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Latest & greatest articles for trauma
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on trauma or other clinical topics then use Trip today.
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CRACKCast E038 – Pediatric Trauma CRACKCast E038 - Pediatric Trauma - CanadiEM CRACKCast E038 – Pediatric Trauma In , by Adam Thomas August 29, 2016 This episode of CRACKCast cover’s Rosen’s Chapter 038, Pediatric Trauma. Fortunately most emergency departments do not see major pediatric trauma frequently; however, it is important for the emergency physician to have the knowledge and skills to feel confident managing these high stakes, and at times high stress, situations. Shownotes – Rosen’s (...) suspected of having non-accidental trauma (NAT) Here are some key formulas to know: cuffed ET: age in years/4 + 3.5 uncuffed ET age in years/4 + 4 tube depth age in years/2 + 12 appropriate tube size X 3 = number of cm at the teeth that the ETT should be taped at. chest tube size: 2 x ETT size femoral line: 3-6 F. 1) List 5 relevant anatomic/physiologic differences between children and adults in relation to trauma management 1. More widely distributed forces in a child = multiple injuries more likely
Barriers Against Implementing Blunt Abdominal Trauma Guidelines in a Hospital: A Qualitative Study Clinical practice guidelines are structured recommendations that help physicians and patients to make proper decisions when dealing with a specific clinical condition. Because blunt abdominal trauma causes a various range of mild, single-system, and multisystem injuries, early detection will help to reduce mortality and resulting disability. Emergency treatment should be initiated based on CPGs (...) . This study aimed to determine the variables affecting implementing blunt abdominal trauma CPGs in an Iranian hospital.This study was conducted as a qualitative and phenomenology study in the Family Hospital in Tehran (Iran) in 2015. The research population included eight experts and key people in the area of blunt abdominal trauma clinical practice guidelines. Sampling was based on purposive and nonrandom methods. A semistructured interview was done for the data collection. A framework method was applied
The onset of rheumatoid arthritis following trauma Rheumatoid arthritis (RA) is known to have many predisposing factors.We studied individuals whose RA was initiated by physical injuries.Sixty patients (43 females), previously well, developed RA following trauma. No other known environmental or familial influences were present. Fourteen sustained a fracture; of the 46 who did not, 36 sustained multiple injuries that in part involved the axial skeleton. Subsequent unremitting daily pain (...) , stiffness, limited motion, pain on motion, and/or swelling in the injured areas were mandatory for inclusion.Nine months after injuries (span: 2 weeks-36 months), more obvious signs of inflammation (IM) appeared in multiple other joints that were previously not affected by the original trauma. In those with laboratory tests done prior to the spread of IM (30/60), 22 (73%) were normal until an average 8 months after the spread of IM. Of the entire cohort of 60, only 23% had a positive rheumatoid factor
Complications and in-hospital mortality in trauma patients treated in intensive care units in the United States, 2013 Traumatic injury is a leading cause of morbidity and mortality worldwide, but epidemiologic data about trauma patients who require intensive care unit (ICU) admission are scant. This study aimed to describe the annual incidence of ICU admission for adult trauma patients, including an assessment of risk factors for hospital complications and mortality in this population.This (...) was a retrospective study of adults hospitalized at Level 1 and Level 2 trauma centers after trauma and recorded in the National Trauma Data Bank in 2013. Multiple logistic regression analyses were performed to determine predictors of hospital complications and hospital mortality for those who required ICU admission.There were an estimated total of 1.03 million ICU admissions for trauma at Level 1 and Level 2 trauma centers in the United States in 2013, yielding an annual incidence of 3.3 per 1000 population
Effectiveness of cadaverâ€based educational seminar for trauma surgery: skills retention after halfâ€year followâ€up In Japan, trauma surgery training remains insufficient, and on-the-job training has become increasingly difficult because of the decreasing number of severe trauma patients and the development of non-operative management. Therefore, we assessed whether a 1-day cadaver-based seminar is effective for trauma surgery training.Data were collected from 11 seminars carried out from (...) in the seminar repeatedly is suggested to be effective for skills retention in trauma surgery.
A survival prediction logistic regression models for blunt trauma victims in Japan This research aimed to propose a logistic regression model for Japanese blunt trauma victims.We tested whether the logistic regression model previously created from data registered in the Japan Trauma Data Bank between 2005 and 2008 is still valid for the data from the same data bank between 2009 and 2013. Additionally, we analyzed whether the model would be highly accurate even when its coefficients were rounded (...) off to two decimal places.The model was proved to be highly accurate (94.56%) in the recent data (2009-2013). We also showed that the model remains valid without respiratory rate data and the simplified model would maintain high accuracy.We propose the equation of survival prediction of blunt trauma victims in Japan to be Ps = 1/(1+e-b), where b = -0.76 + 1.03 × Revised Trauma Score - 0.07 × Injury Severity Score - 0.04 × age.
