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management of polytrauma

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https://www.readbyqxmd.com/read/29223612/predictive-value-of-focused-assessment-with-sonography-for-trauma-fast-for-laparotomy-in-unstable-polytrauma-egyptians-patients
#1
Adel Hamed Elbaih, Sameh T Abu-Elela
PURPOSE: The emergency physicians face significant clinical uncertainty when multiple trauma patients arrive in the emergency department (ED). The priorities for assessment and treatment of polytrauma patients are established in the primary survey. Focused assessment with sonography for trauma (FAST) is very essential clinical skill during trauma resuscitation. Use of point of care ultrasound among the trauma team working in the primary survey in emergency care settings is lacking in Suez Canal University Hospitals even ultrasound machine not available in ED...
November 23, 2017: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
https://www.readbyqxmd.com/read/29218392/unusual-circumstances-to-diagnose-cervical-pott-s-disease
#2
Mohamed Ali Kedous, Ahmed Msakni, Wael Chebbi, Mourad Zaraa, Mohsen Trabelsi
Tuberculous spondylodiscitis usually affects the dorso-lumbar spine, and its cervical location is a rare condition that can mimic other diseases and consequently cause treatment delays. We report a case of tuberculous spondylodiscitis of the lower cervical spine discovered under unusual circumstances in a patient with severe polytrauma involving a cranio-cerebral trauma, a non-displaced fracture of the two laminæ and the spinous process of the C6 vertebrae as well as fibular and tibial shaft fractures. The patient underwent static tibial nailing, and a collar with occipital and chin supports was applied...
December 7, 2017: Skeletal Radiology
https://www.readbyqxmd.com/read/29189532/pediatric-supracondylar-humerus-fractures-aaos-appropriate-use-criteria-versus-actual-management-at-a-pediatric-level-1-trauma-center
#3
Joanne H Wang, William Z Morris, Blaine T Bafus, Raymond W Liu
OBJECTIVES: The purpose of this study was to characterize management of supracondylar humerus fractures (SCHFs) at a level 1 trauma center and identify factors contributing to divergence in management from American Academy of Orthopedic Surgeons (AAOS) the Appropriate Use Criteria (AUC) recommendations. METHODS: A query revealed 556 patients with diagnoses of SCHF between 2013 and 2015 at a pediatric level 1 trauma center. Patients were excluded if they were younger than 2 years of age, older than 12 years of age, were polytrauma patients, or if there was not sufficient clinical or radiographic documentation, resulting in 449 patients...
November 16, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/29169591/radial-nerve-palsy-after-humeral-shaft-fractures-the-case-for-early-exploration-and-a-new-classification-to-guide-treatment-and-prognosis
#4
REVIEW
Gerard Chang, Asif M Ilyas
Radial nerve palsies are a common complication associated with humeral shaft fractures. The authors propose classifying these injuries into 4 types based on intraoperative findings: type 1 stretch/neuropraxia, type 2 incarcerated, type 3 partial transection, and type 4 complete transection. The initial management of radial nerve palsies associated with closed fractures of the humerus remains a controversial topic, with early exploration reserved for open fractures, fractures that cannot achieve an adequate closed reduction requiring fracture repair, fractures with associated vascular injuries, and polytrauma patients...
February 2018: Hand Clinics
https://www.readbyqxmd.com/read/29166203/temporal-profile-of-care-following-mild-traumatic-brain-injury-predictors-of-hospital-admission-follow-up-referral-and-six-month-outcome
#5
John K Yue, Ethan A Winkler, Sourabh Sharma, Mary J Vassar, Jonathan J Ratcliff, Frederick K Korley, Seth A Seabury, Adam R Ferguson, Hester F Lingsma, Sacha Meeuws, Opeolu M Adeoye, Jonathan W Rick, Caitlin K Robinson, Siena M Duarte, Esther L Yuh, Pratik Mukherjee, Sureyya S Dikmen, Thomas W McAllister, Ramon Diaz-Arrastia, Alex B Valadka, Wayne A Gordon, David O Okonkwo, Geoffrey T Manley
OBJECTIVE: To investigate the clinical management and medical follow-up of patients with mild traumatic brain injury (mTBI) presenting to emergency departments (EDs). METHODS: Overall, 168 adult patients with mTBI from the prospective, multicentre Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) Pilot study with Glasgow Coma Scale (GCS) 13-15, no polytrauma and alive at six months were included. Predictors for hospital admission, three-month follow-up referral and six-month functional disability (Glasgow Outcome Scale-Extended (GOSE) ≤ 6) were analysed using multivariable regression...
