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https://www.readbyqxmd.com/read/29140964/whole-body-computed-tomography-in-severely-injured-patients
#1
Stefan Huber-Wagner, Karl-Georg Kanz, Marc Hanschen, Martijn van Griensven, Peter Biberthaler, Rolf Lefering
PURPOSE OF REVIEW: To provide an update on the relevant and recent studies on whole-body computed tomography (WBCT) imaging of severely injured patients. RECENT FINDINGS: The advantages of WBCT in time saving, diagnostic accuracy and even in survival have been proven in numerous studies. WBCT can also be beneficial in haemodynamically unstable major trauma patients. The CT scanner should be located close to the emergency department or even in the trauma room. The issue of radiation is still quite important, however, iterative as well as split-bolus protocols can nowadays reduce radiation significantly...
November 14, 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29140951/platelet-aggregation-after-blunt-trauma-is-associated-with-the-acute-respiratory-distress-syndrome-and-altered-by-cigarette-smoke-exposure
#2
Farzad Moazed, Carolyn Hendrickson, Mary Nelson, Amanda Conroy, Mitchell J Cohen, Carolyn S Calfee
BACKGROUND: The risk of the acute respiratory distress syndrome (ARDS) is increased in passive and active smokers after blunt trauma. However, the mechanisms responsible, including the role of platelet aggregation, for this association are unknown. METHODS: We analyzed 215 patients with severe blunt trauma from a prospective observational cohort at a Level 1 trauma center between 2010 - 2015. Subjects underwent impedance-based platelet aggregometry in response to platelet agonists arachidonic acid (ASPI), adenosine diphosphate (ADP), collagen (COL) and thrombin receptor activating peptide-6 (TRAP)...
November 14, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29140948/hypertonic-saline-resuscitation-following-emergent-laparotomy-and-temporary-abdominal-closure
#3
Tyler J Loftus, Philip A Efron, Trina M Bala, Martin D Rosenthal, Chasen A Croft, R Stephen Smith, Frederick A Moore, Alicia M Mohr, Scott C Brakenridge
BACKGROUND: Our objective was to establish the safety of 3% hypertonic saline (HTS) resuscitation for trauma and acute care surgery patients undergoing emergent laparotomy and temporary abdominal closure (TAC) with the hypothesis that HTS administration would be associated with hyperosmolar hypercholoremic acidosis, lower resuscitation volumes, and higher fascial closure rates, without adversely affecting renal function. METHODS: We performed a retrospective cohort analysis of 189 trauma and acute care surgery patients who underwent emergent laparotomy and TAC, comparing patients with normal baseline renal function who received 3% HTS at 30 mL/h (n=36) to patients with standard resuscitation (n=153) by baseline characteristics, resuscitation parameters, and outcomes including primary fascial closure and KDIGO stages of acute kidney injury...
November 14, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29139608/current-state-of-screening-high-ace-youth-and-emerging-adults-in-primary-care
#4
Michelle Pardee, Elizabeth Kuzma, Chin Hwa Gina Y Dahlem, Nicole Boucher, Cynthia S Darling-Fisher
BACKGROUND AND PURPOSE: Trauma comes in many forms, including interpersonal, community, and institutional trauma. The adverse childhood event (ACE) studies demonstrated that adverse experiences in childhood can have a profound, cumulative impact on the course of health and development over a lifetime. It is critical for healthcare providers, such as nurse practitioners (NPs), working in primary care to screen adolescents and emerging adults for a history of ACEs and trauma. A review of current assessment tools used in assessing this population in health settings is needed to determine how screening for ACEs is being performed...
November 15, 2017: Journal of the American Association of Nurse Practitioners
https://www.readbyqxmd.com/read/29138652/trauma-a-major-cause-of-death-among-surgical-inpatients-of-a-nigerian-tertiary-hospital
#5
Onyeanunam Ngozi Ekeke, Kelechi Emmanuel Okonta
Introduction: Trauma presents a significant global health burden. Death resulting from trauma remains high in low income countries despite a steady decrease in developed countries. Analysis of the pattern of death will enable intervention to reduce these deaths from trauma in developing countries. This study aims to present the pattern of trauma-related deaths in the surgical wards of University of Port Harcourt Teaching Hospital (UPTH). Methods: This was a retrospective study of all patients who died from trauma during admission into the surgical wards of UPTH from 2007 to 2012...