Cardiac Troponin I is Increased in Patients with Polytrauma and Chest or Head Trauma. Results of A Retrospective Case-Control Study We performed a retrospective case-control study to assess the values of cardiac troponin I (cTnI) in a large number of patients admitted to the emergency department (ED) with different types of trauma.The study population consisted of all patients aged 18 years or older admitted to the local ED with all types of traumas over a 1-year period. Results of cTnI were (...) compared with those of 125 consecutive blood donors and 25 non-cardiac chest pain ED patients.The final study population consisted of 380 trauma patients, 10 with isolated abdominal trauma, 99 with isolated trauma of the limbs, 49 with isolated chest trauma, 145 with isolated head trauma and 77 with polytrauma. The concentration of cTnI did not differ among the three study populations, but the frequency of measurable values was substantially higher in patients with trauma (63%) than in blood donors
Impact of morphine use in reducing the need for CT scan in patients with cervical spine trauma: a double blinded randomized clinical trial. Cervical spine trauma occurs mostly among young males due to falls and car accidents. The CT scan technology is replacing radiography in many medical clinics as it is very capable in detecting subtle cervical spine injuries. However, the use of CT scan for routine screening in patients with cervical spine trauma remains controversial due to its radiation (...) risks and relatively high cost.The focus of this research was on using morphine in patients with cervical spine trauma. The objective was to determine the ability of morphine to reduce the number of patients in need of CT scans.This double-blinded randomized clinical trial study was conducted from April 2014 to March 2015 in Hasheminejad Hospital in Mashhad, Iran. We enrolled 67 patients with cervical spine trauma and normal radiography in the study. They were divided randomly into two groups
Immediate total-body CT scanning versus conventional imaging and selective CT scanning in patients with severe trauma (REACT-2): a randomised controlled trial. 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.We undertook (...) an international, multicentre, randomised controlled trial at four hospitals in the Netherlands and one in Switzerland. Patients aged 18 years or older with trauma with compromised vital parameters, clinical suspicion of life-threatening injuries, or severe injury were randomly assigned (1:1) by ALEA randomisation to immediate total-body CT scanning or to a standard work-up with conventional imaging supplemented with selective CT scanning. Neither doctors nor patients were masked to treatment allocation
2016LancetControlled trial quality: predicted high
Outcomes of abdominal trauma patients with hemorrhagic shock requiring emergency laparotomy: efficacy of intraâ€aortic balloon occlusion The aims of this study were to investigate outcomes of abdominal trauma in patients with hemorrhagic shock requiring emergency laparotomy and clarify the beneficial effects of intra-aortic balloon occlusion (IABO) for intra-abdominal hemorrhage in patients with critically uncontrollable hemorrhagic shock (CUHS).We reviewed 44 hemorrhagic shock patients who (...) - international normalized ratio, and Ps between the two groups (21 responders and 23 non-responders) were statistically significant (P < 0.05). Intra-aortic balloon occlusion was attempted in 19 of 23 patients (82.6%) with CUHS, and there were no statistically significant differences in presenting Glasgow Coma Scale, body temperature, lactate, prothrombin time - international normalized ratio, or Revised Trauma Score between the survivors (n = 12) and non-survivors (n = 7). The only significant differences
Sarcopenia is a predictive factor for prolonged intensive care unit stays in highâ€energy blunt trauma patients Sarcopenia has been increasingly reported as a prognostic factor for outcome in settings such as cirrhosis, liver transplantation, and emergent surgery. We aimed to elucidate the significance of sarcopenia in severe blunt trauma patients.We retrospectively analyzed 84 patients emergently admitted to the intensive care unit at Kyushu University Hospital (Fukuoka, Japan) from May 2012 (...) significantly longer than those of non-sarcopenic patients (18.7 versus 6.4 days, respectively; P < 0.001). Univariate and multivariate analyses showed sarcopenia to be a significant risk factor for prolonged intensive care unit stay.Sarcopenia is a risk factor that predicts prolonged intensive care unit stay in high-energy blunt trauma patients.
