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Trauma sedation

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https://www.readbyqxmd.com/read/28460809/ultrasound-guided-interscalene-nerve-block-vs-procedural-sedation-by-propofol-and-fentanyl-for-anterior-shoulder-dislocations
#1
Esmaeil Raeyat Doost, Mohammad Mehdi Heiran, Mitra Movahedi, Amirhossein Mirafzal
BACKGROUND: Few studies were performed to compare ultrasound guided brachial plexus block with procedural sedation for reduction of shoulder dislocations in the Emergency Department (ED). This study was done to provide further evidence regarding this comparison. METHODS: This was a randomized clinical trial performed on patients presenting with anterior shoulder dislocations to the emergency department of an academic level 2 trauma center. Exclusion criteria were any contraindications to the drugs used, any patient which may not be potentially assigned into both groups because of an underlying medical condition, presence of neurovascular compromise related to the dislocation, presence of concomitant fractures, and patient refusal to participate in the study...
April 14, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28421958/acute-limb-compartment-syndrome-in-the-lower-leg-following-trauma-assessment-in-the-intensive-care-unit
#2
Emma Limbert, Julie Santy-Tomlinson
Acute limb compartment syndrome (ALCS) is a serious complication of traumatic injury. Although ALCS can occur in any limb, it most commonly occurs following injury to the lower leg, particularly in fractures of the tibia. Practitioners should recognise and treat ALCS as early as possible to prevent the development of further, potentially serious, complications. Most of the literature recommends that patients at risk of ALCS should be carefully monitored, with a focus on pain as the main symptom. However, patients in the intensive care unit (ICU) who are unconscious or sedated may be unable to report pain or are unreliable in doing so, therefore it is necessary to consider alternative assessments for ALCS...
April 19, 2017: Nursing Standard
https://www.readbyqxmd.com/read/28420470/-explore-objective-clinical-variables-for-detecting-delirium-in-icu-patients-a-prospective-case-control-study
#3
Xiaojiang Liu, Jie Lyu, Youzhong An
OBJECTIVE: The aim of this case-control study is to explore clinical objective variables for diagnosing delirium of intensive care unit (ICU) patients. METHODS: According to the method of prospective case-control study, critical adult postoperative patients who were transferred to ICU of Peking University People's Hospital from October 2015 to May 2016 and needed mechanical ventilation were included. After evaluating the Richmond agitation sedation scale score (RASS), the patients whose score were -2 or greater were sorted into two groups, delirium and non-delirium, according to the confusion assessment method for the ICU (CAM-ICU)...
April 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28417851/nuclear-medicine-techniques-in-pediatric-bone-imaging
#4
REVIEW
Laura A Drubach
An important mandate when imaging pediatric patients is the reduction of radiation exposure to the lowest possible level consistent with good quality diagnostic imaging, so individual selection of radiopharmaceutical dosage and imaging technique is essential. Although the logistics of image acquisition and the approach to interpretation mirror the more common use in adults, the challenges of imaging young children typically require greater attention to patient preparation, positioning, and supervision during imaging, with the use of parental or family engagement in the procedure, gentle restraint, and occasionally the need for sedation...
May 2017: Seminars in Nuclear Medicine
https://www.readbyqxmd.com/read/28380152/incontinence-associated-dermatitis-a-cohort-study-in-critically-ill-patients
#5
Tânia Couto Machado Chianca, Paula Caroline Gonçales, Patrícia Oliveira Salgado, Beatriz de Oliveira Machado, Gilmara Lopes Amorim, Carla Lúcia Goulart Constant Alcoforado
Objectives: Estimate incidence, determine risk factors and propose a prediction model for the development of incontinence- associated dermatitis critically ill adult patients. Method: Concurrent cohort study with 157 critically ill patients. Data collection was daily performed between February and July 2015, at a public teaching hospital of Belo Horizonte, Minas Gerais. Data was entered in a database and subjected to descriptive, survival and multivariate analysis...
