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Sample records for craniocerebral trauma

  1. Bear maul craniocerebral trauma in Kashmir Valley.

    PubMed

    Bashir, Sheikh Adil; Rasool, Altaf; Zaroo, Mohamad Inam; Wani, Adil Hafeez; Zargar, Haroon Rashid; Darzi, Mohammad Ashraf; Khursheed, Nayil

    2013-01-01

    Craniocerebral injuries constitute the bulk of the trauma patients in all the tertiary-care hospitals. Bear attacks as a cause of trauma to the brain and its protective covering are rare. This was a hospital-based retrospective (January 1990 to July 2005) and prospective study (August 2005 to December 2010). Craniocerebral trauma was seen in 49 patients of bear maul injuries. Loss of scalp tissue was seen in 17 patients, 13 of whom had exposed pericranium and needed split-thickness skin grafting, while 4 patients with exposed skull bones required scalp transposition flaps as an initial procedure. Skull bone fractures without associated brain injury were observed in 24 cases. Frontal bone was the site of fracture in the majority of cases (95%). Surgical intervention was needed in 18 patients for significantly depressed fractures. Three of these patients had depressed frontal bone fractures with underlying contusions and needed brain debridement and duraplasty. Injury to the brain was observed in 8 patients. Trauma to the brain and its protective coverings as a result of bear attacks is rarely known. Brain injury occurs less commonly as compared to soft tissue and bony injury. Craniocerebral trauma as a result of bear assaults has been a hitherto neglected area of trauma as the past reported incidence has been very low. Of late, the incidence and severity of such attacks has assumed grave proportions in areas adjacent to known bear habitats. An innocuous-looking surface wound might be the only presentation of an underlying severe brain trauma. Public awareness has to be generated to protect the people living in hilly areas.

  2. [A sociological evaluation of medical care measures in craniocerebral trauma].

    PubMed

    Babenko, A I; Orekhova, G G

    2003-01-01

    According to a questionnaire of 830 patients and 153 neurologists, both a timely asking for medical care and a timely treatment at specialized neurology hospitals are the key factor that cuts the rate of complications in craniocerebral trauma. Finally, a differential approach to treatment schemes with due respect to a trauma severity, availability of rehabilitation centers and application of new medical technologies, e.g. cranio-sacral therapy, are equally important.

  3. [Solcoseryl in intensive therapy in severe craniocerebral trauma].

    PubMed

    Marusanov, V E; Miroshnichenko, A G; Nikolau, S A; Petrova, N V; Bichun, A B

    2000-01-01

    The state of processes of lipid peroxidation and antioxidant defense was studied in patients with severe isolated craniocerebral closed injury. It was found that starting from the first days in the hospital the patients demonstrated marked alterations in the thiol-disulfide and ascorbate metabolism, activation of lipid peroxidation processes and lower antioxidant defense. The use of Solcoseryl as a component of the antioxidant therapy in treatment of the above mentioned category of patients resulted in considerably better indices of the thiol-disulfide metabolism. The isolated use of Solcoseryl failed to influence the ascorbate metabolism and lipid peroxidation. Solcoseryl used in combination with the ascorbic acid led to normalization of the thiol-disulfide and ascorbade metabolism without influencing the lipid peroxidation processes. Combined use of Solcoseryl and ascorbic acid promoted normalization of the neurological status and stabilization of the arterial pressure level.

  4. Sequelae of closed craniocerebral trauma and the efficacy of piracetam in its treatment in adolescents.

    PubMed

    Zavadenko, N N; Guzilova, L S

    2009-05-01

    The efficacy of piracetam in treating the sequelae of moderate and severe closed craniocerebral trauma (CCT) in adolescents was evaluated in studies of 42 patients aged 12-18 years who had suffered CCT 1.5-5 years prior to the study. Adolescents of the experimental group (20 individuals) received piracetam (Nootropil) at doses of 40-50 mg/kg (daily daily 1600-2400 mg) for one month; patients of group 2 (22 individuals) served as controls. Piracetam was found to have positive therapeutic effects on impairments to higher mental (memory, attention, executive) and motor (coordination) functions and on measures of the speeds of cognitive and motor operations.

  5. Acute effects of physiotherapeutic respiratory maneuvers in critically ill patients with craniocerebral trauma

    PubMed Central

    de Cerqueira Neto, Manoel Luiz; Moura, Álvaro Vieira; Cerqueira, Telma Cristina Fontes; Aquim, Esperidião Elias; Reá-Neto, Álvaro; Oliveira, Mirella Cristine; da Silva Júnior, Walderi Monteiro; Santana-Filho, Valter J.; Herminia Scola, Rosana

    2013-01-01

    OBJECTIVE: To evaluate the effects of physiotherapeutic respiratory maneuvers on cerebral and cardiovascular hemodynamics and blood gas variables. METHOD: A descriptive, longitudinal, prospective, nonrandomized clinical trial that included 20 critical patients with severe craniocerebral trauma who were receiving mechanical ventilation and who were admitted to the intensive care unit. Each patient was subjected to the physiotherapeutic maneuvers of vibrocompression and increased manual expiratory flow (5 minutes on each hemithorax), along with subsequent airway suctioning with prior instillation of saline solution, hyperinflation and hyperoxygenation. Variables related to cardiovascular and cerebral hemodynamics and blood gas variables were recorded after each vibrocompression, increased manual expiratory flow and airway suctioning maneuver and 10 minutes after the end of airway suctioning. RESULTS: The hemodynamic and blood gas variables were maintained during vibrocompression and increased manual expiratory flow maneuvers; however, there were increases in mean arterial pressure, intracranial pressure, heart rate, pulmonary arterial pressure and pulmonary capillary pressure during airway suctioning. All of the values returned to baseline 10 minutes after the end of airway suctioning. CONCLUSION: Respiratory physiotherapy can be safely performed on patients with severe craniocerebral trauma. Additional caution must be taken when performing airway suctioning because this technique alters cerebral and cardiovascular hemodynamics, even in sedated and paralyzed patients. PMID:24141836

  6. [Complications in Le Fort facial fractures combined with craniocerebral trauma].

    PubMed

    Dimov, Zh; Abramov, G; Dimov, K; Kr'stev, N; Kr'stev, D

    1999-01-01

    The present research is based on the most frequent traumas and fractures in the middle zone of the face (second and third type by Rene le Fort) and the proceeded from them complications for a period of four years in the clinic of Neurosurgery in NIUMN "Pirogov". From the 280 patients that were studied the complications were observed in 54 of them. We worked up the received results statistically and presented them in drawing.

  7. [Effects of combined action of radon baths and transcranial magnetotherapy on cerebral circulation in patients in an intermediate period of a mild craniocerebral trauma].

    PubMed

    Moliavchikova, O V; Cherevashchenko, L A; Grinzaĭd, Iu M; Aĭvazov, V N; Zhuravlev, M E

    2007-01-01

    The authors propose combined therapy improving cerebral circulation in patients in an intermediate period of a mild craniocerebral trauma. The combination consists of radon baths and transcranial magnetotherapy which raise blood volume filling, relieve vascular resistance, improve venous outflow.

  8. [Lipid peroxidation processes and activity of brain succinate dehydrogenase in experimental craniocerebral trauma].

    PubMed

    Demchuk, M L; Medvedev, A E; Promyslov, M Sh; Gorkin, V Z

    1993-01-01

    A statistically significant decrease in the activity of succinate dehydrogenase (SDH) was found in the rabbit brain after craniocerebral injury. The decrease in the activity of brain SDH was not shown to result from "competitive inhibition" by malonate accumulated after activation of lipid peroxidation. The activity of brain SDH was normalized by directed modification of the function of the central nervous system via administration of phenamine (amphetamine) into the injured animals.

  9. Brain SPECT and Neuropsychological Examination in Patients with a History of Minor Craniocerebral Trauma Nine Years after Head Injury.

    PubMed

    Dawid, S; Marks, W; Lasek, J; Witkowski, Z; Goŀąbek-Dropiewska, K; Sitek, E J; Wieczorek, D; Brockhuis, B; Lass, P

    2010-03-01

    Focal perfusion deficits disclosed by single photon emission computerized tomography (SPECT) show more diffuse brain dysfunction than computed tomography (CT) examinations in case of head trauma. The aim of the study was to evaluate SPECT as an enhancing and complementary diagnostic method in patients after minor craniocerebral trauma (mCCT) and establish a possible correlation between clinical symptoms and disturbances of cerebral blood flow (CBF). SPECT examination and neuropsychological assessment was performed in seven patients about nine years after head injury, scoring 13-15 points on the Glasgow COMA SCALE and without evidence of structural brain damage. Neuropsychological assessment addressed global cognitive status, verbal and visual memory, working memory, object and space perception, executive function, self-assessment of memory, mood and health-related complaints. A direct relationship was shown between mCCT and the observed CBF disorders, and between the CBF disorders and cognitive dysfunction. Because of its sensitivity, SPECT, should be regarded as a method complementary to CT in mCCT.

  10. [The dynamics of the individual profiles of brain asymmetry in patients with craniocerebral trauma under the influence of emoxipin treatment].

    PubMed

    Fedulov, A S; Teterkina, T I; Oleshkevich, F V

    1992-01-01

    The authors studied the effect of the drug emoxypin on the brain functional asymmetry (A) in 36 patients with craniocerebral trauma attended by occurrence of focal traumatic injuries (FTI) to the brain (experimental group). The control group consisted of 61 patients who received the traditional intensive therapy for FTI (isolated brain contusion of moderate and severe degree, intracerebral hematomas measuring 30-50 cm3 in volume in the contusion focus). Favorable changes of the brain FA indices in the individual asymmetry profiles were noted, respectively, in 76.7% and 40.9% of patients given and not given emoxypin. Complete normalization of brain FA indices by the 25th-30th day after the beginning of treatment was recorded in 60.9% of patients in the control group and in 37% of those in the experimental group. The dynamics of individual asymmetry profiles in patients with FTI provides evidence that emoxypin improves the attention, mental efficiency, memory capacity, and selectivity of mnemonic processes.

