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EM Trauma

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46 papers 25 to 100 followers
By Terren Trott
Gregory Gebauer, Meredith Osterman, James Harrop, Alexander Vaccaro
BACKGROUND: Strict criteria have been used before removing cervical collars in patients with injuries who have midline pain or are unable to be reliably examined. This sometimes leads to prolonged immobilization in cervical collars or use of MRI to rule out injury. Several studies suggest a collar may be removed in the absence of fractures, dislocation, or pathologic subluxation on a cervical CT scan. This may avoid the morbidity of prolonged cervical immobilization or cost of advanced imaging study but risks devastating consequences from missing injuries...
June 2012: Clinical Orthopaedics and related Research
Eduardo Gonzalez, Ernest E Moore, Hunter B Moore, Michael P Chapman, Theresa L Chin, Arsen Ghasabyan, Max V Wohlauer, Carlton C Barnett, Denis D Bensard, Walter L Biffl, Clay C Burlew, Jeffrey L Johnson, Fredric M Pieracci, Gregory J Jurkovich, Anirban Banerjee, Christopher C Silliman, Angela Sauaia
BACKGROUND: Massive transfusion protocols (MTPs) have become standard of care in the management of bleeding injured patients, yet strategies to guide them vary widely. We conducted a pragmatic, randomized clinical trial (RCT) to test the hypothesis that an MTP goal directed by the viscoelastic assay thrombelastography (TEG) improves survival compared with an MTP guided by conventional coagulation assays (CCA). METHODS: This RCT enrolled injured patients from an academic level-1 trauma center meeting criteria for MTP activation...
June 2016: Annals of Surgery
P Guilabert, G Usúa, N Martín, L Abarca, J P Barret, M J Colomina
Since 1968, when Baxter and Shires developed the Parkland formula, little progress has been made in the field of fluid therapy for burn resuscitation, despite advances in haemodynamic monitoring, establishment of the 'goal-directed therapy' concept, and the development of new colloid and crystalloid solutions. Burn patients receive a larger amount of fluids in the first hours than any other trauma patients. Initial resuscitation is based on crystalloids because of the increased capillary permeability occurring during the first 24 h...
September 2016: British Journal of Anaesthesia
Adam L Sharp, Ganesh Nagaraj, Ellen J Rippberger, Ernest Shen, Clifford J Swap, Matthew A Silver, Taylor McCormick, David R Vinson, Jerome R Hoffman
BACKGROUND: Millions of head computed tomography (CT) scans are ordered annually, but the extent of avoidable imaging is poorly defined. OBJECTIVE: To determine the prevalence of likely avoidable CT imaging among adults evaluated for head injury in 14 community emergency departments (ED) in Southern California from 2008-2013. METHODS: We conducted an electronic health record (EHR) data-base and chart review of adult ED trauma encounters receiving a head CT from 2008-2013...
July 30, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
David R Jeffcoach, Juan J Gallegos, Sophy A Jesty, Patricia N Coan, Jason Chen, Robert Eric Heidel, Brian J Daley
INTRODUCTION: Cardiopulmonary resuscitation was designed for sudden cardiac events usually triggered by thrombotic phenomena. Despite this, it is routinely used in trauma resuscitations as per the American Heart guidelines. There is no data supporting the use of chest compressions in hemorrhagic shock. An evidence-based cardiopulmonary resuscitation (CPR) protocol has been developed for dogs. We sought to determine the effects and outcomes of chest compressions in hemorrhagic shock in a canine model...
July 2016: Journal of Trauma and Acute Care Surgery
Thomas Erik Wurmb, Michael Bernhard
No abstract text is available yet for this article.
August 13, 2016: Lancet
Joanne C Sierink, Kaij Treskes, Michael J R Edwards, Benn J A Beuker, Dennis den Hartog, Joachim Hohmann, Marcel G W Dijkgraaf, Jan S K Luitse, Ludo F M Beenen, Markus W Hollmann, J Carel Goslings
BACKGROUND: Published work suggests a survival benefit for patients with trauma who undergo total-body CT scanning during the initial trauma assessment; however, level 1 evidence is absent. We aimed to assess the effect of total-body CT scanning compared with the standard work-up on in-hospital mortality in patients with trauma. METHODS: We undertook an international, multicentre, randomised controlled trial at four hospitals in the Netherlands and one in Switzerland...