March 30, 2017: Revista Gaúcha de Enfermagem
https://www.readbyqxmd.com/read/28372905/apoe-%C3%AE%C2%B54-positive-patients-suffering-severe-traumatic-head-injury-are-more-prone-to-undergo-decompressive-hemicraniectomy
#6
Zandra Olivecrona, Lars-Owe D Koskinen
OBJECT: In this paper we tested the hypothesis if patients with severe traumatic brain injury and presence of the apolipoprotein E (APOE) ε4 allele are more prone to undergo the surgical procedure decompressive hemicraniectomy (DC) in order to bring the intracranial pressure (ICP) under control. METHODS: In this prospective consecutive study patients with sTBI were enrolled (n=48). Inclusion criteria were arrival to our level one trauma university hospital within 24h after trauma, patient age between 15 and 70years, Glasgow Coma Scale (GCS) score ≤8 at the time of intubation and sedation, an initial cerebral perfusion pressure >10mmHg...
March 31, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28359259/propofol-and-sufentanil-may-affect-the-patients-sleep-quality-independently-of-the-surgical-stress-response-a-prospective-nonrandomized-controlled-trial-in-1033-patients-undergone-diagnostic-upper-gastrointestinal-endoscopy
#7
Ming Lei, Peng Zhang, Yunfei Liu, Fangfang Fu, Ling Ye, Tao Zhu
BACKGROUND: It is unknown whether sedative per se contributes to the postoperative sleep disturbance. Diagnostic upper gastrointestinal endoscopy (UGE) is a minimally invasive procedure which is not likely to cause tissue trauma and pain. The purpose of this study was to evaluate the sleep quality of patients undergoing routine (without sedative) diagnostic UGE or UGE with sedative, before, 1 week, and 1 month after the procedure. METHODS: One thousand and thirty-three patients undergoing UGE were enrolled...
March 31, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28323290/incidence-and-risk-factors-for-delirium-development-in-icu-patients-a-prospective-observational-study
#8
Marcela Kanova, Peter Sklienka, Roman Kula, Michal Burda, Jana Janoutova
BACKGROUND AND AIMS: Delirium is an acute brain dysfunction and a frequent complication in critically ill patients. When present it significantly worsens the prognosis of patients. The aim of this study was to evaluate the incidence of delirium and risk factors for delirium in a mixed group of trauma, medical and surgical ICU patients. METHODS: A prospective observational study was conducted in one of the six-bed Intensive Care Units of the University Hospital Ostrava in the Czech Republic during a 12-month period...
March 14, 2017: Biomedical Papers of the Medical Faculty of the University Palacký, Olomouc, Czechoslovakia
https://www.readbyqxmd.com/read/28289942/structured-reporting-of-mri-of-the-shoulder-improvement-of-report-quality
#9
Sebastian Gassenmaier, Marco Armbruster, Florian Haasters, Tobias Helfen, Thomas Henzler, Sedat Alibek, Dominik Pförringer, Wieland H Sommer, Nora N Sommer
OBJECTIVES: To evaluate the effect of structured reports (SRs) in comparison to non-structured narrative free text (NRs) shoulder MRI reports and potential effects of both types of reporting on completeness, readability, linguistic quality and referring surgeons' satisfaction. METHODS: Thirty patients after trauma or with suspected degenerative changes of the shoulder were included in this study (2012-2015). All patients underwent shoulder MRI for further assessment and possible surgical planning...
March 13, 2017: European Radiology
https://www.readbyqxmd.com/read/28288325/trochanteric-hip-fracture-during-cardioversion-therapy-a-case-report
#10
J Gómez, J Albareda, L Ezquerra
INTRODUCTION: Trochanteric hip fractures in elderly patients with osteoporosis are commonly caused by low energy trauma. The cardioversion therapy is an extremely rare cause of this type of fracture. PRESENTATION OF CASE: We report the case of a woman with hip fracture after cardioversion. DISCUSSION: We discuss the production mechanism of this injury and the importance of the care of the osteoporotic bone under these therapies. CONCLUSION: The propofol sedation should be complemented with skeletal muscle relaxants in the cardioversion therapy to avoid hip fracture in select patients with osteoporosis...
