Latest & greatest articles for trauma

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Top results for trauma

421. Trauma - neck and back trauma

Trauma - neck and back trauma INTRODUCTION Spinal cord injury (SCI) most commonly affects young and ?t people and will continue to affect them to a varying degree for the rest of their lives. In the extreme, SCI may prove immediately fatal where the upper cervical cord is damaged, paralysing the diaphragm and respiratory muscles. Partial cord damage, however, may solely affect individual sensory or motor nerve tracts producing varying long-term disability. It is important to note (...) immobilisation. 25 Immobilisation – hazards The value of routine out of hospital spinal immobilisation remains uncertain and any bene?ts may be outweighed by the risks of rigid collar immobilisation, including: 1. airway dif?culties 2. increased intra-cranial pressure 26-31 3. increased risk of aspiration 32 4. restricted respiration 33,34 5. dysphagia 35 6. skin ulceration 36-38 7. can induce pain, even in those with no injury 10,39 Neck and Back Trauma Trauma Emergencies October 2006 Page 1 of 8 Trauma

2007 Joint Royal Colleges Ambulance Liaison Committee

422. Trauma - burns and scalds in adults

Trauma - burns and scalds in adults INTRODUCTION Burns arise in a number of accident situations, and may have a variety of accompanying injuries or pre- existing medical problems associated with the burn injury. Scalds, ?ame or thermal burns, chemical and electrical burns will all produce a different burn pattern, and inhalation of smoke or toxic chemicals from the fire may cause serious accompanying complications. A number of burn cases will also be seriously injured following falls from (...) retrospective study. Burns 1999;25(4):345-51. 2 Cooke MW, Ferner RE. Chemical burns causing systemic toxicity. Arch Emerg Med 1993;10(4):368-71. Burns and Scalds in Adults Trauma Emergencies October 2006 Page 3 of 4 Trauma EmergenciesSELECT BIBLIOGRAPHY Gordon M, Goodwin CW. Burn management: initial assessment, management, and stabilization. Nursing Clinics of North America 1997;32(2):237-49. Ashworth HL, Cubison TCS, Gilbert PM. Treatment before transfer: the patient with burns. Emergency Medicine Journal

2007 Joint Royal Colleges Ambulance Liaison Committee

423. Trauma - trauma in pregnancy

Trauma - trauma in pregnancy Trauma Emergencies INTRODUCTION Coping with pregnant women with major injuries is a rare problem, but demands a special approach. Pregnancy produces physiological changes, particularly in the cardiovascular system: ? cardiac output increases by 20–30% in ?rst 10 weeks of pregnancy ? average heart rate increases by 10 to 15 beats per minute ? both systolic and diastolic blood pressure (BP) fall on average by 10–15mmHg ? in the supine position the enlarged uterus (...) displacement must be employed (see manual displacement below) 3. signs of shock appear very late during pregnancy and hypotension is an extremely late sign. Any signs of hypovolaemia during pregnancy are likely to indicate a 35% (class III) blood loss and must be treated aggressively. ESTABLISH LARGE BORE IV CANNULATION EARLY. HISTORY Refer to trauma emergencies guideline. Enquire about stage of the pregnancy, and any problems so far with the pregnancy. Ask the mother if she has her pregnancy record card

2007 Joint Royal Colleges Ambulance Liaison Committee

424. Trauma - trauma emergencies in adults (overview)

Trauma - trauma emergencies in adults (overview) Trauma Emergencies INTRODUCTION All trauma patients should be assessed and managed in a systematic way, using the primary survey to identify patients with actual or potentially life threatening injuries. If any abnormality is detected during the assessment, the need for senior clinical support should be considered. This guideline uses mechanism of injury and primary survey as the basis of care for all trauma patients. All these guidelines re?ect (...) the principles of the Pre- Hospital Trauma Life Support (PHTLS RCS Ed)1, and Advanced Trauma Life Support (ATLS) training courses. BASIC TRAUMA INCIDENT PROCEDURE Safety: 1. SELF – personal protective equipment is mandatory 2. SCENE 3. CASUALTY. Remember, safety is dynamic and needs to be continually re-assessed throughout. Scene Assessment: ? consider resources required ? consider possibility of major incident/chemical, biological, radiological or nuclear (CBRN) (refer to CBRN guideline) ? early situation

