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https://www.readbyqxmd.com/read/29223612/predictive-value-of-focused-assessment-with-sonography-for-trauma-fast-for-laparotomy-in-unstable-polytrauma-egyptians-patients
#1
Adel Hamed Elbaih, Sameh T Abu-Elela
PURPOSE: The emergency physicians face significant clinical uncertainty when multiple trauma patients arrive in the emergency department (ED). The priorities for assessment and treatment of polytrauma patients are established in the primary survey. Focused assessment with sonography for trauma (FAST) is very essential clinical skill during trauma resuscitation. Use of point of care ultrasound among the trauma team working in the primary survey in emergency care settings is lacking in Suez Canal University Hospitals even ultrasound machine not available in ED...
November 23, 2017: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
https://www.readbyqxmd.com/read/29214091/keeping-an-open-mind-cognitive-bias-in-the-evaluation-of-an-infant-with-posterior-lateral-rib-fractures
#2
Katie Johnson, Donald Chris Derauf, Raymond Stetson, Paul Galardy, Jason Homme
A four-month-old former premature male is incidentally found to have posterior-lateral rib fractures during evaluation of a febrile illness. This finding led to the initiation of a workup for nonaccidental trauma. A thorough history and physical exam ultimately led to the diagnosis, which was not related to abuse. This case highlights a rare sequela of patent ductus arteriosus repair, cautions medical teams to remain aware of how cognitive bias can affect diagnostic decision-making, and emphasizes the importance of a thorough history, physical exam, and medical record review in cases of suspected nonaccidental trauma...
2017: Case Reports in Pediatrics
https://www.readbyqxmd.com/read/29212880/standardizing-the-evaluation-of-nonaccidental-trauma-in-a-large-pediatric-emergency-department
#3
Lauren C Riney, Theresa M Frey, Emily T Fain, Elena M Duma, Berkeley L Bennett, Eileen Murtagh Kurowski
BACKGROUND AND OBJECTIVES: Variability exists in the evaluation of nonaccidental trauma (NAT) in the pediatric emergency department because of misconceptions and individual bias of clinicians. Further maltreatment, injury, and death can ensue if these children are not evaluated appropriately. The implementation of guidelines for NAT evaluation has been successful in decreasing differences in care as influenced by race and ethnicity of the patient and their family. Our Specific, Measurable, Achievable, Realistic, and Timely aim was to increase the percent of patients evaluated in the emergency department for NAT who receive guideline-adherent evaluation from 47% to 80% by December 31, 2016...
December 6, 2017: Pediatrics
https://www.readbyqxmd.com/read/29205678/perioperative-management-of-gastrostomy-tube-placement-in-duchenne-muscular-dystrophy-adolescent-and-young-adult-patients-a-role-for-a-perioperative-surgical-home
#4
Ariane Boivin, Richard Antonelli, Navil F Sethna
BACKGROUND: In past decades, Duchenne muscular dystrophy patients have been living longer and as the disease advances, patients experience multisystemic deterioration. Older patients often require gastrostomy tube placement for nutritional support. For optimizing the perioperative care, a practice of multidisciplinary team can better anticipate, prevent, and manage possible complications and reduce the overall perioperative morbidity and mortality. AIMS: The aim of this study was to review our experience with perioperative care of adolescent and young adults with Duchenne muscular dystrophy undergoing gastrostomy by various surgical approaches in order to identify challenges and improve future perioperative care coordination to reduce morbidity...
December 5, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29203574/blunt-chest-trauma-a-clinical-chameleon
#5
REVIEW
Kaveh Eghbalzadeh, Anton Sabashnikov, Mohamed Zeriouh, Yeong-Hoon Choi, Alexander C Bunck, Navid Mader, Thorsten Wahlers
The incidence of blunt chest trauma (BCT) is greater than 15% of all trauma admissions to the emergency departments worldwide and is the second leading cause of death after head injury in motor vehicle accidents. The mortality due to BCT is inhomogeneously described ranging from 9% to 60%. BCT is commonly caused by a sudden high-speed deceleration trauma to the anterior chest, leading to a compression of the thorax. All thoracic structures might be injured as a result of the trauma. Complex cardiac arrhythmia, heart murmurs, hypotension, angina-like chest pain, respiratory insufficiency or distention of the jugular veins may indicate potential cardiac injury...
