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initial assessment and management of a trauma patient

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https://www.readbyqxmd.com/read/28334590/a-prospective-emergency-department-quality-improvement-project-to-improve-the-treatment-of-vaso-occlusive-crisis-in-sickle-cell-disease-lessons-learned
#1
Paula Tanabe, Caroline E Freiermuth, David M Cline, Susan Silva
BACKGROUND: Guidelines recommend rapid, aggressive management of vaso-occlusive crisis (VOC) for patients with sickle cell disease (SCD). A large prospective research and quality improvement (QI) project was conducted to measure changes in clinical outcomes in two EDs-academic medical centers with emergency medicine residency programs and Level 1 trauma centers-during a 2.5-year time period (October 2011-March 2014). METHODS: A QI team used a Plan-Do-Study-Act approach to modify and implement changes to opioid analgesic protocols for the emergency department (ED) treatment of VOC...
March 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28286623/effective-management-of-bone-fractures-with-the-illuminoss%C3%A2-photodynamic-bone-stabilization-system-initial-clinical-experience-from-the-european-union-registry
#2
Thomas Gausepohl, Dietmar Pennig, Steffen Heck, Sascha Gick, Paul A Vegt, Jon E Block
The IlluminOss(®) system (IS) uses a light-curable polymer contained within an inflatable balloon catheter, forming a patient customized intramedullary implant. A registry was established in Germany and The Netherlands to prospectively collect technical and clinical outcomes in patients treated with IS for fractures of the phalange, metacarpal, radius, ulna, distal radius, fibula, clavicle and/or olecranon. Humeral, femoral, tibial and pelvic fractures were included under compassionate use. Procedural success included successful placement of the device at the target fracture site and achievement of fracture stabilization...
February 20, 2017: Orthopedic Reviews
https://www.readbyqxmd.com/read/28254445/new-device-for-intermittent-emptying-of-the-bladder-in-female-children-and-adolescents-a-pilot-study
#3
Salvador V C Lima, Fábio O Vilar, Eugênio S Lustosa, Daniel C C Aragão, Fernanda C F S Calisto, Flávia C M Pinto
INTRODUCTION: Urinary incontinence (UI) is a challenging problem for the urological community. Clean intermittent catheterization (CIC) is the most commonly used method to restore bladder emptying to the state close to the physiological condition. This procedure can cause negative aspects such as pain and possible urethral injury. In addition, there is a negative impact on self-image and decline in quality of patient's life. The aim of the present study was to evaluate the safety and efficacy of a new intraurethral self-retaining device (ISRD), in female children and adolescents, as an attractive alternative to CIC...
February 16, 2017: Journal of Pediatric Urology
https://www.readbyqxmd.com/read/28248804/standardizing-the-initial-resuscitation-of-the-trauma-patient-with-the-primary-assessment-completion-tool-pact-using-video-review
#4
Lee Ann Wurster, Rajan K Thakkar, Kathy J Haley, Krista K Wheeler, Jeremy Larson, Michael Stoner, Yaffa Gewirtz, Todd Holman, Don Buckingham, Jonathan I Groner
BACKGROUND: Major trauma resuscitations at pediatric trauma centers have an elevated risk for error due to their high acuity and relatively low frequency. The Advanced Trauma Life Support® (ATLS®) treatment paradigm was established to improve the management of trauma patients during the initial resuscitation phase and has been shown to improve outcomes through a standardized approach. The goal of this quality improvement project was to decrease assessment physician variability and improve the compliance with the ATLS® primary assessment for major resuscitations...
February 28, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28210404/infraorbital-nerve-decompression-for-infraorbital-neuralgia-causalgia-following-blowout-orbital-fractures-a-case-series
#5
Bijan Beigi, Mazda Beigi, Nuwan Niyadurupola, Manuel Saldana, Nabil El-Hindy, Deepak Gupta
The purpose of this study was to present the management of a series of patients referred with infraorbital nerve paraesthesia that developed after insignificant orbital floor fracture without diplopia or exophthalmos, and that did not require initial surgical repair. This is a retrospective interventional case series. The main outcome and measures were assessment of preoperative symptoms including neuralgia and sensory symptoms; review of periorbital computed tomography (CT) scans; and assessment of postoperative effects of surgery for infraorbital nerve decompression...
