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Blunt Neck Trauma

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1121. Endoesophageal pull through. A technique for the treatment of cancers of the cardia and lower esophagus. Full Text available with Trip Pro

Endoesophageal pull through. A technique for the treatment of cancers of the cardia and lower esophagus. Transthoracic and extrathoracic approaches to cancers of the lower esophagus and cardia each have advantages and drawbacks; the trauma of thoracotomy must be balanced against that of blunt mediastinal extraction of the esophagus. A different surgical approach is proposed in this paper, avoiding both thoracotomy and encroachment upon thoracic mediastinal structures. This technique is based (...) on the removal of the tumor and the esophageal mucosa above it as a distinct anatomic layer by blunt dissection through separate abdominal and neck incisions. This is followed by pulling upward a segment of stomach (or colon) through the esophageal muscular tunnel into the neck for a cervical anastomosis. This endoesophageal pull through (EEPT) approach has been used in the surgical treatment of a total of ten patients, six with adenocarcinomas of the cardia and four with squamous cell carcinomas

1988 Annals of Surgery

1122. Five thousand seven hundred sixty cardiovascular injuries in 4459 patients. Epidemiologic evolution 1958 to 1987. Full Text available with Trip Pro

by a consistent evaluation and treatment philosophy, 4459 patients were treated for 5760 cardiovascular injuries. Eighty-six per cent of the patients were male, and the average age was 30.0 years. Penetrating trauma was the etiology in more than 90% (GSW,51.5%; SW,31.1%; SGW,6.8%). All other injuries were iatrogenic or secondary to blunt trauma. Truncal injuries (including the neck) accounted for 66% of all injuries treated, while lower extremity injuries (including the groin) accounted for only 19%. Injuries (...) Five thousand seven hundred sixty cardiovascular injuries in 4459 patients. Epidemiologic evolution 1958 to 1987. Large epidemiologic analyses of cardiovascular injuries have been limited to studies of military campaigns compiled from many surgeons working in many hospitals with variable protocols. A detailed civilian vascular trauma registry provides a unique opportunity for an epidemiologic evolutionary profile. During the last 30 years in a single civilian trauma center directed

1989 Annals of Surgery

1123. Two cases of isolated first rib fracture Full Text available with Trip Pro

Two cases of isolated first rib fracture Isolated first rib fractures are uncommon. They are usually associated with severe blunt trauma, although other mechanisms have been suggested, these being (a) indirect trauma, (b) sudden contraction of the neck muscles, and (c) stress or fatigue fractures attributable to repeated pull of muscles. Two cases are reported of stress fracture of the first rib, who presented to the accident and emergency department.

2001 Emergency Medicine Journal : EMJ

1124. Posttraumatic lipoma: analysis of 10 cases and explanation of possible mechanisms. (Abstract)

of the lesions (12 altogether) were located on an upper extremity, 5 on a lower extremity, 2 on the trunk, and 1 on the neck. Excision of tumors and primary closure were performed in 92% of the lesions, and only one liposuction was performed. Aesthetic results were achieved in all patients. There were no complications and recurrences.The effect of blunt trauma on fat tissue may be explained by different theories. We summarized possible mechanisms into two groups according to our observations and review (...) Posttraumatic lipoma: analysis of 10 cases and explanation of possible mechanisms. Trauma and lipoma are the most frequently met occurrences in clinical routine. Although lipomas are well-known fatty tumors both clinically and pathologically, the precise etiology is still unknown. Generally, posttraumatic lipomas are known as "pseudolipoma," which describes herniation of deeper fat through Scarpa's layer secondary to trauma. Here we present 10 patients with lipoma secondary to blunt trauma

2003 Dermatologic Surgery

1125. Clinical practice implications of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders: from concepts and findings to recommendations. (Abstract)

of major pathology and no or little interference with daily activities; Grade II neck pain with no signs of major pathology, but interference with daily activities; Grade III neck pain with neurologic signs of nerve compression; Grade IV neck pain with signs of major pathology. In the emergency room after blunt trauma to the neck, triage should be based on the NEXUS criteria or the Canadian C-spine rule. Those with a high risk of fracture should be further investigated with plain radiographs and/or CT (...) or Grade II neck pain without trauma. Those with confirmed Grade III and severe persistent radicular symptoms might benefit from corticosteroid injections or surgery. Those with confirmed Grade IV neck pain require management specific to the diagnosed pathology.The best available evidence suggests initial assessment for neck pain should focus on triage into 4 grades, and those with common neck pain (Grade I and Grade II) might be offered the listed noninvasive treatments if short-term relief is desired.