2017: Pan African Medical Journal
https://www.readbyqxmd.com/read/29137906/can-different-physicians-providing-urgent-and-non-urgent-treatment-improve-patient-flow-in-emergency-department
#6
Flora Fei-Fei Yau, Tsung-Cheng Tsai, Yan-Ren Lin, Kuan-Han Wu, Yuan-Jhen Syue, Chao-Jui Li
BACKGROUND: Emergency Department (ED) overcrowding is a worldwide problem, and it might be caused by prolonged patient stay in the ED. This study tried to analyze if different practice models influence patient flow in the ED. MATERIALS AND METHODS: A retrospective, 1-year cohort study was conducted across two EDs in the largest healthcare system in Taiwan. A total of 37,580 adult non-trauma patients were involved in the study. The clinical practice between two ED practice models was compared...
November 6, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29136314/syncope-prognosis-based-on-emergency-department-diagnosis-a-prospective-cohort-study
#7
Cristian Toarta, Muhammad Mukarram, Kirtana Arcot, Soo-Min Kim, Sarah Gaudet, Marco L A Sivilotti, Brian H Rowe, Venkatesh Thiruganasambandamoorthy
OBJECTIVE: Relatively little is known about outcomes after disposition among syncope patients assigned various diagnostic categories during emergency department (ED) evaluation. We sought to measure the outcomes among these groups within 30 days of the initial ED visit. METHODS: We prospectively enrolled adult syncope patients at six EDs and excluded patients with pre-syncope, persistent mental status changes, intoxication, seizure, and major trauma. Patient characteristics, ED management, diagnostic impression (presumed vasovagal, orthostatic, cardiac, or other/unknown) at the end of the ED visit and physicians' confidence in assigning the etiology were collected...
November 14, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29135535/blood-glucose-concentrations-in-prehospital-trauma-patients-with-traumatic-shock-a-retrospective-analysis
#8
Janett Kreutziger, Wolfgang Lederer, Stefan Schmid, Hanno Ulmer, Volker Wenzel, Maarten W Nijsten, Daniel Werner, Thomas Schlechtriemen
BACKGROUND: Deranged glucose metabolism after moderate to severe trauma with either high or low concentrations of blood glucose is associated with poorer outcome. Data on prehospital blood glucose concentrations and trauma are scarce. OBJECTIVES: The primary aim was to describe the relationship between traumatic shock and prehospital blood glucose concentrations. The secondary aim was to determine the additional predictive value of prehospital blood glucose concentration for traumatic shock when compared with vital parameters alone...
November 11, 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/29133262/911-emergency-medical-services-and-re-triage-to-level-i-trauma-centers
#9
Eric Kuncir, Dean Spencer, Kelly Feldman, Cristobal Barrios, Kenneth Miller, Stephanie Lush, Matthew Dolich, Michael Lekawa
BACKGROUND: Interfacility transfer of under-triaged patients to higher level trauma centers has been found to result in a delay of appropriate care and increase in mortality. To address this, for the last 10 years, our region has utilized 911 EMS paramedics for rapid re-triage of under-triaged patients to our institution's Level I trauma center. We sought to determine if utilizing 911 EMS for re-triage (911-RT) to our institution was associated with worse outcomes-with mortality as the primary outcome-compared to direct EMS transport from point of injury...
September 27, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/29132593/the-impact-of-helicopter-emergency-medical-service-night-operations-in-south-east-england
#10
Leigh Curtis, Mark Salmon, Richard M Lyon
OBJECTIVE: This study sought to assess the impact of a helicopter emergency medical service (HEMS) capable of night operations. METHODS: This is a retrospective case review of all night HEMS missions attended by a charity air ambulance service in South East England over a 2-year period (October 1, 2013, to October 1, 2015). RESULTS: During the 2-year trial period, the HEMS service undertook a total of 5,004 missions and attended to 3,728 patients...
