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management of polytrauma

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https://www.readbyqxmd.com/read/28639869/economic-burden-of-inpatient-admission-of-ankle-fractures
#1
Justin D Stull, Suneel B Bhat, Justin M Kane, Steven M Raikin
BACKGROUND: Ankle fractures are among the most prevalent traumatic orthopaedic injuries. A large proportion of patients sustaining operative ankle fractures are admitted directly from the emergency department prior to operative management. In the authors' experience, however, many closed ankle injuries may be safely and effectively managed on an outpatient basis. The aim of this study was to characterize the economic impact of routine inpatient admission of ankle fractures. METHODS: A retrospective review of all outpatient ankle fracture surgery performed by a single foot and ankle fellowship-trained surgeon at a tertiary level academic center in 2012 was conducted to identify any patients requiring postoperative inpatient admission...
June 1, 2017: Foot & Ankle International
https://www.readbyqxmd.com/read/28623468/-intracranial-pressure-monitoring-in-polytrauma-patients-with-traumatic-brain-injury
#2
REVIEW
T Neubauer, W Buchinger, E Höflinger, J Brand
BACKGROUND: The monitoring of intracranial pressure (ICP) represents a cornerstone in the intensive care of patients with traumatic brain injury (TBI) and the industry provides various technical solutions to this end. Decompressive craniectomy can be an option if conservative measures fail to reduce excessive ICP. OBJECTIVE: To examine the pathophysiology of ICP in trauma, the management of polytrauma involving TBI, and the indications for decompressive craniectomy; and to compare the different monitoring systems and their complications...
June 16, 2017: Der Unfallchirurg
https://www.readbyqxmd.com/read/28612105/-polytrauma-and-concomitant-traumatic-brain-injury-the-role-of-the-trauma-surgeon
#3
REVIEW
A Antoni, T Heinz, J Leitgeb
BACKGROUND: Concomitant traumatic brain injury (TBI) increases mortality and reduces quality of life of polytrauma patients. These facts demand effective treatment strategies while the growing specialization of medicine is questioning the role of the trauma surgeon in the management of these patients. OBJECTIVES: Which factors influence outcome of polytrauma with concomitant TBI? Who should be responsible for the management of these patients and what is the limit of management? MATERIALS AND METHODS: A literature search using Medline via PubMed was performed with Medical Subject Headings and text word search...
June 13, 2017: Der Unfallchirurg
https://www.readbyqxmd.com/read/28598952/a-pediatric-burn-outpatient-short-stay-program-decreases-patient-length-of-stay-with-equivalent-burn-outcomes
#4
Tiffany Zens, Amy Yan, Christina Lee, Cindy Schmitz, Lee Faucher, Angela Gibson
Traditionally, small pediatric burns are managed with inpatient admission and daily dressing changes. In 2011, our burn center implemented an outpatient short stay (OSS) program in which small pediatric burns were managed as an outpatient utilizing Mepilex Ag dressings changed under moderate sedation every 5 to 7 days. Pediatric burn cases were queried for 2 time periods: before the OSS program (2009-2010) and after the OSS program (2013-2014). Burns > 15% TBSA, children with polytrauma, and children > 10 years old were excluded...
June 6, 2017: Journal of Burn Care & Research: Official Publication of the American Burn Association
https://www.readbyqxmd.com/read/28593009/ultrasound-as-point-of-care-in-management-of-polytrauma-and-its-complication
#5
Saverio Latteri, Giulia Malaguarnera, Maurizio Mannino, Antonio Pesce, Giuseppe Currò, Stefania Tamburrini, Mario Scuderi
PURPOSE: Traumatic injuries constitute a major risk for patients in emergency units. Point-of-care ultrasound may be a determinant in reducing the deleterious impact of complications and in prognosis. METHODS: We describe the case of a 28-year-old female who reported cranial trauma, abdominal and thoracic trauma, and suspected bilateral fracture of the femur. RESULTS: Ultrasound was useful for evaluating and monitoring multiple organ failure...