  11. Pediatric crushing head injury: biomechanics and clinical features of an uncommon type of craniocerebral trauma.

    PubMed

    López-Guerrero, Antonio López; Martínez-Lage, Juan F; González-Tortosa, José; Almagro, María-José; García-Martínez, Silvia; Reyes, Susana B

    2012-12-01

    Head injuries constitute one of the leading causes of pediatric morbidity and mortality. Most injuries result from accidents involving an acceleration/deceleration mechanism. However, a special type of head injury occurs when the children sustain a traumatism whose main component is a static load in relation to a crushing mechanism with the head relatively immobile. We report a series of children who sustained a craniocerebral injury of variable severity produced by head crushing. We also analyze epidemiological and clinical data, and biomechanics in these injuries. Mean age of the group (13 boys/6 girls) was 4.1 years. All patients showed external lesions (scalp wounds or hemorrhage from the nose, ears, or throat). Eleven children were initially unconscious. Six children presented cranial nerve deficits in addition to impaired hearing. Skull base fractures were seen in most cases with extension to the vault in 11 instances. Fourteen patients had an associated intracranial lesion, including two with diffuse axonal injury. Surgery was performed in three instances. Only seven patients were left with sequelae. The observed skull, brain, and cranial nerve lesions corresponded to a mechanism of bilateral compression of the children's heads mainly occasioned by a static load, although an associated component of dynamic forces was also involved. The skull and its covering and the cranial nerves were the most severely affected structures while the brain seemed to be relatively well preserved. Most crush injuries appear to be preventable by the appropriate supervision of the children.

  12. [Prolactinoma after craniocerebral trauma].

    PubMed

    Schultz, A M; Huber, J C

    1993-09-01

    A female patient, now twenty-four years old, suffered from a severe cerebral contusion in 1983 as a result of a car accident. At the time of the accident, she had a regular menstrual cycle. Since 1985, she has contracted oligomenorrhoea and since 1988 secondary amenorrhoea. In 1988, we diagnosed by CT-scan and NMR-imaging an excessive hyperprolactinaemia caused by a pituitary adenoma. Neither surgical intervention, nor conservative medication could reduce the prolactin level to normal. We suspect, that there is an association between the cranial injury and the appearance of the pituitary tumour.

  13. [Evaluation of cognitive deficits after craniocerebral injury].

    PubMed

    Misić-Pavkov, G; Pejakov, L; Bozić, K; Filipović, D

    1997-01-01

    The study included 90 persons, one year after experiencing closed craniocerebral trauma. The purpose was to determine, by neuropsychological and neurophysiological methods, the presence of cognitive deficit as a result of cerebral trauma. It is possible to objectivize the organically conditioned cognitive deficit in case of a significant number of patients, and also, by the application of certain methodology, to grade the intensity of existing changes. When compared with other examined parameters, the presence of cognitive deficit was more often in patients of older ages and in those with more serious craniocerebral trauma. A special attention was made to the sensitivity of the used instruments for the verification of cognitive deficit. Among them, Wisconsin test and the method of cognitive evoked potential P-300 appeared to be the most reliable ones.

  14. [Computerized tomography and craniocerebral trauma].

    PubMed

    Richter, H P; Braun, V

    1993-11-01

    Computed tomography (CT) is now the standard neuroradiological examination for patients with major head injuries, although conventional X-ray of the skull should not be neglected. Whereas the latter only shows such skull pathology as fractures or intracranial air following a basal fracture, CT clearly visualizes intracranial pathology. It allows differentiation between haematoma and contusion, between localized oedema and generalized brain swelling; CT is therefore indicated in every patient with disturbed consciousness, focal neurological signs, and/or secondary clinical impairment, and also in all drunken patients with head injury. In a patient with impaired consciousness and focal neurological deficit the probability of a pathologic CT is 85%. An extracerebral haematoma is often present, which needs urgent evacuation. A modern, non-expensive communications system using a standard telephone line enables hospitals without a neurosurgical unit to send CT pictures that are difficult to interpret to a neurosurgeon and to discuss them on-line by telephone. This system has now been in operation for over 2 years and has improved the care of patients with head injury in our region. It is highly efficient and reliable and improves cooperation between distant hospitals. It also helps to avoid unnecessary transfers, which are not only expensive but may even harm a critically ill patient.

  15. Severe craniocerebral trauma with sequelae caused by Flash-Ball® shot, a less-lethal weapon: Report of one case and review of the literature.

    PubMed

    Hiquet, Jean; Gromb-Monnoyeur, Sophie

    2016-07-01

    The use of Flash-Ball® as a non-lethal weapon by several special units within the police and police forces started in France in 1995. Little literature is available concerning injuries caused by Flash-Ball® shooting. However, we report the case of a healthy 34-year-old male victim of a Flash-Ball® shooting during a riot following a sports event. This young man presented serious craniocerebral injuries with a left temporal fracture, moderate cerebral oedema, fronto-temporal haemorrhagic contusion along with an extra-dural hematoma and subarachnoid hemorrhage requiring neurological and rehabilitation care for two months leaving important sequelae. Although the risk is obviously lower than with firearms, Flash-Ball® is nonetheless potentially lethal and may cause serious physical injuries, particularly after a shot to the head. © The Author(s) 2015.

  16. Analysis of blood trace elements and biochemical indexes levels in severe craniocerebral trauma adults with Glasgow Coma Scale and injury severity score.

    PubMed

    Xu, Guangtao; Hu, Bo; Chen, Guiqian; Yu, Xiaojun; Luo, Jianming; Lv, Junyao; Gu, Jiang

    2015-04-01

    We aimed to investigate the correlation between the Glasgow Coma Scale (GCS), the injury severity score (ISS) and serum levels of trace elements (TE) in severe trauma patients to analyze alteration of the levels of trace elements and serum biochemical indexes in the period of admission from 126 adult cases of severe brain trauma with traffic accidents. Multi-trace elements for patients in the trauma-TE groups were used. The results indicated that all patients presented an acute trace elements deficiency syndrome (ATEDs) after severe trauma, and the correlation between ISS and serum levels of Fe, Zn, and Mg was significant. Compared to the normal control group, levels of the trace elements in serum were significantly decreased after trauma, suggesting that enhancement of immunity to infection and multiple organ failure (MOF) via the monitoring and supplement of trace elements will be a good strategy to severe traumatic patients in clinics.

  17. [Psychological consequences of moderate to severe cranio-cerebral injuries: dysexecutive syndrome. Preliminary report].

    PubMed

    Sippel, Volkmar; Polak, Jarosław; Gościński, Igor; Moskała, Marek; Dziasek, Ireneusz; Madroszkiewicz, Ewa; Gierowski, Józef Krzysztof

    2002-01-01

    The late sequel of cranio-cerebral trauma are common causes of decreased mental capability and pathology localized in frontal lobes which can cause the dysexecutive syndrome (the individual has a goal but has difficulty in generating or activating the appropriate goal directed behavior). We analysed 58 patients, random-chosen, treated in the Neurotraumatology Department in Kraków after craniocerebral injury. Among them, 6 patients were found who scored more than average in DEX questionnaire. It was shown that diagnosis of DEX enables use of neuropsychological rehabilitation, which can improve final outcome.

  18. Principles for managing penetrating craniocerebral injuries caused by firearm missiles.

    PubMed

    Zhang, X; Yi, S Y; Liu, W P; Zhang, Z W; Wang, L G; Li, A M

    1996-07-01

    Penetrating craniocerebral firearm injuries remain one of the most lethal causes of all trauma and are common both in war or peace time. Data were reviewed for 4140 severely head-injured patients (Glasgow Coma Scale (GCS) scores 3-8) treated at Xi-Jing Hospital between 1973 and 1993; 51 of these patients had acute penetrating craniocerebral injuries caused by firearm missiles. These patients consisted of 46 males (90.2%) and 5 females (9.8%) ranging in age from 3 months to 48 years (median 22.4 years). The lesion types included 2 tangential wounds, 37 tubular wounds and 12 through-and-through wounds. All cases were urgent with the patients in severe and unstable states. After emergency treatment and operation, 5 cases died (9.8%). Follow up studies at three months showed that 23 cases (45.1%) had made a good recovery. Moderate disability, severe disability and vegetative states in this series were 29.4%, 13.7% and 2.0% respectively. Long term follow up studies indicated that 32 were able to resume their occupation. The principles for managing penetrating craniocerebral firearm injuries and suggestions for operation are discussed.

  19. Movement disorders secondary to craniocerebral trauma.

    PubMed

    Krauss, Joachim K

    2015-01-01

    Over the past few decades it has been recognized that traumatic brain injury may result in various movement disorders. In survivors of severe head injury, post-traumatic movement disorders were reported in about 20%, and they persisted in about 10% of patients. The most frequent persisting movement disorder in this population is kinetic cerebellar outflow tremor in about 9%, followed by dystonia in about 4%. While tremor is associated most frequently with cerebellar or mesencephalic lesions, patients with dystonia frequently have basal ganglia or thalamic lesions. Moderate or mild traumatic brain injury only rarely causes persistent post-traumatic movement disorders. It appears that the frequency of post-traumatic movement disorders overall has been declining which most likely is secondary to improved treatment of brain injury. In patients with disabling post-traumatic movement disorders which are refractory to medical treatment, stereotactic neurosurgery can provide long-lasting benefit. While in the past the primary option for severe kinetic tremor was thalamotomy and for dystonia thalamotomy or pallidotomy, today deep brain stimulation has become the preferred treatment. Parkinsonism is a rare consequence of single head injury, but repeated head injury such as seen in boxing can result in chronic encephalopathy with parkinsonian features. While there is still controversy whether or not head injury is a risk factor for the development of Parkinson's disease, recent studies indicate that genetic susceptibility might be relevant.

  20. Recovery and Cognitive Retraining after Craniocerebral Trauma.

    ERIC Educational Resources Information Center

    Prigatano, George P.