August 13, 2016: Lancet
Matthew M Carrick, Catherine Anne Morrison, Nicole M Tapia, Jan Leonard, James W Suliburk, Michael A Norman, Francis J Welsh, Bradford G Scott, Kathy R Liscum, Sally R Raty, Matthew J Wall, Kenneth L Mattox
BACKGROUND: Hemorrhagic shock is responsible for one third of trauma related deaths. We hypothesized that intraoperative hypotensive resuscitation would improve survival for patients undergoing operative control of hemorrhage following penetrating trauma. METHODS: Between July 1, 2007, and March 28, 2013, penetrating trauma patients aged 14 years to 45 years with a systolic blood pressure of 90 mm Hg or lower requiring laparotomy or thoracotomy for control of hemorrhage were randomized 1:1 based on a target minimum mean arterial pressure (MAP) of 50 mm Hg (experimental arm, LMAP) or 65 mm Hg (control arm, HMAP)...
June 2016: Journal of Trauma and Acute Care Surgery
Daniel K Nishijima, Steven R Offerman, Dustin W Ballard, David R Vinson, Uli K Chettipally, Adina S Rauchwerger, Mary E Reed, James F Holmes
STUDY OBJECTIVE: Patients receiving warfarin or clopidogrel are considered at increased risk for traumatic intracranial hemorrhage after blunt head trauma. The prevalence of immediate traumatic intracranial hemorrhage and the cumulative incidence of delayed traumatic intracranial hemorrhage in these patients, however, are unknown. The objective of this study is to address these gaps in knowledge. METHODS: A prospective, observational study at 2 trauma centers and 4 community hospitals enrolled emergency department (ED) patients with blunt head trauma and preinjury warfarin or clopidogrel use from April 2009 through January 2011...
June 2012: Annals of Emergency 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
Daniel C Cullinane, Henry J Schiller, Martin D Zielinski, Jaroslaw W Bilaniuk, Bryan R Collier, John Como, Michelle Holevar, Enrique A Sabater, S Andrew Sems, W Matthew Vassy, Julie L Wynne
BACKGROUND: Hemorrhage from pelvic fracture is common in victims of blunt traumatic injury. In 2001, the Eastern Association for the Surgery of Trauma (EAST) published practice management guidelines for the management of hemorrhage in pelvic trauma. Since that time there have been new practice patterns and larger experiences with older techniques. The Practice Guidelines Committee of EAST decided to replace the 2001 guidelines with an updated guideline and systematic review reflecting current practice...
December 2011: Journal of Trauma
Malkeet Gupta, David L Schriger, Jonathan R Hiatt, Henry G Cryer, Areti Tillou, Jerome R Hoffman, Larry J Baraff
STUDY OBJECTIVE: Routine pan-computed tomography (CT, including of the head, neck, chest, abdomen/pelvis) has been advocated for evaluation of patients with blunt trauma based on the belief that early detection of clinically occult injuries will improve outcomes. We sought to determine whether selective imaging could decrease scan use without missing clinically important injuries. METHODS: This was a prospective observational study of 701 patients with blunt trauma at an academic trauma center...
November 2011: Annals of Emergency Medicine
Nicholas D Caputo, Chris Stahmer, George Lim, Kaushal Shah
BACKGROUND: Traumatic injury in the United States is the Number 1 cause of mortality for patients 1 year to 44 years of age. Studies suggest that early identification of major injury leads to better outcomes for patients. Imaging, such as computed tomography (CT), is routinely used to help determine the presence of major underlying injuries. We review the literature to determine whether whole-body CT (WBCT), a protocol including a noncontrast scan of the brain and neck and a contrast-enhanced scan of the chest, abdomen, and pelvis, detects more clinically significant injuries as opposed to selective scanning as determined by mortality rates...
