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26 papers 1000+ followers EM Trauma
By Merlin Curry MD, EMT-P
J E Smith, S Le Clerc, P A F Hunt
Attempts to resuscitate patients in traumatic cardiac arrest (TCA) have, in the past, been viewed as futile. However, reported outcomes from TCA in the past five years, particularly from military series, are improving. The pathophysiology of TCA is different to medical causes of cardiac arrest, and therefore, treatment priorities may also need to be different. This article reviews recent literature describing the pathophysiology of TCA and describes how the military has challenged the assumption that outcome is universally poor in these patients...
December 2015: Emergency Medicine Journal: EMJ
Gil Z Shlamovitz, William R Mower, Jonathan Bergman, Jonathan Crisp, Heather K DeVore, David Hardy, Martine Sargent, Sunil D Shroff, Eric Snyder, Marshall T Morgan
STUDY OBJECTIVE: Current advanced trauma life support guidelines recommend that a digital rectal examination be performed as part of the initial evaluation of all trauma patients. Our goal is to estimate the test characteristics of the digital rectal examination in trauma patients. METHODS: We conducted a retrospective medical record review study of consecutive trauma patients treated in our emergency department from January 2003 to February 2005 for whom the trauma team was activated and who had a documented digital rectal examination...
July 2007: Annals of Emergency Medicine
Randall M Chesnut, Nancy Temkin, Nancy Carney, Sureyya Dikmen, Carlos Rondina, Walter Videtta, Gustavo Petroni, Silvia Lujan, Jim Pridgeon, Jason Barber, Joan Machamer, Kelley Chaddock, Juanita M Celix, Marianna Cherner, Terence Hendrix
BACKGROUND: Intracranial-pressure monitoring is considered the standard of care for severe traumatic brain injury and is used frequently, but the efficacy of treatment based on monitoring in improving the outcome has not been rigorously assessed. METHODS: We conducted a multicenter, controlled trial in which 324 patients 13 years of age or older who had severe traumatic brain injury and were being treated in intensive care units (ICUs) in Bolivia or Ecuador were randomly assigned to one of two specific protocols: guidelines-based management in which a protocol for monitoring intraparenchymal intracranial pressure was used (pressure-monitoring group) or a protocol in which treatment was based on imaging and clinical examination (imaging-clinical examination group)...
December 27, 2012: New England Journal of Medicine
H R Guly, O Bouamra, M Spiers, P Dark, T Coats, F E Lecky
AIM: The Advanced Trauma Life Support (ATLS) system classifies the severity of shock. The aim of this study is to test the validity of this classification. METHODS: Admission physiology, injury and outcome variables from adult injured patients presenting to hospitals in England and Wales between 1989 and 2007 and stored on the Trauma Audit and Research Network (TARN) database, were studied. For each patient, the blood loss was estimated and patients were divided into four groups based on the estimated blood loss corresponding to the ATLS classes of shock...
May 2011: Resuscitation
Amani D Politano, Lin M Riccio, Douglas E Lake, Craig G Rusin, Lauren E Guin, Christopher S Josef, Matthew T Clark, Robert G Sawyer, J Randall Moorman, James F Calland
BACKGROUND: Analysis and modeling of data monitoring vital signs and waveforms in patients in a surgical/trauma intensive care unit (STICU) may allow for early identification and treatment of patients with evolving respiratory failure. METHODS: Between February 2011 and March 2012, data of vital signs and waveforms for STICU patients were collected. Every-15-minute calculations (n = 172,326) of means and standard deviations of heart rate (HR), respiratory rate (RR), pulse-oxygen saturation (SpO2), cross-correlation coefficients, and cross-sample entropy for HR-RR, RR-SpO2, and HR-SpO2, and cardiorespiratory coupling were calculated...
