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Penetrating Trauma

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3. Penetrating Trauma-Lower Abdomen and Pelvis.

Penetrating Trauma-Lower Abdomen and Pelvis. American College of Radiology End User License Agreement ACR Appropriateness Criteria is a registered trademark of the American College of Radiology. By accessing the ACR Appropriateness Criteria®, you expressly agree and consent to the terms and conditions as described at: http://www.acr.org/~/media/ACR/Documents/AppCriteria/TermsandConditions.pdf Personal use of material is permitted for research, scientific and/or information purposes only. You (...) Criteria ® Clinical Condition: Suspected Lower Urinary Tract Trauma Variant 1: Penetrating trauma, lower abdomen/pelvis. Radiologic Procedure Rating Comments RRL* X-ray retrograde cystography 8 ??? CT pelvis with bladder contrast (CT cystography) 8 A CT cystogram and retrograde cystogram are equivalent, but CT has become the first-line choice for acute trauma imaging. If CT has been performed, a CT cystogram is preferable. ???? CT pelvis with IV contrast 5 Routine enhanced CT alone is inadequate

2019 American College of Radiology

4. Prehospital spine immobilization/spinal motion restriction in penetrating trauma

Prehospital spine immobilization/spinal motion restriction in penetrating trauma Prehospital spine immobilization/spinal motion restriction in penetrating trauma - Practice Management Guideline Search » Prehospital spine immobilization/spinal motion restriction in penetrating trauma Published 2018 Citation: Authors Velopulos, Catherine, G., MD, MHS; Shihab, Hasan, M., MPH; Lottenberg, Lawrence, MD; Feinman, Marcie, MD; Raja, Ali, MD, MBA, MPH; Salomone, Jeffrey; Haut, Elliott, R., MD, PhD (...) Abstract BACKGROUND Spine immobilization in trauma has remained an integral part of most emergency medical services protocols despite a lack of evidence for efficacy and concern for associated complications, especially in penetrating trauma patients. We reviewed the published evidence on the topic of prehospital spine immobilization or spinal motion restriction in adult patients with penetrating trauma to structure a practice management guideline. METHODS We conducted a Cochrane style systematic review

2018 Eastern Association for the Surgery of Trauma

5. Conservative management of penetrating ocular trauma caused by a nail gun Full Text available with Trip Pro

Conservative management of penetrating ocular trauma caused by a nail gun To report the conservative management of a penetrating ocular trauma caused by a nail gun with a six-month follow up.A 21 year-old healthy female suffered an ocular penetrating trauma with a nail gun. She presented with a metallic foreign body that partially entered her left eye through the nasal sclera via pars plana, 3 mm posterior to the limbus, but did not reach the retina. Surgical removal of the foreign body (...) and closure of the scleral wound, without vitrectomy, was performed 16 h after the injury. Intravitreal prophylactic antibiotic was administered. Retinal atrophy developed in the areas that had commotio retinae at presentation, but no further complications were observed.and Importance: Pars plana vitrectomy may not be necessary in all penetrating ocular traumas with intraocular foreign body, as long as the foreign body is accessible from the exterior of the eye and there are no other conditions

2018 American journal of ophthalmology case reports

6. Case report of bilateral penetrating renal trauma caused by a wooden stick. Full Text available with Trip Pro

Case report of bilateral penetrating renal trauma caused by a wooden stick. Kidney is the most frequently injured organ of the genitourinary system during trauma. Bilateral penetrating renal trauma (BPRT) is extremely rare and sporadically reported in the previous literature. Here, we reported a unique case of BPRT.A 43-year-old man, with no medical history, was accidentally penetrated by a wooden stick and presented with sharp pain in the left flank.Laboratory tests revealed microscopic (...) hematuria, mildly elevated leucocyte and amylase, normal hemoglobin (145 g/L) and creatinine (1.05 mg/dl). Computed tomography demonstrated bilateral penetrating renal injuries with perinephric/subcapsular hematoma, fracture of the second lumbar vertebra and 10th rib.An emergency exploratory laparotomy was executed immediately. According to the American Association for the Surgery of Trauma Organ Injury Scale grading system, grade V and III injuries were considered for the left and right kidney

2020 Medicine

7. Managing penetrating renal trauma: Experience from two UK major trauma centres. Full Text available with Trip Pro

Managing penetrating renal trauma: Experience from two UK major trauma centres. To present our series of patients with penetrating renal trauma treated at two urban major trauma centres and to discuss the contemporary management of such injuries.We reviewed prospective urological trauma databases for all patients presenting with penetrating renal trauma between January 2005 and October 2016. Patient demographics, clinical characteristics, imaging, management and follow-up data were (...) injuries requiring operative management are common in penetrating renal trauma, while urologists should limit or have a high threshold for surgical intervention.© 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd.

