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A Two-Center Validation of "Patient Does Not Follow Commands" and Three Other Simplified Measures to Replace the Glasgow Coma Scale for Field Trauma Triage 29729813 2018 05 06 1097-6760 2018 May 02 Annals of emergency medicine Ann Emerg Med A Two-Center Validation of "Patient Does Not Follow Commands" and Three Other Simplified Measures to Replace the Glasgow Coma Scale for Field Trauma Triage. S0196-0644(18)30312-3 10.1016/j.annemergmed.2018.03.038 Out-of-hospital personnel worldwide calculate (...) the 13-point Glasgow Coma Scale (GCS) score as a routine part of field trauma triage. We wish to independently validate a simpler binary assessment to replace the GCS for this task. We analyzed trauma center registries from Loma Linda University Health (2003 to 2015) and Denver Health Medical Center (2009 to 2015) to compare the binary assessment "patient does not follow commands" (ie, GCS motor score <6) with GCS score less than or equal to 13 for the prediction of 5 trauma outcomes: emergency
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
Conservative management of penetrating ocular trauma caused by a nail gun 30003177 2018 11 14 2451-9936 11 2018 Sep American journal of ophthalmology case reports Am J Ophthalmol Case Rep Conservative management of penetrating ocular trauma caused by a nail gun. 115-118 10.1016/j.ajoc.2018.06.010 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 (...) . 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 (such as vitreous hemorrhage, retinal detachment, endophthalmitis, etc) that are an indication for vitrectomy. Irving Enrique Carral-Santander CS Retina Department, Asociación para Evitar la Ceguera en México, Hospital "Dr. Luis Sánchez Bulnes" IAP. Mexico City, Mexico. Dhariana Acón
A retrospective cohort study to compare post-injury admissions for infectious diseases in burn patients, non-burnÂ trauma patients and uninjured people 29942812 2018 11 14 2321-3868 6 2018 Burns & trauma Burns Trauma A retrospective cohort study to compare post-injury admissions for infectious diseases in burn patients, non-burn trauma patients and uninjured people. 17 10.1186/s41038-018-0120-5 Injury triggers a range of systemic effects including inflammation and immune responses. This study (...) aimed to compare infectious disease admissions after burn and other types of injury using linked hospital admissions data. A retrospective longitudinal study using linked health data of all patients admitted with burns in Western Australia ( n = 30,997), 1980-2012, and age and gender frequency matched cohorts of people with non-burn trauma ( n = 28,647) and no injury admissions ( n = 123,399). Analyses included direct standardisation, negative binomial regression and Cox proportional hazards
Recent opioid use and fall-related injury among older patients with trauma 29685910 2018 05 03 1488-2329 190 16 2018 Apr 23 CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne CMAJ Recent opioid use and fall-related injury among older patients with trauma. E500-E506 10.1503/cmaj.171286 Evidence for an association between opioid use and risk of falls or fractures in older adults is inconsistent. We examine the association between recent opioid use (...) and the risk, as well as the clinical outcomes, of fall-related injuries in a large trauma population of older adults. In a retrospective, observational, multicentre cohort study conducted on registry data, we included all patients aged 65 years and older who were admitted (hospital stay > 2 d) for injury in 57 trauma centres in the province of Quebec, Canada, between 2004 and 2014. We looked at opioid prescriptions filled in the 2 weeks preceding the trauma in patients who sustained a fall, compared
New advances in intra-operative imaging in trauma 29951253 2018 11 14 2058-5241 3 5 2018 May EFORT open reviews EFORT Open Rev New advances in intra-operative imaging in trauma. 168-172 10.1302/2058-5241.3.170055 The invention of flat-panel detectors led to a revolution in medical imaging. The major benefits of this technology are a higher image quality and dose reduction. Flat-panel detectors have proved to be superior to standard C-arms (= C-arm with radiograph source and image intensifier (...) is not possible.The introduction of flat-panel detectors has led to improvements in intra-operative image quality combined with dose reduction. The possibility of high-quality 3D imaging in combination with navigation can assure optimal implant placement. Due to immediate control of the osteosynthesis, revision surgery at a later time can be prevented. Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170055. Richter Peter H PH Orthopaedic Trauma Department, Universität Ulm, Germany. Gebhard
