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Trauma, critical Care

Alan Bleakley
Inequalities in society are reflected in patterns of disease and access to health care, where the disadvantaged suffer most. Traditionally, doctors have kept politics out of their work, even though politics often shape medicine. What political responsibilities, then, should doctors have as they facilitate the learning of medical students? The article in this issue by Kumagai, Jackson, and Razack goes straight to the heart of this question. These authors ask whether educators should be wary of "cutting close to the bone" in discussing issues that may restimulate trauma in some medical students...
October 25, 2016: Academic Medicine: Journal of the Association of American Medical Colleges
Paula Ferrada, Rao R Ivatury, David A Spain, Kimberly A Davis, Michel Aboutanos, John J Fildes, Thomas M Scalea
INTRODUCTION: Acute Care Surgery (ACS), Trauma and Surgical Critical Care (SCC) fellowships graduate fellows deemed qualified to perform complex cases immediately upon graduation. We hypothesize international fellow rotations (IFR) can be a resource to supplement operative case exposure METHODS: A survey was sent to all program directors of ACS and SCC fellowships via email. Data was captured and analyzed using the Research Electronic Data Capture (REDCap) tool. RESULTS: The survey was sent to 113 program directors (PDs) with a response rate of 42%...
October 25, 2016: Journal of Trauma and Acute Care Surgery
Chiara Robba, Andrea Ortu, Federico Bilotta, Alessandra Lombardo, Mypinder S Sekhon, Fabio Gallo, Basil F Matta
BACKGROUND: Veno-venous extra-corporeal membrane oxygenation (vv-ECMO) is an established salvage therapy for severe respiratory failure, and may provide an alternative form of treatment for trauma-induced acute respiratory distress syndrome (ARDS) when conventional treatments have failed. The need for systemic anticoagulation is a relative contraindication in patients with bleeding risks, especially in multi traumatic injury. METHODS: We describe a case series of four trauma patients with ARDS who were managed with ECMO admitted to the Neuro Critical Care Unit (NCCU) at Addenbrooke's Hospital, Cambridge (UK), from January 2000 to January 2016...
October 25, 2016: Journal of Trauma and Acute Care Surgery
Pauline K Park, Jeremy W Cannon, Wen Ye, Lorne H Blackbourne, John B Holcomb, William Beninati, Lena M Napolitano
BACKGROUND: The overall incidence and mortality of acute respiratory distress syndrome (ARDS) in civilian trauma settings have decreased over the past four decades; however, the epidemiology and impact of ARDS on modern combat casualty care are unknown. We sought to determine the incidence, risk factors, resource utilization, and mortality associated with ARDS in current combat casualty care. METHODS: This was a retrospective review of mechanically ventilated US combat casualties within the Department of Defense Trauma Registry (formerly the Joint Theater Trauma Registry) during Operation Iraqi Freedom/Enduring Freedom (October 2001 to August 2008) for ARDS development, resource utilization, and mortality...
November 2016: Journal of Trauma and Acute Care Surgery
P Michel, D Wähnert, M Freistühler, M G Laukoetter, S Rehberg, M J Raschke, P Garcia
BACKGROUND: Secondary abdominal compartment syndrome is well known as a life-threatening complication in critically ill patients in an intensive care unit. Massive crystalloid fluid resuscitation has been identified as the most important risk factor. The time interval from hospital admittance to the development of manifest abdominal compartment syndrome is usually greater than 24 hours. In the absence of any direct abdominal trauma, we observed a rapidly evolving secondary abdominal compartment syndrome shortly after hospital admittance associated with massive transfusion of blood products and only moderate crystalloid resuscitation...
October 19, 2016: Journal of Medical Case Reports
Joseph A Carcillo, J Michael Dean, Richard Holubkov, John Berger, Kathleen L Meert, Kanwaljeet J S Anand, Jerry Zimmerman, Christopher J Newth, Rick Harrison, Jeri Burr, Douglas F Willson, Carol Nicholson, Michael J Bell, Robert A Berg, Thomas P Shanley, Sabrina M Heidemann, Heidi Dalton, Tammara L Jenkins, Allan Doctor, Angie Webster
BACKGROUND: Nosocomial infection remains an important health problem in long stay (>3 days) pediatric intensive care unit (PICU) patients. Admission risk factors related to the development of nosocomial infection in long stay immune competent patients in particular are not known. METHODS: Post-hoc analysis of the previously published Critical Illness Stress induced Immune Suppression (CRISIS) prevention trial database, to identify baseline risk factors for nosocomial infection...