2017: Brain Injury: [BI]
https://www.readbyqxmd.com/read/29162249/functional-outcome-after-calcaneus-fractures-a-comparison-between-polytrauma-patients-and-isolated-fractures
#6
Pablo Renovell-Ferrer, Xavier Bertó-Martí, José Diranzo-García, Luis Barrera-Puigdorells, Vicente Estrems-Díaz, Antonio Silvestre-Muñoz, Antonio Brú-Pomer
BACKGROUND: Displaced intra-articular calcaneal fractures (DIACFs) can have long-term consequences in terms of foot pain and disability. This injury frequently occurs in the context of polytrauma patients and its influence in long-term functional prognosis is well known. The purpose of this study is to compare the etiology, severity, and functional outcome of the operated DIACFs between polytrauma patients and isolated cases. METHODS: Eighty-six patients with operated displaced intra-articular calcaneal fractures through open reduction and internal fixation (ORIF) were managed at our institution between January 1, 2008 and December 31, 2015...
November 2017: Injury
https://www.readbyqxmd.com/read/29159851/comparison-of-three-fixation-methods-in-treatment-of-tibial-fracture-in-adolescents
#7
REVIEW
Lixiang Lin, Yang Liu, Chuanlu Lin, Yifei Zhou, Yongzeng Feng, Xiaolong Shui, Kehe Yu, Xiaolang Lu, Jianjun Hong, Yang Yu
BACKGROUND: Tibial fractures are the most common musculoskeletal injury in adolescents. The optimal management of tibial fractures in adolescents is controversial. In this study, we compared the outcomes including complications of three fixation methods in tibial fractures of adolescents and explored the factors associated with the complications. METHODS: A retrospective cohort study about 83 diaphyseal tibial fractures in 79 children and adolescents, who were treated with plate fixation (PF), elastic stable intramedullary nail fixation (ESINF), or external fixation (EF), was conducted...
November 21, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/29132582/airway-management-in-trauma
#8
REVIEW
George Kovacs, Nicholas Sowers
Airway management in the trauma patient presents numerous unique challenges beyond placement of an endotracheal tube and outcomes are dependent on the provider's ability to anticipate difficulty. Airway management strategies for the care of the polytrauma patient are reviewed, with specific considerations for those presenting with traumatic brain injury, suspected c-spine injury, the contaminated airway, the agitated trauma patient, maxillofacial trauma, and the traumatized airway. An approach to airway management that considers the potential anatomic and physiologic challenges in caring for these complicated trauma patients is presented...
February 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29098965/orthopedic-injuries-in-pediatric-trauma
#9
Eman Loubani, Rodrick Lim, Debra Bartley
Trauma remains the leading cause of death in children, of which the majority of patients have orthopedic injuries. The range of injured bones is various, each requiring knowledge and expertise to appropriately manage in a timely fashion. The importance of a systematic approach to the pediatric polytrauma patient is paramount. This chapter will highlight orthopedic issues important to the pediatric polytrauma patient including the unique anatomy and properties of pediatric bone. A systematic approach to the pediatric polytrauma patient will also be discussed...
