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1-20 of 213 results with category "Trauma"
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.
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In 290 trauma patients diagnosed with dementia prior to injury, when compared to 3000 patients over age 65 without dementia and similar injury severity score, the dementia patients had a much higher rate of discharge to an institution instead of back to home living. This was particularly true of older women.
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A retrospective study looking at use of transdermal Buprenorphine in older trauma patients with rib fractures found a good safety profile (less naloxone use) and less overall opioid use however no change in overall length of stay or mortality. Adding this to your multimodal pain strategy in older patients with rib fractures seems like a reasonable plan.
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Body armor/ bullet resistant vests used by law enforcement are designed to stop penetration by handgun rounds. These rounds have less velocity than rifle rounds. When caring for someone who has been shot while wearing body armor, verify no penetration has occurred and then look for blunt injuries such as rib fractures, liver injuries, pneumothorax, cardiac contusion, vertebral injury, etc. Behind Armor Blunt Trauma (BABT) is the technical term for injuries caused by the transfer of kinetic energy that occurs when these vests are struck.
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This narrative review of the trauma literature looking at chronic pain after trauma found:
- Chronic pain occurs in 30–70% of trauma survivors, with prevalence varying by injury type.
- Key risk factors include female sex, younger age, pre-existing pain, psychological distress, and social disadvantage.
- Validated prediction models are available for musculoskeletal trauma
- Thoracic trauma is under represented in the pain literature, is often underrecognized, and less protocols are available for treatment
- Thoracic pain typically occurs through intercostal nerve damage and persistent pain following thoracic injury
- The authors suggest “A trauma-specific, biopsychosocial approach is key to reducing chronic pain and improving recovery.”
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This German retrospective review of 1500 level one trauma center patients (ICU level or ISS over 9) found obesity was an independent predictor of ARDS, multisystem organ failure, and sepsis but not pneumonia or mortality.
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This systematic literature review looking at gender differences in trauma care reveals:
- Women were older with more low-energy trauma than men.
- Women were more likely to suffer from pelvic and spinal cord injuries.
- Women were more likely to be under-triaged and under-treated.
- Sex/gender-based differences in mortality were inconsistent across studies.
- Adjusted mortality appeared similar between women and men
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In this retrospective cohort study looking at splenic injury management and outcomes in the UK, patients over age 65 had much higher mortality and were more often managed conservatively (vs splenectomy or embolization) despite having a lower splenic injury grade and lower overall injury severity score compared to those under 65. Many factors are possible here including frailty, reluctance to intervene in older patients, and lower mechanism of injury bias away from evaluation and management.
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Looking at trauma patients evaluated at a major trauma center before and after EMS switched from semi-rigid to soft cervical collars for immobilization found no difference in adverse outcomes. Add this to the mounting evidence that our current practice of spinal immobilization may not offer any benefit.
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Bradycardia accompanying hypotension can be found in spinal cord injury (loss of autonomic reflex), beta blocker and calcium channel blocker overdose, intrinsic cardiac electrophysiologic derangement, and, often forgotten, intrabdominal hemorrhage. In the appropriate setting (blunt trauma, ruptured ectopic pregnancy), bradycardic hypotensive patients should be considered the same as tachycardic hypotensive patients and get a work up and treatment focused on Hemoperitoneum.