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Latest & greatest articles for trauma
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HBOC-201 Vasoactivity in a Phase III Clinical Trial in Orthopedic Surgery Subjects-Extrapolation of Potential Risk for Acute Trauma Trials Vasoactivity has hampered progress of hemoglobin-based oxygen carriers (HBOCs) due to concern for adverse blood pressure responses and secondary complications. A recent formulation, highly polymerized HBOC-201 (Biopure, Cambridge, MA), has been found to be less vasoactive than prior less polymerized formulations, and to improve outcome in animal models (...) of hemorrhagic shock (HS) compared with standard resuscitation fluids. HBOCs are envisioned to have life- saving potential for severe trauma patients for whom death due to HS is common despite transport to level I trauma centers. As part of a benefit:risk analysis for a proposed clinical trial of HBOC-201 in patients with traumatic HS, we analyzed data from a previous phase III clinical trial of this HBOC that involved orthopedic surgery patients, for vasoactivity and related effects, with focus on patients
Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. The number of trauma centres using whole-body CT for early assessment of primary trauma is increasing. There is no evidence to suggest that use of whole-body CT has any effect on the outcome of patients with major trauma. We therefore compared the probability of survival in patients with blunt trauma who had whole-body CT during resuscitation with those who had not.In a retrospective (...) , multicentre study, we used the data recorded in the trauma registry of the German Trauma Society to calculate the probability of survival according to the trauma and injury severity score (TRISS), revised injury severity classification (RISC) score, and standardised mortality ratio (SMR, ratio of recorded to expected mortality) for 4621 patients with blunt trauma given whole-body or non-whole-body CT.1494 (32%) of 4621 patients were given whole-body CT. Mean age was 42.6 years (SD 20.7), 3364 (73%) were
Serum lactate as a marker for mortality in patients presenting to the emergency department with trauma BestBets: Serum lactate as a marker for mortality in patients presenting to the emergency department with trauma Serum lactate as a marker for mortality in patients presenting to the emergency department with trauma Report By: Kevin KC Hung - Emergency Medicine Resident Search checked by Colin A Graham - Professor Institution: Accident & Emergency Medicine Academic Unit, The Chinese University (...) of Hong Kong Date Submitted: 22nd January 2008 Date Completed: 29th January 2009 Last Modified: 29th January 2009 Status: Green (complete) Three Part Question In [a patient presenting to the emergency department with non-thermal trauma] is [serum lactate] a [predictor of mortality]? Clinical Scenario A 40 year-old man presents to the emergency department with multiple injuries after being involved in a road traffic crash. You wonder whether an initial serum lactate taken in the ED is a useful
Use of pericardiocentesis for patients with cardiac tamponade in penetrating chest trauma BestBets: Use of pericardiocentesis for patients with cardiac tamponade in penetrating chest trauma Use of pericardiocentesis for patients with cardiac tamponade in penetrating chest trauma Report By: Kevin KC Hung - Emergency Medicine Resident Search checked by Colin A Graham - Associate Professor Institution: Chinese University of Hong Kong Date Submitted: 27th June 2007 Date Completed: 29th January 2009 (...) Last Modified: 29th January 2009 Status: Green (complete) Three Part Question In [patient with cardiac tamponade in penetrating chest trauma] does [pericardiocentesis] reduce [mortality and morbidity]? Clinical Scenario A 43-year-old male is brought into the resuscitation room having been stabbed with a knife in his left chest. The patient is hypotensive (blood pressure 80/40mmHg) but remains conscious, and cardiac tamponade is suspected. A focussed abdominal sonography for trauma scan (FAST) shows
Using ultrasound to detect peritoneal fluid in a pregnant patient with abdominal trauma BestBets: Using ultrasound to detect peritoneal fluid in a pregnant patient with abdominal trauma Using ultrasound to detect peritoneal fluid in a pregnant patient with abdominal trauma Report By: Helene Svinos - Medical Student Search checked by Anna O' Malley - Medical Student Institution: University of Manchester Date Submitted: 9th June 2008 Date Completed: 11th March 2009 Last Modified: 11th March 2009 (...) Status: Green (complete) Three Part Question In [a pregnant patient who has suffered a blunt abdominal trauma] is [abdominal ultrasound effective] at [detecting peritoneal fluid]? Clinical Scenario A pregnant patient in her 3rd trimester is brought in by ambulance following an accident in a car where she was the driver. You wonder how effective ultrasound would be in detecting the presence of peritoneal fluid in such a late stage of pregnancy. Search Strategy Medline 1950 to November Week 1 2008
The use of tocolytic therapy in a pregnant trauma patient BestBets: The use of tocolytic therapy in a pregnant trauma patient The use of tocolytic therapy in a pregnant trauma patient Report By: Helene Svinos - Medical Student Search checked by Anna O' Malley - Medical Student Institution: University of Manchester Date Submitted: 9th June 2008 Date Completed: 11th March 2009 Last Modified: 11th March 2009 Status: Green (complete) Three Part Question In a [pregnant trauma patient] does (...) [tocolytic therapy] improve [outcome for mother and foetus]? Clinical Scenario A pregnant woman of 32 weeks gestation is admitted to the ED after a fall. She has blunt abdominal trauma and is having what seem to be uterine contractions. You wonder whether you start tocolytic therapy to try to prevent or delay a premature delivery and so prevent some of the possible complications for both mother and baby. Search Strategy Medline 1950 to November week 1 2008 using Ovid Interface EMBASE 1980-2008 Week 1
Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. There are few data on long-term mortality following osteoporotic fracture and fewer following subsequent fracture.To examine long-term mortality risk in women and men following all osteoporotic fractures and to assess the association of subsequent fracture with that risk.Prospective cohort from the Dubbo Osteoporosis Epidemiology Study of community-dwelling women and men aged 60 years (...) and older from Dubbo, Australia, who sustained a fracture between April 1989 and May 2007.Age- and sex-specific standardized mortality ratios (SMRs) compared with the overall Dubbo population for hip, vertebral, major, and minor fractures.In women, there were 952 low-trauma fractures followed by 461 deaths, and in men, 343 fractures were followed by 197 deaths. Age-adjusted SMRs were increased following hip fractures (SMRs, 2.43 [95% confidence interval [CI], 2.02-2.93] and 3.51 [95% CI, 2.65-4.66
Harness Suspension Trauma ? First Aid Management Guideline 9.1.5 Page 1 of 2 July 2009 AUSTRALIAN RESUSCITATION COUNCIL AUSTRALIAN RESUSCITATION COUNCIL GUIDELINE 9.1.5 HARNESS SUSPENSION TRAUMA – FIRST AID MANAGEMENT INTRODUCTION Suspension trauma, or orthostatic shock, has been reported to affect victims who are suspended within a body harness for a prolonged period of time (5 to 30 minutes). 1,2 It presents with the development of a range of symptoms which may result in unconsciousness (...) or death, and is thought to occur as a result of low blood pressure secondary to blood pooling in the legs, pelvis and abdomen of victims who are suspended and motionless. RECOGNITION The signs and symptoms of suspension trauma are the same to those of shock. Suspension trauma should be considered where the victim has been suspended by a harness for a prolonged period, and are exhibiting any of the following: 3 ? faintness ? breathlessness ? sweating ? paleness ? nausea ? dizziness ? low blood pressure
The Efficacy of Recombinant Activated Factor VII in Severe Trauma The Efficacy of Recombinant Activated Factor VII in Severe Trauma - Annals of Emergency Medicine Email/Username: Password: Remember me Search Terms Search within Search Share this page Access provided by Volume 54, Issue 5, Pages 737–744.e1 The Efficacy of Recombinant Activated Factor VII in Severe Trauma x Daniel K. Nishijima Affiliations Department of Emergency Medicine, University of California, Davis Medical Center (...) ) in severe trauma is controversial. This evidence-based emergency medicine review evaluates the existing evidence about the efficacy and safety of rFVIIa for the management of severe trauma. Methods We searched MEDLINE, EMBASE, the Cochrane Library, and other databases. We limited our review to prospective, controlled trials that involved the therapeutic use of rFVIIa in the emergency department phase of care. We included studies with blunt and penetrating severe trauma. The primary outcome measure
Pulseless electrical activity, focused abdominal sonography for trauma, and cardiac contractile activity as predictors of survival after trauma Pulseless electrical activity (PEA) secondary to both blunt and penetrating trauma is associated with minimal survival. The pericardial view of the focused abdominal sonography for trauma (p-FAST) can differentiate between patients with and without organized cardiac activity and may assist in the decision to terminate ongoing resuscitation.A (...) retrospective review was performed for all patients presenting to a level I trauma center from January 2006 through January/2009 who had PEA on arrival or developed PEA in the emergency department. Additional data abstracted included outcome, the p-FAST findings, and mechanism of injury. Recorded FAST examinations were reviewed by a blinded ultrasound trained physician.During the study period 25 patients presented with PEA and three developed PEA during initial resuscitation. Contractile cardiac activity
Balance capabilities after lateral ankle trauma and intervention: a meta-analysis Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
Continuous renal replacement therapy (CRRT) versus sustained low-efficiency daily dialysis (SLED) for adults with non-trauma-related acute renal failure Continuous renal replacement therapy (CRRT) versus sustained low-efficiency daily dialysis (SLED) for adults with non-trauma-related acute renal failure Continuous renal replacement therapy (CRRT) versus sustained low-efficiency daily dialysis (SLED) for adults with non-trauma-related acute renal failure Record Status This is a bibliographic (...) record of a published health technology assessment. No evaluation of the quality of this assessment has been made for the HTA database. Report may be purchased from . Citation Continuous renal replacement therapy (CRRT) versus sustained low-efficiency daily dialysis (SLED) for adults with non-trauma-related acute renal failure . Lansdale: HAYES, Inc.. 2009 Authors' objectives Approximately 1% of all patients admitted to hospitals have acute kidney failure, which is also referred to as acute renal