September 11, 2017: Current Pediatric Reviews
https://www.readbyqxmd.com/read/29088951/update-on-critical-care-for-acute-spinal-cord-injury-in-the-setting-of-polytrauma
#10
John K Yue, Ethan A Winkler, Jonathan W Rick, Hansen Deng, Carlene P Partow, Pavan S Upadhyayula, Harjus S Birk, Andrew K Chan, Sanjay S Dhall
Traumatic spinal cord injury (SCI) often occurs in patients with concurrent traumatic injuries in other body systems. These patients with polytrauma pose unique challenges to clinicians. The current review evaluates existing guidelines and updates the evidence for prehospital transport, immobilization, initial resuscitation, critical care, hemodynamic stability, diagnostic imaging, surgical techniques, and timing appropriate for the patient with SCI who has multisystem trauma. Initial management should be systematic, with focus on spinal immobilization, timely transport, and optimizing perfusion to the spinal cord...
November 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29054228/novel-airway-and-ventilator-management-of-tracheobronchial-disruption-after-blunt-trauma
#11
Nitin Mehdiratta, Michael Archer, Melissa Stewart, Bradley Dennis, Eric Grogan
Tracheobronchial injuries can be difficult to diagnose and manage, especially in the presence of polytrauma. A 50-year-old woman presented as a Level I trauma activation after being struck by a motor vehicle. Initial evaluation demonstrated intracranial hemorrhage and multiple chest injuries, including multilevel bilateral rib fractures, pneumomediastinum, and concern for tracheobronchial injury. After initial stabilization, bronchoscopy was performed and demonstrated an injury to the carina. We report a novel airway and ventilation strategy in the setting of concomitant tracheobronchial injury after severe blunt chest trauma in which extracorporeal support is contraindicated...
November 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29050055/-polytrauma-management-treatment-of-severely-injured-patients-in-er-and-or
#12
Christian von Rüden, Volker Bühren, Mario Perl
The adequate treatment of severely injured patients is challenging and can only be successfully executed when it starts at the accident site and is continued in all treatment phases including the early rehabilitation phase. Treatment should be performed by an interdisciplinary team guided by a trauma surgeon in order to adequately manage the severe injuries some of which are life-threatening. Treatment of polytrauma patients is a key task of certified trauma centers and must follow standardized guidelines. For a successful therapy of severely injured patients lifetime training at regular intervals in well-established polytrauma concepts is a mandatory requirement...
October 2017: Zeitschrift Für Orthopädie und Unfallchirurgie
https://www.readbyqxmd.com/read/29040811/mobile-emergency-simulation-training-for-rural-health-providers
#13
Douglas Martin, Brent Bekiaris, Gregory Hansen
INTRODUCTION: Mobile emergency simulation offers innovative continuing medical educational support to regions that may lack access to such opportunities. Furthermore, satisfaction is a critical element for active learning. Together, the authors evaluated Canadian rural healthcare providers' satisfaction from high fidelity emergency simulation training using a modified motorhome as a mobile education unit (MEU). METHODS: Over a 5-month period, data was collected during 14 educational sessions in nine different southern Manitoban communities...
July 2017: Rural and Remote Health
https://www.readbyqxmd.com/read/29018873/the-treatment-of-perilunate-ligament-injuries-in-multiply-injured-patients
#14
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/29018144/ogilvie-s-syndrome-treated-with-an-emergency-laparotomy-right-hemicolectomy-and-end-ileostomy
#15
Andrew James Robinson, John-Patrick Quigley, Athene Banks, Martin Farmer
Acute colonic pseudo-obstruction (ACPO), or Ogilvie's syndrome, is a rare clinical entity in which there is massive non-toxic colonic dilatation in the absence of a mechanically obstructing lesion. It is an important yet poorly recognised cause of surgical morbidity and mortality occurring typically in elderly patients with multiple comorbidities. ACPO can often be reversed conservatively with colonoscopic or nasogastric decompression. Surgical intervention is seldom necessary. We present a case of Ogilvie's syndrome in which a healthy 76-year-old man developed life-threatening pseudo-obstruction following rib polytrauma after a mechanical fall...