June 2017: Journal of Ultrasound
https://www.readbyqxmd.com/read/28590348/incidence-of-adult-respiratory-distress-syndrome-ards-in-trauma-patients-a-systematic-review-and-meta-analysis-over-a-period-of-three-decades
#6
Roman Pfeifer, Nicole Heussen, Emilia Michalewicz, Ralf-Dieter Hilgers, Hans-Christoph Pape
BACKGROUND: In trauma patients, acute respiratory distress syndrome (ARDS) is associated with high morbidity and mortality. Changes in diagnostics, management and treatment may have influenced the incidence of ARDS. Therefore, the purpose of this manuscript is to evaluate whether there is a difference in the incidence of posttraumatic ARDS 1) over time, 2) attributable to geographic distribution, and 3) related to admitting surgical subspecialities. METHODS: A comprehensive search of articles published in English and German language was conducted using PubMed, MEDLINE, and the ISI Web of Science...
June 6, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28495203/treatment-of-air-leak-in-polytrauma-patients-with-blunt-chest-injury
#7
Gabriel Halat, Lukas L Negrin, Konstantina Chrysou, Beatrix Hoksch, Ralph A Schmid, Gregor J Kocher
INTRODUCTION: Precise diagnostics and an adequate therapeutic approach are mandatory in the treatment of air leak in polytrauma patients with blunt chest trauma. The aim of this study was to evaluate the incidence, characteristics, and management of air leak following this injury pattern. PATIENTS AND METHODS: Data from 110 polytrauma patients was collected retrospectively. Fifty-four patients received initial treatment by chest tube placement for pneumothorax. These patients were classified into two groups, one with severe air leak and one with minor air leak...
May 1, 2017: Injury
https://www.readbyqxmd.com/read/28491210/-surgical-treatment-of-the-humeral-pallet-fractures-in-adults
#8
Redouane Hani, Mustapha Nekkaoui, Mohammed Kharmaz, Mohamed El Ouadghiri, Abdou Lahlou, Mly Omar Lamrani, Ahmed El Bardouni, Mustapha Mahfoud, Mohamed Saleh Berrada
The treatment of humeral pallet fractures is mainly based on reconstruction surgery with osteosynthesis. We collected the data of 40 patients with humeral pallet fracture from our archives in the Department of Orthopaedics and Traumatology at the Ibn Sina University Hospital, Rabat from january 2012 to december 2014. The aim of our study was to highlight the clinical, therapeutic and evolutionary features of these fractures as well as the challenges in managing these complex fractures and in evaluating the results...
2017: Pan African Medical Journal
https://www.readbyqxmd.com/read/28487103/the-high-risk-polytrauma-patient-and-inferior-vena-cava-filter-use
#9
Onur Berber, Aswin Vasireddy, Obi Nzeako, Adel Tavakkolizadeh
OBJECTIVES: The aim of this study was to assess the impact on practice of vena cava filter insertion guidelines (Eastern Association for the Surgery of Trauma: practice management guidelines). DESIGN: The study was performed at a level 1 trauma centre with data from the 'Trauma Audit and Research Network' cross-referenced to hospital data. RESULTS: A total of 1138 specific 'high-risk' major trauma patients were identified over a 6-year period...
April 20, 2017: Injury
https://www.readbyqxmd.com/read/28484529/secondary-communicating-hydrocephalus-management-by-implantation-of-external-ventricular-shunt-and-minimal-gradual-increase-of-cerebrospinal-fluid-pressure
#10
Keyvan Mostofi, Madjid Samii
BACKGROUND: This paper presents a new management strategy explaining the process used by implantation of external ventricular drainage (EVD) and very gradual increase of intracranial pressure for treatment of acute hydrocephalus. During the last 30 years' experience in professional practice, the senior author (M.S.) discovered that there are some options of regulations between cerebral spinal fluid (CSF) production and resorption. This theory shows that minimal continuous increase of the CSF pressure as long as the patient general neurological condition is unchanged and appears as normal can lead to definitive treatment of hydrocephalus without needing to set a shunt...
