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management of polytrauma

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https://www.readbyqxmd.com/read/28432428/tranexamic-acid-for-treatment-and-prophylaxis-of-bleeding-and-hyperfibrinolysis
#1
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...
April 21, 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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
https://www.readbyqxmd.com/read/28246625/endovascular-management-of-a-combined-subclavian-and-vertebral-artery-injury-in-an-unstable-polytrauma-patient-case-report-and-literature-review
#10
Christian David Weber, Philipp Kobbe, Christian Herren, Andreas H Mahnken, Frank Hildebrand, Hans-Christoph Pape
While blunt trauma of the head and neck are a common pattern of injury, significant problems related to the prompt diagnosis and optimal management of traumatic artery injuries have been reported in the literature. While patients with major artery injuries might develop hemorrhagic shock very rapidly, patients with blunt cerebrovascular injuries (BCVI) can present asymptomatic, but complications like basilar territory infarction, cortical blindness and death may occur. We report the life- and limb-saving management in a 57-year-old hemodynamically unstable trauma patient...
January 2017: Bulletin of Emergency and Trauma
https://www.readbyqxmd.com/read/28243715/volume-replacement-during-trauma-resuscitation-a-brief-synopsis-of-current-guidelines-and-recommendations
#11
REVIEW
M Maegele, M Fröhlich, M Caspers, S Kaske
INTRODUCTION: Intravascular volume and fluid replacement are still cornerstones to correct fluid deficits during early trauma resuscitation, but optimum strategies remain under debate. METHODS: A synopsis of best current knowledge with reference to the following guidelines and recommendations is presented: (1) The European Guideline on Management of Major Bleeding and Coagulopathy following Trauma (fourth edition), (2) S3 Guideline on Treatment of Patients with Severe and Multiple Injuries [English Version of the German Guideline S3 Leitlinie Polytrauma/Schwerverletzten-Behandlung/AWMF Register-Nr...
February 27, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/28217583/profile-of-trauma-patients-in-the-emergency-department-of-a-tertiary-care-hospital-in-south-india
#12
Kundavaram Paul Prabhakar Abhilash, Nilanchal Chakraborthy, Gautham Raja Pandian, Vineet Subodh Dhanawade, Thomas Kurien Bhanu, Krishna Priya
BACKGROUND: Trauma is an increasing cause of morbidity and mortality in India. This study was done to improve the understanding of the mode of trauma, severity of injuries, and outcome of trauma victims in our hospital. MATERIALS AND METHODS: This was a retrospective observational study of all adult trauma patients more than 18-year-old presenting to our emergency department (ED). Details of the incident, injuries, and outcome were noted. RESULTS: The ED attended to 16,169 patients during the 3-month study period with 10% (1624/16,169) being adult trauma incidents...
July 2016: Journal of Family Medicine and Primary Care
https://www.readbyqxmd.com/read/28195897/base-of-skull-blocks-for-open-reduction-and-internal-fixation-of-faciomaxillary-fractures
#13
Sandeep Mehrotra, Sunil Anand
INTRODUCTION: Faciomaxillary fractures (FMF) occur in a significant proportion of trauma patients. Nearly all polytrauma patients and even those with isolated FMF are managed under general anesthesia for definitive management. We propose the use of regional nerve blocks as a safe and effective means for open reduction and fixation of isolated FMF. AIM AND OBJECTIVES: The aim is to evaluate the feasibility, effectiveness and safety of base of skull maxillomandibular and distal trigeminal nerve blocks in the management of FMF...
February 14, 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28190439/neurologic-complications-of-polytrauma
#14
R M Jha, L Shutter
Neurologic complications in polytrauma can be classified by etiology and clinical manifestations: neurovascular, delirium, and spinal or neuromuscular problems. Neurovascular complications include ischemic strokes, intracranial hemorrhage, or the development of traumatic arteriovenous fistulae. Delirium and encephalopathy have a reported incidence of 67-92% in mechanically ventilated polytrauma patients. Causes include sedation, analgesia/pain, medications, sleep deprivation, postoperative state, toxic ingestions, withdrawal syndromes, organ system dysfunction, electrolyte/metabolic abnormalities, and infections...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28164622/using-the-expression-of-mirnas-as-biomarkers-for-the-evaluation-acute-respiratory-distress-syndrome-in-the-critically-ill-polytrauma-patient
#15
REVIEW
Marius Papurica, Alexandru F Rogobete, Carmen A Cradigati, Mirela Sarandan, Raluca Dumache, Lavinia M Bratu, Sonia E Popovici, Dorel Sandesc, Corina Vernic, Ovidiu H Bedreag
BACKGROUND: A high percentage of critically ill polytrauma patients develop acute respiratory distress syndrome (ARDS), both because of the primary traumatic injuries and because of the secondary post-traumatic injuries. For adequate management of these patients, new complex evaluation and monitoring methods are needed, methods that could answer as many questions as possible regarding the pathophysiological changes associated with ARDS. Currently, a series of clinical and biochemical markers are being used which unfortunately do not respond to the needs of an intensive care clinician...