December 4, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/29200474/personal-preference-of-mode-of-delivery-what-do-urogynaecologists-choose-preliminary-results-of-the-decision-study
#6
Julia Bihler, Ralf Tunn, Christl Reisenauer, Jan Pauluschke-Fröhlich, Philipp Wagner, Harald Abele, Katharina K Rall, Gert Naumann, Markus Wallwiener, Sara Y Brucker, Markus Hübner
Introduction: Currently, almost every third child in Germany is delivered by caesarean section. Apart from straightforward and clear indications for caesarean section which account for approx. 10%, the large proportion of relative indications in particular needs to be critically reviewed if the current C-section rate is to be effectively lowered. It is more than doubtful, however, whether this can be a realistic goal in Germany, especially in the context of international developments...
November 2017: Geburtshilfe und Frauenheilkunde
https://www.readbyqxmd.com/read/29200065/cardiac-arrest-in-the-operating-room-part-2-special-situations-in-the-perioperative-period
#7
Matthew D McEvoy, Karl-Christian Thies, Sharon Einav, Kurt Ruetzler, Vivek K Moitra, Mark E Nunnally, Arna Banerjee, Guy Weinberg, Andrea Gabrielli, Gerald A Maccioli, Gregory Dobson, Michael F O'Connor
As noted in part 1 of this series, periprocedural cardiac arrest (PPCA) can differ greatly in etiology and treatment from what is described by the American Heart Association advanced cardiac life support algorithms, which were largely developed for use in out-of-hospital cardiac arrest and in-hospital cardiac arrest outside of the perioperative space. Specifically, there are several life-threatening causes of PPCA of which the management should be within the skill set of all anesthesiologists. However, previous research has demonstrated that continued review and training in the management of these scenarios is greatly needed and is also associated with improved delivery of care and outcomes during PPCA...
November 30, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29195571/impact-of-discordant-views-in-the-management-of-descending-thoracic-aortic-aneurysm
#8
Peter Chiu, Anna-Margaretha Sailer, Michael Baiocchi, Andrew B Goldstone, Justin M Schaffer, Jeff Trojan, Dominik Fleischmann, R Scott Mitchell, D Craig Miller, Michael D Dake, Y Joseph Woo, Jason T Lee, Michael P Fischbein
Thoracic endovascular aortic repair has a lower perceived risk than open surgical repair and has become an increasingly popular alternative. Whether general consensus exists regarding candidacy for either operation among open and endovascular specialists is unknown. A retrospective review of isolated descending thoracic aortic aneurysm at our institution between January 2005 and October 2015 was performed, excluding trauma and dissection. Two cardiac surgeons, 2 cardiovascular surgeons, 1 vascular surgeon, and 1 interventional radiologist gave their preference for open vs endovascular repair...
2017: Seminars in Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29194491/healthcare-providers-perceptions-of-a-situational-awareness-display-for-emergency-department-resuscitation-a-simulation-qualitative-study
#9
Lisa A Calder, Abhi Bhandari, George Mastoras, Kathleen Day, Kathryn Momtahan, Matthew Falconer, Brian Weitzman, Benjamin Sohmer, A Adam Cwinn, Stanley J Hamstra, Avi Parush
Importance: Emergency resuscitation of critically ill patients can challenge team communication and situational awareness. Tools facilitating team performance may enhance patient safety. Objectives: To determine resuscitation team members' perceptions of the Situational Awareness Display's utility. Design: We conducted focus groups with healthcare providers during Situational Awareness Display development. After simulations assessing the display, we conducted debriefs with participants...
November 29, 2017: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/29194318/non-compliance-with-acs-cot-recommended-criteria-for-full-trauma-team-activation-is-associated-with-undertriage-deaths
#10
Christopher J Tignanelli, Wayne E Vander Kolk, Judy N Mikhail, Matthew J Delano, Mark R Hemmila
BACKGROUND: The appropriate triage of acutely injured patients within a trauma system is associated with improved rates of mortality and optimal resource utilization. The American College of Surgeons Committee on Trauma (ACS-COT) put forward six minimum criteria (ACS-6) for full trauma team activation (TTA). We hypothesized that ACS-COT verified trauma center compliance with these criteria is associated with low under-triage rates and improved overall mortality. METHODS: Data from a state-wide collaborative quality initiative was utilized...