    1987-01-01

    Historical and present-day ideas concerning recovery of higher brain functions and cognitive retraining after traumatic brain injury are considered. Clinical guidelines for helping patients understand and compensate for residual higher cerebral deficits are suggested. A holistic- or milieu-oriented program is considered the most helpful…

  1. Image guided surgery in the management of craniocerebral gunshot injuries

    PubMed Central

    Elserry, Tarek; Anwer, Hesham; Esene, Ignatius Ngene

    2013-01-01

    Background: A craniocerebral trauma caused by firearms is a complex injury with high morbidity and mortality. One of the most intriguing and controversial part in their management in salvageable patients is the decision to remove the bullet/pellet. A bullet is foreign to the brain and, in principle, should be removed. Surgical options for bullet extraction span from conventional craniotomy, through C-arm-guided surgery to minimally invasive frame or frameless stereotaxy. But what is the best surgical option? Methods: We prospectively followed up a cohort of 28 patients with cranio-cerebral gunshot injury (CCHSI) managed from January to December 2012 in our department of neurosurgery. The missiles were extracted via stereotaxy (frame or frameless), C-arm-guided, or free-hand-based surgery. Cases managed conservatively were excluded. The Glasgow Outcome Score was used to assess the functional outcome on discharge. Results: Five of the eight “stereotactic cases” had an excellent outcome after missile extraction while the initially planned stereotaxy missed locating the missile in three cases and were thus subjected to free hand craniotomy. Excellent outcome was obtained in five of the nine “neuronavigation cases, five of the eight cases for free hand surgery based on the bony landmarks, and five of the six C-arm-based surgery. Conclusion: Conventional craniotomy isn’t indicated in the extraction of isolated, retained, intracranial firearm missiles in civilian injury but could be useful when the missile is incorporated within a surgical lesion. Stereotactic surgery could be useful for bullet extraction, though with limited precision in identifying small pellets because of their small sizes, thus exposing patients to same risk of brain insult when retrieving a missile by conventional surgery. Because of its availability, C-arm-guided surgery continues to be of much benefit, especially in emergency situations. We recommend an extensive long-term study of these

  2. [Forensic medical evaluation of thanatogenesis in craniocerebral injury].

    PubMed

    Guseĭnov, G K; Fetisov, V A; Bogomolov, D V

    2010-01-01

    Causes of death in survivors of a craniocerebral injury are described. Transition of cerebral tanatogenesis to pulmonary one during the hospital stay of the affected subjects has been documented. Respiratory distress syndrome in adult patients is shown to play an important role in the development of pneumonia after a craniocerebral injury.

  3. Craniocerebral injury promotes the repair of peripheral nerve injury

    PubMed Central

    Wang, Wei; Gao, Jun; Na, Lei; Jiang, Hongtao; Xue, Jingfeng; Yang, Zhenjun; Wang, Pei

    2014-01-01

    The increase in neurotrophic factors after craniocerebral injury has been shown to promote fracture healing. Moreover, neurotrophic factors play a key role in the regeneration and repair of peripheral nerve. However, whether craniocerebral injury alters the repair of peripheral nerve injuries remains poorly understood. Rat injury models were established by transecting the left sciatic nerve and using a free-fall device to induce craniocerebral injury. Compared with sciatic nerve injury alone after 6–12 weeks, rats with combined sciatic and craniocerebral injuries showed decreased sciatic functional index, increased recovery of gastrocnemius muscle wet weight, recovery of sciatic nerve ganglia and corresponding spinal cord segment neuron morphologies, and increased numbers of horseradish peroxidase-labeled cells. These results indicate that craniocerebral injury promotes the repair of peripheral nerve injury. PMID:25374593

  4. Craniocerebral gunshot injury in newborn

    PubMed Central

    Dabdoub, CB; Serra, SM; da Cunha, AH; Silveira, EN; Lopez, A; Azevedo-Filho, H

    2012-01-01

    Head wounds caused by firearms in newborns are an under-studied phenomenon in Latin America due to either the low frequency of such events or inadequate documentation. Nonetheless, a progressive increase is noted, with different frequencies reported for different geographic areas. We present the case of a 28-day-old newborn who suffered traumatic brain injury from a gunshot wound stemming from urban violence. This is one of the youngest patients reported with this type of head trauma in the literature. PMID:24960794

  5. Trauma.

    PubMed

    Huisman, Thierry A G M; Poretti, Andrea

    2016-01-01

    Traumatic brain and spine injury (TBI/TSI) is a leading cause of death and lifelong disability in children. The biomechanical properties of the child's brain, skull, and spine, the size of the child, the age-specific activity pattern, and variance in trauma mechanisms result in a wide range of age-specific traumas and patterns of brain and spine injuries. A detailed knowledge about the various types of primary and secondary pediatric head and spine injuries is essential to better identify and understand pediatric TBI/TSI, which enhances sensitivity and specificity of diagnosis, will guide therapy, and may give important information about the prognosis. The purposes of this chapter are to: (1) discuss the unique epidemiology, mechanisms, and characteristics of TBI/TSI in children; (2) review the anatomic and functional imaging techniques that can be used to study common and rare pediatric TBI/TSI and their complications; (3) comprehensively review frequent primary and secondary brain injuries; and (4) to give a short overview of two special types of pediatric TBI/TSI: birth-related and nonaccidental injuries.

  6. Management of Craniocerebral Gunshot Injuries: A Review

    PubMed Central

    Alvis-Miranda, Hernando Raphael; Adie Villafañe, Roberto; Rojas, Alejandro; Alcala-Cerra, Gabriel

    2015-01-01

    Craniocerebral gunshot injuries (CGI) are increasingly encountered by neurosurgeons in civilian and urban settings. Unfortunately this is a prevalent condition in developing countries, with major armed conflicts which is not very likely to achieve a high rate of prevention. Management goals should focus on early aggressive, vigorous resuscitation and correction of coagulopathy; those with stable vital signs undergo brain computed tomography scan. Neuroimaging is vital for surgical purposes, especially for determine type surgery, size and location of the approach, route of extraction of the foreign body; however not always surgical management is indicated, there is also the not uncommon decision to choose non-surgical management. The treatment consist of immediate life salvage, through control of persistent bleeding and cerebral decompression; prevention of infection, through extensive debridement of all contaminated, macerated or ischemic tissues; preservation of nervous tissue, through preventing meningocerebral scars; and restoration of anatomic structures through the hermetic seal of dura and scalp. There have been few recent studies involving penetrating craniocerebral injuries, and most studies have been restricted to small numbers of patients; classic studies in military and civil environment have identified that this is a highly lethal or devastating violent condition, able to leave marked consequences for the affected individual, the family and the health system itself. Various measures have been aimed to lower the incidence of CGI, especially in civilians. It is necessarily urgent to promote research in a neurocritical topic such as CGI, looking impact positively the quality of life for those who survive. PMID:27169063

  7. [Training in cognitive functions in neurologic rehabilitation of craniocerebral trauma].

    PubMed

    Friedl-Francesconi, H; Binder, H

    1996-01-01

    This study evaluates a new cognitive rehabilitation therapy for patients after severe head injury. In addition to the standard neurological rehabilitation therapy, one group was trained by the Wiener Determinationsgerät (WDT), a second group was treated by the new program REHACOM, while a third group received only conventional neurological rehabilitation therapy. The three groups each consisted of 12 patients; two groups received 20 sessions of training, each lasting 40 minutes. At the beginning as well as after the therapy a psychological test battery was applied, consisting of HAWIE, TULUC, AACHENER APHASIETEST, and BENTON-Test. They were also tested by a specific neuropsychological battery regarding hemispheric specialization. REHACOM showed significantly higher values on the HAWIE as well as on BENTON-Test than the other two groups. REHACOM also improved in right-hemispheric dimensions while WDT group did not improve in attention. Right-hemispheric training was more effective than attentional stimulation.

  8. [Dynamics of various electrophysiologic indices in patients with mild acute closed craniocerebral injuries during complex treatment using reflexotherapy].

    PubMed

    Petelin, L S; Goĭdenko, V S; Biblina, I M

    1985-01-01

    An analysis of 117 cases of acute closed craniocerebral trauma (CCCT) of a mild degree, the time-course of the EEG, EchoEG and REG findings in the process of treatment has shown that mild CCCT was expressed clinically in CSF hypertension, as well as vegetovascular and asthenoneurotic syndromes. The detection at the early stages of the injury of the leading clinical syndrome contributes to the conduction of purposeful therapeutic measures. A positive time-course of some electrophysiological parameters indicates the normalization of vegetovascular dysfunctions under the impact of acupuncture, which permits the use of this method in the multiple modality treatment of CCCT in the acute period.

  9. [Modern aspects of forensic medical diagnostics of the craniocerebral injury].

    PubMed

    Pigolkina, E Iu; Dorosheva, Zh V; Sidorovich, Iu V; Bychkov, A A

    2012-01-01

    The authors report the results of the investigations of craniocerebral injuries (CCI) including crystallographic studies of brain liquor obtained after the injury and non-traumatic pathological processes. The additional forensic medical criteria for the severity of craniocerebral injuries have been developed and the objective signs of CCI determined to be used for diagnostic purposes in the cases with concomitant diseases and also in the subjects of advanced and declining age. The diagnostic methods for the elucidation of the nature of chronic subdural hematomas and the estimation of the time of their formation have been improved.

  10. [Computer analysis of erythrocyte catalase activity in diagnosis of mild brain trauma and concussion].

    PubMed

    Porodenko, V A; Budnik, V E

    2005-01-01

    A complex investigation of catalase activity in erythrocytes was conducted basing on the results of computer quantitative morphometry of histochemical examination of blood samples from persons with mild craniocerebral trauma. It was found that erythrocytic catalase activity correlates with severity of brain trauma. A novel technique of objective histochemical diagnosis of trauma is described. It provides objective grounds for expert conclusions. Differential features of erythrocytic shape were defined in a small series of micropreparations vs the rest blood samples.

  11. [Brain arousal dysfunction in severe craniocerebral injury treated with acupuncture].