October 9, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28985633/role-of-negative-pressure-therapy-as-damage-control-in-soft-tissue-reconstruction-for-open-tibial-fractures
#16
Mario Cherubino, Luigi Valdatta, Pierluigi Tos, Salvatore D'Arpa, Luigi Troisi, Pellegatta Igor, Federica Corradi, Umraz Khan
The concept of damage control orthopaedics (DCO) is a strategy that focuses on managing orthopaedic injuries in polytrauma patients who are in an unstable physiological state. The concept of DCO is an extension of damage control surgery or damage limitation surgery (DCS/DLS). Recently, it has become clear that certain patients, following extensive soft tissue trauma, could benefit from the idea of DCS. In the management of severe lower extremity trauma with exposed fracture sites, aggressive early wound excision debridement, early internal fixation, and vascularized wound coverage within a few days after trauma were proposed...
October 2017: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/28958361/surgical-management-of-musculoskeletal-trauma
#17
REVIEW
Daniel J Stinner, Dafydd Edwards
Musculoskeletal injuries cause a significant burden to society and can have a considerable impact on patient morbidity and mortality. It was initially thought that these patients were too sick to undergo surgery and later believed that they were too sick not to undergo surgery. The pendulum has subsequently swung back and forth between damage control orthopedics and early total care for polytrauma patients with extremity injuries and has settled on providing early appropriate care (EAC). The decision-making process in providing EAC is reviewed in an effort to optimize patient outcomes following severe extremity trauma...
October 2017: Surgical Clinics of North America
https://www.readbyqxmd.com/read/28933334/-damage-control-surgery-in-polytrauma-patients-with-pelvic-fractures-is-it-possible-to-use-internal-fixation
#18
L Havlůj, V Džupa, R Gürlich
Current polytrauma management is multidisciplinary, with Damage Control Surgery (DCS), Damage Control Orthopaedics (DCO) and Damage Control Resuscitation (DCR) being applied in the first few hours after injury. The most severe group of polytrauma patients are those with circulatory instability and massive blood loss as a consequence of unstable pelvic fractures. In treating these patients, of crucial importance is the speed and quality of stabilisation of pelvic fracture fragments. The authors present two case reports of polytrauma patients with unstable pelvic fractures, in whom open reduction and internal fixation was performed on the anterior fracture segment through extended laparotomy in order to stop bleeding into the abdominopelvic cavity as part of the DCS approach...
2017: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
https://www.readbyqxmd.com/read/28926486/comorbid-posttraumatic-stress-disorder-and-traumatic-brain-injury-generalization-of-prolonged-exposure-ptsd-treatment-outcomes-to-postconcussive-symptoms-cognition-and-self-efficacy-in-veterans-and-active-duty-service-members
#19
Gregory K Wolf, Gregory J Mauntel, Tracy Kretzmer, Eric Crawford, Christina Thors, Thad Q Strom, Rodney D Vanderploeg
OBJECTIVES: To examine (a) generalization of the effectiveness of prolonged exposure (PE) therapy for posttraumatic stress disorder (PTSD) in improving postconcussive symptoms (PCSs) and other outcomes in military service members and Veterans (VA) with histories of mild to severe traumatic brain injury (TBI), and (b) factors associated with PCS reduction. SETTING: VA polytrauma medical center. PARTICIPANTS: Consecutive referrals for PTSD treatment of Active Duty (n = 17) or Veterans (n = 27) diagnosed with PTSD and TBI (N = 44)...
September 18, 2017: Journal of Head Trauma Rehabilitation
https://www.readbyqxmd.com/read/28921846/improvement-of-polytrauma-management-quality-inspection-of-a-newly-introduced-course-concept
#20
Ingo Gräff, Shahab Ghamari, Sylvia Schacher, Procula Glien, Rolf Fimmers, Torsten Baehner, Se-Chan Kim
RATIONALE, AIMS, AND OBJECTIVES: A systematic literature search for training course concepts for care of severely injured and severely ill patients respecting improvement of process and outcome yielded little data. For several years, the University Hospital of Bonn has hosted a shock-room management course which, on the one hand, communicates human factor aspects and, on the other hand, pursues interdisciplinary and interprofessional team training. The Bonn shock-room management course (BSM-course®) differs from other courses in both format and principles...
September 17, 2017: Journal of Evaluation in Clinical Practice
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