November 21, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29193548/rephill-protocol-for-a-randomised-controlled-trial-of-pre-hospital-blood-product-resuscitation-for-trauma
#11
I M Smith, N Crombie, J R Bishop, A McLaughlin, D N Naumann, M Herbert, J M Hancox, G Slinn, N Ives, M Grant, G D Perkins, H Doughty, M J Midwinter
OBJECTIVES: To describe the 'Resuscitation with Pre-HospItaL bLood products' trial (RePHILL) - a multi-centre randomised controlled trial of pre-hospital blood product (PHBP) administration vs standard care for traumatic haemorrhage. BACKGROUND: PHBP are increasingly used for pre-hospital trauma resuscitation despite a lack of robust evidence demonstrating superiority over crystalloids. Provision of PHBP carries additional logistical and regulatory implications, and requires a sustainable supply of universal blood components...
November 28, 2017: Transfusion Medicine
https://www.readbyqxmd.com/read/29191536/the-enigma-of-orbital-compartment-syndrome-after-lumbar-spine-surgery-in-the-prone-position-case-report-and-literature-review
#12
Jorge Luiz Amorim Correa, Marcus André Acioly
Perioperative visual loss (POVL) after spinal surgery is a devastating complication for both the patient and the surgical team. Two major causes are known: ischemic optic neuropathy (ION) and central retinal artery occlusion (CRAO). The traditional understanding of CRAO has been consistently related to the occurrence of periocular trauma and signs of increased intraorbital pressure in addition to visual loss. Such orbital signs are, however, not a feature of any common POVL syndrome. A 55-year-old woman underwent prolonged lumbar decompression and fusion for spinal stenosis under general anesthesia in the prone position...
November 27, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/29189678/attempting-to-validate-the-overtriage-undertriage-matrix-at-a-level-i-trauma-center
#13
James W Davis, Rachel C Dirks, Lawrence P Sue, Krista L Kaups
BACKGROUND: The Optimal Resources Document mandates trauma activation based on injury mechanism, physiologic and anatomic criteria and recommends using the overtriage/undertriage matrix (Matrix) to evaluate the appropriateness of trauma team activation. The purpose of this study was to assess the effectiveness of the Matrix method by comparing patients appropriately triaged with those undertriaged. We hypothesized that these two groups are different, and Matrix does not discriminate the needs or outcomes of these different groups of patients...
December 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29189524/magnitude-of-soft-tissue-defect-as-a-predictor-of-free-flap-failures-does-size-matter
#14
Mark Shasti, Julio J Jauregui, Awais Malik, Gerard Slobogean, Walter Andrew Eglseder, Raymond A Pensy
OBJECTIVES: To examine the relationship between the magnitude of soft-tissue defect and the risk of free-flap and limb-salvage complications/failures. DESIGN: Retrospective cohort. SETTING: Level I Trauma Center. PATIENTS: One hundred twelve patients with free tissue transfers between January 2009 and June 2015. INTERVENTION: A standardized approach using a consistent team of 2 orthopaedic microvascular surgeons was used for each free-flap reconstruction...
December 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/29181343/retained-drain-after-anterior-cruciate-ligament-surgery-a-silent-threat-to-an-athlete-s-career-a-case-report
#15
Ravi Gupta, Anubhav Malhotra, Munish Sood, Gladson David Masih
Introduction: Breaking of surgical drain during the removal and retention of broken drain fragment is an avoidable complication. Such a complication brings disrepute to the operating team and causes psychological as well as further surgical trauma to the patient as a return to the operating room is required many a times to remove the retained drain fragment. Case Report: We report a case of an undetected retained drain fragment inside the knee joint of a 24-year-old male international kabaddi player, who remained asymptomatic for 5 months, when the residual drain fragment was removed arthroscopically...
