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Trauma management

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https://www.readbyqxmd.com/read/28731937/an-adapted-clavien-dindo-scoring-system-in-trauma-as-a-clinically-meaningful-nonmortality-endpoint
#1
David N Naumann, Laura E Vincent, Nicola Pearson, Alastair Beaven, Iain M Smith, Kieran Smith, Emma Toman, Helen R Dorrance, Keith Porter, Charles E Wade, Bryan A Cotton, John B Holcomb, Mark J Midwinter
BACKGROUND: There is no consensus on reporting nonmortality trauma complications in a graded manner. The Clavien-Dindo scale of complications was originally for elective surgery and requires adaptation to provide meaningful data for trauma patients. In particular, the original score does not account for those treated without surgery. We report an adapted Clavien-Dindo in trauma (ACDiT) scale and apply it to patients managed operatively and nonoperatively. METHODS: A combined prospective and retrospective international multicenter observational study was undertaken to apply the ACDiT scale to 484 trauma patients at three university teaching hospitals (Birmingham, England (n = 303); Houston, Texas (n = 113); and Glasgow, Scotland (n = 68))...
August 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28731843/telemedicine-use-decreases-rural-emergency-department-length-of-stay-for-transferred-north-dakota-trauma-patients
#2
Nicholas M Mohr, J Priyanka Vakkalanka, Karisa K Harland, Amanda Bell, Brian Skow, Dan M Shane, Marcia M Ward
BACKGROUND: Telemedicine has been proposed as one strategy to improve local trauma care and decrease disparities between rural and urban trauma outcomes. OBJECTIVES: This study was conducted to describe the effect of telemedicine on management and clinical outcomes for trauma patients in North Dakota. METHODS: Cohort study of adult (age ≥18 years) trauma patients treated in North Dakota Critical Access Hospital (CAH) Emergency Departments (EDs) from 2008 to 2014...
July 21, 2017: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
https://www.readbyqxmd.com/read/28730297/trauma-to-the-bladder-and-ureter-a-review-of-diagnosis-management-and-prognosis
#3
REVIEW
B Phillips, S Holzmer, L Turco, M Mirzaie, E Mause, A Mause, A Person, S W Leslie, D L Cornell, M Wagner, R Bertellotti, J A Asensio
BACKGROUND: Injuries to the ureter or bladder are relatively rare. Therefore, a high level of clinical suspicion and knowledge of operative anatomy is of utmost importance for their management. Herein, a review of the literature related to the modern diagnosis, management, and prognosis for bladder and ureteral injuries is presented. METHODS: A literature search was conducted through PubMed. A thorough search of the world's literature published in English was completed...
July 20, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/28730244/keratoacanthoma-centrifugum-marginatum-an-unusual-clinical-and-histopathological-diagnostic-pitfall
#4
Tiberiu Augustin Georgescu, Ana Maria Oproiu, Mihai George Rădăşan, Adrian Vasile Dumitru, Diana Costache, Oana Maria Pătraşcu, Anca Mihaela Lăzăroiu, Alina Elena Chefani, Maria Sajin, Mariana Costache
Keratoacanthoma centrifugum marginatum (KCM) is a very rare variant of keratoacanthoma characterized by progressive peripheral growth accompanied by central healing. The tumor has the peculiar ability to involute spontaneously. A careful differential diagnostic with other skin carcinomas or hyperkeratotic lesions is required in order to ensure appropriate clinical management. We report a case of KCM in a 62-year-old man presenting with a solitary, large exophytic, sessile tumor located on the ventral side of the right lower leg, which developed over the course of one year from an initial erythematous papule...
2017: Romanian Journal of Morphology and Embryology, Revue Roumaine de Morphologie et Embryologie
https://www.readbyqxmd.com/read/28729005/influence-of-late-fluid-management-on-the-outcomes-of-severe-trauma-patients-a-retrospective-analysis-of-294-severely-injured-patients
#5
Mehdi Mezidi, Mehdi Ould-Chikh, Pauline Deras, Camille Maury, Orianne Martinez, Xavier Capdevila, Jonathan Charbit
BACKGROUND: Liberal late fluid management (LFM) is associated with higher morbi-mortality in critically ill populations. The aim of the study was to assess the association between LFM and duration of mechanical ventilation in a severe trauma population. METHODS: A retrospective analysis of consecutive patients with an ISS≥16 and a length of stay in the intensive care unit (ICU)≥7 days was performed. The conservative LFM group included patients with at least 2 consecutive days with a negative fluid balance between day 3 and day 7; other patients were allocated to the liberal LFM group...