    PubMed

    Tu, Xiao-Hua; He, Zeng-Yi; Fu, Xiao; Chen, Yan-Hua; Chen, You-Lin; Kang, Shao-Jun

    2010-12-01

    To explore the early rehabilitation effect of acupuncture on brain arousal in severe craniocerebral injury. One hundred and two cases of severe craniocerebral injury were randomly divided into an observation group and a control group, 51 cases in each one. Based on the conventional nursing care in neurological external medicine, in observation group, acupuncture was applied at Shuigou (GV 26), Neiguan (PC 6) and Sanyinjiao (SP 6) mainly. In control group, functional electric stimulation was applied at stimulate the affected muscles of the upper limbs. Thirty days later, the lucid rate from coma, lucid interval and clinical efficacy were compared between two groups. RESULTS; The lucid rate from coma was 82.4% (42/51) in observation group, which was higher than 56.9% (29/51) in control group (P < 0.01). The lucid interval in observation group was shortened remarkably as compared with control group (P < 0.01), and the clinical efficacy was superior apparently to that in control group (P < 0.01). On the basis of conventional treatment, acupuncture intervention at early stage can accelerate the recovery of brain arousal function in patients with severe craniocerebral injury.

  12. [Provision of medical care to the wounded with craniocerebral injuries at stages of medical evacuation in mountains and desert areas].

    PubMed

    Orlov, V P

    2015-01-01

    The author shows that surgery with craniocerebral injuries should be fully performed at the stage of specialized medical care. Wounded have to be evacuated not earlier than 5-7 days after surgery with the mandatory use of a special air transport ("Scalpel" or "Spasatel"), accompanied by Anaesthetist. In the absence of the possibility of surgery in 5-7 days at this stage the wounded have to be evacuated by air to the center hospitals. On the stage there are only patients requiring specialized care because of health reasons. Wounded with gunshot wounds of the soft tissues of the head, and those with mild forms of brain damage during the explosive and combat injury (concussion, mild brain contusion) can be evacuated by air transport accompanied by a doctor or paramedic at any period of time after the injury (trauma).

  13. Civilian craniocerebral gunshot injuries in a developing country: presentation, injury characteristics, prognostic indicators, and complications.

    PubMed

    Khan, Muhammad Babar; Kumar, Rajesh; Irfan, Furqan Bin; Irfan, Affan Bin; Bari, Muhammad Ehsan

    2014-01-01

    Civilian craniocerebral gunshot injuries (CGIs) are rare but increasing in incidence in the developing world and there is scare literature on presentation, injury characteristics, prognostic indicators, and complications of brain trauma due to projectiles. A retrospective review of 51 civilian patients with CGI who presented to the Aga Khan University Hospital between 1998 and 2011 was carried out. Presentation, injury characteristics, and complications were analyzed with emphasis on outcomes and prognostic indicators. There were 43 male and 8 female patients with an average age of 28.92 (±12.33) years. Twenty-three patients had a Glasgow Coma Scale (GCS) score of 13-15, 6 patients had a GCS score of 9-12, and 22 patients had a GCS score of 3-8 on admission. The overall mortality rate was 22% (n = 11). The most common postoperative neurologic deficits were motor deficits (19 patients) followed by aphasias (11 patients). On univariate analysis, admission GCS score and bi- or multilobar injuries were found to be highly predictive of neurologic outcome. There was no difference in outcomes between penetrating and perforating injuries. We also failed to find a statistically significant correlation between ventricular injury and outcomes in our patients. Admission GCS and number of lobes involved are highly prognostic of outcome. Patients with a GCS score ≥9 and unilobar injury on computed tomographic scans may benefit the most from surgical management. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Epidemiology of cranio-cerebral injuries in emergency medical services practice.

    PubMed

    Szarpak, Łukasz; Madziała, Marcin

    2011-12-01

    Head injuries have always accompanied the man. Cranio-cerebral injuries are the most common and often can lead to an imminent threat to life. THE AIM OF THE STUDY was the analysis of interventions of Emergency Medical Service teams in respect of patients manifesting symptoms indicative of suffered cranio-cerebral injuries. We analyzed the emergency intervent card (protection medically Piaseczno and Otwock in 2009)--the cranio-cerebral injuries (CCI). We analyzed 1049 cases of CCI. Twice as likely to cranial injuries--brain affected men population. Most accidents happened in the afternoon (13-18) and in the summer months (June-August). Falls from height were the most common cause of cranio-cerebral injuries, but most cases related to the superficial bruising of the head. Cranio-cerebral injuries are the predominant group among all the injuries. Men twice as likely to suffer injury--cranial cerebral compared to women. Most CCI suffer economically active people of 30-39 years age bracket. The most common cause of injury--cranial brain are falls from height, also traffic accidents and falls at the same level. Contusion skins, open wound of the head and concussion injuries are the most common forms of cranio-cerebral injuries.

  15. [Clinical and social fate of craniocerebral injuries in young adults].

    PubMed

    Girard, V; Schadelle, J M

    1976-03-01

    After looking 15 years back, the authors based two detailed observations of young adult cranio-cerebral injured taken amongst a group of 30 others who had been the subject of a medical doctorate thesis. From then on, the authors drew notions of semeiology, concerning the subjects becoming aware of their body before being injured, when waking up from coma and during the phasis of after effects. They mean to suggest to consider the notions of "normal person" and of pre-traumatic mind, of "present person" and of traumatic mind, and of "future person" and of post-traumatic mind. They attempted to write a comparative essay with the cerebral and physical disable of early youth. By way of conclusion, they briefly studied the attitudes of the clinical, familial and social relations and of the medical and legal consequences of these attitudes.

  16. Craniocerebral Gunshot Injuries; A Review of the Current Literature

    PubMed Central

    Alvis-Miranda, Hernando Raphael; M. Rubiano, Andres; Agrawal, Amit; Rojas, Alejandro; Moscote-Salazar, Luis Rafael; Satyarthee, Guru Dutta; Calderon-Miranda, Willem Guillermo; Hernandez, Nidia Escobar; Zabaleta-Churio, Nasly

    2016-01-01

    Craniocerebral gunshot injuries (CGI) are increasingly encountered by neurosurgeons in civilian and urban settings. Unfortunately, more   prevalent condition in developing countries, with major armed conflicts which is still persisting, since the main trigger is violence at the national or state level. Management goals of CGI should focus on aggressive resuscitation and correction of coagulopathy; those with stable vital signs should undergo CT scan head at the earliest possible opportunity. Neuroimaging is vital for   planning of surgical management, especially to determine the type of surgery, routes of the approach to the surgical target area and  extraction of the impacted foreign bodies, however, surgical management is not always indicated. Although subset of such cases may be managed even with non-surgical management. The treatment comprises of immediate life salvaging resuscitative measures including control of the  persistent bleeding, care of associated injury, management of raised intracranial pressure, prevention of cerebrospinal fistula formation by primary watertight dural repair and  prevention of infection, through extensive debridement of contaminated, macerated or ischemic tissues; preservation of nervous tissue and restoration of anatomic structures through the hermetic sealing of dural and scalp defect. Recently, only few studies of craniocerebral penetrating injuries are published that too involving smaller patients sample sizes; although classic studies in the military and civil situation noticed associated relatively very high mortality and morbidity and psychological as well as economic impact on the   affected individual, the family and the health system in providing ongoing care to the sufferers and society at large.  Currently various measures are advocated with aim to reduce the incidence of CGI especially in civilian populations. It is highly necessary and immensely urgent to promote research in a neurocritical care of CGI to

  17. Cranial trauma in ancient Greece: from Homer to classical authors.

    PubMed

    Konsolaki, Eleni; Astyrakaki, Elisabeth; Stefanakis, George; Agouridakis, Panos; Askitopoulou, Helen

    2010-12-01

    This article presents literary evidence on traumatic cranio-cerebral injuries in ancient Greece from about 900 B.C. to 100 B.C. The main sources of information are epic and classic Greek texts of that period. Homer provides the first literary source of head trauma, which he portrayed in his epic poems The Iliad and The Odyssey. He describes 41 injuries of the head, face and cervical spine, of which all but two were fatal. Subsequently, other classical authors like Plato, Plutarch and others illustrate cases of cranial trauma that occurred mainly in the battlefields, during athletic games or in unusual accidents. They describe some interesting cases of head trauma in prominent men, such as the poet Aeschylos, the kings Pyrrhos and Kyros and Alexander the Great. Most of these descriptions show that the ancient Greeks possessed very good knowledge of the anatomy of the head and neck region and also of the pathophysiological consequences of trauma in the region.

  18. [The morphological changes in the myocardium associated with the craniocerebral injury].

    PubMed

    Boyarinov, G A; Deryugina, A V; Zaitsev, R R; Yakovleva, E I; Nikol'sky, V O; Boyarinova, L V; Galkina, M V

    2017-01-01

    The objective of the present study was to evaluate the structural changes in the capillaries, arterioles, venules, and cardiomyocytes in the myocardium of the rats following the craniocerebral injury (CCI). Eighteen non-pedigree white female rats with the craniocerebral injury were used as the CCI model. All the animals were given an intraperitoneal injection of sodium thiopental (100 mg/kg b.w.) within 3, 7, and 12 days after the injury. The heart was removed after thoracotomy and the myocardial tissue was examined with the light and electron microscopes. It was shown that the rats with the craniocerebral injury developed well apparent changes in the myocardial tissue during the early post-traumatic period that affected not only the blood vessels themselves (capillaries, arterioles, venules) but also the intra- and extravascular structures. Changes in the microcirculatory system included damages to the mitochondria, myofibrils, cell nuclei, sarcoplasmic reticulum, and cardiomyocytes. It is concluded that the morphological changes in the myocardium of the animals associated with the craniocerebral injury can induce the development of functional disorders in the cardiovascular system during the early post-traumatic period.

  19. [Importance of interdisciplinary cooperation in multiple trauma management].

