1-20 of 222 results with category "Trauma"
Bottom Line: Burn care is directed by the managing surgeons at regional burn centers. Where available, hyperbaric oxygen treatment can be a beneficial adjunct.
Studies and clinical experience of hyperbaric oxygen treatment in burns has shown modulation of burn shock, dampening of the inflammatory response, reduction of edema, reversal of the zone of stasis, reduction of ischemia and ischemic necrosis, prevention of progression of partial- to full-thickness injury, modulation of inflammation, effecting modulation of hyper-metabolic syndrome, lessening of the capillary leak, preservation of dermal elements, a reduced need for grafting, shortened hospital stay, reduced physiological post-discharge problems, and a reduction in cost of care.
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This study conclusion states: “Prehospital epinephrine administration in patients with traumatic cardiac arrest was associated with increased survival to hospital discharge and prehospital ROSC.” When you investigate the methods, only 809 of the 22,105 patients in traumatic cardiac arrest actually received epinephrine. In the study country, EMS gets orders from base station physicians for epinephrine. Why did these 809 get the epinephrine and the other 97% did not? It is hard to know what to do with this data. It certainly doesn’t say epinephrine saves patients in traumatic cardiac arrest. More research is needed.
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In a randomized pragmatic study of critically ill trauma patients, video laryngoscopy was successful in 88% of first pass attempts versus 68% in direct laryngoscopy.
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This Japanese hospital has a CT scanner hybrid resuscitation room. They did a retrospective study comparing their blunt trauma patients to a Japanese trauma database. Their patients had a shorter time to operative or interventional procedure, slightly less PRBC use over 24 hours and similar 24 hour mortality.
Interesting concept. Not ready for adoption.
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This South African study looked at 219 trauma patients who required damage control surgery and, not surprisingly, low GCS, low pH and elevated lactate all were independently associated with mortality.
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Question
The construction worker presents to the ED with this rash. What is it and what is the treatment?
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These authors used a database of 323 hospitals to find over 20,000 firearm injured patients. They looked at positive cultures to assess for post injury infection. Infection rate was 5%. Most infections were in the immediate post injury period. Those with surgical procedures on head, neck, lower abdomen, and spine were most likely to develop infection. Infection did not appear to be associated with increased mortality. Current guidelines recommend antibiotics for the first 24 hours post injury only.
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Looking at a national EMS database, these authors found advanced airway management (intubation, cricothyrotomy, rescue devices) occurred in 4/1000 trauma patients. Firearm related injury and motorcycle crashes had the highest use rate. Firearm related injury had the highest use rate of cricothyrotomy. This data should help drive prehospital education.
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The US FDA has approved the first freeze dried plasma. It is stored at room temperature in plastic bags which makes it ideal for austere environments. It is easily reconstituted and is given to patients who require plasma, bypassing the need to thaw FFP.
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Intuitively, both younger and older patients would have better outcomes at level 1 vs level 3 centers. This was true in younger patients in this large trauma database study. It was only true for older patients with traumatic brain injury and a high injury severity score. Is this a function of care delivery being better at level 3 or less geriatric focus at level 1 trauma centers?
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This Canadian study found women, even when controlling for injury severity, socioeconomic conditions etc, were less likely to be admitted to a trauma center than their male counterparts. Further investigation into this bias is warranted.
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This review article in the Journal of Trauma and Acute Care Surgery states:
“In obtunded patients, an adequate and normal high-quality CT supports collar removal without the need for adjunctive imaging.”
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In a randomized multicenter trial comparing direct vs video laryngoscopy in trauma patient intubation, video had a higher first pass success rate and equal complication to direct laryngoscopy.
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This multicenter study looked at trauma patients with a hemothorax who underwent early tube thoracostomy vs. being observed. They found volume of over 300 ml predicted observation failure. Those observed had shorter hospital stays and less ICU admissions. Twenty two percent of observation patients required tube thoracostomy. The failed observation group had similar outcomes except longer hospital stays.
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This nice review article reminds us “The AO-Spine classification is the most frequently utilized system for thoracic and lumbar fractures, and it categorizes fractures into three types. Type A fractures are compression injuries. In these fractures, the assessment of the involvement of the posterior elements of the vertebral body is essential. Type B fractures are distraction injuries implying tension band involvement, whereas type C fractures are translational or dislocated injuries. The AO-Spine Upper Cervical Injury Classification System… In this classification system, type A injuries have no ligamentous involvement and are considered stable. Type B injuries have tension band or ligamentous injury and may be unstable. Type C injuries are characterized by significant translation and loss of anatomic integrity and are considered unstable."
These authors argue that bystander interventions in the early minutes (they call them the diamond minutes) can have an impact on trauma survival. Particular attention to External hemorrhage control; Airway opening and maintenance; Safe positioning of unconscious patients; Mitigation of early hypoxia and hypothermia could improve survival. We need to publicize this information and undo the years of teaching not to move these patients due to concern of secondary spinal cord injury. Many studies have dispelled that concern.
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This article suggest that freeze-dried plasma (FDP) is an acceptable adjunct to whole blood for prehospital resuscitation of trauma patients. “FDP is pathogen-reduced, shelf-stable for up to two years at room temperature, lightweight, and rapidly reconstituted at the point of care.” This method offers an advantage when caring for patients in remote areas with long transport times and has been used by NATO and Canadian armed forces.
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Of the 215 Norwegian patients on oral anticoagulation seen for a head injury and having a normal initial head CT, none developed delayed hemorrhage. Median age was 83 years.
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Here are two techniques to remove a helmet from an injured motorcyclist. The first uses a cast saw to bivalve the helmet. A link for a video is also provided.
