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Trauma, critical Care

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https://www.readbyqxmd.com/read/29161399/global-lessons-developing-military-trauma-care-and-lessons-for-civilian-practice
#1
T Woolley, J A Round, M Ingram
The wars in Iraq and Afghanistan have helped to shape the modern Defence Medical Services. Many lessons were learnt including the need for rapid haemorrhage control, senior decision-making and the evolution of deployed transfusion support. These changes were implemented simultaneously with a coherent, end-to-end medical plan from point of wounding through to rehabilitation. Implementation of the medical plan is harmonious with the NHS trauma pathway, and is key to ensuring effective delivery. Military anaesthetists have a long pre-deployment training pathway starting with a Certificate of Completion of Training (CCT) in anaesthesia and/or critical care, and with an emphasis on military skills related to their specific role...
December 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29154111/pten-expression-and-its-association-with-glucose-control-and-calorie-supplementation-in-critically-ill-patients
#2
Alessio Molfino, Francesco Alessandri, Paola Mosillo, Donatella Dell'Utri, Alessio Farcomeni, Maria Ida Amabile, Alessandro Laviano
BACKGROUND & AIM: Phosphatase and tensin homologue (PTEN) reduces insulin sensitivity. Since critically ill patients present insulin resistance, we aimed at assessing the role of PTEN expression on glucose homeostasis and clinical outcome in patients admitted to an intensive care unit (ICU) and receiving artificial nutrition. METHODS: Observational, single-center study conducted in one ICU in Rome, Italy on adult patients hospitalized for trauma. Plasma glucose levels and its variability were recorded in patients receiving artificial nutrition...
November 4, 2017: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/29142631/mortality-and-epidemiology-in-256-cases-of-pediatric-traumatic-brain-injury-korean-neuro-trauma-data-bank-system-kntdbs-2010-2014
#3
Hee-Won Jeong, Seung-Won Choi, Jin-Young Youm, Jeong-Wook Lim, Hyon-Jo Kwon, Shi-Hun Song
Objective: Among pediatric injury, brain injury is a leading cause of death and disability. To improve outcomes, many developed countries built neurotrauma databank (NTDB) system but there was not established nationwide coverage NTDB until 2009 and there have been few studies on pediatric traumatic head injury (THI) patients in Korea. Therefore, we analyzed epidemiology and outcome from the big data of pediatric THI. Methods: We collected data on pediatric patients from 23 university hospitals including 9 regional trauma centers from 2010 to 2014 and analyzed their clinical factors (sex, age, initial Glasgow coma scale, cause and mechanism of head injury, presence of surgery)...
November 2017: Journal of Korean Neurosurgical Society
https://www.readbyqxmd.com/read/29139608/current-state-of-screening-high-ace-youth-and-emerging-adults-in-primary-care
#4
Michelle Pardee, Elizabeth Kuzma, Chin Hwa Gina Y Dahlem, Nicole Boucher, Cynthia S Darling-Fisher
BACKGROUND AND PURPOSE: Trauma comes in many forms, including interpersonal, community, and institutional trauma. The adverse childhood event (ACE) studies demonstrated that adverse experiences in childhood can have a profound, cumulative impact on the course of health and development over a lifetime. It is critical for healthcare providers, such as nurse practitioners (NPs), working in primary care to screen adolescents and emerging adults for a history of ACEs and trauma. A review of current assessment tools used in assessing this population in health settings is needed to determine how screening for ACEs is being performed...
November 15, 2017: Journal of the American Association of Nurse Practitioners
https://www.readbyqxmd.com/read/29132578/major-trauma-outside-a-trauma-center-prehospital-emergency-department-and-retrieval-considerations
#5
REVIEW
Preston J Fedor, Brian Burns, Michael Lauria, Clare Richmond
Care of the critically injured begins well before the patient arrives at a large academic trauma center. It is important to understand the continuum of care from the point of injury in the prehospital environment, through the local hospital and retrieval, until arrival at a trauma center capable of definitive care. This article highlights the important aspects of trauma assessment and management outside of tertiary or quaternary care hospitals. Key elements of each phase of care are reviewed, including management pearls and institutional strategies to facilitate effective and efficient treatment of trauma patients from the point of injury forward...
February 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29132574/major-abdominal-trauma-critical-decisions-and-new-frontiers-in-management
#6
REVIEW
Megan Brenner, Christopher Hicks
A standardized approach should be used with a patient with abdominal trauma, including primary and secondary surveys, followed by additional diagnostic testing as indicated. Specific factors can make the diagnosis of serious abdominal trauma challenging, particularly in the face of multiple and severe injuries, unknown mechanism of injury, altered mental status, and impending or complete cardiac arrest. Advances in technology in diagnosis and/or treatment with ultrasound, helical computed tomography, and resuscitative endovascular balloon occlusion of the aorta (REBOA) have significantly advanced trauma care, and are still the focus of current and ongoing investigations...