    PubMed

    Vyhnánek, F

    2014-05-01

    Multiple trauma represents the most serious type of trauma in which the result of the treatment depends on the quality of pre-hospital care according to ATLS (Advanced Trauma Life Support) as well as on the availability of emergency specialized care in traumatology centres. Resuscitation in the early post-injury phase involves prevention of the lethal triad (hypothermia, acidosis, coagulopathy) development, as early as during pre-hospital care and also during admission to a traumatology department (damage control resuscitation). Damage control resuscitation involves permissive hypotension and coagulopathy correction with red blood cells (RBCs), fresh frozen plasma and platelets administration with crystalloid solutions restriction. Management in a traumatology centre involves : 1. Determining the sequence for treating each of the injuries step by step: a) control of external and intracavitary bleeding, b) operation for craniocerebral injuries, c) external fixation of fractures. 2. Phased management of intracavitary injuries (damage control surgery) and injuries of the extremities (damage control orthopaedics). 3. Non-operative management of solid organs injuries including radiointervention procedures. 4. Post-injury intensive care after the primary operation (treatment of the lethal triad). 5. Treatment regimen extension in craniocerebral injuries (stabilisation of cerebral perfusion pressure with sufficient oxygenation). 6. Modern therapeutic strategies in mechanical ventilation (protective, non-invasive ventilation). 7. Integration of new imaging methods such as MDCT (Multidetector Computed Tomography). Ensuring complex management in polytrauma treatment requires active cooperation of numerous clinical disciplines, already in the early post-injury period.

  20. [The shame-blame-worry complex in parents of children after craniocerebral trauma].

    PubMed

    Voll, R

    1993-11-01

    The care complex of parents of brain damaged children represents a defense mechanism against the parents' shame-guilt-dilemma. The care complex does not meet with a coping behaviour being beneficial to the children, but demands rather too much of such children and adolescents. There is overprotection, a changed emotional acceptance of the child and a changed method of upbringing together with a strict control over achievements at school and therapies still necessary. Variants of the parents' subjective guilt with regard to the child are described in several case vignettes. Methods of the psychotherapeutic treatment of parents are discussed. Finally, an outlook in the consequences of the care complex as regards the self-image and self-acceptance in adolescence are given.

  1. ['Advanced trauma life support' in Netherlands].

    PubMed

    van Vugt, A B

    2000-10-28

    Introduction of the principles of advanced trauma life support (ATLS) in the management of accident victims has been in progress in the Netherlands since 1995. The main ATLS principles are that the aid giver treats the most dangerous disorder first and does no further damage. After assessment and, if necessary, treatment of the airways, the respiration, the circulation and any craniocerebral injury, an exploratory examination is carried out. Physicians receive theoretical and practical instructions in this form of management during an intensive two-day course, counselled by a coordinating organization in the USA. Most of those attending are interns in general surgery, traumatology and orthopaedics, gatekeeper doctors of emergency rooms and army medical officers. The standardized way of thinking improves the communication and understanding between the various disciplines involved in trauma care, in part because there exist comparable programmes for ambulance care and emergency care. Other measures improving the quality of trauma care are regionalization of the trauma care, medical helicopter teams and evaluation of the effects of ATLS as an operating procedure.

  2. Penetrating craniocerebral injury caused by a pneumatic nail gun: an unsuccessful attempt of suicide.

    PubMed

    Panourias, I G; Slatinopoulos, V K; Arvanitis, D L

    2006-07-01

    Nail guns are powerful tools commonly used in the building industry. As a result of their improper use, many accidents of bodily injury, including death, have already been reported over the last 50 years; their use in suicide attempts, however, is rare. In this paper, an unusual case of unsuccessful suicidal craniocerebral penetrating injury committed with a pneumatic nail gun by a 23-year-old man is presented. The particular findings that suggest a suicidal attempt are also discussed.

  3. Day Center experience in rehabilitation of craniocerebral injured patients.

    PubMed

    Stern, J M; Groswasser, Z; Alis, R; Geva, N; Hochberg, J; Stern, B; Yardeni, Y

    1985-01-01

    The Day Center for head-injured patients specialises in treating patients at later stages following brain trauma. The goal of therapy is social reintegration as measured by the quality of family and social life and by actual occupational status. At this later stage, a year or more since injury, the cognitive and behavioral aspects of brain damage determine the outcome of rehabilitation. The therapy aims at preserving as well as improving patients' overall performance including family life and therefore their families are treated as well. As the patients are not hospitalised at this stage, the asset of this model is that it constitutes an arresting factor in preventing regressive attitudes acquired during hospitalisation which is a sheltered framework. The Day Center System encourages the patients to cope "in vivo" with reality, while the therapy given strives at providing them with the instruments needed for coping in actual life situations. We present here our experience in 38 patients admitted consecutively during the course of a year. The results show that the therapeutic milieu was of great help in preserving as well as improvement patients' performance; furthermore, it is evident that some improvement was achieved even after several years post trauma.

  4. Ear trauma.

    PubMed

    Eagles, Kylee; Fralich, Laura; Stevenson, J Herbert

    2013-04-01

    Understanding basic ear anatomy and function allows an examiner to quickly and accurately identify at-risk structures in patients with head and ear trauma. External ear trauma (ie, hematoma or laceration) should be promptly treated with appropriate injury-specific techniques. Tympanic membrane injuries have multiple mechanisms and can often be conservatively treated. Temporal bone fractures are a common cause of ear trauma and can be life threatening. Facial nerve injuries and hearing loss can occur in ear trauma.

  5. Characteristics of a rat model of an open craniocerebral injury at simulated high altitude

    PubMed Central

    Yu, An-Yong; Xu, Quan-Hong; Hu, Sheng-Li; Li, Fei; Chen, Yu-Jie; Yin, Yi; Zhu, Gang; Lin, Jiang-Kai

    2014-01-01

    To establish a rat model of an open craniocerebral injury at simulated high altitude and to examine the characteristics of this model. Rats were divided randomly into a normobaric group and a high-altitude group and their corresponding control groups. A rat model of an open craniocerebral injury was established with a nail gun shot. Simulated high-altitude conditions were established with a hypobaric chamber at 0.6 ATA to mimic pressure at an altitude of 4000 m. Mortality, brain water content (BWC), Evans blue content, pathology, regional cerebral blood flow (rCBF), partial pressure of brain tissue oxygen (PbtO2), and brainstem auditory-evoked potential were observed after injury. The mortality of the high-altitude group was significantly greater than that of the normobaric group within 72 h after injury (P<0.05). BWC and Evans blue content increased by 48 h after injury (P<0.05); pathological changes in damaged brains were more serious. In contrast, rCBF and PbtO2 had decreased markedly by 72 h (P<0.01); brainstem auditory-evoked potential values were significantly prolonged (P<0.05). Moreover, an inverse correlation between rCBF and BWC and a positive correlation between rCBF and PbtO2 were found. The rat model of an open craniocerebral injury at simulated high altitude can be established successfully using a nail gun shot and a hypobaric chamber. The injury characteristics at high altitude were more serious, rapid, and prolonged than those in the normobaric group. PMID:25191925

  6. Revisiting neuroimaging of abusive head trauma in infants and young children.

    PubMed

    Hsieh, Kevin Li-Chun; Zimmerman, Robert A; Kao, Hung Wen; Chen, Cheng-Yu

    2015-05-01

    The purpose of this article is to use a mechanism-based approach to review the neuroimaging findings of abusive head trauma to infants. Advanced neuroimaging provides insights into not only the underlying mechanisms of craniocerebral injuries but also the long-term prognosis of brain injury for children on whom these injuries have been inflicted. Knowledge of the traumatic mechanisms, the key neuroimaging findings, and the implications of functional imaging findings should help radiologists characterize the underlying causes of the injuries inflicted, thereby facilitating effective treatment.

  7. Systemic trauma.

    PubMed

    Goldsmith, Rachel E; Martin, Christina Gamache; Smith, Carly Parnitzke

    2014-01-01

    Substantial theoretical, empirical, and clinical work examines trauma as it relates to individual victims and perpetrators. As trauma professionals, it is necessary to acknowledge facets of institutions, cultures, and communities that contribute to trauma and subsequent outcomes. Systemic trauma-contextual features of environments and institutions that give rise to trauma, maintain it, and impact posttraumatic responses-provides a framework for considering the full range of traumatic phenomena. The current issue of the Journal of Trauma & Dissociation is composed of articles that incorporate systemic approaches to trauma. This perspective extends conceptualizations of trauma to consider the influence of environments such as schools and universities, churches and other religious institutions, the military, workplace settings, hospitals, jails, and prisons; agencies and systems such as police, foster care, immigration, federal assistance, disaster management, and the media; conflicts involving war, torture, terrorism, and refugees; dynamics of racism, sexism, discrimination, bullying, and homophobia; and issues pertaining to conceptualizations, measurement, methodology, teaching, and intervention. Although it may be challenging to expand psychological and psychiatric paradigms of trauma, a systemic trauma perspective is necessary on both scientific and ethical grounds. Furthermore, a systemic trauma perspective reflects current approaches in the fields of global health, nursing, social work, and human rights. Empirical investigations and intervention science informed by this paradigm have the potential to advance scientific inquiry, lower the incidence of a broader range of traumatic experiences, and help to alleviate personal and societal suffering.

  8. Craniocerebral gunshot wound in a baby chimpanzee--an uncommon experience of neurosurgical treatment conducted in the Guinean forest.

    PubMed

    Champeaux, C; Raballand, E

    2015-02-01

    An orphan female chimpanzee was wounded by a left craniocerebral gunshot complicated with a right hemiparesis. Local treatment and long-term antibiotherapy failed to lead to healing. A neurosurgical procedure was planned and achieved. She fully recovered, and 2 years after the procedure, there is no evidence of infection. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. [Posttraumatic disturbances in patients with light craniocerebral injury and their correction via various variants of dynamic magnetotherapy].

    PubMed

    Cherevashchenko, L A; Moliavchikova, O V; Zhuravlev, M E

    2008-01-01

    Examination of 90 patients in intermediate period of slight craniocerebral injury before and after use of curative technologies with including of dynamic magnetotherapy suboccipitally or transcranially. It is established, that choosing rehabilitation methods, it is necessary to take into consideration clinical manifestation of disease, state of cerebral blood circulation, vegetative nervous system, bioelectrogenesis of cerebrum.

