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Trauma anaesthesia

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https://www.readbyqxmd.com/read/29794121/prehospital-emergency-anaesthesia-an-updated-survey-of-uk-practice-with-emphasis-on-the-role-of-standardisation-and-checklists
#1
Mark R Burgess, Kate Crewdson, David J Lockey, Zane B Perkins
INTRODUCTION: Prehospital emergency anaesthesia (PHEA or 'prehospital rapid sequence intubation') is a high-risk procedure. Standard operating procedures (SOPs) and checklists within healthcare systems have been demonstrated to reduce human error and improve patient safety. We aimed to describe the current practice of PHEA in the UK, determine the use of checklists for PHEA and describe the content, format and layout of any such checklists currently used in the UK. METHOD: A survey of UK prehospital teams was conducted to establish the incidence and conduct of PHEA practice...
May 24, 2018: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29730073/a-profile-of-surgical-burden-and-anaesthesia-services-at-mozambique-s-central-hospital-a-review
#2
REVIEW
J Matthew Kynes, Camila B Walters, Emilia Pinto, Emilia Jeque, Ka Kelly McQueen
BACKGROUND: Surgical and anaesthesia data, including outcomes, remain limited in low-income countries (LIC). This study reviews the surgical burden and anaesthesia services at a tertiary care hospital in Mozambique. METHODS: Information on activities within the department of anaesthesia at XXX Central Hospital for 2014-15 was collected from its annual report and verified by the Chairman of Anaesthesia. Personnel information and health care metrics for the hospital in 2015 were collected and verified by hospital leadership...
May 3, 2018: International Journal of Surgery
https://www.readbyqxmd.com/read/29730069/severe-trismus-and-contraindicated-exodontia-in-a-patient-with-fibrodysplasia-ossificans-progressiva-case-report
#3
A Geddis-Regan
Fibrodysplasia ossificans progressiva is a rare genetic disease of connective tissue in which muscles, ligaments, and tendons ossify either spontaneously or after trauma. Patients can develop physical disabilities and restriction of respiratory function. A patient attended a maxillofacial surgery outpatient clinic with severe trismus and mouth opening limited to 2mm. The risks of intervention were many from both anaesthetic and surgical perspectives, which prevented the extraction of carious teeth. The patient was referred to a special care dentistry team who provided endodontic stabilisation without local anaesthesia...
May 2, 2018: British Journal of Oral & Maxillofacial Surgery
https://www.readbyqxmd.com/read/29706249/isolated-traumatic-brain-injury-results-in-significant-pre-hospital-derangement-of-cardiovascular-physiology
#4
M Gavrilovski, M El-Zanfaly, R M Lyon
INTRODUCTION: Major trauma can result in both life-threatening haemorrhage and traumatic brain injury (TBI). The pre-hospital management of these conditions, particularly in relation to the cardiovascular system, is very different. TBI can result in cardiovascular instability but the exact incidence remains poorly described. This study explores the incidence of cardiovascular instability in patients undergoing pre-hospital anaesthesia for suspected TBI. METHODS: Retrospective case series of all pre-hospital trauma patients attended by Kent, Surrey & Sussex Air Ambulance Trust (United Kingdom) trauma team during the period 1 January 2015-31 December 2016...
April 20, 2018: Injury
https://www.readbyqxmd.com/read/29666093/bougie-associated-bronchial-injury-complicated-by-a-nephropleural-fistula-after-percutaneous-nephrolithotomy-a-tale-of-two-complications
#5
Aparna Pande, Rashmi Ramachandran, Vimi Rewari
We present a case of bronchial injury following bougie-assisted endotracheal intubation in a patient with difficult airway scheduled to undergo right percutaneous nephrolithotomy under general anaesthesia. The patient developed pleuritic pain along with right pleural effusion on the third postoperative day which was diagnosed by the anaesthesiologist who was following up the patient for airway trauma-associated complications. However, the patient was diagnosed to have a nephropleural fistula, a rare complication of supracostal access to percutaneous nephrolithotomy, which was managed successfully...
April 17, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29547425/are-short-subspecialty-courses-the-educational-answer
#6
Faye M Evans, Juan C Duarte, Carolina Haylock Loor, Wayne Morriss
There is an urgent need to train more anesthesia providers in low- and middle-income countries (LMICs). There is also a need to provide more educational opportunities in subspecialty areas of anesthetic practice such as trauma management, pain management, obstetric anesthesia, and pediatric anesthesia. Together, these subspecialty areas make up a large proportion of the clinical workload in LMICs. In these countries, the quality of education may be variable, there may be few teachers, and opportunities for continued learning and mentorship are rare...
