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Marc L Martel, Lauren R Klein, Andrew J Lichtenheld, Allan M Kerandi, Brian E Driver, Jon B Cole
BACKGROUND: Altered mental status is a commonly evaluated problem in the ED. Ethanol intoxication is common, and prehospital history may bias emergency physicians to suspect this as the cause of altered mental status. Quantitative ethanol measurement can rapidly confirm the diagnosis, or if negative, prompt further evaluation. Our objective was to identify the etiologies of altered mental status in ED patients initially presumed to be intoxicated with ethanol but found to have negative quantitative ethanol levels...
March 12, 2018: American Journal of Emergency Medicine
Ashley C McGinity, Caroline S Zhu, Leslie Greebon, Elly Xenakis, Elizabeth Waltman, Eric Epley, Danielle Cobb, Rachelle Jonas, Susannah E Nicholson, Brian J Eastridge, Ronald M Stewart, Donald H Jenkins
The mortality from hemorrhage in trauma patients remains high. Early balanced resuscitation improves survival. These truths, balanced with the availability of local resources and our goals for positive regional impact, were the foundation for the development of our pre-hospital whole blood initiative-using low titer cold stored O RhD positive whole blood (LTOWB). The main concern with use of RhD positive blood is the potential development of isoimmunization in RhD negative patients. We used our retrospective massive transfusion protocol (MTP) data to analyze the anticipated risk of this change in practice...
March 16, 2018: Journal of Trauma and Acute Care Surgery
Brian E Bunnell, Tatiana M Davidson, Kenneth J Ruggiero
Peritraumatic distress is defined as the emotional and physiological distress experienced during and/or immediately after a traumatic event and is associated with the development and severity of posttraumatic stress disorder (PTSD) and related psychological difficulties. The Peritraumatic Distress Inventory (PDI) is a widely-used self-report measure for which psychometric evaluation has been limited. This study sought to assess the factor structure and predictive validity of the PDI with a clinical sample of 600 traumatically injured patients admitted to a Level I trauma center, 271 of whom completed a phone-based PTSD screening ∼30-days post-injury...
March 9, 2018: Journal of Anxiety Disorders
Brian M Blair, Fernandino Vilson, Neil J Kocher, Edward Kloniecke, Joseph Y Clark
Fracture of the penis is a well-recognized yet relatively uncommon urologic event. Forceful, blunt trauma with lateral bending of the penis in an erect state typically results in a transverse rupture of the tunica albuginea of the corpus cavernosum. Longitudinal tears of the corpus cavernosum are by themselves considered infrequent. We present a rare case of a patient with longitudinal rupture of the distal corpus cavernosum with concomitant extension to the corpus spongiosum causing partial urethral disruption as a result of trauma during sexual intercourse...
March 13, 2018: Urology
Sarah B Cairo, Malachi Fisher, Brian Clemency, Charlotte Cipparone, Evelyn Quist, Kathryn D Bass
PURPOSE: Patient triage to the appropriate destination is critical to prehospital trauma care. Triage decisions are challenging in a region without collocated pediatric and adult trauma centers. METHODS: A regional survey was administered to emergency medical response units identifying variability and confusion regarding factors influencing patient disposition. A course was developed to guide the triage of pediatric and pregnant trauma patients. Pre- and posttests were administered to address course principles, including decision making and triage...
February 11, 2018: Journal of Pediatric Surgery
John P Lichtenberger, Andrew M Kim, Dane Fisher, Peter S Tatum, Brian Neubauer, P Gabriel Peterson, Brett W Carter
Introduction: Combat-related thoracic trauma (CRTT) is a significant contributor to morbidity and mortality of the casualties from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Penetrating, blunt, and blast injuries are the most common mechanisms of trauma to the chest. Imaging plays a key role in the battlefield management of CRTT casualties. This work discusses the imaging manifestations of thoracic injuries from blunt trauma and blast injury, emphasizing epidemiology and diagnostic clues seen during OEF and OIF...
March 1, 2018: Military Medicine
John P Lichtenberger, Andrew M Kim, Dane Fisher, Peter S Tatum, Brian Neubauer, P Gabriel Peterson, Brett W Carter
Introduction: Combat-related thoracic trauma is a significant contributor to morbidity and mortality of the casualties from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Penetrating, blunt, and blast injuries were the most common mechanisms of trauma. Imaging plays a key role in the management of combat-related thoracic trauma casualties. This review discusses the imaging manifestations of thoracic injuries from penetrating trauma, emphasizing epidemiology and diagnostic clues seen during OEF and OIF...