March 2017: Craniomaxillofacial Trauma & Reconstruction
https://www.readbyqxmd.com/read/28205078/enoxaparin-dose-reduction-for-thrombocytopenia-in-patients-with-cancer-a-quality-assessment-study
#6
Simon Mantha, Yimei Miao, Jonathan Wills, Rekha Parameswaran, Gerald A Soff
The development of thrombocytopenia in the setting of therapeutic anticoagulation for venous thromboembolic disease (VTE) is common in cancer patients, but guidelines for management are based on limited past data and have not been validated. In 2011, Memorial Sloan Kettering Cancer Center (MSKCC) implemented the following guidelines in this setting: administer full dose enoxaparin for a platelet count > 50,000/mcL, half-dose enoxaparin for a platelet count of 25,000-50,000/mcL, and hold anticoagulation for a platelet count < 25,000/mcL...
February 16, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28126266/educational-review-of-predictive-value-and-findings-of-computed-tomography-scan-in-diagnosing-bowel-and-mesenteric-injuries-after%C3%A2-blunt-trauma-correlation-with-trauma-surgery-findings-in%C3%A2-163%C3%A2-patients
#7
Francesco Cinquantini, Gregorio Tugnoli, Alice Piccinini, Carlo Coniglio, Sergio Mannone, Andrea Biscardi, Giovanni Gordini, Salomone Di Saverio
BACKGROUND AND AIMS: Laparotomy can detect bowel and mesenteric injuries in 1.2%-5% of patients following blunt abdominal trauma. Delayed diagnosis in such cases is strongly related to increased risk of ongoing sepsis, with subsequent higher morbidity and mortality. Computed tomography (CT) scanning is the gold standard in the evaluation of blunt abdominal trauma, being accurate in the diagnosis of bowel and mesenteric injuries in case of hemodynamically stable trauma patients. Aims of the present study are to 1) review the correlation between CT signs and intraoperative findings in case of bowel and mesenteric injuries following blunt abdominal trauma, analysing the correlation between radiological features and intraoperative findings from our experience on 25 trauma patients with small bowel and mesenteric injuries (SBMI); 2) identify the diagnostic specificity of those signs found at CT with practical considerations on the following clinical management; and 3) distinguish the bowel and mesenteric injuries requiring immediate surgical intervention from those amenable to initial nonoperative management...
January 23, 2017: Canadian Association of Radiologists Journal, Journal L'Association Canadienne des Radiologistes
https://www.readbyqxmd.com/read/28126218/imaging-genitourinary-trauma
#8
REVIEW
Bari Dane, Alexander B Baxter, Mark P Bernstein
Contrast-enhanced multidetector computed tomography (MDCT) has become a critical tool in the evaluation of the trauma patient. MDCT can quickly and accurately assess trauma patients for renal, ureteral, and bladder injuries. Moreover, CT guides clinical management triaging patients to those requiring discharge, observation, angioembolization, and surgery. Recognition of urinary tract trauma on initial scan acquisition should prompt delayed excretory phase imaging to identify urine leaks. Urethral and testicular trauma are imaged with retrograde urethrography and sonography, respectively...
March 2017: Radiologic Clinics of North America
https://www.readbyqxmd.com/read/28099375/routine-neurosurgical-consultation-is-not-necessary-in-mild-blunt-traumatic-brain-injury
#9
Paul R Lewis, Casey E Dunne, James D Wallace, Jason B Brill, Richard Y Calvo, Jayraan Badiee, Michael J Sise, Vishal Bansal, C Beth Sise, Steven R Shackford
BACKGROUND: The Brain Trauma Foundation guidelines provide indications for neurosurgical intervention in traumatic brain injury (TBI) with moderate or severe intracranial hemorrhage (ICH). In TBI patients with less severe ICH, the utility of neurosurgical consultation remains unclear. We sought to determine if routine neurosurgical consultation is necessary for mild blunt TBI patients with ICH. METHODS: A retrospective cohort study was conducted on 500 consecutive blunt TBI patients aged 15 years or older with Glasgow Coma Scale score of ≥13 and ICH on initial head computed tomography admitted to a Level I trauma center over 28 months...