April 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29452810/interleukin-6-is-both-necessary-and-sufficient-to-produce-perioperative-neurocognitive-disorder-in-mice
#7
J Hu, X Feng, M Valdearcos, D Lutrin, Y Uchida, S K Koliwad, M Maze
BACKGROUND: Perioperative neurocognitive disorders (PND) result in long-term morbidity and mortality with no effective interventions available. Because interleukin-6 (IL-6), a pro-inflammatory cytokine, is consistently up-regulated by trauma, including after surgery, we determined whether IL-6 is a putative therapeutic target for PND in a mouse model. METHODS: Following institutional approval, adult (12-14 weeks) male C57/Bl6 mice were pretreated with the IL-6 receptor (IL6R) blocking antibody tocilizumab prior to open tibia fracture with internal fixation under isoflurane anaesthesia...
March 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29432291/long-term-neurocognitive-outcomes-following-surgery-and-anaesthesia-in-early-life
#8
Tom G Hansen, Thomas Engelhardt
PURPOSE OF REVIEW: Repeated controversial and alarming statements of the potential dangers of anaesthetic agents on neurological outcomes in children continue to be issued based primarily on preclinical studies. This review assesses the current evidence of laboratory and clinical data and identifies areas of concerns. RECENT FINDINGS: Published animal and laboratory data consistently indicate that prolonged and excessive use of anaesthetic agents can lead to morphological changes and neurocognitive impairment in animals without a clear cut-off age or a superiority of one technique over another...
June 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29315456/pre-hospital-emergency-anaesthesia-in-awake-hypotensive-trauma-patients-beneficial-or-detrimental
#9
K Crewdson, M Rehn, K Brohi, D J Lockey
BACKGROUND: The benefits of pre-hospital emergency anaesthesia (PHEA) are controversial. Patients who are hypovolaemic prior to induction of anaesthesia are at risk of severe cardiovascular instability post-induction. This study compared mortality for hypovolaemic trauma patients (without major neurological injury) undergoing PHEA with a patient cohort with similar physiology transported to hospital without PHEA. METHODS: A retrospective database review was performed to identify patients who were hypotensive on scene [systolic blood pressure (SBP) < 90 mmHg], and GCS 13-15...
April 2018: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29313908/human-factors-in-preventing-complications-in-anaesthesia-a-systematic-review
#10
REVIEW
C P L Jones, J Fawker-Corbett, P Groom, B Morton, C Lister, S J Mercer
Human factors in anaesthesia were first highlighted by the publication of the Anaesthetists Non-Technical Skills Framework, and since then an awareness of their importance has gradually resulted in changes in routine clinical practice. This review examines recent literature around human factors in anaesthesia, and highlights recent national reports and guidelines with a focus on team working, communication, situation awareness and human error. We highlight the importance of human factors in modern anaesthetic practice, using the example of complex trauma...
January 2018: Anaesthesia
https://www.readbyqxmd.com/read/29260897/coccydynia-could-age-trauma-and-body-mass-index-be-independent-prognostic-factors-for-outcomes-of-intervention
#11
P Kodumuri, S Raghuvanshi, R Bommireddy, Z Klezl
Introduction The aetiology of coccydynia can be multifactorial, with several associated factors such as obesity, female gender and low mood. The long-term results of operative interventions, such as manipulation under anaesthesia and coccygectomy are variable, ranging from 63-90%. Materials and methods Our aim was to identify whether age, trauma and body mass index (BMI) were independent prognostic factors in coccydynia treatment. All patients who presented to the Royal Derby Hospital with a primary diagnosis of coccydynia between January 2011 and January 2015 who had injections, manipulation under anaesthesia or coccygectomy were included...
January 2018: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/29171247/care-of-patients-undergoing-weaning-from-mechanical-ventilation-in-critical-care
#12
Susan Elliott, Nicola Morrell-Scott
There are several reasons why mechanical ventilation - the use of an artificial device to assist a patient to breathe - may be initiated, for example to enable general anaesthesia for patients undergoing surgery, and for those with a compromised airway or respiratory failure. It is important that critical care nurses have the skills and knowledge to care for patients who are undergoing weaning from mechanical ventilation. This is to ensure that patients are weaned safely and as soon as possible, to improve their outcomes and avoid an increase in patient mortality and morbidity through complications that can arise such as airway trauma and ventilator-associated pneumonia...
November 22, 2017: Nursing Standard
https://www.readbyqxmd.com/read/29161465/neuromuscular-electrical-stimulation-for-the-prevention-of-venous-thromboembolism
#13
REVIEW
Shahab Hajibandeh, Shahin Hajibandeh, George A Antoniou, James Rh Scurr, Francesco Torella
BACKGROUND: Venous thromboembolism (VTE) is a serious but preventable cause of morbidity and mortality. Neuromuscular electrical stimulation systems (NMES) for the prevention of VTE may be beneficial for patients in whom pharmacological or standard mechanical prophylaxis methods are contraindicated or are regarded as unsafe or impractical. Although findings of experimental studies suggest that NMES reduce venous stasis, the clinical utility and effectiveness of NMES in VTE prevention remain controversial...
