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initial assessment and management of a trauma patient

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https://www.readbyqxmd.com/read/28509822/fracture-prevention-in-the-orthopaedic-environment-outcomes-of-a-coordinator-based-fracture-liaison-service
#1
Earl R Bogoch, Victoria Elliot-Gibson, Dorcas Beaton, Joanna Sale, Robert G Josse
BACKGROUND: Fracture liaison services focus on secondary fracture prevention by identifying patients at risk for future fracture and initiating appropriate evaluation, risk assessment, education, and therapeutic intervention. This study describes key clinical outcomes including bone mineral densitometry, physician assessment, and pharmacotherapy initiation in pharmacotherapy-naïve patients undergoing treatment for fragility fracture in a Canadian fracture liaison service. METHODS: We determined rates of post-fracture investigation and treatment for inpatients and outpatients with a fragility fracture seen in a coordinator-based fracture liaison service at an urban university trauma hospital...
May 17, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28506455/trauma-morning-report-is-the-ideal-environment-to-teach-and-evaluate-resident-communication-and-sign-outs-in-the-80-hour-work-week
#2
Mary E Ottinger, Sean F Monaghan, Shea C Gregg, Andrew H Stephen, Michael D Connolly, David T Harrington, Charles A Adams, William G Cioffi, Daithi S Heffernan
BACKGROUND: The 80h work week has raised concerns that complications may increase due to multiple sign-outs or poor communication. Trauma Surgery manages complex trauma and acute care surgical patients with rapidly changing physiology, clinical demands and a large volume of data that must be communicated to render safe, effective patient care. Trauma Morning Report format may offer the ideal situation to study and teach sign-outs and resident communication. MATERIALS AND METHODS: Surgery Residents were assessed on a 1-5 scale for their ability to communicate to their fellow residents...
May 1, 2017: Injury
https://www.readbyqxmd.com/read/28505521/short-simulation-exercises-to-improve-emergency-department-nurses-self-efficacy-for-initial-disaster-management-controlled-before-and-after-study
#3
Carl-Oscar Jonson, Jenny Pettersson, Jonas Rybing, Heléne Nilsson, Erik Prytz
INTRODUCTION: Head nurses at emergency departments often assume responsibility for managing the initial response to a major incident, and to create surge capacity. Training is essential to enable these nurses to perform an effective disaster response. Evaluating the effects of such training is however complicated as real skill only can be demonstrated during a real major incident. Self-efficacy has been proposed as an alternative measure of training effectiveness. PURPOSE: The aim of this study was to examine if short, small-scale computer-based simulation exercises could improve head emergency nurses' general and specific self-efficacy and initial incident management skills...
April 29, 2017: Nurse Education Today
https://www.readbyqxmd.com/read/28500499/-anesthesiological-care-of-trauma-patients-in-orthogeriatric-co-management
#4
Markus F Luger, Thomas J Luger
Elderly patients increasingly need to undergo surgery under anesthesia, especially following trauma. A timely interdisciplinary approach to the perioperative management of these patients is decisive for the long-term outcome. Orthogeriatric co-management, which includes geriatricians and anesthesiologists from an early stage, is of great benefit for geriatric patients. Patient age, comorbidities and self-sufficiency in activities of daily life are decisive for an anesthesiological assessment of the state of health and preoperative risk stratification...
May 12, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28496385/initial-assessment-and-evaluation-of-traumatic-facial-injuries
#5
REVIEW
Tuan A Truong
The care of the facial trauma patient continues to evolve in the ever-changing face of medicine. Patients can be reassured that their care is managed by a variety of specialists knowledgeable in the assessment and management of complex facial injuries. Thanks in part to advances in imaging modalities, bone fixation techniques and technology, and a wider array of reconstructive procedures, the foundation upon which the reconstructive ladder of facial injuries rests continues to expand. The overall goal of repair is a return to a preinjury state of form and function...
May 2017: Seminars in Plastic Surgery
https://www.readbyqxmd.com/read/28493802/placental-imaging-normal-appearance-with-review-of-pathologic-findings
#6
Shaimaa Fadl, Mariam Moshiri, Corinne L Fligner, Douglas S Katz, Manjiri Dighe
The placenta plays a crucial role throughout pregnancy, and its importance may be overlooked during routine antenatal imaging evaluation. Detailed systematic assessment of the placenta at ultrasonography (US), the standard imaging examination during pregnancy, is important. Familiarity with the normal and abnormal imaging appearance of the placenta along with the multimodality and methodical approach for evaluation of its related abnormalities is necessary, so that radiologists can alert clinicians regarding appropriate prompt management decisions...
