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Trauma & critical care

Craig R Ainsworth, Jeffrey Dellavolpe, Kevin K Chung, Leopoldo C Cancio, Phillip Mason
INTRODUCTION: Recent reports on the use of extracorporeal membrane oxygenation (ECMO) in critically ill burn patients with Acute Respiratory Distress Syndrome (ARDS) recommended against the use of ECMO. The authors cited the high mortality rates associated with the use of ECMO in these patients with no appreciable benefit. Accumulating evidence from referral centers suggests improved survival in patients with ARDS receiving ECMO. We report our recent experience treating patients with severe ARDS with ECMO in a burn intensive care unit...
June 11, 2018: Burns: Journal of the International Society for Burn Injuries
Séverin Ramin, Margaux Hermida, Ingrid Millet, Thibault Murez, Valérie Monnin, Mazen Hamoui, Xavier Capdevila, Jonathan Charbit
BACKROUND: The objective was to assess the predictive performance of different intravascular contrast extravasation (ICE) characteristics for need for pelvic transarterial embolization (TAE) to determine the risk factors of false-positives. METHODS: A retrospective study was performed in our trauma center between 2010 and 2015. All severe trauma patients with pelvic fracture were included. Pelvic ICE characteristics on computed tomography (CT) scan were studied: arterial (aSICE), portal surface (pSICE), and extension (exSICE) anatomic relationships...
June 12, 2018: Journal of Trauma and Acute Care Surgery
Lisa C Lindley, Elspeth M Slayter
CONTEXT: Children in foster care suffer with serious illness at end of life. However, the relationship between prior trauma exposure and serious illness has received little empirical attention. OBJECTIVES: The objectives were to examine the prevalence and type of trauma exposure, and investigate the relationship between prior trauma and serious illness among foster children at end of life. METHODS: We used national longitudinal foster care data...
June 8, 2018: Journal of Pain and Symptom Management
Eric Pierce, Renato Rapada, Penelope Anne Herder, Anthony J LaPorta, Tuan N Hoang, Mathew Pena, Jeff Blankenship, Jeff Kiser, Sarah Ashley Catlin
BACKGROUND: The US Navy initiated design concepts for a Medical Mission Module Support Container (M3SC), a mobile operating room capable of rapid installation aboard maneuverable ships within proximity of active combat units. The M3SC provides an alternative echelon of care in the current trauma system by decreasing the time between point of injury, arrival, and surgical intervention. The mobile ships used as M3SC platforms, however, are more susceptible to oceanic conditions that can induce detrimental physiologic motion sickness in medical personnel and patients aboard the vessels...
2018: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
Madeleine Mant
The presence of children in English voluntary hospitals during the eighteenth century has only recently come under academic scrutiny. This research examines the surviving admission records of the London Hospital, which consistently record inpatient ages, to illuminate the hospital stays of infant and child patients and examine the morbidity of children during the long eighteenth century. Traumatic cases were the most common category of admission. The proportion of trauma cases admitted to the London Hospital was higher than in provincial English child patient cohorts, potentially reflecting the differential risks faced by rural and urban children...
July 2018: Medical History
Sharon R Lewis, Oliver J Schofield-Robinson, Phil Alderson, Andrew F Smith
BACKGROUND: Critically ill people are at increased risk of malnutrition. Acute and chronic illness, trauma and inflammation induce stress-related catabolism, and drug-induced adverse effects may reduce appetite or increase nausea and vomiting. In addition, patient management in the intensive care unit (ICU) may also interrupt feeding routines. Methods to deliver nutritional requirements include provision of enteral nutrition (EN), or parenteral nutrition (PN), or a combination of both (EN and PN)...
June 8, 2018: Cochrane Database of Systematic Reviews
Marc Gutenstein, Sampsa Kiuru
We describe a phenomenon of self-reinforcing inequality between New Zealand rural hospitals and urban trauma centres. Rural doctors work in remote geographical locations, with rare exposure to managing critical injuries, and with little direct support when they do. Paradoxically, but for the same reasons, they also have little access to the intensive training resources and specialist oversight of their university hospital colleagues. In keeping with international experience, we propose that using simulation-based education for rural hospital trauma and emergency team training will mitigate this effect...