2018 BJU international

8. Prophylactic antibiotics for penetrating abdominal trauma. (Abstract)

Prophylactic antibiotics for penetrating abdominal trauma. Penetrating abdominal trauma occurs when the peritoneal cavity is breached. Routine laparotomy for penetrating abdominal injuries began in the 1800s, with antibiotics first being used in World War II to combat septic complications associated with these injuries. This practice was marked with a reduction in sepsis-related mortality and morbidity. Whether prophylactic antibiotics are required in the prevention of infective complications (...) following penetrating abdominal trauma is controversial, however, as no randomised placebo controlled trials have been published to date. There has also been debate about the timing of antibiotic prophylaxis. In 1972 Fullen noted a 7% to 11% post-surgical infection rate with pre-operative antibiotics, a 33% to 57% infection rate with intra-operative antibiotic administration and 30% to 70% infection rate with only post-operative antibiotic administration. Current guidelines state there is sufficient

2013 Cochrane

9. Facial Nerve Hematoma After Penetrating Middle Ear Trauma: A Cause of Delayed Facial Palsy. (Abstract)

Facial Nerve Hematoma After Penetrating Middle Ear Trauma: A Cause of Delayed Facial Palsy. Penetrating middle ear injury may cause hearing loss, vertigo, or facial nerve injury, although facial nerve paralysis followed by head trauma is a rare condition. In this study, we report a case of a 3-year-old patient with delayed facial palsy on the left side that developed 4 days after an accidental tympanic membrane perforation caused by a cotton-tipped swab. Otoendoscopic examination revealed

2019 Pediatric Emergency Care

10. The use of new procoagulants in blunt and penetrating trauma. (Abstract)

The use of new procoagulants in blunt and penetrating trauma. Uncontrolled bleeding in trauma secondary to a combination of surgical bleeding and trauma-induced complex coagulopathy is a leading cause of death. Prothrombin complex concentrates (PCCs), recombinant activated factor seven (rFVIIa) and recombinant human prothrombin act as procoagulants by increasing thrombin generation and fibrinogen concentrate aids stable clot formation. This review summarizes the current evidence (...) for procoagulant use in the management of bleeding in trauma, and data and evidence gaps for routine clinical use.Retrospective and prospective studies of PCCs (±fibrinogen concentrate) have demonstrated a decreased time to correction of trauma coagulopathy and decreased red cell transfusion with no obvious effect on mortality or thromboembolic outcomes. PCCs in a porcine model of dilutional coagulopathy demonstrated a sustained increase in thrombin generation, unlike recombinant human prothrombin which showed

2019 Current Opinion in Anaesthesiology

11. Penetrating neck trauma with common carotid artery injury caused by a percussive drill: A case report. Full Text available with Trip Pro

Penetrating neck trauma with common carotid artery injury caused by a percussive drill: A case report. Penetrating neck traumas are dangerous and have a high mortality rate, particularly in patients with common carotid artery injuries. Advances in diagnostic imaging technology have shifted management of penetrating neck injuries from mandatory exploration to selective management. The question is now regarding optimal selection of auxiliary examinations to assess "stability" rapidly and guide (...) clinics in managing such patients.A 56-year-old man suffered neck trauma with the right common carotid artery caused by a percussive drill. The carotid artery could not be clearly displayed in computed tomography (CT) angiography imaging.Penetrating neck trauma due to percussive drill bit with common carotid artery injury.X-ray and bedside duplex ultrasound with color Doppler flow imaging were used to assess the state of trauma and the foreign body was removed under general anesthesia.The patient

