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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
#1
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
#2
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/28210788/surgical-management-of-degenerative-meniscus-lesions-the-2016-esska-meniscus-consensus
#3
Ph Beaufils, R Becker, S Kopf, M Englund, R Verdonk, M Ollivier, R Seil
PURPOSE: A degenerative meniscus lesion is a slowly developing process typically involving a horizontal cleavage in a middle-aged or older person. When the knee is symptomatic, arthroscopic partial meniscectomy has been practised for a long time with many case series reporting improved patient outcomes. Since 2002, several randomised clinical trials demonstrated no additional benefit of arthroscopic partial meniscectomy compared to non-operative treatment, sham surgery or sham arthroscopic partial meniscectomy...
February 16, 2017: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/28210414/eye-inside-out-endonasal-endoscopic-reposition-of-eye-from-nose-with-complete-vision-regainment
#4
Girish S Mishra, Sushen Harish Bhatt
Faciomaxillary and ocular trauma is a common entity in most emergency and trauma units. We came across a 68-year-old female patient with a history of bull horn injury over the right eye. Examination revealed an empty orbital socket with unreliable perception of light present. Imaging showed that the eye had displaced posteroinferomedially to be lying in the ethmoid air cells in the nasal cavity. Under nasal endoscopic guidance, the eye was reposited back into the orbital socket and conjunctival sutures were taken to stabilize the position...
March 2017: Craniomaxillofacial Trauma & Reconstruction
https://www.readbyqxmd.com/read/28210364/caudal-edge-of-the-liver-in-the-right-upper-quadrant-ruq-view-is-the-most-sensitive-area-for-free-fluid-on-the-fast-exam
#5
Viveta Lobo, Michelle Hunter-Behrend, Erin Cullnan, Rebecca Higbee, Caleb Phillips, Sarah Williams, Philips Perera, Laleh Gharahbaghian
INTRODUCTION: The focused assessment with sonography in trauma (FAST) exam is a critical diagnostic test for intraperitoneal free fluid (FF). Current teaching is that fluid accumulates first in Morison's pouch. The goal of this study was to evaluate the "sub-quadrants" of traditional FAST views to determine the most sensitive areas for FF accumulation. METHODS: We analyzed a retrospective cohort of all adult trauma patients who had a recorded FAST exam by emergency physicians at a Level I trauma center from January 2012 - June 2013...
February 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28210209/lactate-shuttles-in-neuroenergetics-homeostasis-allostasis-and-beyond
#6
REVIEW
Shayne Mason
Understanding brain energy metabolism-neuroenergetics-is becoming increasingly important as it can be identified repeatedly as the source of neurological perturbations. Within the scientific community we are seeing a shift in paradigms from the traditional neurocentric view to that of a more dynamic, integrated one where astrocytes are no longer considered as being just supportive, and activated microglia have a profound influence. Lactate is emerging as the "good guy," contrasting its classical "bad guy" position in the now superseded medical literature...
2017: Frontiers in Neuroscience
https://www.readbyqxmd.com/read/28209449/maxillofacial-and-concomitant-serious-injuries-an-eight-year-single-center-experience
#7
Fausto Fama, Marco Cicciu, Alessandro Sindoni, Enrico Nastro-Siniscalchi, Roberto Falzea, Gabriele Cervino, Francesca Polito, Francesco De Ponte, Maria Gioffre-Florio
PURPOSE: Maxillofacial injuries are frequently associated with multiple trauma and can determine functional and aesthetic bad outcomes. The severity of maxillofacial injuries may be considerable and can divert clinicians' attention from other concomitant injuries which is less evident but potentially life-threatening. The aim of this study was to find out the concomitant injuries in patients referred to the Emergency Department (ED) of the University Hospital of Messina (North-East Sicily, Italy) for maxillofacial traumas...
January 20, 2017: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
https://www.readbyqxmd.com/read/28203439/evolutional-trends-in-the-management-of-tracheal-and-bronchial-injuries
#8
REVIEW
Brendan Patrick Madden
Tracheal and Bronchial injuries are potentially life threatening complications which require urgent diagnosis and therapeutic intervention. They typically occur in association with blunt and penetrating chest trauma although they are increasingly being encountered in patients following endobronchial intervention and percutaneous tracheostomy insertion. Their precise incidence is unknown. Presenting features include dyspnoea, stridor, respiratory and haemodynamic compromise, haemoptysis, surgical emphysema, pneumothorax and persistent significant airleak...