Pediatric self-inflicted eye trauma due to a major depressive disorder 29997760 2018 11 14 2008-5842 10 5 2018 May Electronic physician Electron Physician Pediatric self-inflicted eye trauma due to a major depressive disorder. 6771-6774 10.19082/6771 Self-inflicted eye trauma is a serious form of self-harm as it may lead to irreversible visual disability. Diagnosing self-inflicted ocular injuries, in all its forms, can be quite challenging. In this report, we are presenting a 5-year-old girl
Crisis Intervention for Adults Using a Trauma-Informed Approach: Initial Four Weeks of Management Third Edition Crisis Intervention for Adults Using a Trauma-Informed Approach: Initial Four Weeks of Management Third Edition | Registered Nurses' Association of Ontario l’Association des infirmières et infirmiers autorisés de l’Ontario Speaking out for nursing. Speaking out for health. » » Crisis Intervention for Adults Using a Trauma-Informed Approach: Initial Four Weeks of Management Third
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 (...) Predisposing factors Male:female = 3:1 Symptoms History of trauma Pain Visual loss Signs Lid laceration: assess depth, contamination and whether canaliculi involved Conjunctiva hyperaemia and chemosis look for foreign bodies but do not remove them assess depth of any conjunctival laceration Corneal laceration check depth check for signs of perforation (shallow or flat AC, Seidel test +ve) possible iris damage (iridodialysis) ± iris prolapse into wound Lens may be subluxated, dislocated, absent
Trauma chemical Trauma (chemical) submit The College submit You're here: Trauma (chemical) Trauma (chemical) 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 The incidence of chemical injuries to the eye has been reported to be 10.7 per 100,000 population, representing an estimated 10% of ocular trauma treated in emergency departments (...) Predisposing factors Domestic accidents, DIY injuries Industrial injuries Assault Riot control Warfare Symptoms Immediate pain, redness, epiphora Visual loss Severe chemical trauma may be relatively pain free (damage to superficial nerves) Signs Burns to eyelids and surrounding skin Particulate matter under lid (evert to examine) Conjunctival chemosis and hyperaemia Limbal and conjunctival blanching (cessation of blood flow in superficial vessels; may indicate poor prognosis) Corneal epithelial defects
Trauma blunt Trauma (blunt) submit The College submit You're here: Trauma (blunt) Trauma (blunt) 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 Blow to the eye: accidental (e.g. RTA, industrial, domestic, sports) or non-accidental (e.g. fist) Also known as ocular contusion Predisposing factors Usually unexpected but may (...) or diplopia due to tissue swelling or muscle tethering by orbital (‘blow-out’) fracture enophthalmos (sunken eye) may also indicate orbital fracture nasal bleeding (direct trauma, or could indicate skull fracture) corneal oedema or laceration AC: hyphaema (blood in aqueous), uveitis, flare and cells traumatic mydriasis Iridodialysis (tearing of iris from its attachment to ciliary body) lens: evidence of subluxation, cataract, capsule damage IOP may be increased secondary to uveitis, or reduced because
Characteristics distinguishing abusive head trauma from accidental head trauma in infants with traumatic intracranial hemorrhage in Japan 29988617 2018 11 14 2052-8817 5 3 2018 Jul Acute medicine & surgery Acute Med Surg Characteristics distinguishing abusive head trauma from accidental head trauma in infants with traumatic intracranial hemorrhage in Japan. 265-271 10.1002/ams2.341 To identify markers for detecting abusive head trauma (AHT) and its characteristics in the Japanese population. We (...) with AHT. The age range of AHT in Japan is significantly different from that of countries in Europe and North America because of familial and sociocultural situations. Absence of bruising, and rib or long bone fractures did not reduce the likelihood of AHT. Subdural hematoma without findings of an impact to the head strongly suggested AHT. Abusive head trauma is a global problem, however, diagnosis and defensive measures likely need to be tailored to accommodate cultural risk factors. Amagasa Shunsuke
