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Latest & greatest articles for trauma
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Resuscitative Thoracotomy in Trauma Units Patron: HRH Princess Royal 7-9 Bream’s Buildings Tel +44 (0)20 7404 1999 London Fax +44 (0)20 7067 1267 EC4A 1DT www.rcem.ac.uk Position statement on Resuscitative Thoracotomy in Trauma Units 20 April 2017 In patients with penetrating chest trauma, ‘resus room’ thoracotomy can be a life- saving procedure, if performed within a short period of the patient sustaining cardiac arrest. The October 2015 Resuscitation Council Guidelines recommend (...) that it should be considered in these circumstances. Outside a Major Trauma Centre setting, it is unlikely that cardiothoracic surgery support will be available to take over the patient’s management immediately following an ED resuscitative thoracotomy. If the Trauma Unit is geographically remote, a lengthy transfer may be required before definitive care can be delivered. In consequence, there may be local resistance to performing ED thoracotomy in such units, based on a belief that it is futile. This may
CRACKCast E055 – Pelvic Trauma CRACKCast E055 - Pelvic Trauma - CanadiEM CRACKCast E055 – Pelvic Trauma In , by Adam Thomas December 26, 2016 This episode of CRACKCast covers Rosen’s Chapter 55, Pelvic Trauma. These patients can decline quickly from blood loss, so recognition and determining injury severity early is important to stabilize them. Shownotes – Rosen’s in Perspective Key message: be scared! Patients can easily exsanguinate into their pelvis from pelvic ring fractures Also requires (...) large amount of force – look for other injuries Epidemiology: Primarily result from MVCs and ped struck trauma. Less commonly (5-10%) falls from height Mortality is 9-22% – independent predictor of death Anatomy Complex structure, but at the core is a ring protecting visceral components (GI tract, vasculature, nerves) Major components of stability: posterior arch (weight bearing), symphysis pubis anteriorly. Unstable ring fractures mostly due to disruption of ligaments of posterior arch. Vascular
Traumatic central cord syndrome after blunt cervical trauma: a pediatric case report Traumatic central cord syndrome (CCS) is the most frequently encountered incomplete spinal cord injury (SCI). The patient presents weakness, which is usually greater in the upper extremities than in the lower extremities, secondary to damage to the cervical spinal cord and anatomic distribution of the corticospinal tracts. CCS is seen commonly after a hyperextension mechanism in older patients with spondylotic (...) changes. There are few literature reports regarding CCS in pediatric patients. We present an unusual case of traumatic CCS in a pediatric patient.A 15-year-old male patient, victim of bullying at school, received cervical blunt trauma with a plastic tube. Within 3 h, the patient developed generalized weakness, which was greater in the upper extremities than in the lower extremities. Upon evaluation, the patient was found with marked upper extremity weakness compared to the lower extremities
The role of biomarkers in ruling out cerebral lesions in mild cranial trauma The role of biomarkers in ruling out cerebral lesions in mild cranial trauma The role of biomarkers in ruling out cerebral lesions in mild cranial trauma San Miguel L, Benahmed N, Devos C, Fairon N, Roberfroid D Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation San (...) Miguel L, Benahmed N, Devos C, Fairon N, Roberfroid D. The role of biomarkers in ruling out cerebral lesions in mild cranial trauma. Brussels: Belgian Health Care Knowledge Centre (KCE). KCE Reports. 2016 Final publication URL Indexing Status Subject indexing assigned by CRD MeSH Biomarkers; Cerebral Hemorrhage, Traumatic; Humans Language Published English Country of organisation Belgium English summary An English language summary is available. Address for correspondence Belgian Health Care Knowledge
The Role of Context in the Implementation of Trauma-Focused Treatments: Effectiveness Research and Implementation in Higher and Lower Income Settings In recent years, the implementation of trauma-focused treatments has expanded across settings that vary widely in the availability of resources, infrastructure, and personnel. The present review aims to inform researchers, policy makers, trainers, and administrators about this diverse range of research. Taking a global health perspective