  10. Early hyperbaric oxygen therapy inhibits aquaporin 4 and adrenocorticotropic hormone expression in the pituitary gland of rabbits with blast-induced craniocerebral injury★

    PubMed Central

    Huo, Jian; Liu, Jiachuan; Wang, Jinbiao; Zhang, Yongming; Wang, Chunlin; Yang, Yanyan; Sun, Wenjiang; Xu, Shaonian

    2012-01-01

    In the present study, rabbits were treated with hyperbaric oxygen for 1 hour after detonator-blast- induced craniocerebral injury. Immunohistochemistry showed significantly reduced aquaporin 4 expression and adrenocorticotropic hormone expression in the pituitary gland of rabbits with craniocerebral injury. Aquaporin 4 expression was positively correlated with adrenocorticotropic hormone expression. These findings indicate that early hyperbaric oxygen therapy may suppress adrenocorticotropic hormone secretion by inhibiting aquaporin 4 expression. PMID:25624795

  11. Childhood Trauma.

    ERIC Educational Resources Information Center

    Falasca, Tony; Caulfield, Thomas J.

    1999-01-01

    Describes some classic causes of trauma and symptoms that can result when a child has been traumatized. Lists several factors that effect the degree to which a child is affected by trauma. Categories a wide range of behaviors displayed by the victims into three groups: affect, memories, and behaviors. Discusses various considerations when…

  12. Childhood Trauma.

    ERIC Educational Resources Information Center

    Falasca, Tony; Caulfield, Thomas J.

    1999-01-01

    Describes some classic causes of trauma and symptoms that can result when a child has been traumatized. Lists several factors that effect the degree to which a child is affected by trauma. Categories a wide range of behaviors displayed by the victims into three groups: affect, memories, and behaviors. Discusses various considerations when…

  13. Men and Sexual Trauma

    MedlinePlus

    ... War Specific to Women Types of Trauma War Terrorism Violence and Abuse Disasters Is it PTSD? Treatment ... Overview Types of Trauma Trauma Basics Disaster and Terrorism Military Trauma Violence & other Trauma Assessment Assessment Overview ...

  14. Common Reactions After Trauma

    MedlinePlus

    ... War Specific to Women Types of Trauma War Terrorism Violence and Abuse Disasters Is it PTSD? Treatment ... Overview Types of Trauma Trauma Basics Disaster and Terrorism Military Trauma Violence & other Trauma Assessment Assessment Overview ...

  15. [Facial trauma and multiple trauma].

    PubMed

    Corre, Pierre; Arzul, Ludovic; Khonsari, Roman Hossein; Mercier, Jacques

    2013-09-01

    The human face contains the sense organs and is responsible for essential functions: swallowing, chewing, speech, breathing and communication. It is also and most importantly the seat of a person's identity. Multiple trauma adds a life-threatening dimension to the physical and psychological impact of a facial trauma.

  16. Preliminary study on controlled hypotension induced by nimodipine in craniocerebral surgery.

    PubMed

    Zhang, P; Wang, B; Wang, E; Chen, X

    1995-06-01

    Nimodipine, produced in China, was applied to lower the blood pressure (BP) in 20 cases in craniocerebral operation. 0.02% solution of Nimodipine was dripped intravenously (by 0.02% of density), at a preliminary speed of 600-800 micrograms/min, and 4-12 mg of total dose. Mean arterial pressure (MAP) decreased and maintained at 7.3-8.0 kPa, and lasted 30-60 minutes. The scopes of decreasing pressure were 33.0%-37.7% of MAP, 31.6%-35.6% of systolic pressure (SP), and 36.1%-41.9% of diastolic pressure (DP). The results of lowering pressure which reduced the intraoperative bleeding were significant. After withdrawal of drug supply for 15-30 minutes, the BP raised up to the normal level. No "rebounding BP rise" occurred.

  17. [The permeability of the hemato-encephalic barrier and the proteolytic potential of the cerebrospinal fluid in severe craniocerebral trauma].

    PubMed

    Churliaev, Iu A; Nikiforova, N V; Lutsik, A A; Kuksinskiĭ, V A; Lykova, O F; Martynenkov, V Ia; Karpenko, V S

    1999-01-01

    To study blood-brain barrier permeability and proteolytic changes in in patients with severe brain injury and to evaluate their impact on its course and outcome, the concentrations of albumin, plasminogen (plasmin), alpha 2-macroglobulin, alpha 2-antiplasmin, and alpha 1-antitrypsin were examined in 58 victims by enzyme immunoassay. The control group comprised 20 patients examined for lumbar discal hernia. The studies indicate that early severe brain injury showed blood-brain barrier dysfunction whose severity can be detected by the spinal fluid levels of albumin, plasminogen, and alpha 2-macroglobulin. Proteolytic changes in spinal fluid are determined by its albumin, plasminogen (plasmin), alpha 2-macroglobulin, alpha 2-antiplasmin, and alpha 1-antitrypsin concentrations and affect the development of secondary brain lesion and they are of practical value.

  18. [The content of the protein markers of hemato-encephalic barrier permeability in the cerebrospinal fluid in severe craniocerebral trauma].

    PubMed

    Kuksinskiĭ, V A; Lutsik, A A; Churliaev, Iu A; Lykova, O F; Nikiforova, N V; Martynenkov, V Ia; Bykov, K V

    1998-01-01

    The CSF levels of albumin, alpha 2-microglobulin and IgG were studied in patients with severe brain injury. Elevated CSF levels of albumin and alpha 2-microglobulin were found in more severe patients. The level of IgG level was within the normal range. Endogenic protease-bound alpha 2-microglobulin may cause secondary cerebral tissue lesion, by closing the vicious circle.

  19. Trauma Ultrasound.

    PubMed

    Wongwaisayawan, Sirote; Suwannanon, Ruedeekorn; Prachanukool, Thidathit; Sricharoen, Pungkava; Saksobhavivat, Nitima; Kaewlai, Rathachai

    2015-10-01

    Ultrasound plays a pivotal role in the evaluation of acute trauma patients through the use of multi-site scanning encompassing abdominal, cardiothoracic, vascular and skeletal scans. In a high-speed polytrauma setting, because exsanguinations are the primary cause of trauma morbidity and mortality, ultrasound is used for quick and accurate detection of hemorrhages in the pericardial, pleural, and peritoneal cavities during the primary Advanced Trauma Life Support (ATLS) survey. Volume status can be assessed non-invasively with ultrasound of the inferior vena cava (IVC), which is a useful tool in the initial phase and follow-up evaluations. Pneumothorax can also be quickly detected with ultrasound. During the secondary survey and in patients sustaining low-speed or localized trauma, ultrasound can be used to help detect abdominal organ injuries. This is particularly helpful in patients in whom hemoperitoneum is not identified on an initial scan because findings of organ injuries will expedite the next test, often computed tomography (CT). Moreover, ultrasound can assist in detection of fractures easily obscured on radiography, such as rib and sternal fractures.

  20. Craniocerebral injuries in war against terrorism --- a contemporary series from Pakistan.

    PubMed

    Bashir, Muhammad-Umair; Tahir, Muhammad-Zubair; Bari, Ehsan; Mumtaz, Sehreen

    2013-01-01

    Terrorism-related bomb attacks on civilian population have increased dramatically over the last decade. Craniocerebral injuries secondary to improvised explosive devices have not been widely reported in the context of unarmored civilians. This series intends to report the spectrum of these injuries secondary to suicidal and implanted bombs as encountered at the Aga Khan University Hospital, Pakistan (AKUH). Further, a few pertinent management guidelines have also been discussed. The hospital database and clinical coding during a 5-year period were examined for head injuries secondary to terrorism-associated blasts. In addition to patient demographics, data analysis for our series included initial Glasgow Coma Scale, presenting neurological complaints, associated non-neurological injuries, management (conservative or operative) to associated complications, and discharge neurological status. A total of 16 patients were included in this series. Among them 9 were victims of suicidal blasts while 7 were exposed to implanted devices. The patients presented with diverse patterns of injury secondary to a variety of shrapnel. A follow-up record was available for 12 of the 16 patients (mean follow-up: 7.8 months), with most patients having no active complaints. The results of this series show that civilian victims of suicidal and improvised bombings present with a wide range of neurological symptoms and injury patterns, which often differ from the neurological injuries incurred by military personnel in similar situations, and thereby often require individualized care.

  1. Chest trauma.

    PubMed

    Budassi, S A

    1978-09-01

    For any patient with obvious or suspected chest trauma, one must first assure an adequate airway and adequate ventilation. One should never hesitate to administer oxygen to a victim with a chest injury. The nurse should be concerned with adequate circulation--this may mean the administration of intravenous fluids, specifically volume expanders, via large-bore cannulae. Any obvious open chest wound should be sealed, and any fractures should be splinted. These patients should be rapidly transported to the nearest Emergency Department capable of handling this type of injury. The majority of patients who arrive in the Emergency Department following blunt or penetrating trauma should be considered to be in critical condition until proven otherwise. On presentation, it is essential to recognize those signs, symptoms, and laboratory values that identify the patient's condition as life-threatening. Simple recognition of these signs and symptoms and early appropriate intervention may alter an otherwise fatal outcome.

  2. Dentoalveolar trauma.

    PubMed

    Olynik, Christopher R; Gray, Austin; Sinada, Ghassan G

    2013-10-01

    Dentoalveolar injuries are an important and common component of craniomaxillofacial trauma. The dentition serves as a vertical buttress of the face and fractures to this area may result in malalignment of facial subunits. Furthermore, the dentition is succedaneous with 3 phases-primary dentition, mixed dentition, and permanent dentition-mandating different treatment protocols. This article is written for nondental providers to diagnose and treat dentoalveolar injuries. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. [Hyperbaric oxygen therapy at different pressure levels for aphasia following craniocerebral injury: efficacy, safety and patient adherence to therapy].