June 8, 2018: New Zealand Medical Journal
Kaihong Chen, Junyao Lv, Guanghuan Wang, Xiaojun Yu, Xiaohu Xu, Guanghui Zhu, Zhuying Shao, Dian Wang, Chang Tang, Shanqing Cai
BACKGROUND: Severe trauma can cause secondary multiple organ dysfunction syndrome and death. The absolute and relative concentrations of trace elements in both critical care and conventional treatment, which can lead to acute trace element deficiency, constitute an important mechanism of multiple organ dysfunction syndrome (MODS)/multiple organ failure (MOF). METHODS: We investigated the changes in serum Cu, Zn, and Fe in early stage trauma of patients with the high injury severity score (ISS) and correlated the change in trace elements with ISS...
June 2018: Medicine (Baltimore)
David A Shaye, Travis Tollefson, Irfan Shah, Gopal Krishnan, Damir Matic, Marcelo Figari, Thiam Chye Lim, Sunil Aniruth, Warren Schubert
BACKGROUND: Trauma is a significant contributor to global disease, and low-income countries disproportionately shoulder this burden. Education and training are critical components in the effort to address the surgical workforce shortage. Educators can tailor training to a diverse background of health professionals in low-resource settings using competency-based curricula. We present a process for the development of a competency-based curriculum for low-resource settings in the context of craniomaxillofacial (CMF) trauma education...
June 6, 2018: World Journal of Surgery
Nathan T Douthit, Seema Biswas
Since 2013, BMJ Case Reports ( has published over 70 global health case reports from five continents, written by doctors, nurses, students, and allied health professionals. These cases, a burgeoning repository of evidence of how real patients are affected by disease, trauma, violence, sexual assault, conflict, migration, adverse living and working conditions, and poor access to health care, discuss, in addition to clinicopathological findings, the global health problems affecting each patient...
2018: Frontiers in Public Health
Hamid Shokoohi, Ali Pourmand, Keith Boniface, Rebecca Allen, Bruno Petinaux, Babak Sarani, James P Phillips
As terrorist actors revise their tactics to outmaneuver increasing counter-terrorism security measures, a recent trend toward less-sophisticated attack methods has emerged. Most notable of these "low tech" trends are the Targeted Automobile Ramming MAss Casualty (TARMAC) attacks. Between 2014 and November 2017, 18 TARMAC attacks were reported worldwide, resulting in 181 deaths and 679 injuries. TARMAC attack-related injuries are unique compared to accidental pedestrian trauma and other causes of mass casualty incidents (MCI), and therefore they require special consideration...
May 29, 2018: American Journal of Emergency Medicine
Elizabeth J Lilley, Katherine C Lee, John W Scott, Nicole J Krumrei, Adil H Haider, Ali Salim, Rajan Gupta, Zara Cooper
BACKGROUND: Palliative care is associated with lower intensity treatment and better outcomes at the end of life. Trauma surgeons play a critical role in end-of-life (EOL) care, however the impact of PC on healthcare utilization at the end of life has yet to be characterized in older trauma patients. METHODS: This retrospective cohort study using 2006-2011 national Medicare claims included trauma patients ≥65 years who died within 180 days after discharge. The exposure of interest was inpatient palliative care during the trauma admission...
May 30, 2018: Journal of Trauma and Acute Care Surgery
Russ S Kotwal, Amanda M Staudt, Edward L Mazuchowski, Jennifer M Gurney, Stacy A Shackelford, Frank K Butler, Zsolt T Stockinger, John B Holcomb, Shawn C Nessen, Elizabeth A Mann-Salinas
BACKGROUND: Timely and optimal care can reduce mortality among critically injured combat casualties. US military Role 2 surgical teams were deployed to forward positions in Afghanistan on behalf of the battlefield trauma system. They received prehospital casualties, provided early damage control resuscitation and surgery, and rapidly transferred casualties to Role 3 hospitals for definitive care. A database was developed to capture Role 2 data. METHODS: A retrospective review and descriptive analysis was conducted of battle-injured casualties transported to US Role 2 surgical facilities in Afghanistan from February 2008 to September 2014...
May 30, 2018: Journal of Trauma and Acute Care Surgery
Juliann Corey, Sharon C OʼDonoghue, Veronica Kelly, Lynn Mackinson, Donna Williams, Kristin OʼReilly, Susan DeSanto-Madeya
BACKGROUND: Policies, procedures, and guidelines standardize care, meet regulatory requirements, and can promote safety in clinical practice. The existing protocols, policies, guidelines, and directives (PPGDs) at a level 1 trauma academic medical center were underused by the intensive care unit clinicians and did not always clearly represent the supporting evidence. AIMS: The goals of this project were to update the Critical Care Practice Manual (CCPM) and to ensure that clinical practice was aligned with best evidence...