2019 Medicine

12. Contemporary management of penetrating renal trauma - A national analysis. Full Text available with Trip Pro

Contemporary management of penetrating renal trauma - A national analysis. Indications for nonoperative management (NOM) after penetrating renal injury remain ill-defined. Using a national database, we sought to describe the experience of operative and nonoperative management in the United States and retrospectively examine risk factors for failure of NOM.The TQIP database 2010-2016 was used to identify patients with penetrating renal trauma. Outcomes of patients treated with an immediate (...) operation (IO) and NOM are described. Failure of NOM was defined as the need for a renal operation after 4 h from arrival. Univariate then multivariable regression analyses were performed to identify predictors of NOM failure.Out of 8139 patients with kidney trauma, 1,842 had a penetrating mechanism of injury and were included. Of those, 89% were male, median age was 28 years, and 330 (18%) were offered NOM. Compared to IO, NOM patients were less likely to have gunshot wound (59% vs 89% p < 0.001

2019 Injury

13. Stimulant drugs are associated with violent and penetrating trauma. (Abstract)

Stimulant drugs are associated with violent and penetrating trauma. Substance abuse is associated with traumatic injuries. Prior studies of drug use and injury have relied on urine drug of abuse screens, which have false positives, false negatives and inability to detect novel drugs. Our study characterizes the relationship between injury mechanism and drugs of abuse detected in serum via confirmatory testing.This prospective observational study was conducted from Jan-Sept 2012 at a level 1 (...) trauma center on trauma patients > 13 years who had blood drawn for routine tests. Demographic, injury and standard laboratory data were abstracted from patient charts. Comprehensive serum drug testing was done using liquid chromatography-time-of-flight mass spectrometry (LC-TOF/MS, LC1200-TOF/MS 6230, Agilent, Santa Clara, CA).Of 272 patients, 71.0% were male, 30.5% had violent injury type and 32.4% had a penetrating injury mechanism. Violent injury type and penetrating injury mechanisms were more

2019 American Journal of Emergency Medicine

14. Association of Prehospital Mode of Transport With Mortality in Penetrating Trauma: A Trauma System-Level Assessment of Private Vehicle Transportation vs Ground Emergency Medical Services. Full Text available with Trip Pro

Association of Prehospital Mode of Transport With Mortality in Penetrating Trauma: A Trauma System-Level Assessment of Private Vehicle Transportation vs Ground Emergency Medical Services. Time to definitive care following injury is important to the outcomes of trauma patients. Prehospital trauma care is provided based on policies developed by individual trauma systems and is an important component of the care of injured patients. Given a paucity of systems-level trauma research, considerable (...) variability exists in prehospital care policies across trauma systems, potentially affecting patient outcomes.To evaluate whether private vehicle prehospital transport confers a survival advantage vs ground emergency medical services (EMS) transport following penetrating injuries in urban trauma systems.Retrospective cohort study of data included in the National Trauma Data Bank from January 1, 2010, through December 31, 2012, comprising 298 level 1 and level 2 trauma centers that contribute data

2017 JAMA surgery

15. Penetrating Colon Trauma Outcomes in Black and White Males. Full Text available with Trip Pro

Penetrating Colon Trauma Outcomes in Black and White Males. Racial disparities have been both published and disputed in trauma patient mortality, outcomes, and rehabilitation. In this study, the objective was to assess racial disparities in patients with penetrating colon trauma.The National Trauma Data Bank was searched for males aged ≥14years from 2010 through 2014 who underwent operative intervention for penetrating colon trauma. The primary outcomes for this study were stoma formation (...) postoperative morbidity rate (52.6% vs 55.3%, p=0.04). The odds of stoma formation (OR=0.92, 95% CI=0.78, 1.09, p=0.35) and the odds of transfer to rehabilitation (OR=1.03, 95% CI=0.82, 1.30, p=0.78) were similar for black versus white patients.Black patients experienced similar rates of stoma formation and transfer to rehabilitation as white patients with penetrating colon trauma. Multivariate analysis confirmed expected findings that trauma severity increased the odds of receiving an ostomy

2018 American journal of preventive medicine

16. Laparoscopy in penetrating abdominal trauma is a safe and effective alternative to laparotomy. (Abstract)

Laparoscopy in penetrating abdominal trauma is a safe and effective alternative to laparotomy. Diagnostic laparoscopy (DL) is an increasingly used modality when approaching penetrating abdominal trauma (PAT). Trauma surgeons can utilize this minimally invasive technique to quickly assess for injury in hemodynamically stable patients. DL with a confirmed injury can be repaired through therapeutic laparoscopy (TL) or conversion to exploratory laparotomy (EL). This study analyzes the use (...) for hemodynamically stable patients with PAT. DL can be converted to TL in the hands of a skilled laparoscopist. In this study, we analyze the use of DL over a 10-year period in patients who presented to our level 1 trauma center with PAT. We also provide a comprehensive review of literature to create clear definitions, and to clarify a systematic stepwise approach of how to effectively perform DL and TL. This study adds to the body of literature supporting the role of laparoscopy in PAT, and advances

