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Trauma, emergency surgery

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https://www.readbyqxmd.com/read/29241339/a-novel-model-for-a-hub-and-spoke-spinal-service-and-improvements-in-the-treatment-of-spinal-pathology-in-a-rural-hospital-setting
#1
Erden Ali, Andrew Macdowell, Thomas Pagonis
INTRODUCTION:   We present a unique pathway for care aimed specifically at spinal patients. As a result of the shift of the spoke direction from the existing hub-and-spoke model, patient care is being redirected successfully with great benefit to a rural department. Within the rural community, it is the spoke that is the main locality to which patients present and at which they are treated. Subspecialty procurement is often more central and located in tertiary referral centres outside of a rural position...
December 2017: Rural and Remote Health
https://www.readbyqxmd.com/read/29239798/retrobulbar-hematoma-a-systematic-review-of-factors-related-to-outcomes
#2
Brian Christie, Lisa Block, Yue Ma, Alexandra Wick, Ahmed Afifi
INTRODUCTION: Retrobulbar hematoma (RBH), a rare but serious condition, can result in permanent vision loss. Although it is a known complication following trauma or facial fracture reduction, sinus surgery, or blepharoplasty, factors related to patient outcomes are not well-defined. A systematic review was performed to determine the relation of patient/treatment factors to outcomes. METHODS: Articles retrieved from a PubMed search (1989-2017) were reviewed. Demographic information, etiology, symptoms, and final vision outcomes were analyzed using Fisher's exact tests, single and multiple predictor logistic regression...
November 24, 2017: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/29238996/quality-management-of-a-massive-transfusion-protocol
#3
John R Hess, Patrick J Ramos, Nina E Sen, Virginia G Cruz-Cody, Erin E Tuott, Max J Louzon, Eileen M Bulger, Saman Arbabi, Monica B Pagano, Ryan A Metcalf
BACKGROUND: Massive transfusion is a response to massive uncontrolled hemorrhage. To be effective, it must be timely and address the patient's needs for blood volume, oxygen transport, and hemostasis. STUDY DESIGN AND METHODS: A review was performed on all activations of the massive transfusion protocol (MTP) in a hospital with large emergency medicine, trauma, and vascular surgery programs. Indications, transfused amounts, and outcomes were determined for each MTP event to determine appropriateness of MTP use...
December 13, 2017: Transfusion
https://www.readbyqxmd.com/read/29230341/pancreatic-laceration-in-a-pediatric-patient-an-unexpected-diagnosis
#4
Michelle J Hong, Lauren M Porter, Debra D Esernio-Jenssen, Andrew C Miller, Marna Rayl Greenberg
Pediatric pancreatic injuries are rare. We present an atypical case that occurred in a 4-year-old male. The child presented with a twenty-four-hour history of vomiting that had progressed to right lower quadrant abdominal pain on examination in the emergency department. The initial differential was gastroenteritis versus appendicitis. An abnormality on the ultrasonography and an elevated lipase level eventually led to an MRI showing a complete transection through the posterior margin of the pancreas. The patient was admitted to pediatric surgery and underwent a successful distal pancreatectomy with preservation of the spleen...
2017: Case Reports in Pediatrics
https://www.readbyqxmd.com/read/29227054/auditing-surgical-service-provision-at-a-south-african-tertiary-institution-implications-for-the-development-of-district-services
#5
G L Laing, D L Skinner, J L Bruce, C Aldous, V Govindasamy, S R Thomson, D L Clarke
BACKGROUND: The optimal management of resources within South African state hospitals has been hampered by a paucity of data due to a lack of robust auditing information systems. This study reviews the use of a Hybrid Electronic Medical Record (HEMR) system to capture and aggregate data pertaining to the inpatient service demands on a South African tertiary surgical service. This dataset was used to analyse the appropriateness of tertiary surgical resource utilisation. METHOD: The HEMR system was implemented at Greys Hospital, in the city of Pietermaritzburg, Kwa-Zulu Natal, South Africa on 1 January 2013...