April 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28091809/a-review-of-penetrating-brain-trauma-epidemiology-pathophysiology-imaging-assessment-complications-and-treatment
#10
REVIEW
Mona T Vakil, Ajay K Singh
Gunshot injuries are the most common cause of penetrating brain injury (PBI) and carry a high morbidity and mortality. The incidence of PBI has increased over the last decade with an estimated 35,000 civilian deaths annually. Patients that survive to reach the hospital require rapid triage and imaging evaluation. CT findings in conjunction with the Glasgow Coma Scale are typically used to determine which patients are surgical candidates. Radiologists should be familiar with the various injury patterns and imaging findings which are poor prognostic indicators, notably brainstem, bilateral hemispheric, multilobar, or transventricular injuries...
January 14, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/28078473/traumatic-atlantoaxial-rotatory-fixation-in-an-adult-patient
#11
María A García-Pallero, Cristina V Torres, Juan Delgado-Fernández, R G Sola
INTRODUCTION: Atlantoaxial rotational fixation (AARF) is a rare entity in adults, with only a few cases reported in the English literature and often associated with a traumatic mechanism. It is an underdiagnosed condition that must be taken into account in the initial assessment of all craniocervical trauma. Both diagnostic and therapeutic delay may be a potential cause of severe neurological damage or even death of the patient. The therapeutic management is controversial given the difficulty of achieving optimum stability and permanent reduction...
January 11, 2017: European Spine Journal
https://www.readbyqxmd.com/read/28004326/utility-of-mdct-findings-in-predicting-patient-management-outcomes-in-renal-trauma
#12
Arthur H Baghdanian, Armonde A Baghdanian, Anthony Armetta, Richard K Babayan, Christina A LeBedis, Jorge A Soto, Stephan W Anderson
PURPOSE: The purpose of this study is to assess the utility of computed tomography (CT) in predicting clinical outcomes in renal trauma. MATERIALS/METHODS: This retrospective study was IRB approved and HIPAA compliant; informed consent was waived. One-hundred-sixty-two, trauma-related renal injuries (157 adults) from January 01, 2006 to December 31, 2013 were included in this retrospective study. CT findings of vascular and collecting system (CS) injuries were recorded, and American Association for the Surgery of Trauma (AAST) renal injury grades were assigned...
December 21, 2016: Emergency Radiology
https://www.readbyqxmd.com/read/27919714/initial-testing-of-a-behavioural-pain-assessment-tool-within-trauma-units
#13
Julie Gregory
Pain is common in trauma patients who may be older and also may have cognitive impairment leading to reduced communication about their pain. A number of observational pain assessment tools are available and have been found to have limited clinical usefulness. The Bolton Pain Assessment Tool (BPAT) was developed following a trial of three established tools and includes a section to involve family and/or close carers in the pain assessment process. The aim of this paper is to present the findings of initial testing of BPAT...
February 2017: International Journal of Orthopaedic and Trauma Nursing
https://www.readbyqxmd.com/read/27913815/-volume-therapy-in-the-severely-injured-patient-recommendations-and-current-guidelines
#14
Sigune Kaske, Marc Maegele
BACKGROUND: Volume therapy is a cornerstone of early resuscitation of severely injured trauma patients, but the optimal strategy remains under debate. A recent Cochrane review could not find evidence for or against early volume replacement or large versus small amounts of fluid. METHOD: Current recommendations and guidelines regarding volume therapy in severely injured patients are summarized based upon the updated European Trauma Guideline on the management of major bleeding and coagulopathy following trauma (fourth edition) and the S3-Guideline Polytrauma and combined with a selective review of the literature...
January 2017: Der Unfallchirurg
https://www.readbyqxmd.com/read/27857493/are-standard-antero-posterior-and-20%C3%A2-caudal-radiographs-a-true-assessment-of-mid-shaft-clavicular-fracture-displacement
#15
Jonathan Wright, Nick Aresti, Charlotte Heuveling, Livio Di Mascio
AIMS: Decision-making in management of clavicle fractures is often based on the degree of displacement and shortening present on plain radiographs. We aimed to evaluate whether plain radiographs provide an accurate representation of the true displacement present, which can be difficult to image in orthogonal planes. METHODS: Consecutive high-energy trauma patients with midshaft clavicular fractures requiring further CT imaging of the thorax/abdomen for other associated injuries between 2009 and 2012 were evaluated...