Dynamic activity of NF-kappaB in multiple trauma patients and protective effects of ulinastain. To investigate the dynamic activity of NF-kappaB at the early stage of injury in multiple trauma patients and the protective effects of ulinastain.From January 2008 to May 2010, patients with multiple traumas admitted to our emergency department were enrolled in this study. Their age varied from 20-55 years. All enrolled patients were assigned randomly into control group (26 cases of multiple (...) within 12 hours after injury and subsequently injected at the interval of every 8 hours for 7 days. NF-kappaB activity in monocytes and the level of TNF-alpha,IL-1, IL-6 in serum on admission (day 0), day 1, 2, 3, 4, and 7 were measured. Data were compared and analyzed between different groups.NF-kappaB activity in monocytes and TNF-alpha,IL-1 and IL-6 of these patients reached peak levels at 24 hour after trauma, with gradual decrease to normal at 72 hour after trauma. NF-kappaB activity
Esophageal perforation associated with fracture of the upper thoracic spine from blunt trauma: a case report We report the successful conservative management of an unusual case of esophageal perforation associated with an upper thoracic spinal fracture from blunt trauma in Minamata, Kumamoto, Japan. A 69-year-old man became paraplegic secondary to an L1 burst fracture caused by a boating accident and underwent posterior fixation on the day of admission. The patient also had a minimally (...) displaced T4 vertebral fracture. Fever, dyspnea and elevated inflammatory markers all persisted postoperatively. Computed tomography showed free mediastinal air at the T4 level, and an esophagram showed contrast medium leakage, which helped diagnose esophageal perforation. The esophageal perforation healed with conservative treatment without life-threatening complications. The possibility of esophageal injury should always be considered when treating upper thoracic spinal injuries due to blunt trauma.
Utility of anterior segment swept-source optical coherence tomography for imaging eyes with antecedent ocular trauma To evaluate the utility of swept source optical coherence tomography (SS-OCT) for the analysis of anterior segment structures in cases with previous traumatic eye injuries.We report three eyes of three patients with anterior segment traumatic eye injury and highlight the role of SS-OCT in their evaluation and management. This technology enabled us to visualize the structural (...) details of anterior segment of the eye and augment the clinical examination in our patients. Given that it is non-invasive and that there is no contact involved, it may be an ideal imaging modality for traumatic eye injuries for viewing the details before and after any clinical intervention especially in the sub-acute setting.The anterior segment SS-OCT is a useful device allowing non-invasive, non-contact, real-time, cross-sectional anterior segment images of eyes with previous ocular trauma.
Analysis of consumption of medical resources in terms of intensive care unit/hospital stay and severity using Japan Trauma Data Bank We analyzed the length of intensive care unit or hospital stay of trauma patients to assess the consumption of medical resources using the Japan Trauma Data Bank.We classified 60,580 cases registered between 2004 and 2010 in the Japan Trauma Data Bank by hospital ward on emergency admission.A total of 9,564 intensive care patients could be moved to the general (...) ward before hospital transfer or discharge; 6,217 cases were transferred to another hospital and 9,444 cases were discharged directly from the intensive care unit. The length of intensive care unit or hospital stay correlated with the injury severity score. There were 5,856 patients (68%) from the non-survivors who died within 3 days of admission.Based on the Japan Trauma Data Bank data for many trauma patients, there are numerous cases of long-term stay ≥15 days in intensive care in patients who
Complete cervical tracheal transection due to blunt trauma A 31-year-old man was caught up in the rotor of a snow-removing truck. He was diagnosed with tension pneumothorax and managed with tube thoracostomy in the ambulance. But he was left with respiratory discomfort. Computed tomography scan suggested the diagnosis of complete cervical tracheal transection.The endotracheal tube was advanced distal to the transection site under bronchoscopic guidance, which stabilized the patient's
Ventricular septal perforation after blunt chest trauma due to blows from a fist A 40-year-old man received fist blows to his chest and abdomen. He presented with external jugular vein distention and facial congestion. Chest X-ray showed bilateral pulmonary congestion. A Levine V/VI holosystolic murmur was audible. Echocardiography showed left-to-right shunt flow across the perimembranous region of the ventricular septum. The diameter of the hole was approximately 13 mm. We diagnosed (...) chest trauma is a rare form of cardiac trauma. It is important to consider the timing of the operation and the best method to ensure cardiac repair.
Decrease in Behavioral Problems and Trauma Symptoms Among At-Risk Adopted Children Following Web-Based Trauma-Informed Parent Training Intervention. Children who have experienced early adversities are at risk for behavioral problems and trauma symptoms. Using a two-group, pre-post intervention design, the authors evaluated the effectiveness of an online parent training for Trust-Based Relational Intervention, a trauma-informed, attachment-based intervention, in reducing behavioral problems (...) and trauma symptoms in at-risk adopted children. Children of parents in the treatment group (n = 48) demonstrated significant decreases in behavioral problems and trauma symptoms after intervention. Scores for children in a matched-sample control group did not change. Findings suggest this intervention can effectively reduce behavioral problems and trauma symptoms in children with histories of adversities.