April 2017: Asian Journal of Neurosurgery
https://www.readbyqxmd.com/read/28450995/-epidemiological-aspects-of-spinal-traumas-about-139-cases
#11
Joseph Synèse Bemora, Willy Francis Rakotondraibe, Mijoro Ramarokoto, Willy Ratovondrainy, Clément Andriamamonjy
Spinal trauma is one of the most common types of injuries among victims of traffic accidents, sports accidents, domestic accidents and workplace accidents. We conducted a 3-year retrospective study of 139 cases of spinal trauma hospitalized and treated in the Neurosurgery department of the CHUJRA, Madagascar. This study shows that 25.17% of injured patients were between 21 and 30 years of age, with a clear male predominance (69.78%; sex ratio 2.3). Falls were the dominating traumatic injury mechanism (33.09%) with risk factors including alcohol use (8...
2017: Pan African Medical Journal
https://www.readbyqxmd.com/read/28432428/tranexamic-acid-for-treatment-and-prophylaxis-of-bleeding-and-hyperfibrinolysis
#12
Ingrid Pabinger, Dietmar Fries, Herbert Schöchl, Werner Streif, Wolfgang Toller
Uncontrolled massive bleeding with subsequent derangement of the coagulation system is a major challenge in the management of both surgical and seriously injured patients. Under physiological conditions activators and inhibitors of coagulation regulate the sensitive balance between clot formation and fibrinolysis. In some cases, excessive and diffuse bleeding is caused by systemic activation of fibrinolysis, i. e. hyperfibrinolysis (HF). Uncontrolled HF is associated with a high mortality. Polytrauma patients and those undergoing surgical procedures involving organs rich in plasminogen proactivators (e...
May 2017: Wiener Klinische Wochenschrift
https://www.readbyqxmd.com/read/28427480/lessons-from-a-large-trauma-center-impact-of-blunt-chest-trauma-in-polytrauma-patients-still-a-relevant-problem
#13
REVIEW
Konstantina Chrysou, Gabriel Halat, Beatrix Hoksch, Ralph A Schmid, Gregor J Kocher
BACKGROUND: Thoracic trauma is the third most common cause of death after abdominal injury and head trauma in polytrauma patients. The purpose of this study was to investigate epidemiological data, treatment and outcome of polytrauma patients with blunt chest trauma in order to help improve management, prevent complications and decrease polytrauma patients' mortality. METHODS: In this retrospective study we included all polytrauma patients with blunt chest trauma admitted to our tertiary care center emergency department for a 2-year period, from June 2012 until May 2014...
April 20, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28424745/distinguishing-the-unique-neuropathological-profile-of-blast-polytrauma
#14
W Brad Hubbard, Shaylen Greenberg, Carly Norris, Joseph Eck, Erin Lavik, Pamela VandeVord
Traumatic brain injury sustained after blast exposure (blast-induced TBI) has recently been documented as a growing issue for military personnel. Incidence of injury to organs such as the lungs has decreased, though current epidemiology still causes a great public health burden. In addition, unprotected civilians sustain primary blast lung injury (PBLI) at alarming rates. Often, mild-to-moderate cases of PBLI are survivable with medical intervention, which creates a growing population of survivors of blast-induced polytrauma (BPT) with symptoms from blast-induced mild TBI (mTBI)...
2017: Oxidative Medicine and Cellular Longevity
https://www.readbyqxmd.com/read/28399527/blunt-traumatic-extracranial-cerebrovascular-injury-and-ischemic-stroke
#15
Paul M Foreman, Mark R Harrigan
BACKGROUND: Ischemic stroke occurs in a significant subset of patients with blunt traumatic cerebrovascular injury (TCVI). The patients are victims of motor vehicle crashes, assaults or other high-energy collisions, and suffer ischemic stroke due to injury to the extracranial carotid or vertebral arteries. SUMMARY: An increasing number of patients with TCVI are being identified, largely because of the expanding use of computed tomography angiography for screening patients with blunt trauma...
April 11, 2017: Cerebrovascular Diseases Extra
https://www.readbyqxmd.com/read/28396930/initial-management-of-complex-hand-injuries-in-military-or-austere-environments-how-to-defer-and-prepare-for-definitive-repair
#16
Camille Choufani, Olivier Barbier, Antoine Grosset, James Charles Murison, Didier Ollat, Sylvain Rigal, Laurent Mathieu
INTRODUCTION: The damage control orthopedics (DCO) concept is a sequential surgical management strategy indicated when ideal primary treatment is not possible or suitable. DCO principles are routinely applied to hand traumas in wartime practice, but could also be useful in a civilian setting when immediate specialized management cannot be carried out. METHODS: The authors report three typical observations of soldiers treated for a complex hand trauma on the field by orthopedic surgeons from the French Military Health Service (FMHS)...