October 2016: Journal of Clinical Orthopaedics and Trauma
https://www.readbyqxmd.com/read/27855665/evaluation-of-a-new-imaging-tool-for-use-with-major-trauma-cases-in-the-emergency-department
#16
Moritz Crönlein, Konstantin Holzapfel, Marc Beirer, Lukas Postl, Karl-Georg Kanz, Dominik Pförringer, Stefan Huber-Wagner, Peter Biberthaler, Chlodwig Kirchhoff
BACKGROUND: The aim of this study was to evaluate potential benefits of a new diagnostic software prototype (Trauma Viewer, TV) automatically reformatting computed tomography (CT) data on diagnostic speed and quality, compared to CT-image data evaluation using a conventional CT console. METHODS: Multiple trauma CT data sets were analysed by one expert radiology and one expert traumatology fellow independently twice, once using the TV and once using the secondary conventional CT console placed in the CT control room...
November 17, 2016: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/27843433/successful-treatment-of-lasiodiplodia-theobromae-keratitis-assessing-the-role-of-voriconazole
#17
Stephen Tak-Lun Li, Evan Po-Fat Yiu, Angela Hiu-Yan Wong, John Chun-Ting Yeung, Lester Wang-Hon Yu
PURPOSE: The aim of this paper is to report the successful management of the first case of Lasiodiplodia theobromae keratitis in Hong Kong. METHODS: We conducted a case report. RESULTS: A 43-year-old Chinese male with a history of diabetes developed left eye keratitis after a trauma during tree felling. Fungal keratitis was diagnosed using a confocal microscope on day 1, and L. theobromae was confirmed from the culture. He was given oral voriconazole, topical natamycin, and topical and intracameral amphotericin B...
September 2016: Case Reports in Ophthalmology
https://www.readbyqxmd.com/read/27832693/distance-learning-can-be-as-effective-as-traditional-learning-for-medical-students-in-the-initial-assessment-of-trauma-patients
#18
RANDOMIZED CONTROLLED TRIAL
Shervin Farahmand, Ebrahim Jalili, Mona Arbab, Mojtaba Sedaghat, Mandana Shirazi, Fatemeh Keshmiri, Arsalan Azizpour, Somayeh Valadkhani, Shahram Bagheri-Hariri
Distance learning is expanding and replacing the traditional academic medical settings. Managing trauma patients seems to be a prerequisite skill for medical students. This study has been done to evaluate the efficiency of distance learning on performing the initial assessment and management in trauma patients, compared with the traditional learning among senior medical students. One hundred and twenty senior medical students enrolled in this single-blind quasi-experimental study and were equally divided into the experimental (distance learning) and control group (traditional learning)...
September 2016: Acta Medica Iranica
https://www.readbyqxmd.com/read/27823937/orbital-blowout-fractures-a-novel-ct-measurement-that-can-predict-the-likelihood-of-surgical-management
#19
Tamer N Mansour, Megan Rudolph, Derek Brown, Natalie Mansour, M Reza Taheri
OBJECTIVE: The purpose of this study is to identify an accurate and reliable computed tomographic (CT) measurement that can identify those patients presenting to the emergency department (ED) with orbital floor fracture (BOF) who require surgical repair to prevent ensuing visually debilitating diplopia and/or enophthalmos. METHODS: In this retrospective institutional review board-approved study, we reviewed 99 patients older than 18 years with orbital fractures treated in a level I trauma center from 2011 through 2015...
January 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27818032/laryngeal-injury-and-pneumomediastinum-due-to-minor-blunt-neck-trauma-case-report
#20
Yasutaka Kuniyoshi, Azusa Kamura, Sumie Yasuda, Makoto Tashiro, Yoichiro Toriyabe
BACKGROUND: Serious isolated laryngeal injuries are uncommon in children. CASE REPORT: We describe the case of an 8-year-old boy with laryngeal injury and pneumomediastinum due to minor blunt neck trauma. He presented to the emergency department complaining of odynophagia and hoarseness, but without respiratory distress. Emphysema was seen between the trachea and vertebral body on initial cervical spine x-ray study, and flexible laryngoscopy revealed erythema and mild edema of both the right vocal cord and the arytenoid region...
November 3, 2016: Journal of Emergency Medicine
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