June 15, 2017: Injury
https://www.readbyqxmd.com/read/28728875/the-use-and-uptake-of-pupillometers-in-the-intensive-care-unit
#6
Matthew Hao Lee, Biswadev Mitra, Jiun Kae Pui, Mark Fitzgerald
BACKGROUND: Traumatic brain injury (TBI) is a significant public health issue. Assessing pupil reactivity is a crucial aspect of its management and the pupillometer has been shown to be a more objective tool compared to the standard penlight. Its use, however, is not widespread. OBJECTIVE: To investigate the paucity in uptake, we examined the frequency of use of pupillometers (NeurOptics(®)NPi-100™) amongst Intensive Care Unit (ICU) doctors and nurses, evaluated its user-friendliness and explored barriers to its use...
July 17, 2017: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/28728716/thoracic-trauma-injuries-evaluation-and-treatment
#7
REVIEW
Joseph J Platz, Loic Fabricant, Mitch Norotsky
Thoracic injury is common in high-energy and low-energy trauma, and is associated with significant morbidity and mortality. Evaluation requires a systematic approach prioritizing airway, respiration, and circulation. Chest injuries have the potential to progress rapidly and require prompt procedural intervention. For the diagnosis of nonemergent injuries, a careful secondary survey is essential. Although medicine and trauma management have evolved throughout the decades, the basics of thoracic trauma care have remained the same...
August 2017: Surgical Clinics of North America
https://www.readbyqxmd.com/read/28727609/atrial-natriuretic-peptide-a-potential-early-therapy-for-the-prevention-of-multiple-organ-dysfunction-syndrome-following-severe-trauma
#8
Rong-Wei Zhang, Li-Li Liu, Lan-Lan Zeng, Rui-Jie Li, Ye-Hua Shen, Bin Zhang, Zi-Zhuo Liu, Meng-Fei Chen, Sheng-Mao Jiang, Li-Bing Jiang, Xiao-Gang Zhao, Shou-Yin Jiang
Trauma remains a tremendous medical burden partly because of increased expenditure for the management of multiple organ dysfunction syndrome (MODS) developed during hospital stay. The intestinal barrier injury continues to be a second insult resulting in MODS which currently lacks efficient strategies for prevention. Recent studies have uncovered multi-organ protective benefits of atrial natriuretic peptide (ANP) in cardiovascular disease. However, the role of ANP in prevention of MODS following severe trauma has not been understood...
July 19, 2017: Shock
https://www.readbyqxmd.com/read/28724441/computed-tomography-during-initial-management-and-mortality-among-hemodynamically-unstable-blunt-trauma-patients-a-nationwide-retrospective-cohort-study
#9
Yusuke Tsutsumi, Shingo Fukuma, Asuka Tsuchiya, Tatsuyoshi Ikenoue, Yosuke Yamamoto, Sayaka Shimizu, Miho Kimachi, Shunichi Fukuhara
BACKGROUND: Although many hemodynamically unstable trauma patients undergo computed tomography (CT) to identify a source of bleeding, this practice is currently only recommended by a few guidelines. To clarify whether CT has harmful effects among these patients, we examined the association between CT during initial management and mortality among unstable blunt trauma patients. METHODS: This was a retrospective cohort study based on Japan Trauma Data Bank 2004-2014 registry data...
July 19, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28724333/the-impact-of-acute-management-on-the-occurrence-of-medical-complications-during-the-specialized-spinal-cord-injury-acute-hospitalization-following-motor-complete-cervical-spinal-cord-injury
#10
Andréane Richard-Denis, Debbie Erhmann Feldman, Cynthia Thompson, Jean-Marc Mac-Thiong
CONTEXT/OBJECTIVE: Determine the impact of early admission and complete perioperative management in a specialized spinal cord injury (SCI) trauma center (SCI-center) on the occurrence of medical complications following tetraplegia. DESIGN: A retrospective comparative cohort study of prospectively collected data involving 116 individuals was conducted. Group 1 (N=87) was early managed in a SCI-center promptly after the trauma, whereas Group 2 (N=29) was surgically and preoperatively managed in a non-specialized (NS) center before being transferred to the SCI-center...