February 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29125417/loss-of-mechanosensitive-sclerostin-may-accelerate-cranial-bone-growth-and-regeneration
#7
Kyung Shin Kang, Jeff Lastfogel, Laurie L Ackerman, Andrew Jea, Alexander G Robling, Sunil S Tholpady
OBJECTIVE Cranial defects can result from trauma, infection, congenital malformations, and iatrogenic causes and represent a surgical challenge. The current standard of care is cranioplasty, with either autologous or allogeneic material. In either case, the intrinsic vascularity of the surrounding tissues allows for bone healing. The objective of this study was to determine if mechanotransductive gene manipulation would yield non-weight-bearing bone regeneration in a critical size calvarial defect in mice. METHODS A mouse model of Sost deletion in Sost knockout (KO) mice was created in which the osteocytes do not express sclerostin...
November 10, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29123889/a-case-of-non-cardiogenic-pulmonary-edema-provoked-by-intravenous-acetazolamide
#8
Yuichiro Ono, Makiko Morifusa, Satoru Ikeda, Chika Kunishige, Yoshiki Tohma
Case: A 61-year-old man was diagnosed with severe chest trauma after a car accident and had had difficulty in weaning from a ventilator because of flail chest and dilated cardiomyopathy. On the 17th day in the intensive care unit, he received i.v. acetazolamide to increase urine output. One hour after the injection, he suddenly developed severe hypoxia. Chest radiography revealed a butterfly shadow. He received other diuretics and a vasodilator, which seemed slowly to resolve the respiratory failure...
July 2017: Acute Medicine & Surgery
https://www.readbyqxmd.com/read/29118899/alterations-in-tendon-microenvironment-in-response-to-mechanical-load-potential-molecular-targets-for-treatment-strategies
#9
REVIEW
Mohamed B Fouda, Finosh G Thankam, Matthew F Dilisio, Devendra K Agrawal
Rotator cuff (RC) tendons could beinflicted in many ways with an eventual outcome of pain, weakness and disability, which represent a large burden on health care cost. However, optimal healing, either conservatively or with surgical intervention, remains an issue that needs further investigation. Disorders of the RC tendons may result from external factors like trauma, or internal factors through physiologic and metabolic derangement. Most RC tendon disorders may be asymptomatic and may result from an over-activity of the inflicted shoulder and its tendons...
2017: American Journal of Translational Research
https://www.readbyqxmd.com/read/29103558/disease-and-surgery-of-the-equine-lens
#10
REVIEW
Wendy M Townsend
Examination of the lens is critical, particularly when evaluating horses with visual impairment or performing prepurchase examinations. To adequately evaluate the lens, the pupil must be pharmacologically dilated. A cataract is any lens opacity. The size, density, and position of a cataract determine the impact on vision. Cataracts may be congenital or inherited or occur secondary to trauma or equine recurrent uveitis. Surgical removal is the only treatment option for vision impairing cataracts, but careful selection of surgical candidates is critical for successful outcomes...
December 2017: Veterinary Clinics of North America. Equine Practice
https://www.readbyqxmd.com/read/29093812/-first-person-view-of-pathogen-transmission-and-hand-hygiene-use-of-a-new-head-mounted-video-capture-and-coding-tool
#11
Lauren Clack, Manuela Scotoni, Aline Wolfensberger, Hugo Sax
Background: Healthcare workers' hands are the foremost means of pathogen transmission in healthcare, but detailed hand trajectories have been insufficiently researched so far. We developed and applied a new method to systematically document hand-to-surface exposures (HSE) to delineate true hand transmission pathways in real-life healthcare settings. Methods: A head-mounted camera and commercial coding software were used to capture ten active care episodes by eight nurses and two physicians and code HSE type and duration using a hierarchical coding scheme...
2017: Antimicrobial Resistance and Infection Control
https://www.readbyqxmd.com/read/29092866/effect-of-meaningful-recognition-on-critical-care-nurses-compassion-fatigue
#12
Lesly A Kelly, Cindy Lefton
BACKGROUND: As caregivers in high-pressure environments, critical care nurses are at risk for burnout and secondary trauma-components of compassion fatigue. Recent findings have increased understanding of the phenomena, specifically that satisfaction and meaningful recognition may play a role in reducing burnout and raising compassion satisfaction; however, no large multisite studies of compassion fatigue have been conducted. OBJECTIVES: To examine the effect of meaningful recognition and other predictors on compassion fatigue in a multicenter national sample of critical care nurses...
November 2017: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/29088951/update-on-critical-care-for-acute-spinal-cord-injury-in-the-setting-of-polytrauma
#13
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/29077240/training-and-assessing-critical-airway-breathing-and-hemorrhage-control-procedures-for-trauma-care-live-tissue-versus-synthetic-models
#14
Danielle Hart, Robert Rush, Gregory Rule, Joseph Clinton, Gregory Beilman, Shilo Anders, Rachel Brown, Mary Ann McNeil, Troy Reihsen, Jeffrey Chipman, Robert Sweet
INTRODUCTION: Optimal teaching and assessment methods and models for emergency airway, breathing and hemorrhage interventions are not currently known. The University of Minnesota Combat Casualty Training consortium (UMN CCTC) was formed to explore the strengths and weaknesses of synthetic training models (STMs) versus Live tissue (LT) models. In this study, we compare the effectiveness of best in class STMs versus an anesthetized caprine (goat) model for training and assessing 7 procedures: Junctional hemorrhage control, Tourniquet (TQ) placement, Chest seal, Needle thoracostomy (NCD), Nasopharyngeal airway (NPA), Tube thoracostomy, and Cricothyrotomy (Cric)...