2007 Joint Royal Colleges Ambulance Liaison Committee

425. Trauma - the immersion incident

Trauma - the immersion incident INTRODUCTION There are about 700 deaths by drowning a year in the UK, and many more times that number of near- drowning. A high percentage of these deaths involve children. In the majority of drowning, water enters the lungs, but 10–15% of cases involve intense laryngeal spasm with death resulting from asphyxia (so called dry-drowning). The term near drowning applies to survivors of drowning including those resuscitated from cardiac or respiratory arrest (...) resulting from an immersion incident. It is customary to refer to incidents of near drowning as IMMERSION or SUBMERSION. In submersion incidents the head is below water and the main problems are asphyxia and hypoxia. With immersion the head usually remains above the water and the main problems will be hypothermia and cardiovascular instability from the hydrostatic pressure of the surrounding water on the lower limbs. Trauma is often a major accompanying factor in the immersion incident. In particular

2007 Joint Royal Colleges Ambulance Liaison Committee

426. Trauma - thoracic trauma

Trauma - thoracic trauma INTRODUCTION Thoracic injuries are one of the most common causes of death from trauma, accounting for approximately 25% of such deaths. Despite the very high percentage of serious thoracic injuries, the vast majority of these patients can be managed in hospital by chest drainage and resuscitation and only 10–15% require surgical intervention. In the ?eld, the most common problem associated with thoracic injury is hypoxia, either from impaired ventilation or secondary (...) to hypovolaemia from massive bleeding into the chest (haemothorax), or major vessel disruption (e.g.: ruptured thoracic aorta). HISTORY The mechanism of injury is an important guide to the likelihood of signi?cant thoracic injury. Injuries to the chest wall usually arise from direct contact, for example, intrusion of wreckage in a road traf?c collision or blunt trauma to the chest wall arising from a direct blow. Seat belt injuries come into this category and may cause fractures of the clavicle, sternum

2007 Joint Royal Colleges Ambulance Liaison Committee

427. Paediatric - trauma emergencies in children (overview)

Paediatric - trauma emergencies in children (overview) INTRODUCTION Every year approximately 700 children die as a result of accidents in England and Wales. 1 About half of them die as a result of motor vehicle incidents. Fatalities as a result of cycle and pedestrian incidents are most common in children. While the law states that all children should be restrained in vehicles, 2,3 this is often not complied with and ejection also causes a signi?cant number of deaths and serious injuries (...) . A third of childhood fatalities occur in the home. Burns and falls are the main cause of death in this environment. It is a truism that MOST child deaths could be regarded as avoidable if injury prevention methods had been rigorously applied. The basic principles of the ABC approach to paediatric trauma management are very similar to those of the adult. There are, however, areas of difference in terms of anatomy, relative size and physiological response to injury. This guide is intended to highlight

2007 Joint Royal Colleges Ambulance Liaison Committee

428. Review: Trauma-focused psychological treatments improve post-traumatic stress disorder symptoms Full Text available with Trip Pro

Review: Trauma-focused psychological treatments improve post-traumatic stress disorder symptoms Review: Trauma-focused psychological treatments improve post-traumatic stress disorder symptoms | Evidence-Based Mental Health We use cookies to improve our service and to tailor our content and advertising to you. You can manage your cookie settings via your browser at any time. To learn more about how we use cookies, please see our . Log in using your username and password For personal accounts (...) OR managers of institutional accounts Username * Password * your user name or password? Search for this keyword Search for this keyword Main menu Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? You are here Review: Trauma-focused psychological treatments improve post-traumatic stress disorder symptoms Article Text Therapeutics Review: Trauma-focused psychological treatments improve post-traumatic stress