2009 Journal of Manipulative and Physiological Therapeutics

1126. Assessment of neck pain and its associated disorders: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. (Abstract)

conducted a critical review of the literature (published 1980-2006) on assessment tools and screening protocols for traumatic and nontraumatic neck pain.We found 359 articles on assessment of neck pain. After critical review, 95 (35%) were judged scientifically admissible. Screening protocols have high predictive values to detect cervical spine fracture in alert, low-risk patients seeking emergency care after blunt neck trauma. Computerized tomography (CT) scans had better validity (in adults (...) and elderly) than radiographs in assessing high-risk and/or multi-injured blunt trauma neck patients. In the absence of serious pathology, clinical physical examinations are more predictive at excluding than confirming structural lesions causing neurologic compression. One exception is the manual provocation test for cervical radiculopathy, which has high positive predictive value. There was no evidence that specific MRI findings are associated with neck pain, cervicogenic headache, or whiplash exposure

2009 Journal of Manipulative and Physiological Therapeutics

1127. Thoracic trauma

trauma may well damage the heart, lungs and great vessels, both in isolation or combination. It must be remembered that penetrating wounds to the upper abdomen and the neck may well have caused injuries within the chest, remote from the entry wound. Conversely, penetrating wounds to the chest may well involve injury to the liver, kidneys and spleen. The lung may be damaged with bleeding causing a haemothoraxa or an air leak causing a pneumothorax. Penetrating or occasionally blunt chest injuries may (...) 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

1128. Abdominal trauma

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 (...) is normal. MANAGEMENT Follow Trauma Emergencies Guideline, remembering to: ? ensure ABCD’s and immobilise cervical spine (refer to neck and back guideline). Respiration ? administer high concentration oxygen (O2) (refer to oxygen protocol for administration and information) via a non-rebreathing mask, using the stoma in laryngectomee and other neck breathing patients. High concentration O2 should be administered routinely, whatever the oxygen saturation, in patients sustaining major trauma and long bone

2006 Joint Royal Colleges Ambulance Liaison Committee

1129. The costs and benefits of paramedic skills in pre-hospital trauma care

The results of the study did not show that the paramedics' skills were preventing avoidable deaths. Thus, the authors suggest that paramedics may require different training courses based around different protocols, to be able to make better judgements about when skills should be used, on whom, and in which circumstances. The authors recommend further research in several areas. First, the analysis of alternative paramedic fluid resuscitation protocols in blunt trauma. Second, a comparison (...) The costs and benefits of paramedic skills in pre-hospital trauma care The costs and benefits of paramedic skills in pre-hospital trauma care The costs and benefits of paramedic skills in pre-hospital trauma care Nicholl J, Hughes S, Dixon S, Turner J, Yates D Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical

1998 NHS Economic Evaluation Database.

1130. Role of flexion/extension radiography in neck injuries in adults

. Relevant Paper(s) Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses Brady WJ et al, 1999, USA 451 patients over age 18 years with blunt trauma undergoing SCSR and FECSR Retrospective descriptive review Abnormality on FECSR 372 (82.5%) normal SCSR of whom 5 (1.3%) had abnormal FECSR Patients with blunt trauma and neck complaints & an abnormal SCSR are more likely to have abnormal FECSR showing cervical injury requiring stabilisation than (...) In [a neurologically intact adult patient with neck pain following trauma but normal plain xrays] do [flexion/extension xrays] aid [diagnosis of ligamentous or soft tissue injury with instability]? Clinical Scenario A man attends the emergency department having been involved in a high speed road traffic accident. He complains of neck pain and midline neck spinal tenderness but has no neurological signs or symptoms. Standard 3-view cervical spine radiology (lateral, anteroposterior and odontoid views) reveals