Medical expert testimony as conflict of interest regarding the onset of rheumatoid arthritis following trauma 27920585 2018 11 13 1179-156X 8 2016 Open access rheumatology : research and reviews Open Access Rheumatol Medical expert testimony as conflict of interest regarding the onset of rheumatoid arthritis following trauma. 119-121 Sherry David D DD Division of Rheumatology, Department of Pediatrics, The Children's Hospital of Philadelphia Perelman School of Medicine at the University (...) of Pennsylvania, Philadelphia, PA, USA. eng Journal Article Comment 2016 11 23 New Zealand Open Access Rheumatol 101688698 1179-156X Open Access Rheumatol. 2016 Aug 17;8:77-80 27843373 The author supplies medical expert opinion and testimony in cases involving juvenile idiopathic arthritis and trauma. The author reports no other conflicts of interest in this communication. 2016 12 7 6 0 2016 12 7 6 0 2016 12 7 6 1 epublish 27920585 10.2147/OARRR.S122722 oarrr-8-119 PMC5125996 JAMA. 2009 Nov 25;302(20):2230-4
Collective Review of the Status of Rapid Sequence Intubation Drugs of Choice in Trauma in Low- and Middle-Income Settings (Prehospital, Emergency Department and Operating Room Setting) Establishing a definitive airway in order to ensure adequate ventilation and oxygenation is an important aspect of resuscitation of the polytrauma patient .To review the relevant literature that compares the different drugs used for rapid sequence intubation (RSI) of trauma patients, specifically reviewing (...) : premedication, induction agents and neuromuscular blocking agents across the prehospital, emergency department and operating room setting, and to present the best practices based on the reviewed evidence.A literature review of rapid sequence intubation in the trauma population was carried out, specifically comparison of the drugs used (induction agent, neuromuscular blocking drugs and adjuncts).Studies involving the comparison of drugs used in RSI in, specifically, the trauma patient are sparse
CRACKCast E047 – Genitourinary Trauma CRACKCast E047 - Genitourinary Trauma - CanadiEM CRACKCast E047 – Genitourinary Trauma In , by Chris Lipp October 31, 2016 This episode of CRACKCast covers Rosen’s Chapter 047, Genitourinary Trauma. These patient presentations can range from subtle injuries all the way to significant obvious deformity. This episode helps delineate what to look for and what not to miss when considering GU Trauma. Shownotes – Rosen’s in Perspective People rarely die from (...) renal injuries in the ER (unless their kidney gets pulverized!) There is a reason why we don’t say “ABC…U” Usually the signs and symptoms are subtle, but missing them can lead to long term: Kidney Disease HTN, incontinence, sexual dysfunction Diagnosis of urinary tract trauma is done in a retrograde way A Note on female trauma: Watch for vaginal lacerations in the female with pelvic #’s, but urethral injuries are VERY rare. Protected because of the symphysis pubis and its shorter length Retrograde
CRACKCast E044 – Neck Trauma CRACKCast E044 - Neck Trauma - CanadiEM CRACKCast E044 – Neck Trauma In , by Adam Thomas October 10, 2016 This episode of CRACKCast covers Rosen’s Chapter 044, Neck Trauma. Continuing in our trauma series, this episode tackles the challenging issue of neck trauma and injuries, and explores the anatomy and relevant considerations in the diagnosis and management of both blunt and penetrating neck injuries. Shownotes – Rosen’s in Perspective Wide range of complications (...) from minor wounds to severe hemorrhage, neurologic injury, to airway compromise Apparently stable patients can harbour life threatening injuries Three mechanisms of neck trauma: Blunt Penetrating Strangulation / near hanging Four anatomic injury areas: Laryngotracheal – airway Pharynx oesophageal – digestive tract Vascular system Neurologic system Principles of Disease Penetrating trauma : Aetiologies: GSW’s: High velocity: rifles > 2000 ft/s Have very predictable direct pathways through tissue
CRACKCast E042 – Facial Trauma CRACKCast E042 - Facial Trauma - CanadiEM CRACKCast E042 – Facial Trauma In , by Chris Lipp September 26, 2016 This episode of CRACKCast covers Rosen’s Chapter 042, Facial Trauma. Continuing in our series on all things trauma, this episode tackles the issue of facial trauma and explores some of the nuances in the diagnosis and management of these patients. Shownotes – Rosen’s in Perspective mechanism of facial trauma varies significantly age highly associated (...) with alcohol use 49% of maxillofacial trauma was ETOH related in one study (many from assaults) other common mechanisms include falls, animal bites, sports, and flying debris. much more common in unprotected vehicle users such as ATVs and motorcycles 32% of injured ATV riders will have facial injuries (correlated with serious injury) children < 17 years old, sports injuries are the largest source of facial injuries (20%) children < 6 years old most commonly suffer facial injuries from family pets
