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Blunt Neck Trauma

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1081. Pain in Patients with Polytrauma

March 1 to July 1, 2003, 39% had sustained gunshot wounds, 31% sustained blast and shrapnel injuries, and 34% had blunt/motor vehicle collision mechanisms.(5) Among these 119 patients there were 184 injured areas, and the location of injury was the lower extremity for 62% of patients, the upper extremity for 30%, the head and neck for 25%, the chest for 25%, and the abdomen for 16%. Among 52 patients with orthopedic injuries evacuated during OEF between December 2001 and January 2003, 15 (29%) had (...) , systematic reviews, prospective cohort, case-control, or systematic observational studies that tested the efficacy or effectiveness of specific pain treatment approaches among patients with polytrauma. 2B: One fair-quality retrospective cohort study of patients with trauma-related amputation demonstrated that after controlling for demographic factors, injury characteristics and other medical morbidity, inpatient rehabilitation was marginally associated with increased likelihood of return to work

2008 Veterans Affairs Evidence-based Synthesis Program Reports

1082. Scalpel safety in the operative setting: a systematic review

2007 - The ASERNIP-S Review Group ASERNIP-S Director Professor Guy Maddern ASERNIP-S Royal Australasian College of Surgeons Stepney SA 5069 Protocol Surgeon Mr Michael Patkin Lecturer, Discipline of Surgery University of Adelaide PO Box 312 North Adelaide SA 5006 Advisory Surgeon Dr Michael Sinnott Senior Staff Specialist in Emergency Medicine Princess Alexandra Hospital Ipswich Road Woolloongabba QLD 4102 Advisory Surgeon Mr Robert Black Department of Otolaryngology Head and Neck Surgery Mater

2007 Publication 80

1083. Traumatic cardiac arrest

should be performed on both sides. Support and assist ventilation. C – Hypovolaemia as a result of major blood loss; apply external haemorrhage control and secure vascular access while transferring without delay to de?nitive treatment. D – Major head injury (refer to head trauma guideline) or spinal cord injury (refer to neck and back trauma guideline) impairing ventilation through CNS depression or loss of neuromuscular function. The international literature and published evidenced- based guidelines (...) rapidly to hospital. If a patient has not responded after 20 minutes of Advanced Life Support (ALS) (refer to advanced life support guideline) then resuscitation can be terminated. Arrested in the presence of Emergency Medical Services (EMS): ? termination of resuscitative effort in the patient who has suffered a trauma related cardiac arrest (blunt or penetrating) in the presence of the EMS crew should be considered if the patient has not responded to 20 minutes of ALS. If no cause amenable

2006 Joint Royal Colleges Ambulance Liaison Committee

1084. Cardiac - traumatic cardiac arrest

thoracocentesis should be performed on both sides. Support and assist ventilation. C – Hypovolaemia as a result of major blood loss; apply external haemorrhage control and secure vascular access while transferring without delay to de?nitive treatment. D – Major head injury (refer to head trauma guideline) or spinal cord injury (refer to neck and back trauma guideline) impairing ventilation through CNS depression or loss of neuromuscular function. The international literature and published evidenced- based (...) transferring rapidly to hospital. If a patient has not responded after 20 minutes of Advanced Life Support (ALS) (refer to advanced life support guideline) then resuscitation can be terminated. Arrested in the presence of Emergency Medical Services (EMS): ? termination of resuscitative effort in the patient who has suffered a trauma related cardiac arrest (blunt or penetrating) in the presence of the EMS crew should be considered if the patient has not responded to 20 minutes of ALS. If no cause amenable

2007 Joint Royal Colleges Ambulance Liaison Committee

1085. Osteoporosis Prevention, Diagnosis, and Therapy

the integration of two main features: bone density and bone quality. Bone density is expressed as grams of mineral per area or volume and in any given individual is determined by peak bone mass and amount of bone loss. Bone quality refers to architecture, turnover, damage accumulation (e.g., microfractures) and mineralization. A fracture occurs when a failure-inducing force (e.g., trauma) is applied to osteoporotic bone. Thus, osteoporosis is a significant risk factor for fracture, and a distinction between (...) at the spine predicts spine fracture better than measures at other sites. 17 49,896 Osteoporosis 3/6/01, 10:14 AM 18 Newer measures of bone strength, such as ultrasound, have been introduced. Recent prospective studies using quanti­ tative ultrasound (QUS) of the heel have predicted hip frac­ ture and all nonvertebral fractures nearly as well as DXA at the femoral neck. QUS and DXA at the femoral neck provide independent information about fracture risk, and both of these tests predict hip fracture risk