April 10, 2017: International Orthopaedics
https://www.readbyqxmd.com/read/28378236/a-new-low-dose-multi-phase-trauma-ct-protocol-and-its-impact-on-diagnostic-assessment-and-radiation-dose-in-multi-trauma-patients
#17
Zlatan Alagic, Andreas Eriksson, Erika Drageryd, Sara Rezaei Motamed, Marius C Wick
PURPOSE: Computed tomography (CT) examinations, often using high-radiation dosages, are increasingly used in the acute management of polytrauma patients. This study compares a low-dose polytrauma multi-phase whole-body CT (WBCT) protocol on a latest generation of 16-cm detector 258-slice multi-detector CT (MDCT) scanner with advanced dose reduction techniques to a single-phase polytrauma WBCT protocol on a 64-slice MDCT scanner. METHODS: Between March and September 2015, 109 polytrauma patients (group A) underwent acute WBCT with a low-dose multi-phase WBCT protocol on a 258-slice MDCT whereas 110 polytrauma patients (group B) underwent single-phase trauma CT on a 64-slice MDCT...
April 5, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/28341511/open-and-endovascular-abdominal-aortic-injury-repair-outcomes-in-polytrauma-patients
#18
Anand Dayama, Aksim Rivera, Odunayo Olorunfemi, Ahmed Mahmoud, Catherine A Fontecha, John McNelis
INTRODUCTION: The management of patients with abdominal aortic injury (AAI) remains challenging. Open repair of AAI is still the standard of care although it is associated with high mortality. In past few years, endovascular surgery has evolved as a less invasive alternative to open surgery in emergency settings. The objective of this study was to compare outcomes after open repair versus endovascular repair of AAI in polytrauma patients. METHODS: The National Trauma Data Bank, from 2008 to 2012, was queried to identify trauma patients undergoing open and endovascular repair of AAI using International Classification of Diseases, ninth Edition, and Clinical Modification codes...
March 21, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28286784/the-influence-of-metabolic-imbalances-and-oxidative-stress-on-the-outcome-of-critically-ill-polytrauma-patients-a-review
#19
REVIEW
Alexandru Florin Rogobete, Dorel Sandesc, Marius Papurica, Emil Robert Stoicescu, Sonia Elena Popovici, Lavinia Melania Bratu, Corina Vernic, Adriana Mariana Sas, Adrian Tudor Stan, Ovidiu Horea Bedreag
The critically ill polytrauma patient presents with a series of associated pathophysiologies secondary to the traumatic injuries. The most important include systemic inflammatory response syndrome (SIRS), sepsis, oxidative stress (OS), metabolic disorders, and finally multiple organ dysfunction syndrome (MODS) and death. The poor outcome of these patients is related to the association of the aforementioned pathologies. The nutrition of the critically ill polytrauma patient is a distinct challenge because of the rapid changes in terms of energetic needs associated with hypermetabolism, sepsis, SIRS, and OS...
2017: Burns and trauma
https://www.readbyqxmd.com/read/28277439/role-of-laparoscopy-in-patients-with-abdominal-trauma-at-level-i-trauma-center
#20
Purushottam Parajuli, Subodh Kumar, Amit Gupta, Virinder Kumar Bansal, Sushma Sagar, Biplab Mishra, Maneesh Singhal, Atin Kumar, Shivanand Gamangatti, Babita Gupta, Chhavi Sawhney, Mahesh C Misra
INTRODUCTION: Abdominal trauma is one of the preventable causes of death in polytrauma patients. Decision and timing of laparotomy is a major challenge. Rate of nontherapeutic laparotomy is still high. Laparoscopy can avoid nontherapeutic laparotomy and also provide a reliable and accurate diagnosis of injury. MATERIALS AND METHODS: This ambispective observational study was conducted in the division of Trauma Surgery and Critical Care, JPN Apex Trauma Centre, All India Institute Medical Sciences, New Delhi...
March 8, 2017: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
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