November 21, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29161399/global-lessons-developing-military-trauma-care-and-lessons-for-civilian-practice
#14
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
https://www.readbyqxmd.com/read/29090266/a-cross-sectional-survey-of-anaesthesia-related-expectations-amongst-patients-awaiting-upper-limb-trauma-surgery
#15
Brian Declan O'Donnell, Gabriella Iohom
BACKGROUND AND AIMS: Little is known regarding patients' anaesthesia-related expectations when presenting for upper limb trauma surgery. METHODS: We conducted a prospective cross-sectional survey exploring prior anaesthetic experience, anaesthesia-related knowledge, anaesthesia expectations, the preoperative visit and factors likely to influence anaesthesia choice. The survey was completed by 192 patients. RESULTS: Anaesthetists were identified as doctors by 52%; 53% were unaware of their planned anaesthesia; 58% indicated likely acceptance of regional anaesthesia...
October 2017: Romanian Journal of Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/29090262/conus-medullaris-trauma-is-there-a-greater-risk-in-parturients
#16
Julie Verkooijen, Hilde Coppejans, Els Mertens, Vera Saldien, Marcel Vercauteren
BACKGROUND: There is some evidence that anaesthetists often perform neuraxial blocks at a higher lumbar interspace than intended. It may be questioned whether parturients are at greater risk for neurological damage when the dura is perforated at a more cephalad interspace than L2-L3. METHODS: Thirty-six patients scheduled for elective Caesarean delivery under CSE anaesthesia were selected for study. Using a B-D Durasafe Adjustable needle combination, the skin-to-epidural distance and the width of the epidural space were measured and matched with 36 female patients undergoing the same anaesthetic technique for orthopaedic procedures...
October 2017: Romanian Journal of Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/29066647/buttock-wounds-beware-what-lies-beneath
#17
Stephanie Clark, Suzanne Westley, Alexander Coupland, Mohamad Hamady, Alun H Davies
A 25-year-old man presented to a major trauma centre with multiple stab wounds, most significantly to the right buttock. Triple-phase CT revealed no acute bleeding and his wounds were closed. In the month following injury, he re-presented seven times to the emergency department (ED) complaining of bleeding and wound breakdown. After his seventh ED attendance, he was examined under general anaesthesia. Intraoperatively, profuse arterial bleeding was encountered and the local major haemorrhage protocol was activated...
October 24, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29029368/who-accesses-surgery-at-district-level-in-sub-saharan-africa-evidence-from-malawi-and-zambia
#18
Jakub Gajewski, Rachel Dharamshi, Michael Strader, John Kachimba, Eric Borgstein, Gerald Mwapasa, Mweene Cheelo, Tracey McCauley, Leon Bijlmakers, Ruairi Brugha
OBJECTIVES: To examine age and gender distribution for the most common types of surgery in Malawi and Zambia. METHODS: Data were collected from major operating theatres in eight district hospitals in Malawi and nine in Zambia. Raw data on surgical procedures were coded by specialist surgeons for frequency analyses. RESULTS: In Malawi female surgical patients had a mean age of 25 years, with 91% aged 16-40 years. Females accounted for 85%, and obstetric cases for 75%, of all surgical patients...
December 2017: Tropical Medicine & International Health: TM & IH
https://www.readbyqxmd.com/read/28985089/examining-participant-perceptions-of-an-interprofessional-simulation-based-trauma-team-training-for-medical-and-nursing-students
#19
Rune Bruhn Jakobsen, Sarah Frandsen Gran, Bergsvein Grimsmo, Kari Arntzen, Erik Fosse, Jan C Frich, Per Hjortdahl
High quality care relies on interprofessional teamwork. We developed a short simulation-based course for final year medical, nursing and nursing anaesthesia students, using scenarios from emergency medicine. The aim of this paper is to describe the adaptation of an interprofessional simulation course in an undergraduate setting and to report participants' experiences with the course and students' learning outcomes. We evaluated the course collecting responses from students through questionnaires with both closed-ended and open-ended questions, supplemented by the facilitators' assessment of students' performance...
January 2018: Journal of Interprofessional Care
https://www.readbyqxmd.com/read/28975653/analysis-of-skeletal-muscle-microcirculation-in-a-porcine-polytrauma-model-with-haemorrhagic-shock
#20
Zhi Qiao, Klemens Horst, Michel Teuben, Johannes Greven, Luxu Yin, Yannik Kalbas, René H Tolba, Hans-Christoph Pape, Frank Hildebrand, Roman Pfeifer
Polytraumatised patients with haemorrhagic shock are prone to develop systemic complications, such as SIRS (systemic inflammatory response syndrome), ARDS (acute respiratory distress syndrome) and MOF (multiple organ failure). The pathomechanism of severe complications following trauma is multifactorial, and it is believed that microcirculatory dysfunction plays an important role. The aim of this study was to determine the changes in the microcirculation in musculature over time during shock and subsequent resuscitation in a porcine model of haemorrhagic shock and polytrauma...
October 3, 2017: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
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