2004 BestBETS

1131. Role of flexion/extension radiography in paediatric neck injuries

FECSR is unlikely to be abnormal. If SCSR is equivocal/abnormal FECSR is still unlikely to be abnormal but may help may help to rule out injury in an alert child with no neurological signs complaining of pain & neck tenderness. References Dwek JR, Chung CB. Radiography of cervical spine injury in children: are flexion-extension radiographs useful for acute trauma? Am J Roentgenol 2000;174(6):1617-9. Woods WA, Brady WJ, PollockG, et al. Flexion-extension cervical spine radiography in pediatric blunt (...) In [a neurologically intact child with neck pain following trauma but normal plain xrays] do [flexion/extension xrays] aid [diagnosis of ligamentous or soft tissue injury with instability]? Clinical Scenario A child attends the emergency department, he has been involved in a high speed RTA, complains of neck pain and midline neck spinal tenderness but has no neurological signs/symptoms. Static cervical spine radiology (lateral, AP & odontoid views) reveal no abnormality. You wonder if flexion/extension xrays would

2005 BestBETS

1132. Trauma - abdominal trauma

, what 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 (...) if initial examination is normal. MANAGEMENT Follow Trauma Emergencies Guideline, remembering to: ? ensure ABCD’s and immobilise cervical spine (refer to neck and back guideline). Respiration ? administer high concentration oxygen (O2) (refer to oxygen protocol for administration and information) via a non-rebreathing mask, using the stoma in laryngectomee and other neck breathing patients. High concentration O2 should be administered routinely, whatever the oxygen saturation, in patients sustaining

2007 Joint Royal Colleges Ambulance Liaison Committee

1133. Trauma - thoracic trauma

trauma may well damage the heart, lungs and great vessels, both in isolation or combination. It must be remembered that penetrating wounds to the upper abdomen and the neck may well have caused injuries within the chest, remote from the entry wound. Conversely, penetrating wounds to the chest may well involve injury to the liver, kidneys and spleen. The lung may be damaged with bleeding causing a haemothoraxa or an air leak causing a pneumothorax. Penetrating or occasionally blunt chest injuries may (...) 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

1134. A Prospective, Randomized Trial of Early Versus Late Tracheostomy in Trauma Patients With Severe Brain Injury

A Prospective, Randomized Trial of Early Versus Late Tracheostomy in Trauma Patients With Severe Brain Injury A Prospective, Randomized Trial of Early Versus Late Tracheostomy in Trauma Patients With Severe Brain Injury - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (...) (100). Please remove one or more studies before adding more. A Prospective, Randomized Trial of Early Versus Late Tracheostomy in Trauma Patients With Severe Brain Injury The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT00292097 Recruitment Status : Terminated (Difficulty obtaining enrollment) First

2006 Clinical Trials

1135. Increasing use of endovascular therapy in acute arterial injuries: analysis of the National Trauma Data Bank. Full Text available with Trip Pro

or head and neck (odds ratio, 0.51, P = .007). Total length of hospital stay also tended to be lower for patients undergoing endovascular procedures by 18% (P = .064).The use of endovascular therapy in the setting of acute trauma is increasing in a dramatic fashion and is being used to treat a wide variety of vessels injured by blunt and penetrating mechanisms. Endovascular therapy appears to be particularly suitable for patients who present with less severe injuries and greater hemodynamic stability (...) Increasing use of endovascular therapy in acute arterial injuries: analysis of the National Trauma Data Bank. The application of endovascular technology for the emergency treatment of traumatic vascular injuries is a new frontier. This study examines recent nationwide use of endovascular therapy in acute arterial traumatic injuries.This retrospective study used the National Trauma Data Bank (NTDB). Cases with a diagnosis of arterial vascular injury were identified according to the International

2007 Journal of Vascular Surgery

1136. Magnetic resonance imaging in combination with helical computed tomography provides a safe and efficient method of cervical spine clearance in the obtunded trauma patient. Full Text available with Trip Pro