November 2013: Surgery
Jessica L Mckee, Derek J Roberts, Mary H van Wijngaarden-Stephens, Christine Vis, He Gao, Kathy L Belton, Don Voaklander, Chad G Ball, Ioana Bratu, Geoffrey C Ibbotson, Kevin Martin, Paul Engels, Damian Paton-Gay, Paul Parks, Lyle Thomas, Jonathan Guilfoyle, John B Kortbeek, Andrew W Kirkpatrick
OBJECTIVE: To evaluate the implementation of an all-inclusive philosophy of trauma care in a large Canadian province. BACKGROUND: Challenges to regionalized trauma care may occur where transport distances to level I trauma centers are substantial and few level I centers exist. In 2008, we modified our predominantly regionalized model to an all-inclusive one with the hopes of increasing the role of level III trauma centers. METHODS: We conducted a population-based, before-and-after study of patient admission and transfer practices and outcomes associated with implementation of an all-inclusive provincial trauma system using multivariable Poisson and linear regression and Cox proportional hazard models...
March 2015: Annals of Surgery
Raphael Sun, Dionne Skeete, Kristel Wetjen, Michele Lilienthal, Junlin Liao, Mark Madsen, Gabriel Lancaster, Joel Shilyansky, Kent Choi
BACKGROUND: To minimize radiation exposure in children and reduce resource use, we implemented an age-specific algorithm to evaluate cervical spine injuries at a Level 1 trauma center. The effects of protocol implementation on computed tomography (CT) use in children (≤ 10 y) were determined. METHODS: With institutional review board approval, we conducted a retrospective review using the institutional trauma registry. All pediatric patients (≤ 10 y) (n = 324) between January 2007 and present were reviewed...
July 2013: Journal of Surgical Research
Naomi T Hughes, Randall S Burd, Stephen J Teach
Evidence for changes in adult trauma management often precedes evidence for changes in pediatric trauma management. Many adult trauma centers have adopted damage-control resuscitation management strategies, which target the metabolic syndrome of acidosis, coagulopathy, and hypothermia often found in severe uncontrolled hemorrhage. Two key components of damage-control resuscitation are permissive hypotension, which is a fluid management strategy that targets a subnormal blood pressure, and hemostatic resuscitation, which is a transfusion strategy that targets coagulopathy with early blood product administration...
September 2014: Pediatric Emergency Care
Michal Radomski, Ritesh Agnihothri, Stephanie Knapp, Daniel Scher, Nadia Khati, Kathleen Brindle, Richard Amdur, Jonathan Messing, James Dunne, Babak Sarani
BACKGROUND: The inferior vena cava (IVC) collapses with shock but may also be collapsed in volume-depleted patients in the absence of shock. The speed and availability of computed tomography (CT) make IVC measurement an attractive diagnostic modality for shock. The purpose of this study was to determine if IVC size following injury is associated with shock. METHODS: Retrospective data were collected on 272 trauma patients admitted to an adult trauma center from January 1 to December 31, 2012...
July 2014: Journal of Trauma and Acute Care Surgery
Joseph P Minei, Timothy C Fabian, Danielle M Guffey, Craig D Newgard, Eileen M Bulger, Karen J Brasel, Jason L Sperry, Russell D MacDonald
OBJECTIVE: To investigate the relationship between trauma center volume and outcome. BACKGROUND: The Resuscitation Outcomes Consortium is a network of 11 centers and 60 hospitals conducting emergency care research. For many procedures, high-volume centers demonstrate superior outcomes versus low-volume centers. This remains controversial for trauma center outcomes. METHODS: This study was a secondary analysis of prospectively collected data from the Resuscitation Outcomes Consortium multicenter out-of-hospital Hypertonic Saline Trial in patients with Glasgow Coma Scale score of 8 or less (traumatic brain injury) or systolic blood pressure of 90 or less and pulse of 110 or more (shock)...
September 2014: Annals of Surgery
J W Tuckett, A Lynham, G A Lee, M Perry, U Harrington
OBJECTIVES: In 1978 the Advanced Trauma Life Support guidelines were first implemented and are viewed by many as the gold standard of care in the emergency setting. It may not be immediately obvious where assessment and management of maxillofacial injuries fits within these trauma guidelines. This article aims to provide a concise, contemporary guide for the treatment of maxillofacial trauma in the emergency setting. METHODS: An electronic database search was conducted in PubMed and Science Direct on articles from 1970 to the present day...
