Fazii, Tullio Spina
BACKGROUND: In critically ill patients with colonization/infection of multidrug-resistant organisms, source control surgery is one of the major determinants of clinical success. In more complex cases, the use of different tools for sepsis management may allow survival until complete source control. CASE PRESENTATION: A 42-year-old white man presented with traumatic hemorrhagic shock. Unstable pelvic fractures led to emergency stabilization surgery. Fever ensued with diarrhea, followed by septic shock...
February 22, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28219766/mitochondrial-and-endoplasmic-reticulum-dysfunction-and-related-defense-mechanisms-in-critical-illness-induced-multiple-organ-failure
#3
REVIEW
Steven E Thiessen, Greet Van den Berghe, Ilse Vanhorebeek
Patients with critical illness-induced multiple organ failure suffer from a very high morbidity and mortality, despite major progress in intensive care. The pathogenesis of this condition is complex and incompletely understood. Inadequate tissue perfusion and an overwhelming inflammatory response with pronounced cellular damage have been suggested to play an important role, but interventions targeting these disturbances largely failed to improve patient outcome. Hence, new therapeutic perspectives are urgently needed...
February 17, 2017: Biochimica et Biophysica Acta
https://www.readbyqxmd.com/read/28217595/impact-of-pre-hospital-care-on-the-outcome-of-children-arriving-with-agonal-breathing-to-a-pediatric-emergency-service-in-south-india
#4
Debasis Das Adhikari, Krishna Mahathi, Urmi Ghosh, Indira Agarwal, Anila Chacko, Ebor Jacob, Kala Ebenezer
BACKGROUND: Data on the prehospital interventions received by critically ill children at arrival to Paediatric Emergency Services (PES) is limited in developing countries. This study aims to describe the pre-hospital care scenario, transport and their impact on outcome in non-traumatic, acutely ill children presenting in PES with agonal breathing. METHODS: Prospective observational study done on children aged below 15 years arriving in PES with agonal breathing due to non-trauma related causes...
July 2016: Journal of Family Medicine and Primary Care
https://www.readbyqxmd.com/read/28215195/tetanus-a-potential-public-health-threat-in-times-of-disaster
#5
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/28214722/when-high-pressure-system-constraints-and-a-social-justice-mission-collide-a-socio-structural-analysis-of-emergency-department-social-work-services
#6
Megan Moore, Margaret Cristofalo, Danae Dotolo, Nicole Torres, Alexandra Lahdya, Leyna Ho, Mia Vogel, Mollie Forrester, Bonnie Conley, Susan Fouts
The emergency department (ED) can be a critical intervention point for many patients with multifaceted needs. Social workers have long been part of interdisciplinary ED teams. This study aimed to contribute to the limited understanding of social worker-patient interactions and factors influencing social work services in this setting. This paper reports a qualitative content analysis of social work medical record notes (N = 1509) of services provided to trauma patients in an urban, public, level 1 trauma center and an in-depth analysis of semi-structured interviews with ED social workers (N = 10)...
February 11, 2017: Social Science & Medicine
https://www.readbyqxmd.com/read/28213888/transfusion-in-critical-care-a-uk-regional-audit-of-current-practice
#7
J O M Plumb, M G Taylor, E Clissold, M P W Grocott, R Gill
A consistent message within critical care publications has been that a restrictive transfusion strategy is non-inferior, and possibly superior, to a liberal strategy for stable, non-bleeding critically ill patients. Translation into clinical practice has, however, been slow. Here, we describe the degree of adherence to UK best practice guidelines in a regional network of nine intensive care units within Wessex. All transfusions given during a 2-month period were included (n = 444). Those given for active bleeding or within 24 h of major surgery, trauma or gastrointestinal bleeding were excluded (n = 148)...
February 18, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28208022/protein-requirements-for-critically-ill-patients-with-renal-and-liver-failure
#8
Jayshil J Patel, Craig J McClain, Menaka Sarav, Jill Hamilton-Reeves, Ryan T Hurt
Diseases leading to critical illness induce proteolysis resulting in muscle wasting and negative nitrogen balance. Muscle wasting has been associated with poor intensive care unit (ICU)-related outcomes, including an increased risk for mortality. Acute kidney injury (AKI) represents a common organ dysfunction associated with ICU-related disorders, such as sepsis, trauma, and respiratory failure. AKI and renal replacement therapy lead to amino acid loss. Decompensated liver cirrhosis (DLC) and acute liver failure (ALF) represent more severe forms of liver dysfunction leading to ICU admission...
