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management of polytrauma

Arindam Pande, Soumya Patra, Manabhanjan Jena, Rabin Chakraborty
Thirty-nine year male had a history of road traffic accident with polytrauma. At emergency room he started having chest pain with ventricular tachycardia. He was subsequentially diagnosed with right coronary artery dissection secondary to blunt trauma which is an extremely rare cause of inferior wall myocardial infarction. After some dilemmas, he was ultimately treated with intravascular ultrasound guided coronary angioplasty with stenting and had an uneventful recovery.
September 2016: Indian Heart Journal
Joel Scholten, Ellen Danford, Azadeh Leland, Heather Malecki, Douglas Bidelspach, Brent Taylor, Nina Sayer
PURPOSE OF STUDY: Individualized interdisciplinary care is the hallmark for rehabilitation following traumatic brain injury (TBI). Veterans Health Administration (VHA) utilizes an electronic note template to document Interdisciplinary Rehabilitation and Community Reintegration (IRCR) care plans for Veterans with TBI requiring rehabilitation. All Veterans with a TBI diagnosis, receiving skilled therapy for TBI-related issues, and followed by a case manager must receive a care plan. The purpose of this study was to determine the level of compliance with the IRCR care plan requirements used to identify Veterans with TBI in need of the care plan and to evaluate the reasons for inconsistent compliance...
November 2016: Professional Case Management
Lauren Elizabeth Thomson, Nicola Fry, Richard Jackson
Trauma is one of the leading causes of death worldwide, with road traffic accidents being the leading cause of death in the age group of 15-29 years However, with modern advances in management and the introduction of specialised trauma centres, more and more are surviving severe and life-threatening trauma. The ideal timing of fracture fixation has been the subject of debate for a number of decades. There is evidence to suggest that fracture fixation in the patient with polytrauma is best achieved early on to reduce the incidence of morbidity and mortality, with damage control surgery in the more appropriate option in those patients who are haemodynamically unstable...
October 11, 2016: Postgraduate Medical Journal
Vikas Acharya, Suresh Chandrasekaran, Sujit Nair
INTRODUCTION: The authors present an interesting case of a 19-year-old male who presented as a polytrauma patient following a fall from a height. PRESENTATION OF CASE: He was initially managed on the intensive care unit with intracranial pressure bolt monitoring after being intubated and sedated and having his other traumatic injuries stabilized. Upon attempting to wean sedation and extubation a repeat CT scan of the head was undertaken and showed a new area suggested of cerebral infarction, this was a new finding...
October 3, 2016: International Journal of Surgery Case Reports
Kenneth Chin, Joshua M Abzug, Donald S Bae, Bernard D Horn, Martin Herman, Craig P Eberson
Management of pediatric polytrauma patients is one of the most difficult challenges for orthopaedic surgeons. Multisystem injuries frequently include complex orthopaedic surgical problems that require intervention. The physiology and anatomy of children and adolescent trauma patients differ from the physiology and anatomy of an adult trauma patient, which alters the types of injuries sustained and the ideal methods for management. Errors of pediatric polytrauma care are included in two broad categories: missed injuries and inadequate fracture treatment...
February 15, 2016: Instructional Course Lectures
Mohamed AbdelRahman AbdelFatah
BACKGROUND: There is no settled standard of care or even a consensus between neurosurgeons on the replacement of bone fragments in compound depressed skull fractures (CDSF). MATERIALS AND METHODS: This cohort study retrospectively reviewed the patients with nonmissile CDSF who were admitted to our university hospitals from January 2010 to January 2015. Patients who were managed nonoperatively, polytrauma, comatose patients, and CDSF over the air sinuses were excluded from this study...
October 4, 2016: Acta Neurochirurgica
Patricia Hinton Walker, Arnyce Pock, Catherine G Ling, Kyung Nancy Kwon, Megan Vaughan
Battlefield acupuncture is a unique auricular acupuncture procedure which is being used in a number of military medical facilities throughout the Department of Defense (DoD). It has been used with anecdotal published positive impact with warriors experiencing polytrauma, post-traumatic stress disorder, and traumatic brain injury. It has also been effectively used to treat warriors with muscle and back pain from carrying heavy combat equipment in austere environments. This article highlights the history within the DoD related to the need for nonpharmacologic/opioid pain management across the continuum of care from combat situations, during evacuation, and throughout recovery and rehabilitation...
