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initial assessment and management of a trauma patient

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https://www.readbyqxmd.com/read/29026927/diagnostics-and-early-treatment-in-prehospital-and-emergency-room-phase-in-suspicious-pelvic-ring-fractures
#1
Uwe Schweigkofler, B Wohlrath, H Trentsch, J Greipel, N Tamimi, R Hoffmann, D Wincheringer
BACKGROUND: Testing for mechanical stability in pelvic ring fractures is advocated for the initial assessment and management of pelvic ring fractures. A survey among trauma surgeons showed that 91% agree with this recommendation. The aim of the present study was to describe the actual workup of patients with a high risk for unstable pelvic fractures in daily routine. METHODS: We performed a prospective multicenter observational study on patients admitted to the emergency room with suspected pelvic ring fractures...
October 12, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29023898/impact-of-ketamine-use-on-adjunctive-analgesic-and-sedative-medications-in-critically-ill-trauma-patients
#2
Kaitlin A Pruskowski, Kelly Harbourt, Mehrnaz Pajoumand, Sai-Ho Jason Chui, H Neal Reynolds
BACKGROUND: Ketamine may be used to manage pain and agitation that is refractory to "traditional" agents such as fentanyl, propofol, benzodiazepines, and dexmedetomidine; however, literature describing the use of ketamine continuous infusions for this purpose in critically ill trauma patients is limited. OBJECTIVES: The primary objective of this study was to determine the impact of the initiation of a ketamine continuous infusion on sedative and analgesic use in critically ill trauma patients...
October 10, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/29023379/effect-of-early-pelvic-binder-use-in-the-emergency-management-of-suspected-pelvic-trauma-a-retrospective-cohort-study
#3
Sheng-Der Hsu, Cheng-Jueng Chen, Yu-Ching Chou, Sheng-Hao Wang, De-Chuan Chan
BACKGROUND: We aimed to evaluate the effect of early pelvic binder use in the emergency management of suspected pelvic trauma, compared with the conventional stepwise approach. METHODS: We enrolled trauma patients with initial stabilization using a pelvic binder when suspecting pelvic injury. The inclusion criteria were traumatic injury requiring a trauma team and at least one of the following: a loss of consciousness or a Glasgow coma score (GCS) of <13; systolic blood pressure of <90 mmHg; falling from ≥6 m; injury to multiple vital organs; and suspected pelvic injury...
October 12, 2017: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/29021110/collaborative-care-from-the-emergency-department-for-injured-patients-with-prescription-drug-misuse-an-open-feasibility-study
#4
Lauren K Whiteside, Doyanne Darnell, Karlee Jackson, Jin Wang, Joan Russo, Dennis M Donovan, Douglas F Zatzick
Collaborative Care is a comprehensive longitudinal care management strategy. The purpose of this pilot effectiveness-implementation hybrid study was to determine the feasibility of a Collaborative Care intervention initiated from the Emergency Department and proceeding longitudinally for six months for injured patients with prescription drug misuse (PDM). Adult patients presenting to an urban ED with an injury were screened for eligibility from 2/2015-8/2015. Eligible participants with a positive screen for PDM were enrolled in the 'ED-LINC' intervention which included the following elements: 1) active care coordination and linkage, 2) medication safety and utilization of opioid guidelines 3) longitudinal care management and 4) utilization of Electronic Medical Record (EMR) innovations such as the statewide Emergency Department Information Exchange (EDIE) and statewide prescription monitoring program information for assessment and follow-up...
November 2017: Journal of Substance Abuse Treatment
https://www.readbyqxmd.com/read/29018873/the-treatment-of-perilunate-ligament-injuries-in-multiply-injured-patients
#5
K V Brown, D Tsekes, C G Gorgoni, L Di Mascio
PURPOSE: Perilunate injuries are rare, severe injuries of the carpus. They can present as isolated injuries or in the poly-traumatised patient. This is the first documented series of these injuries treated in a Major Trauma Centre. The aims were to assess the management, treatment algorithm and outcomes, of perilunate injuries in our department, review whether concomitant polytrauma affected those outcomes and identify if delay to definitive treatment had a significant effect on overall outcome...