Magnetic resonance imaging in combination with helical computed tomography provides a safe and efficient method of cervical spine clearance in the obtunded trauma patient. Assessment of the cervical spine (c-spine) in the obtunded blunt trauma patient remains a diagnostic dilemma. In 2002, our institution implemented a new c-spine clearance guideline utilizing c-spine computed tomography (CT) and magnetic resonance imaging (MRI). This study evaluates the safety and efficacy (...) of this guideline.Obtunded blunt trauma patients admitted over a 1-year period, who underwent both a c-spine CT and a c-spine MRI, were identified. Records were reviewed for demographics, mechanism, diagnostic evaluations, injuries, and outcome.Fifty-two patients met inclusion criteria. On average, patients underwent a c-spine CT on postinjury day 0.4 and MRI on postinjury day 4. Forty-four patients had a negative c-spine CT, of whom 13 (30%) had a positive MRI for ligamentous injury (p < 0.01). Thirty-one patients had

2006 Journal of Trauma

1137. Prehospital rapid sequence intubation for head trauma: conditions for a successful program. (Abstract)

into the oropharynx.In all, 1,117 trauma patients were transported. One hundred and seventy-five had attempted RSI (74% male, mean age 31.1 +/- 19.2 years, 91% blunt trauma, 88% with Head/Neck AIS >or=2, mean Injury Severity Score 25.6, mean scene Glasgow Coma Scale score 4.8 +/- 2.4). One hundred and sixty-nine patients (96.6%) had successful scene RSI. Seventy percent were intubated on the first attempt, 89% by the second attempt, and 96% by the third attempt. Of the six patients (3.4% overall) who failed RSI (...) Prehospital rapid sequence intubation for head trauma: conditions for a successful program. Recent reports have questioned the safety and efficacy of prehospital rapid sequence intubation (RSI) for patients with head trauma. The purpose of this study is to determine the rate of successful prehospital RSI, associated complications, and delays in transport of critically injured trauma patients treated by a select, well-trained group of paramedics with frequent exposure to this procedure

2006 Journal of Trauma

1138. The Canadian C-spine rule for radiography in alert and stable trauma patients. (Abstract)

conducted from October 1996 to April 1999, in which physicians evaluated patients for 20 standardized clinical findings prior to radiography. In some cases, a second physician performed independent interobserver assessments.Ten EDs in large Canadian community and university hospitals.Convenience sample of 8924 adults (mean age, 37 years) who presented to the ED with blunt trauma to the head/neck, stable vital signs, and a Glasgow Coma Scale score of 15.Clinically important C-spine injury, evaluated (...) The Canadian C-spine rule for radiography in alert and stable trauma patients. High levels of variation and inefficiency exist in current clinical practice regarding use of cervical spine (C-spine) radiography in alert and stable trauma patients.To derive a clinical decision rule that is highly sensitive for detecting acute C-spine injury and will allow emergency department (ED) physicians to be more selective in use of radiography in alert and stable trauma patients.Prospective cohort study

2001 JAMA

1139. Neck and back trauma

: tenderness isolated to the muscles of the side of the neck is not spinal pain) Patient has no vertebral tenderness nor deformity on palpation? Patient has no neurologic de?cit? Patient has no painful or distracting injuries? IMMOBILISATION NOT REQUIRED NO NO NO NO NO NO Distracting pain is any pain that is suf?cient to cause the patient to focus upon that pain or that which interferes with patient assessment – including both medical and traumatic aetiologies. Including but not limted to: • Blunt 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

2006 Joint Royal Colleges Ambulance Liaison Committee

1140. Trauma - neck and back trauma

: tenderness isolated to the muscles of the side of the neck is not spinal pain) Patient has no vertebral tenderness nor deformity on palpation? Patient has no neurologic de?cit? Patient has no painful or distracting injuries? IMMOBILISATION NOT REQUIRED NO NO NO NO NO NO Distracting pain is any pain that is suf?cient to cause the patient to focus upon that pain or that which interferes with patient assessment – including both medical and traumatic aetiologies. Including but not limted to: • Blunt 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

2007 Joint Royal Colleges Ambulance Liaison Committee

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