July 19, 2017: Journal of Spinal Cord Medicine
https://www.readbyqxmd.com/read/28723783/novel-surgical-management-of-cyclodialysis-cleft-via-anterior-chamber-perfusion-case-report
#11
Jinfei Tang, Ergang Du, Jie Wang
RATIONALE: Cyclodialysis cleft is a relatively rare but severe condition with persistent ocular hypotony, which can cause morphologic changes and visual loss. Here we report a case of a traumatic cyclodialysis cleft that was successfully managed with direct cyclopexy via anterior chamber perfusion. During the operation, if there is aqueous humor flowing out of the deep scleral incision, the cleft is not closed, and surgery should continue until there is no aqueous outflow. PATIENT CONCERNS: A 66-year-old man was treated for severe blunt ocular trauma of the left eye and a resultant cyclodialysis cleft, lens subluxation, choroidal detachment and a cataract...
July 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28722005/a-conservative-management-of-iatrogenically-damaged-distal-root-of-the-mandibular-second-molar
#12
Rashmi Bansal, Sonali Roy, Praveen Chandra, Anuraag Gurtu, Rahul Pandey
Trauma to the adjacent hard and soft tissue is the most common iatrogenic injury during extraction of the mandibular third molar. As every functional component of the dental arch is of prime importance in contemporary dental practice, the major concern must be in conserving the tooth and its structure as much as possible. The present case discusses the application of this conservative approach for management of iatrogenically damaged distal root of the mandibular second molar during extraction of impacted third molar, in which excessive guttering of alveolar bone and fractured apical third of distal root of 37 was observed radiographically...
May 2017: Indian Journal of Dental Research: Official Publication of Indian Society for Dental Research
https://www.readbyqxmd.com/read/28721996/open-reduction-and-internal-fixation-screw-injury-retrospective-study
#13
Preetha Balaji, S M Balaji
BACKGROUND/AIMS: Open reduction and internal fixation (ORIF) is a standard surgical procedure in jaw trauma and in orthognathic surgery. Insertion of screws is a significant risk for accidental tooth root injury with varying outcomes. Contrary evidences are found in literature due to a variety of study designs. This study was undertaken to address the lacunae and possibly estimate the difference in occurrence of tooth damage during or after ORIF between trauma and planned osteotomies...
May 2017: Indian Journal of Dental Research: Official Publication of Indian Society for Dental Research
https://www.readbyqxmd.com/read/28721819/the-application-of-scaffold-materials-in-cartilage-tissue-engineering
#14
Na Fu, Tengzhe Dong, Ai Meng, Zhaosong Meng, Bofeng Zhu, Yunfeng Lin
The management of chondral defects has been a challenge for a long time because of the poor self-healing capacity of articular cartilage. Many approaches ranging from symptomatic treatment to structural cartilage regeneration are not that successful with very limited satisfactory results. Chondral defects caused by tumor, trauma, infection, congenital malformations are very common in clinical trials. It seriously affects the patient's physical function and quality of life. Cartilage tissue engineering, which involves novel natural scaffolds, has emerged as a promising strategy for cartilage regeneration and repair...
July 18, 2017: Current Stem Cell Research & Therapy
https://www.readbyqxmd.com/read/28721318/infective-endocarditis-presenting-as-bilateral-orbital-cellulitis-an-unusual-case
#15
Talal Asif, Badar Hasan, Rehman Ukani, Rebecca R Pauly
Orbital cellulitis is a severe and sight-threatening infection of orbital tissues posterior to the orbital septum. The most common causes of orbital cellulitis are rhinosinusitis, orbital trauma, and surgery. Infective endocarditis (IE) is a systemic infection that begins on cardiac valves and spreads by means of the bloodstream to peripheral organs. Septic emboli can spread to any organ including the eyes and can cause focal or diffuse ophthalmic infection. Ocular complications of IE classically include Roth's spots, subconjunctival hemorrhages, chorioretinitis, and endophthalmitis...