November 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/29223594/femoral-neck-fractures-after-removal-of-hardware-in-healed-trochanteric-fractures
#6
REVIEW
Antonio Barquet, Peter V Giannoudis, Andrés Gelink
INTRODUCTION: Hardware removal in healed trochanteric fractures (TF) in the absence of infection or significant mechanical complications is rarely indicated. However, in patients with persistent pain, prominent material and discomfort in the activities of daily living, the implant is eventually removed. Publications of ipsilateral femoral neck fracture after removal of implants from healed trochanteric fractures (FNFARIHTF) just because of pain or discomfort are rare. The purpose of this systematic review of the literature is to report on the eventual risk factors, the mechanisms, the clinical presentation, and frequency, and to pay special emphasis in their prevention...
December 2017: Injury
https://www.readbyqxmd.com/read/29221814/use-of-interventional-radiology-as-initial-hemorrhage-control-to-improve-outcomes-for-potentially-lethal-multiple-blunt-injuries
#7
Hiroyuki Otsuka, Toshiki Sato, Keiji Sakurai, Hiromichi Aoki, Takeshi Yamagiwa, Shinichi Iizuka, Sadaki Inokuchi
INTRODUCTION: Recently, trauma management has been markedly improved with interventional radiology (IVR) and damage-control strategies. However, the indications for its use in hemodynamically unstable patients with severe trauma remains unclear. In some cases, IVR may be more effective than surgery for damage-control hemostasis; however, performing IVR in life-threatening trauma settings is challenging. To address this, we practiced and evaluated a trauma-management system with emergency physicians who trained for both severe trauma management, and techniques of surgery and IVR...
December 6, 2017: Injury
https://www.readbyqxmd.com/read/29217442/posterior-approach-for-revascularization-in-blunt-popliteal-vessel-injury
#8
Vladimir Makaloski, Arno Stellmes, Doerte Wyss, Salome Weiss, Daniel Becker, Thomas R Wyss, Juerg Schmidli
BACKGROUND: Popliteal vessel injuries are associated with traumatic knee injury often requiring emergency revascularization. Medial and posterior approaches to the popliteal space have been proposed. This study evaluates the outcome of patients treated for traumatic popliteal vessel injuries via a posterior approach. METHODS: Consecutive patients with traumatic vascular injuries in the popliteal segments II and III undergoing surgical repair via a posterior approach between October 2008 and December 2016 were analyzed...
December 4, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29201849/concurrent-surgery-of-craniectomy-and-splenectomy-as-initial-treatment-in-severe-traumatic-head-injury-a-case-report
#9
Hyeong Rae Lee, Nam Kyu You, Sook Jin Seo, Mi Sun Choi
It is not a common case for neurosurgery department and the other departments to perform joint operation at the same time. Patients with severe head injury are a condition in which vital signs are unstable due to severe brain swelling and increased intracranial pressure, and emergency surgery is required. A 44-year-old man visited the trauma center with a motorcycle accident. The Glasgow Coma Scale score at the time of emergency department was 3 points, and the pupil was fixed at 6 mm on both sides. His medical history was unknown...
October 2017: Korean Journal of Neurotrauma
https://www.readbyqxmd.com/read/29200479/management-of-sub-axial-cervical-spine-injuries
#10
Gautam Zaveri, Gurdip Das
Sub-axial cervical spine injuries are commonly seen in patients with blunt trauma. They may be associated with spinal cord injury resulting in tetraplegia and severe permanent disability. Immobilization of the neck, maintenance of blood pressure and oxygenation, rapid clinical and radiological assessment of all injuries, and realignment of the spinal column are the key steps in the emergency management of these injuries. The role of intravenous methylprednisolone administration in acute spinal cord injuries remains controversial...