January 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28203423/clinical-analysis-of-eight-patients-with-blunt-main-stem-bronchial-injuries
#9
Jie Lei, Jinbo Zhao, Feng Tian, Xiaoping Wang, Yongan Zhou, Xiaofei Li, Jian Wang
BACKGROUND: Blunt main stem bronchial injuries are rare but potentially life-threatening injuries in clinical. The aim of this study was to sum up the experience on diagnosis and treatment of blunt main stem bronchial injuries. METHODS: This report retrospective1y analyzed eight cases of main stem bronchial injuries induced by blunt chest trauma between 2013 and 2016 in Tangdu Hospital, Fourth Military Medical University. RESULTS: There were eight patients, including four men and four women...
January 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28203189/a-mystery-of-bilateral-annular-choroidal-and-exudative-retinal-detachment-with-no-systemic-involvement-is-it-part-of-vogt-koyanagi-harada-disease-spectrum-or-a-new-entity
#10
Ibrahim Elaraoud, Walter Andreatta, Li Jiang, Kenan Damer, Jalil Al-Ibrahim
A 65-year-old Caucasian male presented to the eye emergency department with bilateral significant visual loss. He was otherwise healthy with no significant past medical history. Ophthalmic history was significant for chronic open-angle glaucoma, for which the patient was using latanoprost once daily to both eyes. There was no preceding history of trauma or ocular surgery and the patient was emmetropic. Two weeks prior to his presentation, he reported a headache, which settled spontaneously. Slit-lamp examination demonstrated bilateral keratic precipitates, bilateral significantly shallow anterior chamber, and bilaterally normal intraocular pressures of 16 mm Hg...
January 2017: Case Reports in Ophthalmology
https://www.readbyqxmd.com/read/28202206/retrospective-chart-analysis-of-concussion-discharge-instructions-in-the-emergency-department
#11
Allison D Lane, Matthew R Berkman, David Verbunker, Taylor Shekell, Michael Bouska, Lauren Barnett, Allie Keogh, Tomas Nuno, Uwe Stolz, Anna L Waterbrook
BACKGROUND: Recognition and diagnosis of concussion is increasing, but current research shows these patients are discharged from the emergency department (ED) with a wide variability of recommendations and instructions. OBJECTIVE: To assess the adequacy of documentation of discharge instructions given to patients discharged from the ED with concussions. METHODS: This was a quality-improvement study conducted at a University-based Level I trauma center...
February 12, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28196544/diagnostic-error-in-the-emergency-department-follow-up-of-patients-with-minor-trauma-in-the-outpatient-clinic
#12
Pieter-Jan Moonen, Luc Mercelina, Willem Boer, Tom Fret
BACKGROUND: The Emergency Department (ED) is prone to diagnostic error. Most frequent diagnostic errors involved "minor" trauma. Our goal was to determine how frequently a missed diagnosis was detected during follow up and to determine the frequency and causes of primary missed diagnosis and diagnostic error. METHODS: A retrospective single centre study review, during 6 months including all patients presenting to the outpatient clinic after ED admission with a minor trauma...
February 14, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28196343/do-abused-young-children-feel-less-pain
#13
Marie-Hélène Drouineau, Elise Guenego, Véronique Sebille-Rivain, Bénédicte Vrignaud, Martine Balençon, Thomas Blanchais, Karine Levieux, Nathalie Vabres, Georges Picherot, Christèle Gras-le Guen
The objective of this study was to investigate whether acute pain in abused children was under recognized by doctors and nurses compared to children evaluated for accidental injuries. We hypothesize that an abused child's reaction to physical pain could be an additional symptom of this challenging diagnosis. For the observational prospective case control study in an emergency department, children were eligible when: younger than six years old, the reported trauma occurred within the previous seven days, the trauma comprised a bone injury or burn, and the child was able to express his or her pain...
February 11, 2017: Child Abuse & Neglect
https://www.readbyqxmd.com/read/28193544/current-approach-to-liver-traumas
#14
Levent Kaptanoglu, Necmi Kurt, Hasan Ediz Sikar
INTRODUCTION: Liver injuries remain major obstacle for successful treatment, due to size and location of the liver. Requirement for surgery should be determined by clinical factors, most notably hemodynamical state. In this present study we tried to declare our approach to liver traumas. We also tried to emphasize the importance of conservative treatment, since surgeries for liver traumas carry high mortality rates. PRESENTATION OF CASE: Patients admitted to the Department of Emergency Surgery at Kartal Research and Education Hospital, due to liver trauma were retrospectively analyzed between 2003-2013...