October 10, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/28980482/the-utility-of-plain-films-for-nonoperative-fifth-metacarpal-fractures-are-follow-up-radiographs-necessary
#6
Nathanael Heckmann, Marie N Dusch, William C Pannell, Michael Bauschard, Ram K Alluri, Lakshmanan Sivasundaram, Alidad Ghiassi
BACKGROUND: Fifth metacarpal fractures are often treated nonoperatively with serial radiographs; however, the utility of these radiographs in altering clinical management has not been investigated. We hypothesize that follow-up plain films will not alter clinical management and are therefore unnecessary for most patients. METHODS: Between 2007 and 2014, patients with a fifth metacarpal fracture at our level I trauma center were retrospectively reviewed. Patients with inadequate documentation or imaging, ipsilateral upper extremity injuries, or who underwent initial surgical fixation were excluded...
October 1, 2017: Hand: Official Journal of the American Association for Hand Surgery
https://www.readbyqxmd.com/read/28975397/traumatic-inferior-shoulder-dislocation-a-review-of-management-and-outcome
#7
REVIEW
M Nambiar, D Owen, P Moore, A Carr, M Thomas
INTRODUCTION: Traumatic inferior shoulder dislocation (ISD) is rare, estimated to occur in 0.5% of all shoulder dislocations. We describe the demographics, natural history and outcome of this injury. HYPOTHESIS/AIM: The aim of the study is to provide a summary of the demographics, clinical presentation, management and outcome of patients who suffer ISD METHODS: We conducted a systematic review of the English language literature on ISD using PubMed, Medline, CINHAL, Cochrane Database and Evidence-Based Medicine Reviews...
October 3, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/28958650/is-routine-head-ct-indicated-in-awake-stable-older-patients-after-a-ground-level-fall
#8
Rebecca Sartin, Christine Kim, Sharmila Dissanaike
BACKGROUND: Despite the development of several prediction rules to guide head CT imaging, determining whom to screen for head trauma in the geriatric population after a ground level fall remains controversial. The purpose of this study was to assess the impact of head CT on the management of older adult patients who present with a normal GCS after a ground level fall, and to identify factors that could predict the need for neurosurgical intervention. METHODS: A retrospective study was conducted on hemodynamically stable patients >55 years of age with GCS of 15, who presented to a level 1 trauma center after a ground level fall...
September 18, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28927984/limiting-thoracic-ct-a-rule-for-use-during-initial-pediatric-trauma-evaluation
#9
Caroline Q Stephens, Meredith C Boulos, Christopher R Connelly, Arvin Gee, Mubeen Jafri, Sanjay Krishnaswami
BACKGROUND: Despite increases in imaging guidelines for other body-regions during initial trauma assessment and the demonstrated utility of chest radiographs (CXR), guidelines for use of thoracic computed-tomography (TCT) are lacking. We hypothesized that TCT utilization had not decreased relative to other protocolized CTs, and mechanism and CXR could together predict significant injury independent of TCT. METHODS: We performed a retrospective review of blunt trauma patients ≤18 y...
September 4, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28882376/a-novel-approach-to-improving-the-interpretation-of-ct-brain-in-trauma
#10
L R Evans, M C Fitzgerald, D Varma, B Mitra
BACKGROUND: Computed tomography of the brain (CTB) has a fundamental role in the diagnosis and management of traumatic brain injury (TBI). There may be substantial discordance between initial CTB interpretation by emergency clinicians and the final radiology report. This study aimed to assess the utility of a structured reporting template in improving the accuracy of CTB interpretation by emergency clinicians. METHOD: A prospective pre- and post-intervention cohort study was undertaken using a study population of emergency medicine trainees...