March 1, 2018: Military Medicine
Maria L Pacella, Jeffrey M Girard, Aidan G C Wright, Brian Suffoletto, Clifton W Callaway
OBJECTIVES: Psychosocial factors and responses to injury modify the transition from acute to chronic pain. Specifically, posttraumatic stress disorder symptoms (PTSS; reexperiencing, avoidance, and hyperarousal symptoms) exacerbate and co-occur with chronic pain. Yet no study has prospectively considered the associations among these psychological processes and pain reports using experience sampling methods (ESM) during the acute aftermath of injury. This study applied ESM via daily text messaging to monitor and detect relationships among psychosocial factors and post-injury pain across the first 14-days after emergency department (ED) discharge...
March 7, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Brian Chang, Jennifer F Ha, David Zopf
Aggressive fibromatosis is an uncommon, benign tumor of fibroblastic origin with high potential for local invasion. Less than a quarter of these lesions are located in the head and neck, and although extremely rare, associations have been demonstrated with physical trauma. We describe a unique case of oropharyngeal fibromatosis with traumaticetiology, managed successfully with surgical excision of the lesion with negative surgical margins. A 5-year old patient was found to have an aggressive fibromatosis causing oropharyngeal stenosis following tonsillectomy...
April 2018: International Journal of Pediatric Otorhinolaryngology
Shubhi Singh, Brian Blakley
OBJECTIVE: There is uncertainty regarding the safety of surgical antiseptic preparations in the ear. A systematic review of the literature was conducted to assess the evidence regarding ototoxicity of surgical antiseptic preparations. METHODS: A literature search was conducted using the PRISMA methods. Key words included "ototoxicity" "hearing loss", "antiseptic", "surgical preparation", "tympanoplasty", "vestibular dysfunction", "chlorhexidine", "iodine", "povidone", "ethanol", and "hydrogen peroxide" using Medline, Embase, Cochrane Library, Scopus and Web of Science...
March 1, 2018: Journal of Otolaryngology—Head & Neck Surgery
John R Keefe, Shannon Wiltsey Stirman, Zachary D Cohen, Robert J DeRubeis, Brian N Smith, Patricia A Resick
BACKGROUND: Dropout rates for effective therapies for posttraumatic stress disorder (PTSD) can be high, especially in practice settings. Although clinicians have intuitions regarding what treatment patients may complete, there are few systematic data to drive those judgments. METHODS: A multivariable model of dropout risk was constructed with randomized clinical trial data (n = 160) comparing prolonged exposure (PE) and cognitive processing therapy (CPT) for rape-induced PTSD...
February 28, 2018: Depression and Anxiety
Brian Borsari, Matthew M Yalch, Paola Pedrelli, Sharon Radomski, Rachel L Bachrach, Jennifer P Read
OBJECTIVE: This study examined how profiles of alcohol use and symptoms of common mental health disorders (depression and posttraumatic stress disorder [PTSD]) influenced the perceived need for and actual seeking of different types of treatment (for alcohol versus psychological distress) in college student drinkers. PARTICIPANTS: Undergraduate students (N = 164) were assessed between September 2009 and August 2015. METHODS: We classified students into different symptom profiles using model-based clustering and compared these profiles on a variety of variables...
February 28, 2018: Journal of American College Health: J of ACH
Rondi B Gelbard, Paula Ferrada, D Dante Yeh, Brian Williams, Michele Loor, James Yon, Caleb Mentzer, Kosar Khwaja, Mansoor Khan, Anirudh Kohli, Eileen M Bulger, Bryce R H Robinson
BACKGROUND: Necrotizing soft tissue infections (NSTI) are rare, life-threatening, soft-tissue infections characterized by rapidly spreading inflammation and necrosis of the skin, subcutaneous fat, and fascia. While it is widely accepted that delay in surgical debridement contributes to increased mortality, there are currently no practice management guidelines regarding the optimal timing of surgical management of this condition. Although debridement within 24 hours of diagnosis is generally recommended, the time ranges from 3 hours to 36 hours in the existing literature...
February 27, 2018: Journal of Trauma and Acute Care Surgery
Clinton Protack, Brian Wengerter, Raymond A Jean, Shirley Liu, Hamid Mojibian, Bauer Sumpio, Alan Dardik, Adrian A Maung, Young Erben
Objective  In an era of managed care and cost savings, we are faced with the question of whether another test is necessary to confirm our clinical suspicion. We hypothesized that a few computed tomography angiographies (CTAs) are necessary to identify lower extremity vascular injuries (LEVIs). We reviewed our trauma center's experience in the management of LEVI. Methods  A retrospective review of all trauma patients between 2012 and 2016 was performed. Four-thousand nine-hundred fourteen trauma patients were evaluated with 46 suspected LEVIs (either with cross-sectional imaging and/or operative exploration)...