November 2017: Indian Journal of Orthopaedics
https://www.readbyqxmd.com/read/29198715/predicting-mortality-hospital-length-of-stay-and-need-for-surgery-in-pediatric-trauma-patients
#11
Shahrokh Yousefzadeh Chabok, Fatemeh Ranjbar Taklimie, Reza Malekpouri, Alireza Razzaghi
PURPOSE: Pediatric trauma is one of the major health problems around the world which threats the life of children. The survival of injured children depends upon appropriate care, accurate triage and effective emergent surgery. The objective of this study was to determine the predictive values of injury severity score (ISS), new injury severity score (NISS) and revised trauma score (RTS) on children's mortality, hospitalization and need for surgery. METHODS: In this study, records of trauma patients under 15 years old transported from a trauma scene to emergency department of Poursina hospital from 2010 to 2011 were included...
November 4, 2017: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
https://www.readbyqxmd.com/read/29195906/patterns-and-predictors-of-emergency-department-visits-among-older-patients-after-breast-cancer-surgery-a-population-based-cohort-study
#12
Tracy Westley, Ania Syrowatka, David Henault, Young-Soo Rho, Francois Khazoom, Sue-Ling Chang, Robyn Tamblyn, Nancy Mayo, Ari N Meguerditchian
OBJECTIVES: To characterize rates, reasons for, and associated predictors for emergency department (ED) visits after breast cancer (BC) surgery. METHODS: All women over 65 years undergoing curative surgery for non-metastatic incident BC (1998-2012) were identified using Quebec's universal healthcare administrative databases. Reasons for ED visits within 45days of operation were reported. Associated factors were estimated using Cox regression. RESULTS: Of 24,463 patients, 12...
November 28, 2017: Journal of Geriatric Oncology
https://www.readbyqxmd.com/read/29194319/variations-in-outcomes-of-emergency-general-surgery-patients-across-hospitals-a-call-to-establish-emergency-general-surgery-quality-improvement-program-eqip
#13
Gerald O Ogola, Marie L Crandall, Shahid Shafi
BACKGROUND: National Surgical Quality Improvement Program (NSQIP) and Trauma Quality Improvement Program (TQIP) have shown variations in risk-adjusted outcomes across hospitals. Our study hypothesis was that there would be similar variation in risk-adjusted outcomes of Emergency General Surgery (EGS) patients. METHODS: We undertook a retrospective analysis of the National Inpatient Sample database for 2010. Patients with EGS diseases were identified using American Association for the Surgery of Trauma definitions...
November 21, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29189532/pediatric-supracondylar-humerus-fractures-aaos-appropriate-use-criteria-versus-actual-management-at-a-pediatric-level-1-trauma-center
#14
Joanne H Wang, William Z Morris, Blaine T Bafus, Raymond W Liu
OBJECTIVES: The purpose of this study was to characterize management of supracondylar humerus fractures (SCHFs) at a level 1 trauma center and identify factors contributing to divergence in management from American Academy of Orthopedic Surgeons (AAOS) the Appropriate Use Criteria (AUC) recommendations. METHODS: A query revealed 556 patients with diagnoses of SCHF between 2013 and 2015 at a pediatric level 1 trauma center. Patients were excluded if they were younger than 2 years of age, older than 12 years of age, were polytrauma patients, or if there was not sufficient clinical or radiographic documentation, resulting in 449 patients...
November 16, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/29187226/development-and-pilot-testing-of-an-informed-consent-video-for-patients-with-limb-trauma-prior-to-debridement-surgery-using-a-modified-delphi-technique
#15
Yen-Ko Lin, Chao-Wen Chen, Wei-Che Lee, Tsung-Ying Lin, Liang-Chi Kuo, Chia-Ju Lin, Leiyu Shi, Yin-Chun Tien, Yuan-Chia Cheng
BACKGROUND: Ensuring adequate informed consent for surgery in a trauma setting is challenging. We developed and pilot tested an educational video containing information regarding the informed consent process for surgery in trauma patients and a knowledge measure instrument and evaluated whether the audiovisual presentation improved the patients' knowledge regarding their procedure and aftercare and their satisfaction with the informed consent process. METHODS: A modified Delphi technique in which a panel of experts participated in successive rounds of shared scoring of items to forecast outcomes was applied to reach a consensus among the experts...