Predictors of abnormal chest CT after blunt trauma: a critical appraisal of the literature Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
Head (trauma, headaches, etc., not including stress & mental disorders). Guidelines and Measures | Agency for Healthcare Research & Quality HHS.gov Search ahrq.gov Search ahrq.gov Menu Topics A - Z Healthcare Delivery Latest available findings on quality of and access to health care Searchable database of AHRQ Grants, Working Papers & HHS Recovery Act Projects AHRQ Projects funded by the Patient-Centered Outcomes Research Trust Fund You are here Guidelines and Measures Funding for the National
Zoledronic acid (Aclasta) - Treatment of osteoporosis in men at increased risk of fracture, including those with a recent low-trauma hip fracture. Published 12 January 2009 Secretariat - Delta House 50 West Nile Street Glasgow G1 2NP Telephone 0141 225 6997 Fax 0141 248 3778 E-mail firstname.lastname@example.org Chairman Dr Kenneth R Paterson Scottish Medicines Consortium zoledronic acid 5mg/100ml solution for infusion (Aclasta ® ) (No. 535/08) Novartis Pharmaceuticals UK Ltd Statement of Advice 05 (...) December 2008 ADVICE: in the absence of a submission from the holder of the marketing authorisation. zoledronic acid 5mg (Aclasta ® ) is not recommended for use within NHSScotland for the treatment of osteoporosis in men at increased risk of fracture, including those with a recent low-trauma hip fracture. The holder of the marketing authorisation has not made a submission to SMC regarding this product in this indication. As a result we cannot recommend its use within NHSScotland. Advice context
Femoral nerve blockade administered preclinically for pain relief in severe knee trauma is more feasible and effective than intravenous metamizole: a randomized controlled trial Before clinical treatment and during transportation, the analgesic therapy offered to patients with painful knee trauma may be quite insufficient. We hypothesize that a femoral nerve blockade for analgesia can be administered in a preclinical setting at the injury site and provides better pain relief than intravenous (...) ; peripheral vasoconstriction was noted in 26 patients at the injury site and dropped to six at the time of arrival at the hospital. Two of 26 patients in the blockade group did not benefit from the treatment. In the metamizole group, pain and anxiety did not decrease significantly; vasoconstriction persisted in all patients.Patients with painful knee trauma benefited from femoral nerve blockade administered before hospitalization. The treatment can be administered safely in the preclinical setting
Development of a highly accurate nomogram for prediction of the need for exploration in patients with renal trauma To develop and validate a nomogram for predicting the need for renal exploration after renal trauma.From 1995 through 2004, 419 consecutive patients presented to our institution with traumatic renal injury. All were randomly divided into a development (50%, n = 210) and a split sample validation cohort (50%, n = 209). Logistic regression models were used to develop a nomogram (...) for prediction of the need for renal exploration after renal trauma. Internal (200 bootstrap resamples) and 50% split sample validations were performed.Overall, 89 patients (21.2%) underwent renal exploration, from which 60.7% (54 of 89) underwent nephrectomy and 39.3% (35 of 89) underwent renorrhaphy. Nine percent of patients with grade II injury underwent renal exploration, 16% with grade III injuries, 41% with grade IV injuries, and 100% of grade V injuries. The kidney injury scale, the mechanism
Role of depression, stress, and trauma in HIV disease progression Despite advances in HIV treatment, there continues to be great variability in the progression of this disease. This paper reviews the evidence that depression, stressful life events, and trauma account for some of the variation in HIV disease course. Longitudinal studies both before and after the advent of highly active antiretroviral therapies (HAART) are reviewed. To ensure a complete review, PubMed was searched for all English (...) language articles from January 1990 to July 2007. We found substantial and consistent evidence that chronic depression, stressful events, and trauma may negatively affect HIV disease progression in terms of decreases in CD4 T lymphocytes, increases in viral load, and greater risk for clinical decline and mortality. More research is warranted to investigate biological and behavioral mediators of these psychoimmune relationships, and the types of interventions that might mitigate the negative health
A trauma mortality prediction model based on the anatomic injury scale To develop a statistically rigorous trauma mortality prediction model based on empiric estimates of severity for each injury in the abbreviated injury scale (AIS) and compare the performance of this new model with the injury severity score (ISS).Mortality rates at trauma centers should only be compared after adjusting for differences in injury severity, but no reliable measure of injury severity currently exists. The ISS has (...) served as the standard measure of anatomic injury for 30 years. However, it relies on the individual injury severities assigned by experts in the AIS, is nonmonotonic with respect to mortality, and fails to perform even as well as a far simpler model based on the single worst injury a patient has sustained.This study is based on data from 702,229 injured patients in the National Trauma Data Bank (NTDB 6.1) hospitalized between 2001 and 2005. Sixty percent of the data was used to derive an empiric