2007 Evidence-Based Mental Health

429. PTSD plus depression are comorbid conditions but depression can occur independently in the acute aftermath of trauma Full Text available with Trip Pro

PTSD plus depression are comorbid conditions but depression can occur independently in the acute aftermath of trauma PTSD plus depression are comorbid conditions but depression can occur independently in the acute aftermath of trauma | Evidence-Based Mental Health We use cookies to improve our service and to tailor our content and advertising to you. You can manage your cookie settings via your browser at any time. To learn more about how we use cookies, please see our . Log in using your (...) username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? Search for this keyword Search for this keyword Main menu Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? You are here PTSD plus depression are comorbid conditions but depression can occur independently in the acute aftermath of trauma Article Text Prevalence PTSD plus

2006 Evidence-Based Mental Health

430. A national evaluation of the effect of trauma-center care on mortality. Full Text available with Trip Pro

A national evaluation of the effect of trauma-center care on mortality. Hospitals have difficulty justifying the expense of maintaining trauma centers without strong evidence of their effectiveness. To address this gap, we examined differences in mortality between level 1 trauma centers and hospitals without a trauma center (non-trauma centers).Mortality outcomes were compared among patients treated in 18 hospitals with a level 1 trauma center and 51 hospitals non-trauma centers located in 14 (...) states. Patients 18 to 84 years old with a moderate-to-severe injury were eligible. Complete data were obtained for 1104 patients who died in the hospital and 4087 patients who were discharged alive. We used propensity-score weighting to adjust for observable differences between patients treated at trauma centers and those treated at non-trauma centers.After adjustment for differences in the case mix, the in-hospital mortality rate was significantly lower at trauma centers than at non-trauma centers

2006 NEJM

431. A controlled comparison study to evaluate different management strategies for workplace trauma

A controlled comparison study to evaluate different management strategies for workplace trauma EARLY INTERVENTION FOLLOWING TRAUMA: A CONTROLLED LONGITUDINAL STUDY AT ROYAL MAIL GROUP Other titles from IES: Workplace trauma and its management: a review of the literature Rick J, Perryman S, Young K, Guppy A, Hillage J HSE Contract Research Report 170/98, 1998. ISBN 0 7176 1552 9 Cognitive Factors’ Influence on the Expression and Reporting of Work-Related Stress Daniels K, Jones D, Perryman S (...) other titles authored by IES, is on the IES Website, www.employment-studies.co.uk Early Intervention Following Trauma: a controlled longitudinal study at Royal Mail Group Dr Jo Rick, Institute of Work Psychology Siobhán O’Regan, Institute for Employment Studies Andrew Kinder, Atos Origin Report 435 Published by: INSTITUTE FOR EMPLOYMENT STUDIES Mantell Building University of Sussex Campus Falmer Brighton BN1 9RF UK Tel. + 44 (0) 1273 686751 Fax + 44 (0) 1273 690430 http://www.employment

2006 British Occupational Health Research Foundation

432. Trauma emergencies in children ? overview

Trauma emergencies in children ? overview INTRODUCTION Every year approximately 700 children die as a result of accidents in England and Wales. 1 About half of them die as a result of motor vehicle incidents. Fatalities as a result of cycle and pedestrian incidents are most common in children. While the law states that all children should be restrained in vehicles, 2,3 this is often not complied with and ejection also causes a signi?cant number of deaths and serious injuries. A third (...) of childhood fatalities occur in the home. Burns and falls are the main cause of death in this environment. It is a truism that MOST child deaths could be regarded as avoidable if injury prevention methods had been rigorously applied. The basic principles of the ABC approach to paediatric trauma management are very similar to those of the adult. There are, however, areas of difference in terms of anatomy, relative size and physiological response to injury. This guide is intended to highlight those