2018 Surgical endoscopy

17. Postoperative CD4 counts predict anastomotic leaks in patients with penetrating abdominal trauma. Full Text available with Trip Pro

Postoperative CD4 counts predict anastomotic leaks in patients with penetrating abdominal trauma. The influence of trauma- and surgical stress-induced decrease of CD4 count on anastomotic leaks after penetrating abdominal trauma has to date not been investigated. A prospective study was performed to explore the effect of CD4 count 24 h after surgery on the anastomotic leak rate and to identify risk factors for anastomotic leaks.This was a prospective study including 98 patients with small (...) or large bowel resection and subsequent anastomosis due to penetrating abdominal trauma. Univariate analysis identified risk factors for the development of anastomotic leak and also investigated the predictive value of the CD4 count for this complication.Of the 98 patients 23 patients (23%) were HIV-infected. The overall leak rate was 13%. Univariate analysis including all potential risk factors with p-values<0.05 identified six factors leading to a significantly higher rate of anastomotic

2018 Injury

18. A double jeopardy: transection of the aero-digestive tract after penetrating neck trauma Full Text available with Trip Pro

A double jeopardy: transection of the aero-digestive tract after penetrating neck trauma 30455814 2018 12 12 2018 12 12 1937-8688 30 2018 The Pan African medical journal Pan Afr Med J A double jeopardy: transection of the aero-digestive tract after penetrating neck trauma. 185 10.11604/pamj.2018.30.185.14960 Fransvea Pietro P Faculty of Medicine and Psychology, "Sapienza" University of Rome, St Andrea's Hospital, Italy. Keyser Zamira Z Trauma Unit, Tygerberg Hospital Cape Town, South Africa (...) . eng Case Reports Journal Article 2018 06 28 Uganda Pan Afr Med J 101517926 IM Adult Esophagus injuries Humans Hypopharynx injuries Male Neck Injuries etiology pathology Wounds, Gunshot complications Penetreting trauma areodigestive tract surgery 2018 01 24 2018 05 07 2018 11 21 6 0 2018 11 21 6 0 2018 12 13 6 0 epublish 30455814 10.11604/pamj.2018.30.185.14960 PAMJ-30-185 PMC6235508

2018 The Pan African medical journal

19. Frosted branch angiitis with penetrating ocular trauma and retained intraocular foreign body Full Text available with Trip Pro

Frosted branch angiitis with penetrating ocular trauma and retained intraocular foreign body A 54-year-old male sustained ocular trauma with a projectile. Examination of the right eye revealed an intraocular foreign body (IOFB) adjacent to the optic nerve head, vitritis, vitreous hemorrhage, and translucent perivascular sheathing of the retinal vessels in all quadrants suggesting frosted branch angiitis (FBA). The patient underwent vitrectomy with removal of the IOFB and silicone oil tamponade

2018 Indian journal of ophthalmology

20. Triple vessel injury with single penetrating trauma to the lower extremity requiring popliteal to posterior tibial artery bypass Full Text available with Trip Pro

Triple vessel injury with single penetrating trauma to the lower extremity requiring popliteal to posterior tibial artery bypass This is a case report describing the delayed presentation of injury to all three lower extremity infrapopliteal arteries after a 34 year old male sustained multiple gunshot wounds, including one to his left lower extremity. As part of his initial assessment, ankle brachial index was performed and was found to be abnormal. Further work up for this was delayed due (...) to need for emergent trauma laparotomy. After this procedure, more detailed evaluation with CT angiography of the extremity injury was performed. Though imaging indicated adequate perfusion of the lower extremity, serial neurovascular examination revealed inadequate perfusion. The patient required arterial reconstruction and fasciotomies. This case demonstrates the need for continued surveillance of extremity perfusion in atypical trauma cases when index of suspicion suggests the degree of injury may

2018 Trauma Case Reports

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