November 2016: Pediatric Infectious Disease Journal
Tellen D Bennett, Rebecca R Dixon, Cory Kartchner, Peter E DeWitt, Yamila Sierra, Diane Ladell, Allison Kempe, Desmond K Runyan, J Michael Dean, Heather T Keenan
OBJECTIVES: In children with traumatic brain injury, 1) to describe the hospital discharge functional outcome and change from baseline function using the Functional Status Scale and 2) to determine any associations between discharge Functional Status Scale and age, injury mechanism, neurologic examination, imaging, and other predictors of outcome. DESIGN: Prospective observational cohort study, May 2013 to November 2015. SETTING: Two U.S. children's hospitals designated as American College of Surgeons level 1 pediatric trauma centers...
October 6, 2016: Pediatric Critical Care Medicine
Jody M Kaban, Anand Dayama, Srinivas H Reddy, Sheldon Teperman, Melvin E Stone
OBJECTIVE: Our institution began Advanced Trauma Operative Management (ATOM) simulation course in 2007 for senior residents with the aim of increasing opportunities for surgical trainees to gain operative trauma experience. The aim of our study was to evaluate the effect of the ATOM simulation course on residents' choice of trauma as a career as demonstrated by entrance into surgical critical care (SCC) fellowships. DESIGN: Retrospective study of institutional data on graduating residents from 2002 to 2015...
October 11, 2016: International Journal of Surgery
Anna-Barbara Schlüer
While the problem of Pressure Ulcers (PU) in adults has received a great deal of attention, far less is known about PUs in neonates and children. The overall health status of children is generally better and multi-morbidity is limited to a small percentage of patients, like very low term neonates (born before 32 weeks of gestation age), newborns with congenital abnormalities, genetic disorders, perinatal distress syndrome or children with a limited immunity. Survival rates of both critically and chronically ill neonates, infants and children have improved dramatically in recent years, introducing new challenges for medical and nursing care...
October 8, 2016: Journal of Tissue Viability
Craig D Newgard, Rongwei Fu, Eileen Bulger, Jerris R Hedges, N Clay Mann, Dagan A Wright, David P Lehrfeld, Carol Shields, Gregory Hoskins, Craig Warden, Lynn Wittwer, Jennifer N B Cook, Michael Verkest, William Conway, Stephanie Somerville, Matthew Hansen
Importance: Despite a large rural US population, there are potential differences between rural and urban regions in the processes and outcomes following trauma. Objectives: To describe and evaluate rural vs urban processes of care, injury severity, and mortality among injured patients served by 9-1-1 emergency medical services (EMS). Design, Setting, and Participants: This was a preplanned secondary analysis of a prospective cohort enrolled from January 1 through December 31, 2011, and followed up through hospitalization...
October 12, 2016: JAMA Surgery
Yaseen Oweis, Zachary Viets, Anup S Shetty
In the acute care setting, radiologists are frequently asked to assist in the evaluation of patients presenting with signs and symptoms of lower extremity peripheral vascular disease. Non-traumatic peripheral vascular emergencies are most commonly the result of thrombosis, either in a native vessel or within a bypass graft or stent. Arterial emboli, peripheral aneurysm with embolus or thrombosis, and direct arterial trauma are additional, less common causes. Traumatic peripheral vascular emergencies include vessel occlusion, transection, pseudoaneurysms, active extravasation, and arteriovenous fistulas...
October 11, 2016: Abdominal Radiology
Olav Nyttingnes, Torleif Ruud, Jorun Rugkåsa
PURPOSE: Some patients criticize coercive mental health treatment using extremely strong words. This may be connected to poor therapeutic relationships and unfavourable treatment outcomes, so a better understanding of this criticism is warranted. METHODS: Data consisted of detailed notes from 15 all-day dialogue seminars on coercion and voluntariness in Oslo, Norway from 2006 to 2009. Very dissatisfied patients and ex-patients were a central voice through the seminars...
October 7, 2016: International Journal of Law and Psychiatry
Nils Kunze-Szikszay, Lennart A Krack, Pauline Wildenauer, Saskia Wand, Tim Heyne, Karoline Walliser, Christopher Spering, Martin Bauer, Michael Quintel, Markus Roessler
BACKGROUND: Hyperfibrinolysis (HF) is a major contributor to coagulopathy and mortality in trauma patients. This study investigated (i) the rate of HF during the pre-hospital management of patients with multiple injuries and (ii) the effects of pre-hospital tranexamic acid (TxA) administration on the coagulation system. METHODS: From 27 trauma patients with pre-hospital an estimated injury severity score (ISS) ≥16 points blood was obtained at the scene and on admission to the emergency department (ED)...