2006 Joint Royal Colleges Ambulance Liaison Committee

433. Trauma in pregnancy

Trauma in pregnancy Trauma Emergencies INTRODUCTION Coping with pregnant women with major injuries is a rare problem, but demands a special approach. Pregnancy produces physiological changes, particularly in the cardiovascular system: ? cardiac output increases by 20–30% in ?rst 10 weeks of pregnancy ? average heart rate increases by 10 to 15 beats per minute ? both systolic and diastolic blood pressure (BP) fall on average by 10–15mmHg ? in the supine position the enlarged uterus compresses (...) be employed (see manual displacement below) 3. signs of shock appear very late during pregnancy and hypotension is an extremely late sign. Any signs of hypovolaemia during pregnancy are likely to indicate a 35% (class III) blood loss and must be treated aggressively. ESTABLISH LARGE BORE IV CANNULATION EARLY. HISTORY Refer to trauma emergencies guideline. Enquire about stage of the pregnancy, and any problems so far with the pregnancy. Ask the mother if she has her pregnancy record card with her. Enquire

2006 Joint Royal Colleges Ambulance Liaison Committee

434. Thoracic trauma

Thoracic trauma INTRODUCTION Thoracic injuries are one of the most common causes of death from trauma, accounting for approximately 25% of such deaths. Despite the very high percentage of serious thoracic injuries, the vast majority of these patients can be managed in hospital by chest drainage and resuscitation and only 10–15% require surgical intervention. In the ?eld, the most common problem associated with thoracic injury is hypoxia, either from impaired ventilation or secondary (...) to hypovolaemia from massive bleeding into the chest (haemothorax), or major vessel disruption (e.g.: ruptured thoracic aorta). HISTORY The mechanism of injury is an important guide to the likelihood of signi?cant thoracic injury. Injuries to the chest wall usually arise from direct contact, for example, intrusion of wreckage in a road traf?c collision or blunt trauma to the chest wall arising from a direct blow. Seat belt injuries come into this category and may cause fractures of the clavicle, sternum

2006 Joint Royal Colleges Ambulance Liaison Committee

435. Neck and back trauma

Neck and back trauma INTRODUCTION Spinal cord injury (SCI) most commonly affects young and ?t people and will continue to affect them to a varying degree for the rest of their lives. In the extreme, SCI may prove immediately fatal where the upper cervical cord is damaged, paralysing the diaphragm and respiratory muscles. Partial cord damage, however, may solely affect individual sensory or motor nerve tracts producing varying long-term disability. It is important to note (...) immobilisation. 25 Immobilisation – hazards The value of routine out of hospital spinal immobilisation remains uncertain and any bene?ts may be outweighed by the risks of rigid collar immobilisation, including: 1. airway dif?culties 2. increased intra-cranial pressure 26-31 3. increased risk of aspiration 32 4. restricted respiration 33,34 5. dysphagia 35 6. skin ulceration 36-38 7. can induce pain, even in those with no injury 10,39 Neck and Back Trauma Trauma Emergencies October 2006 Page 1 of 8 Trauma

2006 Joint Royal Colleges Ambulance Liaison Committee

436. Limb trauma

Limb trauma INTRODUCTION There is one fundamental rule to apply to these cases and that is NOT to let limb injuries, however dramatic in appearance, distract the clinician from less visible but life-threatening problems such as airway obstruction, compromised breathing, poor perfusion and spinal injury. HISTORY Obtain a history of how the injury was sustained, in particular factors indicating the forces involved. ASSESSMENT However dramatic limb injuries appear, ALWAYS exclude the presence (...) of other TIME CRITICAL injuries by using the PRIMARY SURVEY. Assess and correct de?cits with: ? AIRWAY ? BREATHING ? CIRCULATION ? DISABILITY (mini neurological examination) Evaluate whether the patient is TIME CRITICAL or NON-TIME CRITICAL following criteria as per trauma emergencies guideline. In TIME CRITICAL patients, evidence suggests that haemorrhage control, spinal immobilisation if indicated (refer to neck and back trauma guideline) and rigid splinting are suf?cient treatment of fractures