September 2016: Nursing Outlook
Ovidiu Horea Bedreag, Marius Papurica, Alexandru Florin Rogobete, Mirela Sarandan, Carmen Alina Cradigati, Corina Vernic, Corina Maria Dumbuleu, Radu Nartita, Dorel Sandesc
Nowadays, fluid resuscitation of multiple trauma patients is still a challenging therapy. Existing therapies for volume replacement in severe haemorrhagic shock can lead to adverse reactions that may be fatal for the patient. Patients presenting with multiple trauma often develop hemorrhagic shock, which triggers a series of metabolic, physiological and cellular dysfunction. These disorders combined, lead to complications that significantly decrease survival rate in this subset of patients. Volume and electrolyte resuscitation is challenging due to many factors that overlap...
2016: Burns and trauma
Sanjay Kumar Yadav, Subodh Kumar, Mahesh Chander Misra, Sushma Sagar, V K Bansal
Liver injury is the major cause of morbidity and mortality in polytrauma patients. This study was conducted to know the burden of hepatobiliary injury and its outcome in our setup. It is a retrospective study of all patients with traumatic hepatobiliary injuries from January 2008 through April 2012 at JPNATC, New Delhi. All patients were resuscitated as per ATLS guidelines. Management of patients was based on hemodynamic status and associated injuries. Liver injury occurred in 7.52 % of all trauma admissions and 20...
August 2016: Indian Journal of Surgery
Carlo Biz, Lisa Buffon, Roberto Marin, Natalia Petrova
INTRODUCTION AND BACKGROUND: Trauma is the most frequent cause of death in people under 40 years old. It is an important problem not only because of the high mortality but also because of the consequential disability that can lead to serious economic consequences. STUDY AIMS: This descriptive, comparative study investigates the definitive management of poly-traumatised patients in an Italian Orthopaedic Ward in order to highlight its strengths and weaknesses in comparison with the most recent literature...
April 21, 2016: International Journal of Orthopaedic and Trauma Nursing
Parmeshwar Kumar, V Jithesh, Shakti Kumar Gupta
CONTEXT: Although Intensive Care Units (ICUs) only account for 10% of the hospital beds, they consume nearly 22% of the hospital resources. Few definitive costing studies have been conducted in Indian settings that would help determine appropriate resource allocation. AIM: The aim of this study was to evaluate and compare the cost of intensive care delivery between multispecialty and neurosurgery ICUs at an apex trauma care facility in India. MATERIALS AND METHODS: The study was conducted in a polytrauma and neurosurgery ICU at a 203-bedded Level IV trauma care facility in New Delhi, India, from May 1, 2012 to June 30, 2012...
July 2016: Indian Journal of Critical Care Medicine
Salman Abbasi Fard, Mauricio J Avila, Cameron M Johnstone, Apar S Patel, Christina M Walter, Jesse Skoch, Kamran V Sattarov, Ali A Baaj
Traumatic atlanto-occipital dislocation (AOD) is an ominous injury with high mortality and morbidity in trauma patients. Improved survival has been observed with advancements in pre-hospital and hospital care. Furthermore, high quality imaging studies are accessible at most trauma centers; these are crucial for prompt diagnosis of AOD. The objective of this study is to perform a comprehensive literature review of traumatic AOD, with specific emphasis on identifying prognostic factors for survival. A review of the literature was performed using the Medline database for all traumatic atlanto-occipital articles published between March 1959 and June 2015; 141 patients from 60 total studies met eligibility criteria for study inclusion...
November 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Carl Beyer, Scott Zakaluzny, Misty Humphries, David Shatz
BACKGROUND: Injury to the renal artery is a rare but serious concern in patients suffering blunt trauma. Complications of renovascular injury include prolonged hospitalization, kidney loss, and death. There remains considerable controversy regarding the optimal treatment of blunt renal artery injury. CASE REPORT: We describe the management of a 39 year old woman following blunt polytrauma who underwent a multidisciplinary collaborative procedure with open splenectomy and endovascular repair of an occluded renal artery...
August 20, 2016: Annals of Vascular Surgery
B A Zahoor, J E Piercey, D R Wall, K D Tetsworth
Mucormycosis as a consequence of trauma is a devastating complication; these infections are challenging to control, with a fatality rate approaching 96% in immunocompromised patients. We present a case where a proactive approach was successfully employed to treat mucormycosis following complex polytrauma. Aggressive repeated surgical debridement, in combination with appropriate antifungal therapy, proved successful in this instance. In our opinion, mucormycosis in trauma mandates an aggressive surgical approach...