October 10, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Naranpurev Mendsaikhan, Tsolmon Begzjav, Ganbold Lundeg, Martin W Dünser
CONTEXT: The epidemiology and outcome of critical illness in Mongolia remain undefined. AIM: The aim of this study was to evaluate the epidemiology and outcome of critical illness in Mongolia. SETTINGS AND DESIGN: This is a multicenter, prospective, observational cohort study including 19 Mongolian centers. MATERIALS AND METHODS: Demographic, clinical, and outcome data of patients >15 years admitted to the Intensive Care Units (ICUs) were collected during a 6-month period...
July 2016: International Journal of Critical Illness and Injury Science
Hannington Ssemmanda, Tonny Stone Luggya, Clare Lubulwa, Zeridah Muyinda, Pascal Kwitonda, Humphrey Wanzira, Joseph Ejoku
Background. Critical care in Uganda is a neglected speciality and deemed costly with limited funding/prioritization. We studied admission X-ray and MEWS as mortality predictors of ICU patients requiring mechanical ventilation. Materials and Methods. We did a cross-sectional study in Mulago Hospital ICU and 87 patients for mechanical ventilation were recruited with mortality as the outcome of interest. Chest X-ray results were the main independent variable and MEWS was also gotten for all patients. Results. We recruited 87 patients; most were males (60...
2016: Critical Care Research and Practice
Madhuradhar Chegondi, Jun Sasaki, André Raszynski, Balagangadhar R Totapally
OBJECTIVE: To evaluate the hemoglobin threshold for red cell transfusion in children admitted to a pediatric intensive care unit (PICU). METHODS: Retrospective chart review study. Tertiary care PICU. Critically ill pediatric patients requiring blood transfusion. No intervention. RESULTS: We analyzed the charts of all children between 1 month and 21 years of age who received packed red blood cell (PRBC) transfusions during a 2-year period. The target patients were identified from our blood bank database...
July 2016: Transfusion Medicine and Hemotherapy
J C Oldroyd, K M Venardos, N J Aoki, A J Zatta, Z K McQuilten, L E Phillips, N Andrianopoulos, D J Cooper, P A Cameron, J P Isbister, E M Wood
BACKGROUND: The Australian and New Zealand (ANZ) Massive Transfusion (MT) Registry (MTR) has been established to improve the quality of care of patients with critical bleeding (CB) requiring MT (≥ 5 units red blood cells (RBC) over 4 h). The MTR is providing data to: (1) improve the evidence base for transfusion practice by systematically collecting data on transfusion practice and clinical outcomes; (2) monitor variations in practice and provide an opportunity for benchmarking, and feedback on practice/blood product use; (3) inform blood supply planning, inventory management and development of future clinical trials; and (4) measure and enhance translation of evidence into policy and patient blood management guidelines...
October 6, 2016: BMC Research Notes
Biljana Kuzmanovska, Emilija Cvetkovska, Igor Kuzmanovski, Nikola Jankulovski, Mirjana Shosholcheva, Andrijan Kartalov, Tatjana Spirovska
INTRODUCTION: Rhabdomyolysis is a syndrome of injury of skeletal muscles associated with myoglobinuria, muscle weakness, electrolyte imbalance and often, acute kidney injury as severe complication. THE AIM: of this study is to detect the incidence of rhabdomyolysis in critically ill patients in the surgical intensive care unit (ICU), and to raise awareness of this medical condition and its treatment among the clinicians. MATERIAL AND METHODS: A retrospective review of all surgical and trauma patients admitted to surgical ICU of the University Surgical Clinic "Mother Teresa" in Skopje, Macedonia, from January 1(st) till December 31(st) 2015 was performed...
July 27, 2016: Medical Archives
Kim Foster, Alexandra Young, Rebecca Mitchell, Connie Van, Kate Curtis
INTRODUCTION: Physical injury is a leading cause of death and disability among children worldwide and the largest cause of paediatric hospital admission. Parents of critically injured children are at increased risk of developing mental and emotional distress in the aftermath of child injury. In the Australian context, there is limited evidence on parent experiences of child injury and hospitalisation, and minimal understanding of their support needs. The aim of this investigation was to explore parents' experiences of having a critically injured child during the acute hospitalisation phase of injury, and to determine their support needs during this time...
September 23, 2016: Injury
Robert F Tamburro, Tammara L Jenkins, Patrick M Kochanek
OBJECTIVE: To summarize the scientific priorities and potential future research directions for pediatric critical care research discussed by a panel of experts at the inaugural Strategic Planning Conference of the Pediatric Trauma and Critical Illness Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. DATA SOURCES: Expert opinion expressed during the Strategic Planning Conference. STUDY SELECTION: Not applicable...
September 27, 2016: Pediatric Critical Care Medicine
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