June 14, 2017: Curēus
https://www.readbyqxmd.com/read/28721003/patient-compliance-with-venous-thromboembolism-prophylaxis-vte
#16
John Ross Blackwell, Parag Raval, John-Patrick Quigley, Amit Patel, Donald McBride
Venous thromboembolic disease (VTE) comprises pulmonary embolism (PE) and deep vein thrombosis (DVT), and causes morbidity and mortality, particularly in trauma and orthopaedic patients. Prevalence of 0.9% and 1.2% respectively are reported, with mortality rates up to 13.8%. Chemical thromboprophylactic agents including low molecular weight heparin (LMWH) are considered cost effective in reducing VTE risk. Evidence for anti-platelets including Aspirin for VTE prophylaxis is less compelling and is not supported as monotherapy...
April 2017: Journal of Clinical Orthopaedics and Trauma
https://www.readbyqxmd.com/read/28720187/experiences-with-regional-anesthesia-for-analgesia-during-prolonged-aeromedical-evacuation
#17
Jeffrey M Carness, Melissa A Wilson, Mark J Lenart, Danny E Smith, Susan F Dukes
INTRODUCTION: There is much debate regarding the appropriate analgesic management of patients undergoing medical evacuation following combat trauma. Our primary objective was to review the utility of regional anesthetic techniques in patients undergoing aeromedical evacuation following surgical limb amputation as treatment for combat trauma. METHODS: This study was conducted as an observational retrospective cohort whereby acutely injured amputee patients were identified via the U...
August 1, 2017: Aerospace Medicine and Human Performance
https://www.readbyqxmd.com/read/28720057/use-of-integra-in-the-management-of-complex-hand-wounds-from-cancer-resection-and-nonburn-trauma
#18
Michael Reynolds, David A Kelly, Nicholas J Walker, Clayton Crantford, Anthony J Defranzo
BACKGROUND: Despite extensive use of Integra in burn reconstruction, little has been published regarding its utility in complex hand wounds from nonburn trauma or cancer resection. This study aimed to review outcomes following Integra use for hand reconstruction following cancer resection or nonburn trauma with exposed bone, joints, and/or tendons. METHODS: Retrospective review was performed of patients undergoing hand reconstruction with Integra for exposed bones, joints, or tendons over a 6-year period at a single institution...
February 1, 2017: Hand: Official Journal of the American Association for Hand Surgery
https://www.readbyqxmd.com/read/28720045/neonatal-acute-paronychia
#19
Luke Grome, Gregory Borah
BACKGROUND: Paronychia is defined as infection afflicting the eponychial nail folds of the hand or foot. Such infections are rarely reported in the perinatal age group, and not previously described in a neonate younger than 2 weeks. Trauma resulting in inoculation of the nail fold is the most common predisposing factor to paronychia. Oral trauma in the pediatric population from finger sucking predisposes this population to a different set of bacterial pathogens than adults. Contamination can progress to infection and abscess formation within the nail fold with the most prevalent vector in adult infections being Staphylococcus aureus...
February 1, 2017: Hand: Official Journal of the American Association for Hand Surgery
https://www.readbyqxmd.com/read/28720040/distal-radius-fractures-aaos-appropriate-use-criteria-versus-actual-management-at-a-level-i-trauma-center
#20
James C Kyriakedes, Eugene Y Tsai, Douglas S Weinberg, Charles C Yu, Harry A Hoyen, Kevin Malone, Blaine T Bafus
BACKGROUND: The aim of this study is to determine whether the American Academy of Orthopaedic Surgeons' (AAOS) Appropriate Use Criteria (AUC) for distal radius fractures correlates with actual treatment by orthopedic hand surgeons at a level I trauma center. METHODS: ICD-9 codes were used to retrospectively identify patients who presented with wrist fractures over 1 year. Patients with isolated distal radius fractures were evaluated using the AAOS AUC application for distal radius fractures...
February 1, 2017: Hand: Official Journal of the American Association for Hand Surgery
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