2000 NIH Consensus Statements

1086. The diagnostic accuracy of computed tomography angiography for traumatic or atherosclerotic lesions of the carotid and vertebral arteries: a systematic review

, Nathens A B, Kanne J P, Crandall M L, Crummy T A, Hallam D K, Wang M C, Jarvik J G CRD summary This well-conducted review assessed the accuracy of computed tomography angiography (CTA) for imaging carotid and vertebral arteries. It found that CTA is both a sensitive and specific imaging technique for identifying severe atherosclerotic stenosis and occlusion of the carotid arteries. There was insufficient evidence to determine the accuracy of CTA in the setting of blunt or penetrating trauma. Authors (...) standard test against which the new test was compared Studies that used digital subtraction angiography (DSA) or surgical findings as the reference standard were eligible for inclusion. Participants included in the review Studies that reported primary data on humans were eligible for inclusion. The studies focused on atherosclerosis, penetrating neck injuries, suspected blunt injuries or other aetiology (e.g. spontaneous arterial dissections, carotid cavernous fistulae and mixed aetiology). Outcomes

2003 DARE.

1087. Implementation of the Canadian C-Spine Rule

more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Layout table for eligibility information Ages Eligible for Study: 16 Years and older (Child, Adult, Older Adult) Sexes Eligible for Study: All Accepts Healthy Volunteers: Yes Criteria Inclusion Criteria:All alert, stable adults presenting to the study hospital EDs after sustaining acute blunt trauma to the head or neck will be eligible and consecutive eligible (...) Hospital Research Institute Study Details Study Description Go to Brief Summary: Many thousands of trauma patients are seen in Canadian emergency departments each year. On rare occasions, such patients have a broken neck (cervical spine fracture) but in 98 percent of cases the xrays ordered by the doctors are normal. The total cost of inexpensive but high volume tests such as neck x-rays adds considerably to rising health care costs. In addition, these patients are often immobilized with uncomfortable

2006 Clinical Trials

1088. Delayed rupture of common carotid artery following rugby tackle injury: a case report Full Text available with Trip Pro

Delayed rupture of common carotid artery following rugby tackle injury: a case report Common Carotid Artery (CCA) is an uncommon site of injury following a blunt trauma, its presentation with spontaneous delayed rupture is even more uncommon and a rugby tackle leading to CCA injury is a rare event. What makes this case unique and very rare is combination of all of the above.Mr H. presented to the Emergency Department with an expanding neck haematoma and shortness of breath. He was promptly (...) intubated and had contrast CT angiography of neck vessels which localized the bleeding spot on posteromedial aspect of his Right CCA. He underwent emergency surgery with repair of the defect and made an uneventful recovery post operatively.Delayed post traumatic rupture of the CCA is an uncommon yet potentially life threatening condition which can be caused by unusual blunt injury mechanism. A high index of suspicion and low threshold for investigating carotid injuries in the setting of blunt trauma

2008 World journal of emergency surgery : WJES

1089. A case of post traumatic retropharyngeal abscess Full Text available with Trip Pro

A case of post traumatic retropharyngeal abscess Retropharyngeal abscess following blunt trauma neck is rare. We report one such unusual case which was drained surgically.

2006 Indian Journal of Otolaryngology and Head & Neck Surgery

1090. Percutaneous endoscopic gastrostomy (PEG) — An useful ‘surgical’ measure Full Text available with Trip Pro

Percutaneous endoscopic gastrostomy (PEG) — An useful ‘surgical’ measure Eight patients were studied to evaluate the efficacy of a surgeonled percutaneous endoscopic gastrostomy (PEG). Three patients underwent PEG at the time of elective surgery (carcinoma larynx-2, carcinoma tonsil-1), two underwent placements during emergency surgery for neck trauma (blunt injury-1, penetrating injury-1) and three for palliation (recurrent tongue carcinoma-1, recurrent epilaryngeal carcinoma-1 (...) , metastatic neck nodes-1). For patients undergoing intraoperative PEG, the operative time was prolonged by an average of 12 minutes. There were no major procedural or feedingrelated complications in any of the patients. Individual subjective tolerability was good in all patients. A surgeonled PEG is a simple and safe means of combining all the advantages of enteral nutrition with none of the disadvantages of nasogastric tube feeding in emergency, elective head and neck operations and in palliation