    PubMed

    Li, Qin

    2015-08-01

    To observe the clinical effect of hyperbaric oxygen (HBO) therapy at different pressure levels on aphasia after craniocerebral injury and assess the patient adherence to the therapies. Thirty-one patients with aphasia after craniocerebral injury receiving 30 sessions of HBO therapy at the pressure level of 0.175 MPa and another 31 patients receiving 0.2 MPa therapy were recruited as the treatment groups 1 and 2, respectively; 31 patients who refused to have HBO therapy served as the control group. All the patients received routine therapy. The therapeutic effects were assessed using Western Aphasia Battery (WAB) before and after the therapy. The WAB item and AQ scores, curative effect, and recovery time of aphasia were compared between the 3 groups. The total response rate was significantly lower in the control group as compared with those in treatment groups 1 and 2 (58.06% vs 83.87% and 87.1%). WAB item scores and AQ scores, curative effect, and recovery time of aphasia all showed significant differences between the control group and the two treatment groups (P<0.05), but not between the latter 2 groups (P>0.05). Compared with 0.20 MPa HBO therapy, 0.175 MPa HBO therapy showed a better patient adherence with a significantly lowered non-adherence rate (by 31.37%) an increased partial and total adherence rates (by 13.86% and 17.51%, respectively). HBO therapy at the pressure level of 0.175 MPa is more appropriate for treatment of aphasia after craniocerebral injury to ensure the safety, efficacy and patient compliance.

  4. [Clinico-genealogical and phenotypic characteristics of patients with late sequelae of closed cranio-cerebral injuries].

    PubMed

    Shogam, I I; Pesochina, E A

    1990-01-01

    As many as 100 patients with late sequelae of closed craniocerebral injuries (CCCI) and 50 healthy persons underwent a clinico-genealogical and phenotypic analysis. Multifactorial diseases (in particular essential hypertension and other cardiovascular diseases) which correlate with the clinical features of late sequelae of CCCI were noted to occur in the patients' pedigree significantly more often as compared to normal persons. The patients manifest a high frequency of the stigmas of dysembryogenesis. After CCCI part of them manifested certain hereditary diseases. Genetic risk factors should be taken into account in forecasting CCCI outcomes and planning follow up measures.

  5. Trace Element Concentrations in Human Tissues of Death Cases Associated With Secondary Infection and MOF After Severe Trauma.

    PubMed

    Xu, Guangtao; Su, Ruibing; Li, Bo; Lv, Junyao; Sun, Weiqi; Hu, Bo; Li, Xianxian; Gu, Jiang; Yu, Xiaojun

    2015-12-01

    Proper trace element level is crucial for the organs in maintaining normal physiological functions. Multiple organ failure (MOF) might be added to critically ill patients due to a lack of trace elements. Alterations of trace element levels in brain, heart, liver, and kidney after severe trauma, however, have been little studied so far. In this study, tissue samples of the frontal cortex of the brain, interventricular septum of the heart, right lobe of the liver, and upper pole of the kidney were obtained from forensic autopsies, of which 120 cases died during the 5th to 15th day of hospitalization, whereas the trauma death group and 43 cases immediately died due to severe craniocerebral trauma as the control group. Copper (Cu), iron (Fe), zinc (Zn), and selenium (Se) were quantified by inductively coupled plasma atomic emission spectrophotometry (ICP-AES). Cu, Fe, Zn, and Se concentrations in the brain, heart, liver, and kidney in the trauma group decreased dramatically (p<0.05) compared to the control group. The incidence of secondary infection and multiple organ failure (MOF) in the trauma death group were 78.33 and 29.17%, respectively. The concentrations of all elements exhibited a significant correlation with secondary infection and MOF (p<0.01). Our data suggest that low concentrations of Cu, Fe, Zn, and Se in pivotal organs may contribute to the incidence of secondary infection and MOF after severe trauma, which to some extent results in death.

  6. [Computerized tomography in craniocerebral, maxillofacial, cervical, and spinal gunshot wounds. Part II--Clinical contribution and medico- legal aspects].

    PubMed

    Scialpi, M; Boccuzzi, F; Romeo, F; Ax, G; Scapati, C; Rotondo, A; Angelelli, G

    1996-12-01

    To assess the diagnostic and medicolegal contribution of Computed Tomography (CT) in patients with craniocerebral, maxillofacial, neck and spine gunshot wounds, we submitted to CT 106 patients with gunshot wounds examined over a 7-year period (February, 1988 to December, 1994). Twenty-four of them had craniocerebral injuries (23%), 9 maxillofacial (8%), 8 neck (8%) and 10 vertebral (9%) injuries. Emergency CT demonstrated the mechanism of the injury, the bullet path and site, the site of bone and/or metallic fragments, and damage extent. In all perforating cranioencephalic injuries (n = 7) intracerebral or extrathecal bone fragments were demonstrated adjacent to the bullet entrance and exit holes, respectively. In injury monitoring. CT showed injury evolution, retained fragments and complications, thus enabling damage extent assessment. High Resolution Computed Tomography (HRCT) was useful in locating minute orbitary retrobulbar and intraspinal fragments. Magnetic Resonance (MR) Imaging in postoperative patients proved a valuable tool to assess the extent of spinal cord damage. To conclude, CT is a useful technique to examine the patients with gunshot wounds, which helps plan adequate treatment and solve complex medicolegal problems.

  7. Self-Harm and Trauma

    MedlinePlus

    ... War Specific to Women Types of Trauma War Terrorism Violence and Abuse Disasters Is it PTSD? Treatment ... Overview Types of Trauma Trauma Basics Disaster and Terrorism Military Trauma Violence & other Trauma Assessment Assessment Overview ...

  8. [Clinical efficacy observation of acupuncture at suliao (GV 25) on improving regain of consciousness from coma in severe craniocerebral injury].

    PubMed

    Xu, Kai-Sheng; Song, Jian-Hua; Huang, Tiao-Hua; Huang, Zhi-Hua; Yu, Lu-Chang; Zheng, Wei-Ping; Chen, Xiao-Shan; Liu, Chuan

    2014-06-01

    To compare the clinical therapeutic effects differences between acupuncture at Suliao (GV 25) and Shuigou (GV 26) on promoting regain of consciousness from coma in severe craniocerebral injury. Based on regular emergency treatments of neurosurgery, eighty-two cases of craniocerebral injury who were under stable condition were randomly divided into an observation group (42 cases) and a control group (40 cases). Suliao (GV 25) was selected as main aupoint, while Laogong (PC 8) and Yongquan (KI 1), etc. were selected as adjuvant acupoints and Neiguan (PC 6), Sanyinjiao (SP 6), Yifeng (TE 17) and Wangu (GB 12), etc. were selected as matching acupoints in the observation group where a strong needle manipulation was applied to improve the regain of consciousness. The main acupoint of Shuigou (GV 26) along with identical adjuvant acupoints and matching acupoints in the observation group were selected in the control group with identical strong needle manipulation. The treatment was given once a day in both groups, five times per week and ten times were considered as one session. The immediate clinical symptoms after acupuncture at Suliao (GV 25) and Shuigou (GV 26) were observed as well as Glasgow coma scale (GCS) before the treatment, after 45 days and 90 days of treatment to assess the resuscitation time and rate. Also the clinical efficacy was compared between both groups. The occurrence rate of sneezing reflex was 85.7% (36/42) in the observation group, which was higher than 25.0% (10/40) in the control group (P < 0.01). The average resuscitation time was (64.6 +/- 19.4) days in the observation group, which was obviously shorter than (73.8 +/- 14. 6) days in the control group (P < 0.05). The resuscitation rate was 88.1% (37/42) in the observation group, which was similar to 75.0% (30/40) in the control group (P > 0.05). Compared before the treatment, GCS were both improved after the treatment in two groups (both P < 0.01). The 90-day GCS was 9.52 +/- 2.32 in the

  9. Management of open fractures of the tibial shaft in multiple trauma

    PubMed Central

    Stanisław, Bołtuć Witold; Bogusław, Golec Edward

    2008-01-01

    Background: The work presents the assessment of the results of treatment of open tibial shaft fractures in polytrauma patients. Materials and Methods: The study group comprised 28 patients who underwent surgical treatment of open fractures of the tibial shaft with locked intramedullary nailing. The mean age of the patients was 43 years (range from 19 to 64 years). The criterion for including the patients in the study was concomitant multiple trauma. For the assessment of open tibial fractures, Gustilo classification was used. The most common concomitant multiple trauma included craniocerebral injuries, which were diagnosed in 12 patients. In 14 patients, the surgery was performed within 24 h after the injury. In 14 patients, the surgery was delayed and was performed 8–10 days after the trauma. Results: The assessment of the results at 12 months after the surgery included the following features: time span between the trauma and the surgery and complications in the form of osteomyelitis and delayed union. The efficacy of gait, muscular atrophy, edema of the operated limb and possible disturbances of its axis were also taken under consideration. In patients operated emergently within 24 h after the injury, infected nonunion was observed in three (10.8%) males. These patients had grade III open fractures of the tibial shaft according to Gustilo classification. No infectious complications were observed in patients who underwent a delayed operation. Conclusion: Evaluation of patients with open fractures of the tibial shaft in multiple trauma showed that delayed intramedullary nailing performed 8–10 days after the trauma, resulted in good outcome and avoided development of delayed union and infected nonunion. This approach gives time for stabilization of general condition of the patient and identification of pathogens from wound culture. PMID:19753226

  10. Management of War-Related Ballistic Craniocerebral Injuries in a French Role 3 Hospital During the Afghan Campaign.

    PubMed

    Dagain, Arnaud; Aoun, Olivier; Bordes, Julien; Roqueplo, Cédric; Joubert, Christophe; Esnault, Pierre; Sellier, Aurore; Delmas, Jean-Marc; Desse, Nicolas; Fouet, Mathilde; Pernot, Philippe; Dulou, Renaud

    2017-06-01

    France deployed to Afghanistan from 2001 to 2014 within the International Security and Assistance Force. A French role 3 hospital was built in 2009 in the vicinity of Kabul International Airport (KaIA). The objectives of this study were to describe the epidemiology, management, and outcome of war-related craniocerebral injuries during the Afghan campaign in a French role 3 hospital. From March 1, 2010 to September 30, 2012, we conducted a retrospective descriptive study in Kabul, Afghanistan. All patients presenting with a ballistic craniocerebral injury to the KaIA role 3 hospital were included. We analyzed 48 records. Mean age was 21.9 years (1-46 years) with a 37:11 (male:female) sex ratio and a majority Afghan population (n = 41). Civilians represented 64.6% (n = 31) of casualties. On the battlefield, mean Glasgow Coma Scale score was 9.4 [3-15]. On arrival at the KaIA field hospital, 20 of the 48 patients were hemodynamically unstable. All patients underwent a full-body computed tomography scan. The majority of our casualties had associated injuries. Neurosurgery was indicated for 42 (87.5%) patients. The surgery consisted of wound debridement plane by plane associated with decompressive craniectomy (n = 11), debridement craniectomy (n = 19), and craniotomy (n = 12). A total of 32.4% wounded died at the point of injury, 8.4% at the emergency department, and 16.9% after surgery. War casualties with ballistic head injuries were predominantly multitraumatized patients with hemodynamic compromise requiring neurosurgical damage control management and multidisciplinary care. The neurosurgeon has thus an essential role to play. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Ocular trauma in otolaryngology.

