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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 may (...) 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 to evaluate

2019 American College of Radiology

4. Trauma penetrating

Trauma penetrating Trauma (penetrating) submit The College submit You're here: Trauma (penetrating) Trauma (penetrating) The CMGs are guidelines on the diagnosis and management of a range of common and rare, but important, eye conditions that present with varying frequency in primary and first contact care. Share options Aetiology Partial or full-thickness injury of outer wall of eye caused by sharp object Common causes include: assault, industrial or work-related accident, DIY injury (...) Irregular pupil Iris prolapse Commotio retinae Vitreous haemorrhage Differential diagnosis Non-penetrating (blunt) trauma Chemical trauma Management by optometrist Practitioners should recognise their limitations and where necessary seek further advice or refer the patient elsewhere GRADE* Level of evidence and strength of recommendation always relates to the statement(s) immediately above Non pharmacological DO NOT APPLANATE OR EXERT PRESSURE ON EYE Take a careful history patient’s description

2018 College of Optometrists

5. 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

6. Conservative management of penetrating ocular trauma caused by a nail gun (PubMed)

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

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2018 American journal of ophthalmology case reports

7. The incidence of thromboembolism formation following the use of recombinant factor VIIa in patients suffering from blunt force trauma compared with penetrating trauma: a systematic review. (PubMed)

The incidence of thromboembolism formation following the use of recombinant factor VIIa in patients suffering from blunt force trauma compared with penetrating trauma: a systematic review. Rapid replacement of blood loss is critical in patients suffering from traumatic hemorrhage. When the availability of blood products is limited, certain interventions have shown promise in conserving blood supplies. Recombinant factor (rF) VIIa has been administered, as an off-label use, to assist (...) blood cells [PRBCs], fresh frozen plasma [FFP], platelets and crystalloid solutions) in patients suffering from traumatic injuries (blunt force and penetrating trauma).Civilian and combat trauma patients who were 15 years and older suffering from blunt force and penetrating traumatic injuries.Use of rFVIIa as an adjunct to hemorrhage control measures (standard resuscitation efforts consisting of varying amounts of PRBCs, FFP, platelets and crystalloid solutions).This review considered both

2016 JBI database of systematic reviews and implementation reports

8. Managing penetrating renal trauma: Experience from two UK major trauma centres. (PubMed)

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

9. The use of new procoagulants in blunt and penetrating trauma. (PubMed)

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 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

10. Stimulant drugs are associated with violent and penetrating trauma. (PubMed)

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

11. The use of new procoagulants in blunt and penetrating trauma. (PubMed)

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

12. 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. (PubMed)

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

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2017 JAMA surgery

13. Prehospital Spine Immobilization/Spinal Motion Restriction in Penetrating Trauma: a Practice Management Guideline from the Eastern Association for the Surgery of Trauma (EAST).

Prehospital Spine Immobilization/Spinal Motion Restriction in Penetrating Trauma: a Practice Management Guideline from the Eastern Association for the Surgery of Trauma (EAST). 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.We conducted a Cochrane style systematic review and meta-analysis and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology to construct recommendations. Qualitative and quantitative analyses were used to evaluate the literature on the critical outcomes of mortality, neurologic deficit, and potentially reversible neurologic deficit.A total of 24 studies

2017 The journal of trauma and acute care surgery

14. Prophylactic antibiotics for penetrating abdominal trauma. (PubMed)

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

15. Frosted branch angiitis with penetrating ocular trauma and retained intraocular foreign body (PubMed)

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

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2018 Indian journal of ophthalmology

16. Analysis of Prehospital Scene Times and Interventions on Mortality Outcomes in a National Cohort of Penetrating and Blunt Trauma Patients. (PubMed)