2006 Indian Journal of Otolaryngology and Head & Neck Surgery

1091. Axillary artery injury combined with delayed brachial plexus palsy due to compressive hematoma in a young patient: a case report Full Text available with Trip Pro

Axillary artery injury combined with delayed brachial plexus palsy due to compressive hematoma in a young patient: a case report Axillary artery injury in the shoulder region following blunt trauma without association with either shoulder dislocation or fracture of the humeral neck has been previously reported. Axillary artery injury might also be accompanied with brachial plexus injury. However, delayed onset of brachial plexus palsy caused by a compressive hematoma associated with axillary (...) injury after blunt trauma in the shoulder region has been rarely reported. In previous reports, this condition only occurred in old patients with sclerotic vessels. We present a case of a young patient who suffered axillary artery injury associated with brachial plexus palsy that occurred tardily due to compressive hematoma after blunt trauma in the shoulder region without association of either shoulder dislocation or humeral neck fracture.A 16-year-old male injured his right shoulder in a motorbike

2008 Journal of brachial plexus and peripheral nerve injury

1092. Stent-graft repair of traumatic thoracic aortic disruptions. Full Text available with Trip Pro

system trauma (age range, 16-42 years) were seen after motor vehicle accidents between January 1, 2003, and April 1, 2004. Chest x-ray findings warranted thoracic computed tomography scans, which revealed disruptions of the thoracic aorta. Aortograms delineated the extent of the aortic injuries and identified a "landing zone" (neck length range, 1.5-2.0 cm) distal to the subclavian artery but proximal to the tear. The repairs were performed with AneuRx (n= 8) and Excluder (n = 1) proximal aortic (...) Stent-graft repair of traumatic thoracic aortic disruptions. Blunt traumatic thoracic aortic disruption results in pre-hospital death in 80% to 90% of patients. Because of the significant surgical morbidity and mortality associated with open operative repair, endovascular stent-graft repair has been investigated. The objective of this study was to evaluate the efficacy of thoracic aortic disruptions treated with commercially available proximal aortic extension cuffs.Nine patients with multiple

2004 Journal of Vascular Surgery

1093. Pediatric vascular injuries: patterns of injury, morbidity, and mortality. (Abstract)

injury were identified. Those with injuries isolated to the digits and unspecified vessels were excluded (n = 73). The remaining 103 patients were evaluable and are the basis for subsequent comparisons. Seventy-four percent of injuries occurred in male patients. The average age of the male patients was 11.3 years and that of the female patients was 9.1 years (range, 1-18 years; overall, 10.7 years). Penetrating wounds caused 68% of the injuries, followed by blunt trauma (31%) and burns (0.97 (...) Pediatric vascular injuries: patterns of injury, morbidity, and mortality. The purpose of this study was to identify the patterns of injury and associated morbidity/mortality related to pediatric vascular trauma.A retrospective review of children and adolescents treated between 1993 and 2005 was performed. Patients were identified by International Classification of Diseases, Ninth Revision codes within an institutional pediatric trauma registry.One hundred seventy-six patients with vascular

2007 Journal of Pediatric Surgery

1094. Clinical examination and its reliability in identifying cervical spine fractures. Full Text available with Trip Pro

) with that of computed tomography in identifying the presence of c-spine fractures.We prospectively evaluated 534 blunt trauma patients between February 2004 and January 2005. Positive CE was defined as complaints of neck pain, external trauma of the c-spine or neurologic deficit, tenderness or abnormalities to palpation over the cervical spine. Computed tomography was used to define the accuracy of CE.There were 52 patients with, and 482 patients without, c-spine fractures. Forty of the 52 patients with fractures (...) Clinical examination and its reliability in identifying cervical spine fractures. The Eastern Association for the Surgery of Trauma (EAST) guidelines recommend that cervical spine (c-spine) radiographic evaluation is unnecessary in the awake, alert blunt trauma patient who is not intoxicated, has no distracting injuries, and demonstrates no tenderness over the c-spine or neurologic deficits. The purpose of this study was to compare the reliability of the clinical examination (CE