Hypertonic saline as effective as normal saline for trauma patients NIHR DC | Signal - Hypertonic saline as effective as normal saline for trauma patients Dissemination Centre Discover Portal NIHR DC Discover Hypertonic saline as effective as normal saline for trauma patients Published on 13 March 2018 Solutions more concentrated than normal, such as hypertonic saline, are as good as those more usually given to trauma patients with severe blood loss. Survival to hospital discharge was the same (...) in patients treated before arrival at the hospital with either type of fluid. There are around 20,000 cases of major trauma per year in England. Outcomes for patients have improved in the UK over the last 25 years, but as there is still room for improvement this review sought to find evidence that supported or challenged the convention that normal saline is always best. Hypertonic solutions are given to patients in a lower volume, and so can be carried in more compact packaging. They could be preferred
Predicting severe brain injuries from apparent minor head trauma without a scan NIHR DC | Signal - Predicting severe brain injuries from apparent minor head trauma without a scan Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Predicting severe brain injuries from apparent minor head trauma without a scan Published on 8 March 2016 Specific clinical decision rules applied to adults and adolescents with apparent minor head injury identified groups at low risk of severe internal (...) rules to identify serious head trauma in people presenting with minor head injuries. The clinical decision rule was compared against a reference standard, either neuroimaging or follow-up evaluation. What did this study do? This systematic review included 14 studies from eight countries (US, Japan, Korea and from continental Europe) including 23,079 adults and adolescents with minor head trauma, defined as a Glasgow Coma Scale (GCS) of 13 to 15, where 15 is completely alert. The review was carried
Drugs that stimulate bone marrow might save lives in critically ill trauma patients NIHR DC | Signal - Drugs that stimulate bone marrow might save lives in critically ill trauma patients Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Drugs that stimulate bone marrow might save lives in critically ill trauma patients Published on 23 August 2016 Erythropoiesis stimulating agents (ESAs) might improve survival of critically ill patients after trauma. These drugs are synthetic (...) versions of erythropoietin, a natural hormone produced by the kidneys. They boost production of red blood cells from the bone marrow; however the survival effect seems to be independent of the effect on red cell production. ESA’s are already commonly used to treat anaemia associated with chronic kidney disease. This systematic review of trials in critical trauma patients found the survival benefit occurred without an increase in adverse effects, such as blood clots in the leg veins. ESA’s had no effect
French lyophilized plasma versus fresh frozen plasma for the initial management of trauma-induced coagulopathy: a randomized open-label trial 29274254 2018 02 28 1538-7836 16 3 2018 Mar Journal of thrombosis and haemostasis : JTH J. Thromb. Haemost. French lyophilized plasma versus fresh frozen plasma for the initial management of trauma-induced coagulopathy: a randomized open-label trial. 481-489 10.1111/jth.13929 Essentials An immediate supply of plasma in case of trauma-induced coagulopathy (...) is required. The Traucc trial compared French Lyophilised Plasma (FLyP) and Fresh Frozen Plasma (FFP). FLyP achieved higher fibrinogen concentrations compared with FFP. FLyP led to a more rapid coagulopathy improvement than FFP. Background Guidelines recommend beginning hemostatic resuscitation immediately in trauma patients. We aimed to investigate if French lyophilized plasma (FLyP) was more effective than fresh frozen plasma (FFP) for the initial management of trauma-induced coagulopathy. Methods
Blood Transfusion in Trauma: Timing and Product Ratio Emergency Medicine > Journal Club > Archive > February 2018 Toggle navigation February 2018 Blood Transfusion in Trauma: Timing and Product Ratio Vignette It's an active early spring afternoon in the city, and you're pretty sure that just about everyone and their sister have been shot at, with most of the pour souls ending up in your TCC. As these things tend to go, The GSWs thus far are to the extremities or benign grazes (...) , but the excitement of getting the trauma team to come down as you prepare everyone for a potential resuscitation has your adrenaline going despite the lack of interesting pathology. Then, the next EMS call-ahead page hits the comm center: male GSW victim, shot in abdomen. HR 145, BP 110/60. EAT 2". You prep your team. Airway ready if needed, medics and nurses squared away on who is getting access and who is getting vitals. Then the charge nurse casually walks by ans asks if you want to think about getting