February 1, 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28197049/zinc-supplementation-in-adult-mechanically-ventilated-trauma-patients-is-associated-with-decreased-occurrence-of-ventilator-associated-pneumonia-a-secondary-analysis-of-a-prospective-observational-study
#9
Farshad Hasanzadeh Kiabi, Abbas Alipour, Hadi Darvishi-Khezri, Aily Aliasgharian, Amir Emami Zeydi
BACKGROUND: Ventilator-associated pneumonia (VAP) is a type of lung infection that typically affects critically ill patients undergoing mechanical ventilation (MV) in the Intensive Care Unit (ICU). The aim of this analysis is to determine potential association between zinc supplementation with the occurrence of VAP in adult mechanically ventilated trauma patients. SUBJECTS AND METHODS: This secondary analysis of a prospective observational study was carried out over a period of 1 year in ICUs of one teaching hospital in Iran...
January 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28193322/geographic-distribution-of-trauma-burden-mortality-and-services-in-the-united-states-does-availability-correspond-to-patient-need
#10
Arturo J Rios-Diaz, David Metcalfe, Olubode A Olufajo, Cheryl K Zogg, Brian Yorkgitis, Mansher Singh, Adil H Haider, Ali Salim
BACKGROUND: The association between the need for trauma care and trauma services has not been characterized previously. We compared the distribution of trauma admissions with state-level availability of trauma centers (TCs), surgical critical care (SCC) providers, and SCC fellowships, and assessed the association between trauma care provision and state-level trauma mortality. STUDY DESIGN: We obtained 2013 state-level data on trauma admissions, TCs, SCC providers, SCC fellowship positions, per-capita income, population size, and age-adjusted mortality rates...
December 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28187816/multimodal-neurologic-monitoring
#11
G Korbakis, P M Vespa
Neurocritical care has two main objectives. Initially, the emphasis is on treatment of patients with acute damage to the central nervous system whether through infection, trauma, or hemorrhagic or ischemic stroke. Thereafter, attention shifts to the identification of secondary processes that may lead to further brain injury, including fever, seizures, and ischemia, among others. Multimodal monitoring is the concept of using various tools and data integration to understand brain physiology and guide therapeutic interventions to prevent secondary brain injury...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28187248/emergency-department-telemedicine-is-used-for-more-severely-injured-rural-trauma-patients-but-does-not-decrease-transfer-a-cohort-study
#12
Nicholas M Mohr, Karisa K Harland, Elizabeth A Chrischilles, Amanda Bell, Dan M Shane, Marcia M Ward
OBJECTIVES: Traumatic injury is a leading cause of death in the United States, and rural populations are at increased risk of injury and death. Rural residents have limited access to trauma care, and telemedicine has been proposed as one strategy to improve the provision of trauma care locally. The objective of this study was to describe patient-level factors associated with telemedicine consultation in North Dakota critical-access hospital (CAH) emergency departments (EDs) and to measure the association between telemedicine consultation and interhospital transfer...
February 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28187026/an-algorithmic-approach-to-the-suspected-septic-wrist
#13
Jeffrey R Claiborne, Leslie G Branch, Michael Reynolds, Anthony J Defranzo
An acutely painful, erythematous wrist can be due to a variety of pathologic processes, including crystalline arthropathy, infection, trauma, osteoarthritis, and systemic disease. The broad differential diagnosis of the inflamed wrist and nonspecific clinical findings make accurate diagnosis challenging. There is no published clinical or laboratory criterion that reliably differentiates septic wrist arthritis from a sterile inflammatory arthropathy. For septic joint patients, long-term results are notably poorer in patients with a delay in treatment, therefore establishing evidenced-based guidelines deserves attention...
February 10, 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28185977/the-central-role-of-relationships-to-trauma-informed-integrated-care-for-children-and-youth
#14
Jonathan D Brown, Melissa A King, Lawrence S Wissow
OBJECTIVE: Primary care plays an essential role in the primary and secondary prevention of children's mental health problems. A growing series of trials have demonstrated the capacity of primary care providers to deliver care that specifically addresses risks to healthy social and emotional development by incorporating mental health services into their routines and integrating their work with the mental health care system. This paper describes elements common to various integration schemes that seem essential to their success...