September 4, 2017: Injury
https://www.readbyqxmd.com/read/28870273/factors-associated-with-delay-in-trauma-team-activation-and-impact-on-patient-outcomes
#11
Rory Connolly, Michael Y Woo, Jacinthe Lampron, Jeffrey J Perry
OBJECTIVE: Trauma code activation is initiated by emergency physicians using physiological and anatomical criteria, mechanism of injury, and patient demographic factors. Our objective was to identify factors associated with delayed trauma team activation. METHODS: We assessed consecutive cases from a regional trauma database from January 2008 to March 2014. We defined a delay in trauma code activation as a time greater than 30 minutes from the time of arrival. We conducted univariate analysis for factors potentially influencing trauma team activation, and we subsequently used multiple logistic regression analysis models for delayed activation in relation to mortality, length of stay, and time to operative management...
September 5, 2017: CJEM
https://www.readbyqxmd.com/read/28844197/functional-outcome-of-extra-articular-distal-humerus-fracture-fixation-using-a-single-locking-plate-a-retrospective-study
#12
Vivek Trikha, Prabhat Agrawal, Saubhik Das, Sahil Gaba, Arvind Kumar
PURPOSE: The optimal method for fixation of extra-articular distal humerus factures poses a management dilemma. Although various plate configurations have been proposed, anatomic shaped extra-articular distal humerus locking plates have emerged as a viable solution for these complex injuries. We assessed clinico-radiologic outcome in our retrospective case series of extra-articular distal humerus fractures managed with these plates. METHODS: Forty-five patients of extra-articular distal humerus fractures, who were operated at our level 1 trauma centre between January, 2012 and December, 2016, were identified...
September 2017: Journal of Orthopaedic Surgery
https://www.readbyqxmd.com/read/28843959/team-a-low-cost-alternative-to-atls-for-providing-trauma-care-teaching-in-haiti
#13
Anton Kurdin, Andrew Caines, Darrell Boone, Andrew Furey
OBJECTIVE: Trauma resuscitation protocols have unified the care of trauma patients and significantly improved outcomes. However, the success of the Advanced Trauma Life Support course is difficult to reproduce in developing countries due to set-up costs, limitations of resources, and variations of practice. The objective of this study is to assess the Trauma Evaluation and Management (TEAM) course as a low-cost alternative for trauma resuscitation teaching in Low and Middle Income Countries (LMIC)...
August 23, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28839352/reconstruction-of-traumatic-bone-loss-using-the-induced-membrane-technique-preliminary-results-about-11-cases
#14
Noufanangue Kanfitine Kombate, Atchi Walla, Gamal Ayouba, B Moïse Bakriga, Yaovi Yannick Dellanh, Anani Grégoire Abalo, Assang Michel Dossim
INTRODUCTION: The use of Masquelet technique is a serious option to consider for biologic reconstruction of severe bone loss. Here is exposed a continuous and prospective study on bone loss management using that technique. The aims of this study were to assess epidemiology of bone loss due either to trauma or to non-unions and to give preliminary results. PATIENTS AND METHODS: It was a prospective study from April 2015 to december 2016 involving patients treated using the induced membrane technique for a diaphyseal bone defect due either to trauma or non-unions...
December 2017: Journal of Orthopaedics
https://www.readbyqxmd.com/read/28838021/-management-of-thoracic-trauma
#15
Bassam Redwan, Christian Biancosino, Katina Nikolova, Thorsten Greve, Servet Bölükbas
Patients with a thoracic trauma are commonly treated by large bore chest tube thoracostomy and appropriate analgesia. The initial treatment is determined by the assessment of the emergency doctor and/or trauma surgeon. Severe intrathoracic lesions in polytrauma patients are rare. However, such injuries may be acutely life-threating. After primary stabilisation of the patients, imaging studies should be performed to assess the extent of the injuries and determine the treatment of choice. Assessment of such injuries should always be performed in a multidisciplinary team of anaesthesiologists, general surgeons, trauma surgeons and thoracic surgeons...