July 2017: Journal of Orthopaedic Case Reports
https://www.readbyqxmd.com/read/29175878/ionised-calcium-levels-in-major-trauma-patients-who-received-blood-en-route-to-a-military-medical-treatment-facility
#16
Tony Kyle, Ian Greaves, Anthony Beynon, Vicky Whittaker, Mike Brewer, Jason Smith
BACKGROUND: Hypocalcaemia is a common metabolic derangement in critically ill patients. Blood transfusion can also contribute to depleted calcium levels. The aims of this study were to identify the incidence of hypocalcaemia in military trauma patients receiving blood products en route to a deployed hospital facility and to determine if intravenous calcium, given during the prehospital phase, has an effect on admission calcium levels. METHODS: This was a retrospective review of patients transported by the UK Medical Emergency Response Team in Afghanistan between January 2010 and December 2014 who were treated with blood products in the prehospital setting...
November 24, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29174871/resection-of-neurogenic-heterotopic-ossification-nho-of-the-hip
#17
REVIEW
P Denormandie, N de l'Escalopier, L Gatin, A Grelier, F Genêt
Neurogenic heterotopic ossification of the hip is secondary to neurologic lesions such as cranial trauma, stroke, medullary injury or cerebral anoxia. We shall not deal here with the other etiologies of heterotopic ossification. There are numerous locations within the hip, depending on etiology, and relations with adjacent neurovascular structures are sometimes close. Preoperative work-up should include contrast-enhanced CT; scintigraphy is non-contributive. Indications for surgery are decided in a multidisciplinary team meeting, with a contract laying out expected functional gain...
November 22, 2017: Orthopaedics & Traumatology, Surgery & Research: OTSR
https://www.readbyqxmd.com/read/29173457/blast-injury-prevalence-in-skeletal-remains-are-there-differences-between-bosnian-war-samples-and-documented-combat-related-deaths
#18
Marie Christine Dussault, Ian Hanson, Martin J Smith
Court cases at the International Criminal Tribunal for the Former Yugoslavia (ICTY) have seen questions raised about the recognition and causes of blast-related trauma and the relationship to human rights abuses or combat. During trials, defence teams argued that trauma was combat related and prosecutors argued that trauma was related to executions. We compared a sample of 81 cases (males between 18 and 75) from a Bosnian mass grave investigation linked to the Kravica warehouse killings to published combat-related blast injury data from World War One, Vietnam, Northern Ireland, the first Gulf War, Operation Iraqi Freedom and Afghanistan...
November 2017: Science & Justice: Journal of the Forensic Science Society
https://www.readbyqxmd.com/read/29173286/an-airway-rapid-response-system-implementation-and-utilization-in-a-large-academic-trauma-center
#19
Joshua H Atkins, Christopher H Rassekh, Ara A Chalian, Jing Zhao
BACKGROUND: Rapid response teams mobilize resources to patients experiencing acute deterioration. Failed airway management results in death or anoxic brain injury. A codified, systems-based approach to bring personnel and equipment to the bedside for multidisciplinary airway assessment and rescue was reflected in the initial implementation of an airway rapid response (ARR) team. METHODS: A retrospective review of records of 117 ARR events in a 40-month period (August 2011-November 2014) was undertaken at the Hospital of the University of Pennsylvania, a 789-bed, academic, urban, tertiary care, Level 1 trauma center...
December 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/29161399/global-lessons-developing-military-trauma-care-and-lessons-for-civilian-practice
#20
T Woolley, J A Round, M Ingram
The wars in Iraq and Afghanistan have helped to shape the modern Defence Medical Services. Many lessons were learnt including the need for rapid haemorrhage control, senior decision-making and the evolution of deployed transfusion support. These changes were implemented simultaneously with a coherent, end-to-end medical plan from point of wounding through to rehabilitation. Implementation of the medical plan is harmonious with the NHS trauma pathway, and is key to ensuring effective delivery. Military anaesthetists have a long pre-deployment training pathway starting with a Certificate of Completion of Training (CCT) in anaesthesia and/or critical care, and with an emphasis on military skills related to their specific role...
December 1, 2017: British Journal of Anaesthesia
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