November 2017: Air Medical Journal
https://www.readbyqxmd.com/read/29132580/the-kids-are-alright-pediatric-trauma-pearls
#11
REVIEW
Angelo Mikrogianakis, Vincent Grant
Pediatric patients with trauma pose unique challenges, both practical and cognitive, to front-line care providers. The combination of anatomic, physiologic, and metabolic factors leads to unique injury patterns with different approaches and responses to treatment compared with adults. A similar traumatic mechanism can lead to slightly different internal injuries with unique management and treatment strategies between the two groups. This article is intended for community, nonpediatric trauma centers, and emergency physicians who are frequently required to assess, resuscitate, and stabilize injured children before they can be safely transferred to a pediatric trauma center for ongoing definitive care and rehabilitation...
February 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29132578/major-trauma-outside-a-trauma-center-prehospital-emergency-department-and-retrieval-considerations
#12
REVIEW
Preston J Fedor, Brian Burns, Michael Lauria, Clare Richmond
Care of the critically injured begins well before the patient arrives at a large academic trauma center. It is important to understand the continuum of care from the point of injury in the prehospital environment, through the local hospital and retrieval, until arrival at a trauma center capable of definitive care. This article highlights the important aspects of trauma assessment and management outside of tertiary or quaternary care hospitals. Key elements of each phase of care are reviewed, including management pearls and institutional strategies to facilitate effective and efficient treatment of trauma patients from the point of injury forward...
February 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29132573/critical-decisions-in-the-management-of-thoracic-trauma
#13
REVIEW
Morgan Schellenberg, Kenji Inaba
Traumatic injuries to the thorax are common after both blunt and penetrating trauma. Emergency medicine physicians must be able to manage the initial resuscitation and diagnostic workup of these patients. This involves familiarity with a range of radiologic investigations and invasive bedside procedures, including resuscitative thoracotomy. This knowledge is critical to allow for rapid decision making when life-threatening injuries are encountered. This article explores the initial resuscitation and assessment of patients after thoracic trauma, discusses available imaging modalities, reviews frequently performed procedures, and provides an overview of the indications for operative intervention, while emphasizing the critical decision making throughout...
February 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29131775/traumatic-hip-dislocation-what-the-orthopedic-surgeon-wants-to-know
#14
Jacob C Mandell, Richard A Marshall, Michael J Weaver, Mitchel B Harris, Aaron D Sodickson, Bharti Khurana
Hip dislocation is an important orthopedic emergency usually seen in young patients who have experienced high-energy trauma, often resulting in significant long-term morbidity. Rapid identification and reduction is critical, as prolonged dislocation increases the risk of developing avascular necrosis of the femoral head, and posttraumatic osteoarthritis is a common complication, even in the absence of associated fractures. Identification and timely management of hip dislocation are highly dependent on imaging, both at presentation and after attempted reduction...
November 2017: Radiographics: a Review Publication of the Radiological Society of North America, Inc
https://www.readbyqxmd.com/read/29130379/trauma-complexity-and-child-abuse-a-qualitative-study-of-attachment-narratives-in-adult-refugees-with-ptsd
#15
Karin Riber
The present study aimed to identify trauma types over the life course among adult refugees and to explore their accounts of childhood maltreatment. A sample of 43 Arabic-speaking refugees with posttraumatic stress disorder (PTSD) attending a treatment context in Denmark were interviewed. Using a "Trauma Coding Manual" developed for this study, trauma types were identified in interview transcripts. In both men and women with Iraqi and Palestinian-Lebanese backgrounds, high levels of trauma complexity and high rates of childhood maltreatment were found (63%, n = 27)...