March 2018: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
Todd E Thurston, Anee S Jackson, Naiman Nazir, Brian T Andrews, Danielle Crowe
INTRODUCTION: Ideally, all patients with isolated orbit fracture would undergo ophthalmologic evaluation before surgical intervention to rule out concomitant globe injury and possible vision loss. Unfortunately, not all institutions are capable of providing the evaluation before surgery. The authors hypothesize that the anatomic location of a single-wall orbit isolated orbit fracture can help predict the likelihood of ocular injury and thus identify high-risk patients who mandate ophthalmologic evaluation before surgical repair...
February 23, 2018: Journal of Craniofacial Surgery
Frederick B Rogers, William McCune, Shreya Jammula, Brian W Gross, Eric H Bradburn, Deborah K Riley, Jeffrey Manning
Described herein is the utilization of the hospital's Emergency Operations Plan and incident command structure to mitigate damage caused by the sudden loss of the heating, ventilation, and air conditioning system within the entire operating room suite. The ability to ameliorate a devastating situation that occurred during working hours at a busy Level II trauma center can be ascribed to the dedication of the leadership and clinical teams working seamlessly together. Their concerted efforts were augmented by adherence to an established protocol that had been thoroughly substantiated and practiced during numerous training simulations...
October 2017: American Journal of Disaster Medicine
Joshua T Bucher, Christopher Bryczkowski, Grant Wei, Renee L Riggs, Anoop Kotwal, Brian Sumner, Jonathan V McCoy
BACKGROUND: The purpose of our study is to investigate rates of individual procedures performed by residents in our emergency medicine (EM) residency program. Different programs expose residents to different training environments. Our hypothesis is that ultrasound examinations are the most commonly performed procedure in our residency. METHODS: The study took place in an academic level I trauma center with multiple residency and fellowship programs including surgery, surgical critical care, trauma, medicine, pulmonary/critical care, anesthesiology and others...
February 14, 2018: International Journal of Emergency Medicine
Tanya L Zakrison, Rishi Rattan, Davel Milian Valdés, Xiomara Ruiz, Rondi Gelbard, John Cline, David Turay, Xian Luo-Owen, Nicholas Namias, Jessica George, Dante Yeh, Daniel Pust, Brian H Williams
INTRODUCTION: A recent EAST-supported, multicenter trial demonstrated a similar rate of intimate partner and sexual violence (IPSV) between male and female trauma patients, regardless of mechanism. Our objective was to perform a subgroup analysis of our affected male cohort as this remains an understudied group in the trauma literature. METHODS: We conducted a recent EAST-supported, cross-sectional, multicenter trial over one year (03/15-04/16) involving four Level I trauma centers throughout the United States...
February 14, 2018: Journal of Trauma and Acute Care Surgery
Brian Grawe, Amanda J Schroeder, Rafael Kakazu, Malynda S Messer
The lateral collateral ligament is the primary varus stabilizer of the tibiofemoral joint. Diagnosing an injury to this ligament can be challenging in the setting of multiligamentous trauma; however, failure to recognize these injuries can result in instability of the knee and unsatisfactory outcomes after cruciate ligament reconstruction. Recent literature exploring the anatomy and biomechanics of the lateral collateral ligament has enhanced our understanding and improved diagnosis and management of these injuries...
March 15, 2018: Journal of the American Academy of Orthopaedic Surgeons
Francesca L Beaudoin, Roee Gutman, Wanting Zhai, Roland C Merchant, Melissa A Clark, Kenneth A Bollen, Phyllis Hendry, Michael C Kurz, Christopher Lewandowski, Claire Pearson, Brian O'Neil, Elizabeth Datner, Patricia Mitchell, Robert Domeier, Samuel A McLean
African-Americans experience a greater burden of acute pain than non-Hispanic white individuals across of variety of acute medical conditions, but it is unknown if this is the case following trauma. We evaluated pain, pain-related characteristics (e.g. peri-traumatic distress), and analgesic treatment in two cohorts of individuals (African-American (n=931) and non-Hispanic white (n=948)) presenting to the emergency department after a motor-vehicle crash (MVC). We performed a propensity-matched analysis (n=796 in each group) to assess racial differences in acute pain in the ED...
February 9, 2018: Pain
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