April 2014: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
Emma Sydenham, Ian Roberts, Phil Alderson
BACKGROUND: Hypothermia has been used in the treatment of head injury for many years. Encouraging results from small trials and laboratory studies led to renewed interest in the area and some larger trials. OBJECTIVES: To estimate the effect of mild hypothermia for traumatic head injury on mortality and long-term functional outcome complications. SEARCH STRATEGY: We searched the Injuries Group Specialised Register, Current Controlled Trials MetaRegister of trials, Zetoc, ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED) and Conference Proceedings Citation Index-Science (CPCI-S), CENTRAL (The Cochrane Library), MEDLINE and EMBASE...
2009: Cochrane Database of Systematic Reviews
Andrea Colli, Enrico Petranzan
A 48-year-old man was referred to the emergency department for chest trauma related to a motorcycle accident. The findings on cardiac auscultation and electrocardiography were consistent with possible dextrocardia. A chest radiograph and computed tomographic (CT) scan showed a 90-degree rightward..
May 8, 2014: New England Journal of Medicine
Adam Stannard, Jonathan L Eliason, Todd E Rasmussen
No abstract text is available yet for this article.
December 2011: Journal of Trauma
Taufiek K Rajab, Michael J Weaver, Joaquim M Havens
New England Journal of Medicine, Volume 369, Issue 17, October 2013.
October 24, 2013: New England Journal of Medicine
Bruce E Lehnert, Claudia Sadro, Eric Monroe, Mariam Moshiri
Blunt and penetrating trauma to the male pelvis and external genitalia may result in significant injury to the lower genitourinary system including the bladder, urethra, penis, and scrotum. Emergent imaging plays an important role in identifying these injuries and directing appropriate, timely management. In this article, we review indications for dedicated genitourinary system imaging in trauma and illustrate the imaging features of injuries to the lower male genitourinary system in order to facilitate accurate and rapid diagnosis...
February 2014: Emergency Radiology
Kaushal H Shah, J Michael Guthrie
No abstract text is available yet for this article.
April 2014: Annals of Emergency Medicine
David J Lockey, Richard M Lyon, Gareth E Davies
BACKGROUND: Major trauma is the leading worldwide cause of death in young adults. The mortality from traumatic cardiac arrest remains high but survival with good neurological outcome from cardiopulmonary arrest following major trauma has been regularly reported. Rapid, effective intervention is required to address potential reversible causes of traumatic cardiac arrest if the victim is to survive. Current ILCOR guidelines do not contain a standard algorithm for management of traumatic cardiac arrest...
June 2013: Resuscitation
Bradley D Figler, Brad Figler, C Edward Hoffler, William Reisman, K Jeff Carney, Thomas Moore, David Feliciano, Viraj Master
Pelvic ring fractures often result in severely injured patients with multiple organ injuries. The most common associated injuries are intraabdominal or urogenital, and urogenital injuries are the most common associated injuries in those with severe pelvic fractures. Prompt and effective diagnosis and management of these injuries is essential to successful outcomes, but this is potentially complicated by poor communication and coordination among the many specialists involved. To address this, we present a multi-disciplinary review of pelvic fracture-associated bladder and urethral injuries that is specifically geared towards orthopaedic, urology, and trauma surgeons caring for these patients...
August 2012: Injury
Andrea D Hill, Robert A Fowler, Avery B Nathens
BACKGROUND: Evidence suggests that there may be an association between transfer status (direct admission or interhospital transfer) and outcomes in trauma patients. The purpose of this study was to systematically review the current evidence of the association between transfer status and outcomes for patients. METHODS: Systematic search of Medline and EMBASE databases to identify eligible control trials or observational studies that examined the impact of transfer status on trauma patient outcomes...
December 2011: Journal of Trauma
2014-04-07 01:42:16
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