February 27, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28255580/clinical-applications-of-contrast-enhanced-ultrasound-in-the-pediatric-work-up-of-focal-liver-lesions-and-blunt-abdominal-trauma-a-systematic-review
#11
REVIEW
Nicolaj Grønbæk Laugesen, Christian Pallson Nolsoe, Jacob Rosenberg
In pediatrics ultrasound has long been viewed more favorably than imaging that exposes patients to radiation and iodinated contrast or requires sedation. It is child-friendly and diagnostic capabilities have been improved with the advent of contrast-enhanced ultrasound (CEUS). The application of CEUS is indeed promising. However, no ultrasound contrast agent manufactured today is registered for pediatric use in Europe. The contrast agent SonoVue(®) has recently been approved by the FDA under the name of Lumason(®) to be used in hepatic investigations in adults and children...
February 2017: Ultrasound International Open
https://www.readbyqxmd.com/read/28251431/48%C3%A2-h-cessation-of-mechanical-ventilation-during-venovenous-extracorporeal-membrane-oxygenation-in-severe-trauma-a-case-report
#12
Justyna Swol, Yann Fülling, Christopher Ull, Matthias Bechtel, Thomas A Schildhauer
A 32-year-old motorcyclist who was hit by a tram subsequently presented with blunt force thoracic trauma, a pelvic fracture and a penetrating injury to the left lower extremity. Coagulopathy persisted following surgery of the leg and pelvic vascular intervention. Bedside thoracotomy was performed to treat pneumothorax and pneumopericardium. Severe hypoxemia secondary to lung failure ensued, which required venovenous extracorporeal membrane oxygenation (VV ECMO) support. On the third day after the trauma, ultra-protective mechanical ventilation was not possible due to non-existent lung compliance; thus, the ventilator was disconnected, and the T-piece was connected to the blocked tracheal tube left in the airway...
March 1, 2017: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
https://www.readbyqxmd.com/read/28190439/neurologic-complications-of-polytrauma
#13
R M Jha, L Shutter
Neurologic complications in polytrauma can be classified by etiology and clinical manifestations: neurovascular, delirium, and spinal or neuromuscular problems. Neurovascular complications include ischemic strokes, intracranial hemorrhage, or the development of traumatic arteriovenous fistulae. Delirium and encephalopathy have a reported incidence of 67-92% in mechanically ventilated polytrauma patients. Causes include sedation, analgesia/pain, medications, sleep deprivation, postoperative state, toxic ingestions, withdrawal syndromes, organ system dysfunction, electrolyte/metabolic abnormalities, and infections...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28183837/diagnostic-performance-of-ultrafast-brain-mri-for-evaluation-of-abusive-head-trauma
#14
S F Kralik, M Yasrebi, N Supakul, C Lin, L G Netter, R A Hicks, R A Hibbard, L L Ackerman, M L Harris, C Y Ho
BACKGROUND AND PURPOSE: MR imaging with sedation is commonly used to detect intracranial traumatic pathology in the pediatric population. Our purpose was to compare nonsedated ultrafast MR imaging, noncontrast head CT, and standard MR imaging for the detection of intracranial trauma in patients with potential abusive head trauma. MATERIALS AND METHODS: A prospective study was performed in 24 pediatric patients who were evaluated for potential abusive head trauma...
February 9, 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28148613/delirium-in-trauma-patients-prevalence-and-predictors
#15
Kathryn T Von Rueden, Breighanna Wallizer, Paul Thurman, Karen McQuillan, Tiffany Andrews, Jennifer Merenda, Heesook Son
BACKGROUND: Delirium is associated with increased mortality, morbidity, hospital costs, and postdischarge cognitive dysfunction. Most research focuses on nontrauma patients receiving mechanical ventilation in the intensive care unit. OBJECTIVES: To determine the prevalence and predictors of delirium in trauma patients residing in intensive and intermediate care units of an academic medical center. METHODS: Trauma patients were screened for delirium by using the Confusion Assessment Method for the Intensive Care Unit...