2007 Journal of Trauma

1095. Spiral computed tomography for the diagnosis of cervical, thoracic, and lumbar spine fractures: its time has come. (Abstract)

of SF.Retrospective review of all blunt trauma patients over a two year period (1/01-12/02). Patients with neck pain, back pain, or spine tenderness underwent SCT of the symptomatic region. Patients who were unconscious or intoxicated underwent screening SCT of the entire spine. SCT was performed using 5 mm axial cuts with three-dimensional reconstructions in sagittal and coronal planes. Patients with a discharge diagnosis of cervical, thoracic, or lumbar SF were identified from the trauma registry by ICD-9 (...) codes.There were 3,537 blunt trauma patients evaluated, with 236 (7%) sustaining a cervical, thoracic, or lumbar SF. Forty-five patients (19%) sustained a SF in more than one anatomic region. SCT missed SF in two patients. The cervical SF missed by SCT was a compression fracture identified by magnetic resonance imaging and was treated with a rigid collar. The thoracic SF missed by SCT was also a compression fracture identified on plain radiographs and required no treatment.SCT of the spine identified 99.3

2005 Journal of Trauma

1096. What defines a distracting injury in cervical spine assessment? (Abstract)

What defines a distracting injury in cervical spine assessment? The National Emergency X-Radiography Utilization Study defined five criteria for obtaining cervical spine radiographic investigations in blunt trauma patients. Distracting injury was given as the indication for more than 30% of all x-ray studies ordered. The hypothesis of this study was that upper and lower torso injuries would have different effects on clinical cervical spine assessment.This is a single-center, prospective (...) , observational study of admitted, alert, adult blunt-trauma patients. All patients underwent cervical spine plain-film radiography. Data were collected on all injuries, physical examination findings, narcotic administration, and radiograph results. Patients with upper and lower torso injuries were compared in their ability complain of pain or midline tenderness relative to a cervical spine fracture.In all, 406 patients participated. All patients received narcotic analgesics before examination. Forty patients

2005 Journal of Trauma

1097. Traumatic hyoid bone fracture in patient wearing a helmet: a case report. (Abstract)

Traumatic hyoid bone fracture in patient wearing a helmet: a case report. Fractures of hyoid bone are rare and most of the injuries cause by strangulation. Hyoid bone fractures are usually the result of direct trauma to the neck through manual strangulation or hanging, blunt trauma or from projectiles. But hyoid bone fracture caused by helmet strap has not been reported before. We present a young man wearing a helmet had an isolated hyoid bone fractures after a motorcycle-to-motorcycle accident

2008 American Journal of Emergency Medicine

1098. Out-of-hospital endotracheal intubation and outcome after traumatic brain injury. (Abstract)

treated at trauma centers in the Commonwealth of Pennsylvania), adult patients with head/neck Abbreviated Injury Scale score of 3 or greater and undergoing out-of-hospital endotracheal intubation or ED endotracheal intubation were included. Transferred patients were excluded. The primary outcome was death (on hospital discharge). The secondary outcomes were neurologic (good versus poor, inferred from discharge to home versus long-term care facility) and functional outcome (determined from a Functional (...) Impairment Score). The key exposure was endotracheal intubation (out-of-hospital endotracheal intubation versus ED endotracheal intubation). Using multivariate logistic regression, odds estimates for out-of-hospital endotracheal intubation were adjusted using age, sex, head/neck Abbreviated Injury Scale score, Injury Severity Score, mechanism of injury (penetrating versus blunt), admission systolic blood pressure, mode of transport (ground only versus helicopter or helicopter + ground), and the use

2004 Annals of Emergency Medicine

1099. Cerebral infarct secondary to traumatic carotid artery dissection. (Abstract)

Cerebral infarct secondary to traumatic carotid artery dissection. Internal carotid artery dissection is an important cause of ischemic stroke in children and young patients. Children presenting with gross neurological abnormalities after blunt trauma to the head or neck should be considered to have sustained injury to the carotid arteries until proven otherwise. Treatment options include observation, anticoagulation and endovascular stenting, and aggressive surgical repair of the carotid

2007 Pediatric Emergency Care

1100. Traumatic dissection of the internal carotid artery. (Abstract)

) Children presenting with gross neurologic abnormalities following blunt trauma to the head or neck should be considered to have sustained injury to the carotid arteries until proven otherwise. (...) Traumatic dissection of the internal carotid artery. We present the case of an 11-year-old male who had a dissection of his left internal carotid artery following a rather innocuous mechanism of injury. Although this phenomenon is documented in the medical literature, it remains a relatively rare event following blunt injury to the head and neck (0.3% occurrence rate in 1 study spanning 7 years). (Despite its rarity, it remains an important cause of cerebrovascular accidents in children. 2

2004 Pediatric Emergency Care

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