August 23, 2016: Annals of the Royal College of Surgeons of England
M Weuster, A Brück, S Lippross, L Menzdorf, S Fitschen-Oestern, P Behrendt, T Iden, J Höcker, R Lefering, A Seekamp, T Klüter
BACKGROUND: Accidental hypothermia (AH) endangers the patient after polytrauma. Past studies have emphasized this entity as a major risk factor. The aim of this study was to describe the epidemiology of accidental hypothermia in major trauma considering the preclinical and clinical course. Predictors should be elucidated. METHODS: This is a retrospective investigation from the TraumaRegister DGU®. Patients were documented in the period between 2002 and 2012. The study compared multiple injured patients with or without hypothermic temperatures...
August 16, 2016: Journal of Trauma and Acute Care Surgery
G V Oosthuizen, J L Bruce, W Bekker, N Shangase, G L Laing, D L Clarke
BACKGROUND: Pan computed tomography (CT) is widely used in the evaluation of patients with blunt polytrauma, but there is growing concern about the radiation risks imposed. OBJECTIVE: To ascertain whether we were possibly overutilising pan CT in our trauma service, and whether we could safely cut down on scans without missing significant injuries. METHODS: We audited all pan scans performed in the Metropolitan Trauma Service, Pietermaritzburg, South Africa, during the 12-month period 1 January - 31 December 2012...
August 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
William Wynell-Mayow, Borna Guevel, Benjamin Quansah, Ronan O'Leary, Andrew D Carrothers
Addenbrooke's Hospital, the Major Trauma Centre for the East of England Trauma Network, received 1070 major trauma patients between 1st January and 31st December 2014. In order to improve care, an audit was performed of 59 patients meeting our own selection criteria for orthopaedic polytrauma between 1st January 2013 and 31st December 2013. The Cambridge Polytrauma Pathway was devised through NCEPOD guidelines, literature review, internal and external discussion. It facilitates provision of best practice Early Appropriate Care, encompassing - multidisciplinary consultant decisions around the patient in our Neurological and Trauma Critical Care Unit, early full body trauma CT scans, serial measurements of lactate and fibrinogen levels, and out-of-hours orthopaedic theatre reserved for life-and-limb threatening injuries...
October 2016: Injury
G Naqvi, G Johansson, G Yip, A Rehm, A Carrothers, K Stöhr
Introduction Paediatric trauma is a significant burden to healthcare worldwide and accounts for a large proportion of deaths in the UK. Methods This retrospective study examined the epidemiological data from a major trauma centre in the UK between January 2012 and December 2014, reviewing all cases of moderate to severe trauma in children. Patients were included if aged ≤16 years and if they had an abbreviated injury scale score of ≥2 in one or more body region. Results A total of 213 patients were included in the study, with a mean age of 7...
August 4, 2016: Annals of the Royal College of Surgeons of England
Henri de Lesquen, Fabien Beranger, Julie Berbis, Guillaume Boddaert, Antoine Poichotte, Francois Pons, Jean-Philippe Avaro
BACKGROUND: This study reports the challenges faced by French military surgeons in the management of thoracic injury during the latest Afghanistan war. METHODS: From January 2009 to April 2013, all of the civilian, French and Coalition casualties admitted to French NATO Combat Support Hospital situated on Kabul were prospectively recorded in the French Military Health Service Registry (OPEX(®)). Only penetrating and blunt thoracic trauma patients were retrospectively included...
September 2016: Injury
E Girard, J Abba, N Cristiano, M Siebert, S Barbois, C Létoublon, C Arvieux
The spleen and pancreas are at risk for injury during abdominal trauma. The spleen is more commonly injured because of its fragile structure and its position immediately beneath the ribs. Injury to the more deeply placed pancreas is classically characterized by discordance between the severity of pancreatic injury and its initial clinical expression. For the patient who presents with hemorrhagic shock and ultrasound evidence of major hemoperitoneum, urgent "damage control" laparotomy is essential; if splenic injury is the cause, prompt "hemostatic" splenectomy should be performed...
August 2016: Journal of Visceral Surgery
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