August 2017: Zentralblatt Für Chirurgie
https://www.readbyqxmd.com/read/28837540/multi-institutional-analysis-of-neutrophil-to-lymphocyte-ratio-nlr-in-patients-with-severe-hemorrhage-a-new-mortality-predictor-value
#16
Juan Duchesne, Danielle Tatum, Glenn Jones, Brandy Davis, Rosemarie Robledo, Marc DeMoya, Terence O'Keeffe, Paula Ferrada, Tomas Jacome, Rebecca Schroll, Jordan Wlodarczyk, Priya Prikash, Brian Smith, Kenji Inaba, Desmond Khor, Marquinn Duke, Mansoor Khan
BACKGROUND: The neutrophil/lymphocyte ratio (NLR) has been associated as a predictor for increased mortality in critically ill patients. We sought to determine the relationship between NLR and outcomes in adult trauma patients with severe hemorrhage requiring the initiation of massive transfusion protocol (MTP). We hypothesized that the NLR would be a prognostic indicator of mortality in this population. METHODS: This was a multi-institutional retrospective cohort study of adult trauma patients (≥18 years) with severe hemorrhage who received MTP between November 2014 - November 2015...
August 23, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28818179/multiple-trauma-and-emergency-room-management
#17
Michael Frink, Philipp Lechler, Florian Debus, Steffen Ruchholtz
BACKGROUND: The care of severely injured patients remains a challenge. Their initial treatment in the emergency room is the essential link between first aid in the field and definitive in-hospital treatment. METHODS: We present important elements of the initial in-hospital care of severely injured patients on the basis of pertinent publications retrieved by a selective search in PubMed and the current German S3 guideline on the care of severely and multiply traumatized patients, which was last updated in 2016...
July 24, 2017: Deutsches Ärzteblatt International
https://www.readbyqxmd.com/read/28810653/surgical-trauma-and-low-dose-methylprednisolone-modulate-the-severity-of-the-acute-phase-response-induced-by-zoledronic-acid-infusion
#18
Jian Chen, Lipeng Yu, Lixin Chen, Xuan Wu, Pengyu Tang, Jian Yin, Tao Jiang, Guoyong Yin, Jin Fan
The aim of the present study was to investigate risk factors for the development of an acute-phase response (APR) associated with the initial zoledronic acid (ZA) infusion in patients undergoing surgery, and to assess whether its onset may be reduced by post-dose administration of low-dose methylprednisolone (MP) or acetaminophen. A retrospective study of patients with osteoporosis who attended the departments of orthopedics and endocrinology of a single hospital and received 5 mg ZA was conducted; the patients included surgical and non-surgical cases...
August 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28806284/is-extracorporeal-cardiopulmonary-resuscitation-practical-in-severe-chest-trauma-a-systematic-review-in-single-center-of-developing-country
#19
Up Huh, Seunghwan Song, Sung Woon Chung, Sang-Pil Kim, Chung Won Lee, Hyo Young Ahn, Miju Bae, Seon Hee Kim
BACKGROUND: We report our experience with extracorporeal cardiopulmonary resuscitation (ECPR) in patients with rupture of heart and major vessels caused by severe chest trauma. METHODS: From April 2015 to May 2016, 10 patients with suspected injuries to the heart and major vessels following focused assessment with sonography in trauma or computed tomography were selected from patients admitted at a level I trauma centre presenting with cardiac tamponade and tension haemothorax due to severe chest trauma...
August 12, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28797555/to-log-roll-or-not-to-log-roll-that-is-the-question-a-review-of-the-use-of-the-log-roll-for-patients-with-pelvic-fractures
#20
REVIEW
Inês Filipa da Cunha Rodrigues
Pelvic fractures are one of the most serious injuries in polytrauma - massive haemorrhage is a major complication and the leading cause of death. The assessment and early management of these injuries in the Emergency Department (ED) focuses on the recognition of haemodynamic instability and should follow Advanced Trauma Life Support (ATLS) guidelines. The log-roll technique, although an accepted practice in trauma care, has been reported to be inadvisable when a pelvic fracture is suspected. This paper, which includes a case study, briefly explains the pathophysiology and initial management of pelvic fractures...
May 10, 2017: International Journal of Orthopaedic and Trauma Nursing
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