February 10, 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28193297/pre-hospital-transfusion-of-packed-red-blood-cells-in-147-patients-from-a-uk-helicopter-emergency-medical-service
#15
Richard M Lyon, Eleanor de Sausmarez, Emily McWhirter, Gary Wareham, Magnus Nelson, Ashley Matthies, Anthony Hudson, Leigh Curtis, Malcolm Q Russell
BACKGROUND: Early transfusion of packed red blood cells (PRBC) has been associated with improved survival in patients with haemorrhagic shock. This study aims to describe the characteristics of patients receiving pre-hospital blood transfusion and evaluate their subsequent need for in-hospital transfusion and surgery. METHODS: The decision to administer a pre-hospital PRBC transfusion was based on clinical judgment. All patients transfused pre-hospital PRBC between February 2013 and December 2014 were included...
February 14, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28192567/development-and-internal-validation-of-a-clinical-risk-score-for-treating-children-with-mild-head-trauma-and-intracranial-injury
#16
Jacob K Greenberg, Yan Yan, Christopher R Carpenter, Angela Lumba-Brown, Martin S Keller, Jose A Pineda, Ross C Brownson, David D Limbrick
Importance: The appropriate treatment of children with mild traumatic brain injury (mTBI) and intracranial injury (ICI) on computed tomographic imaging remains unclear. Evidence-based risk assessments may improve patient safety and reduce resource use. Objective: To derive a risk score predicting the need for intensive care unit observation in children with mTBI and ICI. Design, Setting, and Participants: This retrospective analysis of the prospective Pediatric Emergency Care Applied Research Network (PECARN) head injury cohort study included patients enrolled in 25 North American emergency departments from 2004 to 2006...
February 13, 2017: JAMA Pediatrics
https://www.readbyqxmd.com/read/28192440/helicopter-emergency-medical-services-in-major-incident-management-a-national-norwegian-cross-sectional-survey
#17
Anne Siri Johnsen, Stephen J M Sollid, Trond Vigerust, Morten Jystad, Marius Rehn
OBJECTIVE: Helicopter Emergency Medical Services (HEMS) aim to bring a highly specialised crew to the scene of major incidents for triage, treatment and transport. We aim to describe experiences made by HEMS in Norway in the management of major incidents. DESIGN: Doctors, rescue paramedics and pilots working in Norwegian HEMS and Search and Rescue Helicopters (SAR) January 1st 2015 were invited to a cross-sectional study on experiences, preparedness and training in major incident management...
2017: PloS One
https://www.readbyqxmd.com/read/28190526/focused-assessment-with-sonography-for-trauma-fast-versus-multidetector-computed-tomography-in-hemodynamically-stable-emergency-patients
#18
R Fornell Pérez
This critically appraised topic (CAT) study aims to evaluate the quality and extent of the scientific evidence that supports the use of focused assessment with sonography for trauma (FAST) versus multidetector computed tomography (MDCT) in hemodynamically stable trauma patients in the emergency room. An efficient search of the literature yielded several recent articles with a high level of evidence. The CAT study concludes that FAST is an acceptable initial imaging test in hemodynamically stable patients, although its performance is limited in certain circumstances...
February 10, 2017: Radiología
https://www.readbyqxmd.com/read/28187864/relation-of-household-income-to-incidence-of-sudden-unexpected-death-in-wake-county-north-carolina
#19
Louisa A Mounsey, Feng-Chang Lin, Irion Pursell, Golsa Joodi, Mary Elizabeth Lewis, Anthony Nwosu, Chani Hodonsky, Ross J Simpson, J Paul Mounsey
The incidence of out-of-hospital sudden unexpected death (OHSUD) in a racially and socioeconomically diverse population has been inadequately studied. We collated all OHSUDs over a 24-month period among 18- to 64-year olds in Wake County, North Carolina, to investigate geographic and socioeconomic disparity in incidence of OHSUD. An electronic query of Wake County Emergency Medical Services (EMS) identified all EMS attended out-of-hospital deaths. After excluding trauma, expected deaths, and deaths occurring in non-free-living subjects, medical records and medical examiner's reports were reviewed by a committee of cardiologists to make the determination of OHSUD...
January 5, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28187806/diagnosis-and-management-of-spinal-cord-emergencies
#20
E P Flanagan, S J Pittock
Most spinal cord injury is seen with trauma. Nontraumatic spinal cord emergencies are discussed in this chapter. These myelopathies are rare but potentially devastating neurologic disorders. In some situations prior comorbidity (e.g., advanced cancer) provides a clue, but in others (e.g., autoimmune myelopathies) it may come with little warning. Neurologic examination helps distinguish spinal cord emergencies from peripheral nervous system emergencies (e.g., Guillain-Barré), although some features overlap...
2017: Handbook of Clinical Neurology
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