October 27, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29069252/stress-trauma-and-posttraumatic-stress-disorder-in-migrants-a-comprehensive-review
#15
Lineth H U Bustamante, Raphael O Cerqueira, Emilie Leclerc, Elisa Brietzke
OBJECTIVE: There is growing evidence supporting the association between migration and posttraumatic stress disorder (PTSD). Considering the growing population of migrants and the particularities of providing culturally sensitive mental health care for these persons, clinicians should be kept up to date with the latest information regarding this topic. The objective of this study was to critically review the literature regarding migration, trauma and PTSD, and mental health services. METHODS: The PubMed, SciELO, LILACS, and ISI Web of Science databases were searched for articles published in Portuguese, English, Spanish, or French, and indexed from inception to 2017...
October 19, 2017: Revista Brasileira de Psiquiatria
https://www.readbyqxmd.com/read/29061476/long-term-changes-of-patient-reported-quality-of-life-after-major-trauma-the-importance-of-the-time-elapsed-after-injury
#16
Evi Fleischhacker, Heiko Trentzsch, David Kuppinger, Franziska Meigel, Felix Beyer, Wolfgang H Hartl
BACKGROUND: Numerous studies have identified various risk factors for a poor health-related quality of life (HRQOL) after severe trauma. The relative importance of the time elapsed after injury, however, is unknown and results of clinical studies have been conflicting. METHODS: A cross-sectional study was performed in two trauma centres using data from the German TraumaRegister DGU(®), which contained prospectively collected information on the type and severity of the injury, on critical care, and on outcome...
October 12, 2017: Injury
https://www.readbyqxmd.com/read/29040247/use-of-ondansetron-for-vomiting-after-head-trauma-does-it-mask-clinically-significant-traumatic-brain-injury
#17
Israel Green-Hopkins, Michael C Monuteaux, Lois Lee, Lise Nigrovic, Rebekah Mannix, Sara Schutzman
OBJECTIVES: We describe ondansetron use in children with head injury evaluated in pediatric emergency departments and its association with return visits and late diagnoses of intracranial injuries requiring intervention. METHODS: Children ages 6 months to 18 years discharged without neuroimaging from 35 pediatric emergency departments with a diagnosis of head injury from 2009 to 2013 were identified retrospectively from the Pediatric Health Information System. We evaluated the rates of ondansetron use during the study period and of the association of ondansetron treatment with the diagnosis of intracranial injury, skull fracture, and return visits within 72 hours requiring admission or operative intervention...
October 16, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29040201/don-t-call-me-crazy-delirium-occurs-outside-of-the-icu
#18
Anthony Cahill, Christopher Pearcy, Khalid Almahmoud, Vaidehi Agrawal, Usha Mani, Phillip Sladek, Michael S Truitt
INTRODUCTION: Delirium has been well studied among patients in the Intensive Care Unit (ICU); however, data beyond the ICU is limited. The purpose of this study is to prospectively evaluate the incidence and associated risk factors for delirium in non-critical care areas (NCCA). METHODS: After IRB approval, a prospective cohort study was conducted at our urban Level I Trauma Center from December 2015 to February 2016. All patients admitted to the designated study area by a trauma surgeon were included...
October 16, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29035926/damage-control-surgery-current-state-and-future-directions
#19
Daniel Benz, Zsolt J Balogh
PURPOSE OF REVIEW: Damage control surgery (DCS) represents a staged surgical approach to the treatment of critically injured trauma patients. Originally described in the context of hepatic trauma and postinjury-induced coagulopathy, the indications for DCS have expanded to the management of extra abdominal trauma and to the management of nontraumatic acute abdominal emergencies. Despite being an accepted treatment algorithm, DCS is based on a limited evidence with current concerns of the variability in practice indications, rates and adverse outcomes in poorly selected patient cohorts...
December 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29035924/rotational-therapy-in-thoracic-injuries-what-is-the-evidence
#20
Philipp Störmann, Ingo Marzi, Sebastian Wutzler
PURPOSE OF REVIEW: To review the current use of continuous lateral rotational therapy (CLRT) in patients with thoracic injuries and its impact on clinical course, complications and outcome. RECENT FINDINGS: Patient positioning is a key factor in the treatment of severe thoracic injuries and CLRT, and intermittent supine and prone position are basic options. There is a lack of randomized controlled studies for trauma patients with chest injury undergoing kinetic therapy as standard of care...
December 2017: Current Opinion in Critical Care
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