May 2017: Radiographics: a Review Publication of the Radiological Society of North America, Inc
https://www.readbyqxmd.com/read/28466615/angiographic-embolization-in-pediatric-abdominal-trauma
#7
Yechiel Sweed, Jonathan Singer-Jordan, Sorin Papura, Norman Loberant, Alon Yulevich
BACKGROUND: Trauma is the leading cause of childhood morbidity and mortality. Abdominal bleeding is one of the common causes of mortality due to trauma. Angiography and embolization are well recognized as the primary treatments in certain cases of acute traumatic hemorrhage in adults; however, evidence is lacking in the pediatric population. OBJECTIVES: To assess the safety and efficacy of transcatheter arterial embolization (TAE) for blunt and penetrating abdominal and pelvic trauma in the pediatric age group...
November 2016: Israel Medical Association Journal: IMAJ
https://www.readbyqxmd.com/read/28438496/from-the-implementing-best-practice-guidelines-in-pain-assessment-and-management-on-a-women-s-psychiatric-inpatient-unit-exploring-patients-perceptions
#8
Cheryl Rolin-Gilman, Bonnie Fournier, Kristin Cleverley
Assessing and managing chronic pain in women with histories of interpersonal trauma, mood disorders and co-morbid addiction is complex. The aim of this paper is to report on the findings from a quality improvement project exploring women's experiences who have co-occurring mental health issues, addiction and chronic pain. Exploring perceptions was an initial step in implementing the Registered Nurses' Association of Ontario (RNAO) Best Practice Guideline (BPG) on the Assessment and Management of Pain. Focus group discussions were conducted using an exploratory design with 10 women who were hospitalized in an acute psychiatric unit...
April 21, 2017: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
https://www.readbyqxmd.com/read/28430746/serial-radiographs-do-not-change-the-clinical-course-of-nonoperative-stable-ota-ao-44-b1-ankle-fractures
#9
Lucas S Marchand, Zachary M Working, Ajinkya A Rane, Lance G Jacobson, Erik N Kubiak, Thomas F Higgins, David L Rothberg
OBJECTIVE: To assess radiographic markers of ankle stability in stable OTA/AO 44-B1 ankle fractures. DESIGN: Retrospective review. SETTING: Academic Level-I trauma hospital. PATIENTS: One hundred thirty-four patients with stable OTA/AO 44-B1 (Danis-Weber B, Supination-External Rotation-II) ankle fractures. INTERVENTION: Analysis of mortise view radiographs at the time of initial evaluation and final follow-up...
May 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28400940/early-diagnosis-of-penetrating-cardiac-and-pleural-injury-by-extended-focused-assessment-with-sonography-for-trauma
#10
K P Singaravelu, Rama Prakasha Saya, Vinay R Pandit
In India, stab injury is not uncommon, but identifying potential life threatening conditions in the emergency room (ER) and initiating prompt treatment are challenging. This is a case report of a young patient who presented to the ER with assault injury to the chest and shock; timely extended focused assessment with sonography for trauma helped to fast-track the patient to the operating room. A brief review of diagnosis and management of penetrating cardiac injury is presented herewith.
October 2016: Heart Views: the Official Journal of the Gulf Heart Association
https://www.readbyqxmd.com/read/28400939/intracardiac-penetrating-injury-with-right-femoral-artery-embolism-due-to-blast-injury
#11
Ahmed Abdulaziz Abuzaid, Thamer Al-Abbasi, Zaid Arekat
Embolization due to blast injury with projectiles entering the bloodstream from the heart is a rare event that is unlikely to be suspected during the initial assessment of trauma patients. We report a case in which a missile penetrating the heart chambers managed to embolize and occlude the right common femoral artery. This was successfully managed by means of a multidisciplinary approach that included exploration, cardiorrhaphy, and embolectomy.
October 2016: Heart Views: the Official Journal of the Gulf Heart Association
https://www.readbyqxmd.com/read/28382256/prognostication-of-traumatic-brain-injury-outcomes-in-older-trauma-patients-a-novel-risk-assessment-tool-based-on-initial-cranial-ct-findings
#12
Stanislaw P Stawicki, Thomas R Wojda, John D Nuschke, Ronnie N Mubang, James Cipolla, William S Hoff, Brian A Hoey, Peter G Thomas, Joan Sweeney, Daniel Ackerman, Jonathan Hosey, Steven Falowski
INTRODUCTION: Advanced age has been traditionally associated with worse traumatic brain injury (TBI) outcomes. Although prompt neurosurgical intervention (NSI, craniotomy or craniectomy) may be life-saving in the older trauma patient, it does not guarantee survival and/or return to preinjury functional status. The aim of this study was to determine whether a simple score, based entirely on the initial cranial computed tomography (CCT) is predictive of the need for NSI and key outcome measures (e...
January 2017: International Journal of Critical Illness and Injury Science
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
#13
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
#14
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
#15
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-using-video-review
#16
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 because of 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...
June 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
#17
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
#18
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...
May 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
#19
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
#20
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
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