Diagnostic accuracy of emergency-performed focused assessment with sonography for trauma (FAST) in blunt abdominal trauma Intra-abdominal hemorrhage due to blunt abdominal trauma is a major cause of trauma-related mortality. Therefore, any action taken for facilitating the diagnosis of intra-abdominal hemorrhage could save the lives of patients more effectively. The aim of this study was to determine the accuracy of focused assessment with sonography for trauma (FAST) performed by emergency (...) physicians.In this cross-sectional study from February 2011 to January 2012 at 7th Tir Hospital in Tehran (Iran), 120 patients with abdominal blunt trauma were chosen and evaluated for abdominal fluid. FAST sonography was performed for all the subjects by emergency residents and radiologists while they were blind to the other tests. Abdominal CTs, which is the gold standard, were done for all of the cases. SPSS 20.0 was used to analyze the results.During the study, 120 patients with abdominal blunt trauma
CJEM Infographic: Does Mode of Transport Confer a Mortality Benefit in Trauma Patients? CJEM Infographic: Does Mode of Transport Confer a Mortality Benefit in Trauma Patients? - CanadiEM CJEM Infographic: Does Mode of Transport Confer a Mortality Benefit in Trauma Patients? In , by Simon Huang September 16, 2016 This month CanadiEM is featuring an article from the Canadian Journal of Emergency Medicine (CJEM) that focuses on the mode of transport for trauma patients. This is primarily a choice (...) between ground and air transport, for which there are no evidence-based guidelines. As shown in this CanadiEM infographic, this study by Buchanan et al. 1 set out to determine if the use of ground or air transport improved trauma patient outcomes. A historical, observational cohort study was performed at the Hamilton General Hospital, using data from 1995-2013. The predicted survival of air and ground transported trauma patients were then calculated using a TRISS-L analysis, and subsequently compared
Trauma recidivism at an emergency department of a Swedish medical center To inform targeted prevention, we studied patterns of trauma recidivism and whether a first injury predicts the risk for a recurrent injury.In a population-based study of 98,502 adult injury events 1999-2012, at the emergency department of Umeå University Hospital, Sweden, we compared non-recidivists with recidivists in terms of patients' sex, age, type of injury and severity of the injury.Thirty-six percent of all (...) patients suffered recurrent injuries, which were associated with a higher proportion of inpatient care and more hospital days. Young men and elderly women were at the highest risk for trauma recidivism. At 20 to 24 years, men had a 2.4 (CI 95 % 2.3-2.5) higher risk than women, a 90 years old woman had almost a 10-fold higher risk for another moderate/severe injury than a 20 years old one. A fracture were associated with a hazard ratio of 1.28 (CI 95 % 1.15-1.42) among men younger than 65 years and 1.31
TREKK Series | Pediatric Multisystem Trauma TREKK Series | Pediatric Multisystem Trauma - CanadiEM TREKK Series | Pediatric Multisystem Trauma In by Ashley Lubberdink September 6, 2016 Editor’s note: This post represents the second in a series led by Drs. Ashley Lubberdink and Kaif Pardhan translating the pediatric guidelines that have been developed by TREKK (TRanslating Emergency Knowledge for Kids). For more information and further pediatric emergency medicine guidelines, please visit (...) the abdominal area. What are some specific considerations unique to pediatric patients in trauma? Airway (pediatric airway is smaller) Larger occiput- causes flexion of airway, especially when on a flat backboard Infants are obligate nasal breathers Relatively larger tongue and smaller oral cavity Floppy epiglottis (omega shaped) Larynx is superior and anterior (C3-C4) Cricoid is narrowest point in the airway Shorter trachea Trachea more cartilaginous and soft Breathing High basal metabolic rate (BMR), high