July 2018: Dimensions of Critical Care Nursing: DCCN
Lakshmi Neelakantan, Sarah Hetrick, Daniel Michelson
Trauma-focused cognitive behavioural therapy (TF-CBT) is an effective intervention for post-traumatic stress disorder, yet implementation may be hindered by practitioners' concerns about how treatment is experienced by users. This metasynthesis systematically reviews qualitative evidence on youth and caregivers' experiences of TF-CBT to better understand user perspectives on process and outcomes of treatment. A systematic review and metasynthesis were undertaken for qualitative studies of treatment experience related to TF-CBT...
May 25, 2018: European Child & Adolescent Psychiatry
Cristina Roman, Gail Edwards, Michael Dooley, Biswadev Mitra
PURPOSE: Results of a systematic literature review to identify roles for emergency medicine (EM) pharmacists beyond traditionally reported activities and to quantify the benefits of these roles in terms of patient outcomes are reported. SUMMARY: Emergency department (ED)-based clinical pharmacy is a rapidly growing practice area that has gained support in a number of countries globally, particularly over the last 5-10 years. A systematic literature search covering the period 1995-2016 was conducted to characterize emerging EM pharmacist roles and the impact on patient outcomes...
June 1, 2018: American Journal of Health-system Pharmacy: AJHP
Rogier van der Sluijs, Eveline A J van Rein, Joep G J Wijnand, Luke P H Leenen, Mark van Heijl
Importance: Field triage of pediatric patients with trauma is critical for transporting the right patient to the right hospital. Mortality and lifelong disabilities are potentially attributable to erroneously transporting a patient in need of specialized care to a lower-level trauma center. Objective: To quantify the accuracy of field triage and associated diagnostic protocols used to identify children in need of specialized trauma care. Evidence Review: MEDLINE, Embase, PsycINFO, and Cochrane Register of Controlled Trials were searched from database inception to November 6, 2017, for studies describing the accuracy of diagnostic tests to identify children in need of specialized trauma care in a prehospital setting...
May 16, 2018: JAMA Surgery
B Hossfeld, R Lechner, F Josse, M Bernhard, F Walcher, M Helm, M Kulla
INTRODUCTION: The effectiveness of a tourniquet in the case of life-threatening hemorrhages of the extremities is well recognized and led to the recommendations on "Tourniquet" of the German Society of Anaesthesiology and Intensive Care (DGAI) in 2016. The aim of this systematic review was to re-evaluate the current medical literature in relation to the published DGAI recommendations. MATERIAL AND METHODS: Based on the analysis of all studies published from January 2015 until January 2018 in the PubMed databases, the publicized recommendations for action on "Tourniquet" of the DGAI were critically re-evaluated...
May 24, 2018: Der Unfallchirurg
Jody C DiGiacomo, L D George Angus, Raina Wallace, Sara Cardozo-Stolberg, Noam Gerber, Swapna Munnangi, Kelley Sookraj, Kathy Skarka
OBJECTIVE: To assess the impact of preassigning a single bed in the surgical intensive care unit (SICU) for the next trauma admission. BACKGROUND: Prolonged emergency department (ED) dwell time before admission to a critical care unit has an adverse effect on patient outcomes and is often due to the lack of an available bed in the intensive care unit (ICU). METHODS: A "Bed Ahead" policy was instituted at an urban level 1 Trauma Public Safety Net Teaching Hospital to preassign 1 SICU bed for the next trauma patient who warrants a critical care admission...
May 23, 2018: Annals of Surgery
Junxin Shi, Jiabin Shen, Sarah Caupp, Angela Wang, Kathryn E Nuss, Brian Kenney, Krista K Wheeler, Bo Lu, Henry Xiang
BACKGROUND: An accurate injury severity measurement is essential for the evaluation of pediatric trauma care and outcome research. The traditional Injury Severity Score (ISS) does not consider the differential risks of the Abbreviated Injury Scale (AIS) from different body regions nor is it pediatric specific. The objective of this study was to develop a weighted injury severity scoring (wISS) system for pediatric blunt trauma patients with better predictive power than ISS. METHODS: Based on the association between mortality and AIS from each of the six ISS body regions, we generated different weights for the component AIS scores used in the calculation of ISS...
May 2, 2018: Journal of Trauma and Acute Care Surgery
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