2006 Joint Royal Colleges Ambulance Liaison Committee

437. Abdominal trauma

Abdominal trauma INTRODUCTION Trauma to the abdomen can be extremely dif?cult to assess even in a hospital setting. In the field, identifying which abdominal structure/s has been injured is less important than identifying that abdominal trauma itself has occurred. It is therefore, of major importance to note abnormal signs associated with blood loss, and establish that abdominal injury is the probable cause, rather than being concerned with, for example, whether the source of that abdominal (...) was the length of the weapon or the type of gun and the range? ASSESSMENT Assess and correct de?cits with: ? AIRWAY ? BREATHING ? CIRCULATION ? DISABILITY (mini neurological examination) Evaluate whether a patient is TIME CRITICAL/ POTENTIALLY TIME CRITICAL or NON-TIME CRITICAL following criteria as per trauma emergencies guideline. If patient is TIME CRITICAL/POTENTIALLY TIME CRITICAL, immobilise cervical spine if indicated (refer to neck and back guideline) and go to nearest suitable receiving hospital

2006 Joint Royal Colleges Ambulance Liaison Committee

438. Trauma emergencies in adults ? overview

Trauma emergencies in adults ? overview Trauma Emergencies INTRODUCTION All trauma patients should be assessed and managed in a systematic way, using the primary survey to identify patients with actual or potentially life threatening injuries. If any abnormality is detected during the assessment, the need for senior clinical support should be considered. This guideline uses mechanism of injury and primary survey as the basis of care for all trauma patients. All these guidelines re?ect (...) the principles of the Pre- Hospital Trauma Life Support (PHTLS RCS Ed)1, and Advanced Trauma Life Support (ATLS) training courses. BASIC TRAUMA INCIDENT PROCEDURE Safety: 1. SELF – personal protective equipment is mandatory 2. SCENE 3. CASUALTY. Remember, safety is dynamic and needs to be continually re-assessed throughout. Scene Assessment: ? consider resources required ? consider possibility of major incident/chemical, biological, radiological or nuclear (CBRN) (refer to CBRN guideline) ? early situation

2006 Joint Royal Colleges Ambulance Liaison Committee

439. Head trauma

Head trauma INTRODUCTION Head injury is estimated to be the cause of 1,000,000 hospital presentations each year in the UK, with an incidence of severe brain injury of between 10 and 15 per 100,000 population. 1 It may be an isolated injury or be part of multi-system traumatic injury. There is a signi?cant association with cervical spinal injury in those with a depressed level of consciousness. 2 Little can be done for primary brain injury, i.e. damage that occurs to the brain at the time (...) and a metabolic acidosis. Blood loss from other sources in a multi-system trauma may lead to hypovolaemia and a fall in the cerebral perfusion pressure. HISTORY Mechanism of injury In a person with altered level of consciousness, at risk of intracranial head injury, an appreciation of the forces that were involved in causing the injury is helpful. With scene indicators such as a “bulls-eye” of the windscreen or blood staining of the dashboard or steering wheel in a motor vehicle collision, or signi?cant

2006 Joint Royal Colleges Ambulance Liaison Committee

440. Alleviating postnatal perineal trauma: to cool or not to cool?

Alleviating postnatal perineal trauma: to cool or not to cool? Alleviating postnatal perineal trauma: to cool or not to cool? Alleviating postnatal perineal trauma: to cool or not to cool? Steen M, Briggs M, King D CRD summary This review examined localised cooling for perineal trauma following childbirth. The authors concluded that it may be effective in reducing inflammatory responses, but that further research is needed to evaluate the impact on healing. The review used relatively rigorous (...) methodology, however, it is difficult to assess the reliability of the conclusions as no statistical data or effects sizes were reported. Authors' objectives To assess the evidence for the use of localised cooling methods to alleviate perineal trauma following childbirth. Searching MEDLINE, CINAHL, MIDIRS and the trials databases of the Cochrane Pregnancy and Childbirth Group were searched for studies published between 1960 and 2005; the search terms were reported. References of relevant publications were

2006 DARE.