November 29, 2017: BMC Medical Ethics
https://www.readbyqxmd.com/read/29183351/thyroid-gland-hemorrhage-after-blunt-neck-trauma-case-report-and-review-of-the-literature
#16
Johannes Lemke, Markus N Schreiber, Doris Henne-Bruns, Gregor Cammerer, Andreas Hillenbrand
BACKGROUND: Thyroid hemorrhage is considered to be an uncommon complication following blunt trauma to the neck. This condition is potentially life-threatening due to airway compression and may therefore require emergency airway management and surgical intervention in some cases. CASE PRESENTATION: We present the case of a 52-year-old woman who experienced a traumatic thyroid gland rupture (right lobe) with subsequent active arterial bleeding from branches of the inferior thyroid artery...
November 28, 2017: BMC Surgery
https://www.readbyqxmd.com/read/29172710/low-rates-of-post-craniotomy-surgical-site-infections-in-a-developing-country-surgical-technique-and-results
#17
Amos O Adeleye
INTRODUCTION: Although neurosurgical surgical site infections (SSI) exert a devastating price on the postoperative course of patients in the developing countries, literature is sparse on the subject from these regions. METHODS: This study is an audit of post-craniotomy SSI in a sub-Sahara African academic neurosurgical practice. It is a retrospective descriptive analysis of neurosurgical SSI in a 7-year consecutive cohort of patients who survived more than 5 days following major cranial surgery...
November 24, 2017: British Journal of Neurosurgery
https://www.readbyqxmd.com/read/29170020/impact-of-race-on-the-surgical-management-of-adhesive-small-bowel-obstruction
#18
Alexander S Chiu, Raymond A Jean, Kimberly A Davis, Kevin Y Pei
BACKGROUND: Small bowel obstruction (SBO) represents roughly 15% of admissions by general surgeons. Management of SBO relies heavily on provider judgement, including decisions on how long to trial non-surgical management and whether to use a laparoscopic or open approach when surgery is needed. Given the subjective nature of these decisions, it is unknown if patient race influences management of SBO. STUDY DESIGN: The National Surgical Quality Improvement Program was used to identify patients who underwent adhesiolysis or small bowel resection for adhesive SBO between 2010-2015 (n=13,896)...
November 20, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/29167615/vocal-cord-paralysis-and-laryngeal-trauma-in-cardiac-surgery
#19
Yung-Yuan Chen, Yeo-Yee Chia, Pa-Chun Wang, Hsiu-Yen Lin, Chiu-Ling Tsai, Shaw-Min Hou
Background: Cardiac surgery - associated iatrogenic laryngeal trauma is often overlooked. We investigated the risk factors of vocal cord paralysis in cardiac surgery. Methods: Medical records were reviewed from 169 patients who underwent elective or emergency cardiac surgeries. Patients had transesophageal echocardiography (TEE) placed either under video fiberscopic image guidance (guided group) or blind placement (blind group). Routine postoperative otolaryngologist consultation with video laryngoscopic recording were performed...
November 2017: Acta Cardiologica Sinica
https://www.readbyqxmd.com/read/29167092/dry-needling-for-patients-with-neck-pain-protocol-of-a-randomized-clinical-trial
#20
Eric Robert Gattie, Joshua A Cleland, Suzanne J Snodgrass
BACKGROUND: Neck pain is a costly and common problem. Current treatments are not adequately effective for a large proportion of patients who continue to experience recurrent pain. Therefore, new treatment strategies should be investigated in an attempt to reduce the disability and high costs associated with neck pain. Dry needling is a technique in which a fine needle is used to penetrate the skin, subcutaneous tissues, and muscle with the intent to mechanically disrupt tissue without the use of an anesthetic...
November 22, 2017: JMIR Research Protocols
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