August 1, 2016: Clinical Laboratory
https://www.readbyqxmd.com/read/28164521/using-the-expression-of-damage-associated-molecular-pattern-damp-for-the-evaluation-and-monitoring-of-the-critically-ill-polytrauma-patient
#16
REVIEW
Marius Papurica, Alexandru F Rogobete, Dorel Sandesc, Carmen A Cradigati, Mirela Sarandan, Raluca Dumache, Florin G Horhat, Lavinia M Bratu, Razvan Nitu, Dan C Crisan, Delia I Horhat, Elena S Popovici, Sonia Tanasescu, Vlad Daliborca, Ovidiu Boruga, Ovidiu H Bedreag
BACKGROUND: The critically ill polytrauma patient continues to be one of the most complex cases in the intensive care unit (ICU). The molecular damage is closely connected with the severe, specific pathophysiological imbalances, such as severe inflammation, infections, hypermetabolism, oxidative stress, and ultimately multiple organ dysfunction syndrome (MODS). METHODS: The literature available on PubMed and Scopus was analysed for this study. The key words used in the search were "biomarkers in critically ill patients", "molecular damage", "sepsis biomarkers", "miRNAs biomarkers", and "oxidative stress"...
October 1, 2016: Clinical Laboratory
https://www.readbyqxmd.com/read/28138737/-care-for-severely-injured-persons-update-of-the-2016-s3-guideline-for-the-treatment-of-polytrauma-and-the-severely-injured
#17
REVIEW
P Hilbert-Carius, T Wurmb, H Lier, M Fischer, M Helm, C Lott, B W Böttiger, M Bernhard
In 2011 the first interdisciplinary S3 guideline for the management of patients with serious injuries/trauma was published. After intensive revision and in consensus with 20 different medical societies, the updated version of the guideline was published online in September 2016. It is divided into three sections: prehospital care, emergency room management and the first operative phase. Many recommendations and explanations were updated, mostly in the prehospital care and emergency room management sections...
March 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28130347/non-traumatic-incidental-findings-in-patients-undergoing-whole-body-computed-tomography-at-initial-emergency-admission
#18
Eduard K Kroczek, Gero Wieners, Ingo Steffen, Tobias Lindner, Florian Streitparth, Bernd Hamm, Martin H Maurer
OBJECTIVE: To evaluate the number, localisation and importance of non-traumatic incidental findings (IFs) in patients with suspected or obvious multiple trauma undergoing whole-body CT (WBCT) in a level-1 trauma centre. METHODS: Between January 2009 and December 2013, a total of 2440 patients with trauma undergoing WBCT at admission to a level-1 trauma centre of a university hospital were retrospectively analysed, through imaging IFs unrelated to trauma with the radiological reports...
January 27, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28119351/are-first-rib-fractures-a-marker-for-other-life-threatening-injuries-in-patients-with-major-trauma-a-cohort-study-of-patients-on-the-uk-trauma-audit-and-research-network-database
#19
Ian Ayenga Sammy, Hridesh Chatha, Fiona Lecky, Omar Bouamra, Marisol Fragoso-Iñiguez, Abdo Sattout, Michael Hickey, John E Edwards
BACKGROUND: First rib fractures are considered indicators of increased morbidity and mortality in major trauma. However, this has not been definitively proven. With an increased use of CT and the potential increase in detection of first rib fractures, re-evaluation of these injuries as a marker for life-threatening injuries is warranted. METHODS: Patients sustaining rib fractures between January 2012 and December 2013 were investigated using data from the UK Trauma Audit and Research Network...
April 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28070029/the-relationship-between-scores-and-outcomes-for-polytrauma-patients-in-the-emergency-department-a-case-study
#20
Maria Gioffre-Florio, Letizia Maria Murabito, Carmela Visalli, Alessandra Villari, Floriana Lauritano, Carla Bramanti, Fausto Fama
AIM: Traumas are one of the most relevant pathological events in health care, because of clinical and prognostic relevance. Morbidity and mortality rates are strongly affected by the timely and correct approach to the patient (golden hour). The objective of this study was to investigate the possible influence of the diagnostic time and of the Injury Severity Score (ISS) on outcomes in trauma patients. MATERIAL OF STUDY: Out of a total of 240,833 emergency patients, we observed, 447 polytrauma...
December 29, 2016: Annali Italiani di Chirurgia
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