October 2014: Journal of Trauma and Acute Care Surgery
Bala Natarajan, Prateek K Gupta, Samuel Cemaj, Megan Sorensen, Georgios I Hatzoudis, Robert Armour Forse
BACKGROUND: During the last decade, focused assessment with sonography for trauma increasingly has become the initial diagnostic modality of choice in trauma patients. It is still questionable, however, whether its use results in the underdiagnosis of intra-abdominal injury. It also remains doubtful whether a positive focused assessment with sonography for trauma affects clinical decision making in hemodynamically stable blunt trauma patients as evidenced through abdominal computerized tomography use...
October 2010: Surgery
Carmen Camacho Leis, Consuelo Canencia Hernández, Ma José Garcia-Ochoa Blanco, Paloma Covadonga Rey Paterna, Ramón de Elias Hernández, Ervigio Corral Torres
BACKGROUND: Several studies recommend not initiating advanced life support in traumatic cardiac arrest (TCA), mainly owing to the poor prognosis in several series that have been published. This study aimed to analyze the survival of the TCA in our series and to determine which factors are more frequently associated with recovery of spontaneous circulation (ROSC) and complete neurologic recovery (CNR). METHODS: This is a cohort study (2006-2009) of treatment benefits...
February 2013: Journal of Trauma and Acute Care Surgery
Ali S Raja, Jennifer Lanning, Arian Gower, Mark I Langdorf, Daniel K Nishijima, Brigitte M Baumann, Gregory W Hendey, Anthony J Medak, William R Mower, Robert M Rodriguez
STUDY OBJECTIVE: The NEXUS chest decision instrument identifies a very-low-risk population of patients with blunt trauma for whom chest imaging can be avoided. However, it requires that all 7 National Emergency X-Ray Utilization Study (NEXUS) chest criteria be absent. To inform patient and physician shared decisionmaking about imaging, we describe the test characteristics of individual criteria of the NEXUS chest decision instrument and provide the prevalence of injuries when 1, 2, or 3 of the 7 criteria are present...
August 2016: Annals of Emergency Medicine
Rachel A Lindor, Eric T Boie, Ronna L Campbell, Erik P Hess, Annie T Sadosty
OBJECTIVES: The objectives were to describe lawsuits against providers for failing to order head computed tomography (CT) in cases of head trauma and to determine the potential effects of available clinical decision rules (CDRs) on each lawsuit. METHODS: The authors collected jury verdicts, settlements, and court opinions regarding alleged malpractice for failure to order head CT in the setting of head trauma from 1972 through February 2014 from an online legal research tool (WestlawNext)...
December 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Zaffer Qasim, Megan Brenner, Jay Menaker, Thomas Scalea
The management of non-compressible torso hemorrhage can be problematic. Current therapy requires either open or interventional radiologic control of bleeding vessels and/or organs. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a new tool to stabilize patients in shock by achieving temporary inflow occlusion of non-compressible torso hemorrhage. This proactive technique represents a paradigm shift in achieving hemodynamic stability in patients as a bridge to definitive hemostasis. REBOA is applicable by trauma professionals, including emergency physicians, at the bedside in the emergency department, but its use needs to be considered within the context of available evidence and a robust system encompassing training, accreditation, multidisciplinary involvement and quality assurance...
November 2015: Resuscitation
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
D Plummer, D Brunette, R Asinger, E Ruiz
STUDY OBJECTIVES: To determine the effect of immediate two-dimensional echocardiography on the time to diagnosis, survival rate, and neurologic outcome of patients with penetrating cardiac injury. DESIGN: A ten-year retrospective review. SETTING: Regional trauma center serving a population base of 1.25 million with 85,000 visits yearly. TYPE OF PARTICIPANTS: All patients presenting to the emergency department with penetrating cardiac injury...
June 1992: Annals of Emergency Medicine
2015-09-24 21:42:05
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