January 1, 2017: Transcultural Psychiatry
https://www.readbyqxmd.com/read/29129793/the-interval-between-vns-tone-pairings-determines-the-extent-of-cortical-map-plasticity
#16
Michael S Borland, Crystal T Engineer, William A Vrana, Nicole A Moreno, Navzer D Engineer, Sven Vanneste, Pryanka Sharma, Meghan C Pantalia, Mark C Lane, Robert L Rennaker, Michael P Kilgard
Repeatedly pairing vagus nerve stimulation (VNS) with a tone or movement drives highly-specific and long-lasting plasticity in auditory or motor cortex, respectively. Based on this robust enhancement of plasticity, VNS paired with rehabilitative training has emerged as a potential therapy to improve recovery, even when delivered long after the neurological insult. Development of VNS delivery paradigms that reduce therapy duration and maximize efficacy would facilitate clinical translation. The goal of the current study was to determine whether primary auditory cortex (A1) plasticity can be generated more quickly by shortening the interval between VNS-tone pairing events or by delivering fewer VNS-tone pairing events...
November 9, 2017: Neuroscience
https://www.readbyqxmd.com/read/29128127/a-crossbow-suicide
#17
Laura Panata, Massimo Lancia, Alessandra Persichini, Sergio Scalise Pantuso, Mauro Bacci
The crossbow is an ancient ranged weapon originally conceived for war and hunting. Although nowadays its use in warfare has been surpassed by firearms, it continues to be used in hunting, sports and recreation. The authors present the case of a 40-year-old man who suffered from severe depression. When his condition further deteriorated, doctors ordered a forced hospitalization but, just a few hours before the measure became effective, the man committed suicide using a crossbow. The autopsy and police investigation showed possession of the crossbow darts which the man used to shoot himself in the head...
October 18, 2017: Forensic Science International
https://www.readbyqxmd.com/read/29126602/the-potential-of-blended-learning-in-education-and-training-for-advanced-civilian-and-military-trauma-care
#18
Linda Sonesson, Kenneth Boffard, Lars Lundberg, Martin Rydmark, Klas Karlgren
INTRODUCTION: In the field of advanced care of the complex trauma patient, there is an emerging need for focused education and training. However, several hospitals do not support further education and training in this field, and the challenge of releasing time for physicians and nurses is well-known. Educational strategies using blended learning, which combines traditional classroom methods with modern computer-assisted methods and media, have not yet been widely used. This study analysed the educational challenges and areas for improvement, according to senior physicians and nurses, and investigated the potential use of blended learning...
November 6, 2017: Injury
https://www.readbyqxmd.com/read/29126452/high-performing-trauma-teams-frequency-of-behavioral-markers-of-a-shared-mental-model-displayed-by-team-leaders-and-quality-of-medical-performance
#19
Bjørn Helge Johnsen, Heidi Kristina Westli, Roar Espevik, Torben Wisborg, Guttorm Brattebø
BACKGROUND: High quality team leadership is important for the outcome of medical emergencies. However, the behavioral marker of leadership are not well defined. The present study investigated frequency of behavioral markers of shared mental models (SMM) on quality of medical management. METHOD: Training video recordings of 27 trauma teams simulating emergencies were analyzed according to team -leader's frequency of shared mental model behavioral markers. RESULTS: The results showed a positive correlation of quality of medical management with leaders sharing information without an explicit demand for the information ("push" of information) and with leaders communicating their situational awareness (SA) and demonstrating implicit supporting behavior...
November 10, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29125952/getting-to-the-core-of-medicine-developing-undergraduate-forensic-medicine-and-pathology-teaching
#20
Richard Martin Jones
Teaching and learning of forensic medicine and pathology in the undergraduate medical curriculum has been in decline for decades in the UK, and yet graduates are expected to be able to recognise, and protect, those who are most vulnerable in society - i.e. at risk of abuse or neglect - a matter highly relevant to the role of the forensic medical practitioner. When Cardiff University School of Medicine created a new 'learner-centred' undergraduate curriculum, championing case-based discussion in small groups, and earlier clinical contact, residual teaching on 'the pathology of trauma' disappeared...
October 16, 2017: Journal of Forensic and Legal Medicine
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