February 6, 2017: Academic Pediatrics
https://www.readbyqxmd.com/read/28183742/preventable-injury-deaths-identifying-opportunities-to-improve-timeliness-and-reach-of-emergency-healthcare-services-in-new-zealand
#15
Rebbecca Lilley, Bridget Kool, Gabrielle Davie, Brandon de Graaf, Shanthi N Ameratunga, Pararangi Reid, Ian Civil, Bridget Dicker, Charles C Branas
BACKGROUND: Traumatic injury is a leading cause of premature death and health loss in New Zealand. Outcomes following injury are very time sensitive, and timely access of critically injured patients to advanced hospital trauma care services can improve injury survival. OBJECTIVE: This cross-sectional study will investigate the epidemiology and geographic location of prehospital fatal injury deaths in relation to access to prehospital emergency services for the first time in New Zealand...
February 9, 2017: Injury Prevention: Journal of the International Society for Child and Adolescent Injury Prevention
https://www.readbyqxmd.com/read/28178202/increased-dicarbonyl-stress-as-a-novel-mechanism-of-multi-organ-failure-in-critical-illness
#16
Bas C T van Bussel, Marcel C G van de Poll, Casper G Schalkwijk, Dennis C J J Bergmans
Molecular pathological pathways leading to multi-organ failure in critical illness are progressively being unravelled. However, attempts to modulate these pathways have not yet improved the clinical outcome. Therefore, new targetable mechanisms should be investigated. We hypothesize that increased dicarbonyl stress is such a mechanism. Dicarbonyl stress is the accumulation of dicarbonyl metabolites (i.e., methylglyoxal, glyoxal, and 3-deoxyglucosone) that damages intracellular proteins, modifies extracellular matrix proteins, and alters plasma proteins...
February 7, 2017: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/28168987/injury-severity-in-pediatric-all-terrain-vehicle-related-trauma-in-nova-scotia
#17
Samuel Jessula, Nadia Murphy, Natalie L Yanchar
BACKGROUND/PURPOSE: In 2004-2005, legislation restricting all-terrain vehicle (ATV) use by children and an extensive social marketing campaign intended to reduce pediatric ATV-related morbidity. The frequency, nature, and severity of pediatric ATV-associated trauma were compared before and after such interventions. METHODS: A retrospective cohort study was performed for all pediatric ATV-related injuries that presented to the provincial level 1 pediatric trauma center from 1998 to 2014...
January 31, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28164614/using-circulating-mirnas-as-biomarkers-for-the-evaluation-and-monitoring-of-the-mitochondrial-damage-in-the-critically-ill-polytrauma-patients
#18
REVIEW
Ovidiu H Bedreag, Marius Papurica, Alexandru F Rogobete, Dorel Sandesc, Raluca Dumache, Carmen A Cradigati, Mirela Sarandan, Lavinia M Bratu, Sonia E Popovici, Laurentiu V Sima
BACKGROUND: The multiple-traumatic critical patient presents a variety of pathophysiological, cellular, and molecular dysfunctions. One of the most important is represented by mitochondrial damage which afterwards is responsible for the augmentation and worsening of a series of pathologies that lead to the worsening of the clinical status of the patient. The severe inflammatory response, sepsis, and the redox imbalance are other pathologies that together with the multiple traumas are responsible for the mitochondrial dysfunctions...
August 1, 2016: Clinical Laboratory
https://www.readbyqxmd.com/read/28163912/the-benefits-of-youth-are-lost-on-the-young-cardiac-arrest-patient
#19
REVIEW
Brian Griffith, Patrick Kochanek, Cameron Dezfulian
Children and young adults tend to have reduced mortality and disability after acquired brain injuries such as trauma or stroke and across other disease processes seen in critical care medicine. However, after out-of-hospital cardiac arrest (OHCA), outcomes are remarkably similar across age groups. The consistent lack of witnessed arrests and a high incidence of asphyxial or respiratory etiology arrests among pediatric and young adult patients with OHCA account for a substantial portion of the difference in outcomes...
2017: F1000Research
https://www.readbyqxmd.com/read/28153385/video-review-as-a-tool-to-improve-orthopedic-residents-performance-of-closed-manipulative-reductions
#20
Nickul S Jain, Ran Schwarzkopf, John A Scolaro
OBJECTIVE: Orthopedic residents commonly perform closed manipulative reductions as a part of their training. Traditionally, this skill is taught early in training but difficult to simulate. Proficiency is achieved through repetition and experience; faculty observation and instruction is unfortunately often limited. Direct resident teaching has been shown to increase competency, comfort, and long-term skill retention. We hypothesize that video review of closed fracture reductions will provide an inexpensive and valuable tool for resident education and improve skill performance...
January 30, 2017: Journal of Surgical Education
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