February 2017: Critical Care Nurse
https://www.readbyqxmd.com/read/28146616/acute-substance-use-as-a-warning-sign-for-suicide-attempts-a-case-crossover-examination-of-the-48-hours-prior-to-a-recent-suicide-attempt
#16
Courtney L Bagge, Guilherme Borges
OBJECTIVE: The extent to which specific categories of acute substance use are short-term risk factors, or warning signs, for suicide attempts is unknown. The aim of the current study was to quantify the near-term effects of sole use and co-use of substances on medically attended suicide attempts. METHODS: The current study used a case-crossover design, comparing substance use within the 24 hours prior to a suicide attempt (case day) to the control day, the matched 24 hours the day prior to the case day...
January 31, 2017: Journal of Clinical Psychiatry
https://www.readbyqxmd.com/read/28106673/outcomes-of-pediatric-fractures-managed-with-closed-reduction-by-orthopaedic-residents-in-the-emergency-department
#17
Vivek Natarajan, Ermias Abebe, James Dunlap, Patrick Bosch, Ozgur Dede, W Timothy Ward, James Roach
BACKGROUND: Closed reduction of pediatric fractures is commonly performed by orthopaedic residents using conscious sedation in the emergency department (ED). The purpose of this study was to determine the rate of satisfactory reductions as performed by residents, and to determine the outcomes of these procedures. METHODS: A retrospective review was performed of all fractures that underwent closed reduction under conscious sedation in the ED of a level 1 pediatric trauma center between January 1, 2010 and November 30, 2014...
June 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28098590/analgesia-and-sedation-requirements-in-mechanically-ventilated-trauma-patients-with-acute-preinjury-use-of-cocaine-and-or-amphetamines
#18
Bridgette Kram, Shawn J Kram, Michelle L Sharpe, Michael L James, Maragatha Kuchibhatla, Mark L Shapiro
BACKGROUND: The purpose of this study was to determine whether mechanically ventilated trauma patients with a positive urine drug screen (UDS) for cocaine and/or amphetamines have different opioid analgesic and sedative requirements compared with similar patients with a negative drug screen for these stimulants. METHODS: This retrospective, single-center cohort study at a tertiary care, academic medical and level 1 trauma center in the United States included patients ≥16 years of age who were admitted to an adult intensive care unit with a diagnosis of trauma between 2009 and 2013 with a UDS documented within 24 hours of admission, and were mechanically ventilated for >24 hours...
March 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27959665/retrospective-analysis-of-the-safety-and-cost-implications-of-pediatric-contrast-enhanced-ultrasound-at-a-single-center
#19
Gibran T Yusuf, Maria E Sellars, Annamaria Deganello, David O Cosgrove, Paul S Sidhu
OBJECTIVE: Because of concern over medical ionizing radiation exposure of children, contrast-enhanced ultrasound (CEUS) has generated interest as an inexpensive, ionizing radiation-free alternative to CT and MRI. CEUS has received approval for pediatric hepatic use but remains off-label for a range of other applications. The purposes of this study were to retrospectively analyze adverse incidents encountered in pediatric CEUS and to assess the financial benefits of reducing the number of CT and MRI examinations performed...
February 2017: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/27939017/regional-analgesia-in-postsurgical-critically-ill-patients
#20
S Moliner Velázquez, R Rubio Haro, C De Andrés Serrano, J De Andrés Ibáñez
Regional analgesia intrinsically, based on its physiological effects, is routinely used for the perioperative treatment of pain associated with surgical procedures. However, in other areas such as the non-surgical treatment of acute pain for patients in a critical condition, it has not been subjected to specific prospective studies. If we confine ourselves to the physiological effects of the nerve block, in a situation of stress, the indications for regional anaesthesia in this group of patients extend to the management of a wide variety of medical as well as postsurgical conditions, of trauma patients and of other painful procedures performed in the patient's bed...
December 7, 2016: Revista Española de Anestesiología y Reanimación
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