Analysis of Prehospital Scene Times and Interventions on Mortality Outcomes in a National Cohort of Penetrating and Blunt Trauma Patients. Recent studies have suggested improved outcomes in victims of penetrating trauma managed with shorter prehospital times and limited interventions. The purpose of the current study was to perform an outcome analysis of patients transported following penetrating and blunt traumatic injuries.We performed a descriptive retrospective analysis of the 2014 National (...) Emergency Medical Services Information System (NEMSIS) public release research data set for patients presenting after acute traumatic injury.A total of 2,018,141 patient encounters met criteria, of which 3.9% were penetrating trauma. Prehospital cardiac arrest occurred in 0.5% blunt and 4.2% penetrating trauma patients. Emergency department (ED) mortality was higher in penetrating than blunt trauma patients (4.1% vs. 0.8%). Scene times were 18.1 ± 36.5 minutes for blunt and 16.0 ± 45.3 minutes

2018 Prehospital emergency care

17. Penetrating neck trauma caused by a rebar: A case report. (PubMed)

Penetrating neck trauma caused by a rebar: A case report. Penetrating neck trauma has a mortality of 3% to 6% and is associated with serious complications, mainly due to the high density of vital structures in this area and the lack of corresponding protection from bone.A 55-year-old man who suffered neck trauma involving the parotid gland, caused by a rebar, after suffering a fall from the second floor of a building.Penetrating neck trauma.The patient underwent a neck exploration under general

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2018 Medicine

18. The Selective Non-operative Management of Penetrating Cervical Venous Trauma is Safe and Effective. (PubMed)

The Selective Non-operative Management of Penetrating Cervical Venous Trauma is Safe and Effective. This paper reviews our experience with penetrating cervical venous trauma and aims to validate the selective non-operative management (SNOM) of these injuries.This was a retrospective review of a prospectively maintained registry. All patients presenting alive with an injury to the internal jugular vein, subclavian vein or innominate vein following a PNI were reviewed for a 6-year period.Among (...) of severe bleeding or hemodynamic instability prior to arrival, but only 20 (26.3%) required immediate exploration. Two (2.6%) patients died as a result of venous injury. No patients developed complications related to the venous injury.SNOM is applicable to a well-defined subset of patients with isolated penetrating cervical venous trauma to the IJV and SCV identified on CTA.

2018 World Journal of Surgery

19. Real-time elastography evaluation of differential penetrating liver trauma in a rabbit model. (PubMed)

Real-time elastography evaluation of differential penetrating liver trauma in a rabbit model. Real-time ultrasound elastography (RTE) is used to examine liver fibrosis and benign and malignant lesions, but its use for the diagnosis of liver trauma has not been examined. The purpose of this study was to examine the use of RTE for the evaluation of differential penetrating liver trauma in a rabbit model.Eighty New Zealand rabbits were divided into 2 groups. In one group, a single incision (type (...) group was significantly higher than in the type '-' lesion group (P<.001). Strain ratios were not different between the groups at each time point, but in each group the values decreased from the 10min time point to the 60min time point (P-value for the trends, <.001).RTE may be able to distinguish mild or severe penetrating liver trauma at 60min or more after injury.Copyright © 2018 Elsevier Inc. All rights reserved.

2018 American Journal of Emergency Medicine

20. The Association of Prehospital Intravenous Fluids and Mortality in Patients with Penetrating Trauma. (PubMed)

The Association of Prehospital Intravenous Fluids and Mortality in Patients with Penetrating Trauma. The optimal approach to prehospital care of trauma patients is controversial, and thought to require balancing advanced field interventions with rapid transport to definitive care.We sought principally to examine any association between the amount of prehospital IV fluid (IVF) administered and mortality.We conducted a retrospective cohort analysis of trauma registry data patients who sustained (...) penetrating trauma between January 2008 and February 2011, as identified in the Pennsylvania Trauma Systems Foundation registry with corresponding prehospital records from the Philadelphia Fire Department. Analyses were conducted with logistic regression models and instrumental variable analysis, adjusted for injury severity using scene vital signs before the intervention was delivered.There were 1966 patients identified. Overall mortality was 22.60%. Approximately two-thirds received fluids and one-third

2018 Journal of Emergency Medicine

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