CRACKCast E039 – Geriatric Trauma CRACKCast E039 - Geriatric Trauma - CanadiEM CRACKCast E039 – Geriatric Trauma In , , by Adam Thomas September 5, 2016 This episode of CRACKCast cover’s Rosen’s Chapter 039, Geriatric Trauma. We see more and more elderly patients in our trauma bay as our population ages, and there are important distinctions in the management of this growing population. Shownotes – Rosen’s in Perspective GERIATRIC trauma is on the rise Have increased morbidity and mortality ATLS (...) recommends that patients older than 55 years old be transferred to a trauma centre regardless of injury severity score Mechanism of injury Falls – #1 MVCs Ped. struck Elder abuse Suicide attempts Burns Need to think about whether a medical problem CAUSED the crash! 1) Name 5 risk factors for falls in the elderly Cognitive impairment Vision and hearing loss Impaired thirst mechanism – dehydration, orthostatic hypotension Reduced respiratory reserve Cardiac disease – Arrythmias, poor CO, etc. Osteophyte
The Management of Urological Trauma Associated with Pelvic Fractures BOAST 14: THE MANAGEMENT OF UROLOGICAL TRAUMA ASSOCIATED WITH PELVIC FRACTURES Background and Justification: Urological trauma is rare and the incidence of severe urethral trauma is 1/million population/year. The majority of cases are due to blunt high-energy trauma with associated multi-system injuries and 80% of these cases are associated with pelvic fractures. Urological injuries are potentially fatal and can result (...) in severe long-term disability. Inclusions: Patients of all ages with potential bladder or urethral trauma. Standards for practice audit: 1. All Major T rauma Centres and T rauma Units should have agreed written guidelines for the management of suspected urological trauma and these must be easily available within the Emergency Department. 2. All patients suffering high-energy trauma must have examination of the perineum and genitalia plus a rectal examination and the findings recorded in the medical
The role of biomarkers in ruling out cerebral lesions in mild cranial trauma 2016 www.kce.fgov.be KCE REPORT 161Cs SYNTHESIS THE ROLE OF BIOMARKERS IN RULING OUT INTRACRANIAL INJURIES IN MILD CRANIAL TRAUMA 2016 www.kce.fgov.be KCE REPORT 161Cs HEALTH TECHNOLOGY ASSESSMENT SYNTHESIS THE ROLE OF BIOMARKERS IN RULING OUT INTRACRANIAL INJURIES IN MILD CRANIAL TRAUMA LORENA SAN MIGUEL, NADIA BENHAMED, CARL DEVOS, NICOLAS FAIRON, DOMINIQUE ROBERFROID 1 Biomarkers in Mild Cranial Trauma KCE Report (...) in theory seemed simple is nevertheless likely to pose problems in the field. Double trouble, in fact. There is first, the risk that this test, originally aimed at symptomatic cranial trauma patients in whom a CT scan would be considered, could immediately be integrated in the routine battery of tests performed in all victims of a cranial trauma. Then, there is the concern for any negative test results to be interpreted as “inconclusive”, rather than serving as reassurance that there is no intracranial
Thrombelastography-Based Dosing of Enoxaparin for Thromboprophylaxis in Trauma and Surgical Patients: A Randomized Clinical Trial Prophylactic enoxaparin is used to prevent venous thromboembolism (VTE) in surgical and trauma patients. However, VTE remains an important source of morbidity and mortality, potentially exacerbated by antithrombin III or anti-Factor Xa deficiencies and missed enoxaparin doses. Recent data suggest that a difference in reaction time (time to initial fibrin formation (...) ) greater than 1 minute between heparinase and standard thrombelastogram (TEG) is associated with a decreased risk of VTE.To evaluate the effectiveness of TEG-adjusted prophylactic enoxaparin dosing among trauma and surgical patients.This randomized clinical trial, conducted from October 2012 to May 2015, compared standard dosing (30 mg twice daily) with TEG-adjusted enoxaparin dosing (35 mg twice daily) for 185 surgical and trauma patients screened for VTE at 3 level I trauma centers in the United
Glasgow Coma Scale Motor Component ("Patient Does Not Follow Commands") Performs Similarly to Total Glasgow Coma Scale in Predicting Severe Injury in Trauma Patients Trauma victims are frequently triaged to a trauma center according to the patient's calculated Glasgow Coma Scale (GCS) score despite its known inconsistencies. The substitution of a simpler binary assessment of GCS-motor (GCS-m) score less than 6 (ie, "patient does not follow commands") would simplify field triage. We compare (...) total GCS score to this binary assessment for predicting trauma outcomes.This retrospective analysis of a statewide trauma registry includes records from 393,877 patients from 1999 to 2013. Patients with initial GCS score less than or equal to 13 were compared with those with GCS-m score less than 6 for outcomes of Injury Severity Score (ISS) greater than 15, ISS greater than 24, death, ICU admission, need for surgery, or need for craniotomy. We judged a priori that differences less than 5% lack