    PubMed

    Govett, G S; Amedee, R G

    1992-05-01

    Otolaryngologists are commonly called upon to emergently evaluate blunt trauma to the facial skeleton. These injuries are occasionally associated with serious trauma to the orbital contents. This manuscript reviews these orbital injuries by considering the pertinent eye anatomy and the extensive examination usually performed by an ophthalmologist. Anterior and posterior segment injuries along with specific trauma to the optic nerve will also be discussed.

  12. Trauma Facts for Educators

    ERIC Educational Resources Information Center

    National Child Traumatic Stress Network, 2008

    2008-01-01

    This paper offers facts which can help educators deal with children undergoing trauma. These include: (1) One out of every 4 children attending school has been exposed to a traumatic event that can affect learning and/or behavior; (2) Trauma can impact school performance; (3) Trauma can impair learning; (4) Traumatized children may experience…

  13. Helping Youth Overcome Trauma

    ERIC Educational Resources Information Center

    Chambers, Jamie C.

    2005-01-01

    The effects of trauma can roll on unchecked like a spirit of death. In its path are strewn its once vibrant victims. Human bonds are rent asunder by the disgrace of trauma. These are the youngsters who have been verbally bashed, physically battered, sexually assaulted, and spiritually exploited. Other traumas of childhood neglect include: (1)…

  14. Trauma system development.

    PubMed

    Lendrum, R A; Lockey, D J

    2013-01-01

    The word 'trauma' describes the disease entity resulting from physical injury. Trauma is one of the leading causes of death worldwide and deaths due to injury look set to increase. As early as the 1970s, it became evident that centralisation of resources and expertise could reduce the mortality rate from serious injury and that organisation of trauma care delivery into formal systems could improve outcome further. Internationally, trauma systems have evolved in various forms, with widespread reports of mortality and functional outcome benefits when major trauma management is delivered in this way. The management of major trauma in England is currently undergoing significant change. The London Trauma System began operating in April 2010 and others throughout England became operational this year. Similar systems exist internationally and continue to be developed. Anaesthetists have been and continue to be involved with all levels of trauma care delivery, from the provision of pre-hospital trauma and retrieval teams, through to chronic pain management and rehabilitation of patients back into society. This review examines the international development of major trauma care delivery and the components of a modern trauma system.

  15. Trauma in pregnancy.

    PubMed

    Mattox, Kenneth L; Goetzl, Laura

    2005-10-01

    The objective of this article was to review the existing standards of practice regarding trauma which occurs during pregnancy. The design of this study was to review the available data from the surgical and obstetrical literature regarding trauma during pregnancy. The design was also to incorporate the contemporary recommendations from the trauma resuscitation courses relating to trauma during pregnancy. Trauma occurs in 5% of pregnancies. A fetus is not considered to be viable until week 25. Motor vehicle accidents account for more than 50% of all trauma during pregnancy, with 82% of fetal deaths occurring during these automobile accidents. With life threatening trauma a 50% fetal loss rate exists. As anatomy, physiology, and even laboratory findings change during pregnancy, the clinician must consider both patients, the mother and fetus. Following blunt trauma abruption of the placenta is the more common cause of fetus loss. Anterior abdominal penetrating trauma almost never fails to injury the uterus and fetus in the last half of pregnancy. Preventive strategies exist in the areas of social violence, automobile restraints and use of alcohol and drugs by the mother. Perimortem caesarian section is rarely successful. Trauma during pregnancy is uncommon, but with increasing trauma severity leads to increased fetal loss. Preventive strategies exist and when admitted monitoring standards should be followed.

  16. Citation classics in trauma.

    PubMed

    Ollerton, Joanne Emma; Sugrue, Michael

    2005-02-01

    The evolution of trauma may be analyzed by review of articles most frequently cited by scientific articles worldwide. This study identified the "trauma classics" by reviewing the most-cited articles ever published in The Journal of Trauma. The Science Citation Index of the Institute for Scientific Information was searched for the 50 most-cited articles in The Journal of Trauma. Of the 12,672 articles published since 1961, 80 were cited over 100 times and 17 over 200 times. The most-cited article was by Baker, a hallmark publication on injury scoring published in 1974. Feeding postinjury, bacterial translocation, and multiple organ failure were common themes. Overall, 32% involved gastrointestinal topics and 18% involved injury scoring, with institutions in the United States publishing 80% of the articles. This study identified the trauma classics from the last 42 years of The Journal of Trauma. Citation analysis has recognized limitations but gives a fascinating insight into the evolution of trauma care.

  17. Improve performance in trauma care.

    PubMed

    Spath, P

    2001-05-01

    Many states have adopted trauma program legislation that includes a statewide trauma registry and performance evaluation activities. Hospitals participating in the trauma network are required to support the statewide activities through submission of data about the trauma patients they treat. By analyzing the quality of care provided to trauma patients, the trauma team members work to improve their services. Consulting editor Patrice Spath, RHIT, provides in-depth advice on how to measure and improve performance in trauma care.

  18. [The risk of an organic lesion in mild craniocerebral injuries with loss of consciousness].

    PubMed

    Rodríguez Cerrillo, M; Borreguero Martínez, E; Jiménez de Diego, L

    1999-10-01

    Despite its high frequency, there is not a consensus for the management of a patient with mild head trauma. In this prospective study we analyzed wether the transient loss of consciousness was associated with a higher risk of cranioencephalic injury in function of patient's age. Fifty-two patients with a Glasgow score of 15 at the Emergency Department but who reported a transient loss of consciousness were included. Patients were divided into two groups, patients aged > or = 60 years (n = 21) and patients aged < 60 years (n = 31). In all patients a head CT scan was performed. Nine abnormal CT scans were found in the group of patients aged > or = 60 years (three head fractures, three brain contusion, two subarachnoid haemorrhages, and one subdural haematoma) and one abnormal CT scan in the group of patients aged < 60 years (cranial fracture). This difference was statistically significant (p < 0.001). In conclusion, an urgent head CT scan should be performed in patients aged over 60 years with mild head trauma and loss of consciousness. In younger patients this scan should be performed when the patient presents with headache and vomiting.

  19. The imaging diagnosis and prognosis assessment of patients with midbrain injury in the acute phase of craniocerebral injury.

    PubMed

    Yu, Ming-kun; Ye, Wei

    2012-01-01

    We prospectively studied the difference between head CT and MRI in the detection of midbrain injury at the acute stage, the characteristics of MRS in the midbrain, and its relationship to the prognosis. The aim of this study is to propose the imaging diagnosis and outcome assessment indicators for midbrain injury.According to the clinical diagnosis standard, 22 patients with midbrain injury were chosen as a midbrain injury group,and 20 cases with craniocerebral injury without brain stem injury as the control group,10 normal adult volunteers as the normal control group. CT was performed on days 1, 3, 5, and 7 respectively,and MRI and MRS within 7 days post-injury. All patients were followed up for 6 months post-injury.The positive diagnosis rate of 63.64% in MRI for midbrain injury was significantly higher than that of 13.63% found in CT. MRI showed that the location of the midbrain injury was closely associated with prognosis. The reduction of NAA/Cr or NAA/Cho ratio was more obvious and the prognosis of the patients poorer. Midbrain injury can be diagnosed more clearly and its severity or prognosis could also be evaluated by MRI and MRS.

  20. About Military Sexual Trauma

    MedlinePlus Videos and Cool Tools

    ... out why Close About Military Sexual Trauma Veterans Health Administration Loading... Unsubscribe from Veterans Health Administration? Cancel Unsubscribe Working... Subscribe Subscribed Unsubscribe 15K ...

  1. Trauma Education and Prevention.

    PubMed

    Sidwell, Richard; Matar, Maher M; Sakran, Joseph V

    2017-10-01

    Trauma education and injury prevention are essential components of a robust trauma program. Educational programs address specific knowledge gaps and provide focused and structured learning. Advanced Trauma Life Support is the most well-known. Each offering seems to be valid, although it has been difficult to prove improved patient care outcomes owing specifically to any of them. Injury prevention offers the best opportunity to limit death and disability owing to trauma. Injury prevention initiatives have paid tremendous dividends in reducing the mortality rates for motor vehicle crashes. Modern injury prevention efforts focus on reducing distracted driver rates and increasing helmet use. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. SURGICAL TREATMENT OF UPPER AND MIDDLE FACIAL ZONE TRAUMAS IN PROGRESS OF CONCOMITANT TRAUMATIC CRANIOFACIAL INJURIES.

    PubMed

    Lagvilava, G; Gvenetadze, Z; Toradze, G; Devidze, I; Gvenetadze, G

    2015-09-01

    In 2012-2015, 207 patients with concomitant craniofacial injuries, who underwent surgical treatment, were observed; among them 176 were men and 31- women. Age of the patients ranged from 16 to 60 years. According to localization and severity of trauma and a priority of surgical intervention, the patients conventionally were divided into 3 groups by the authors: I group (65 patients) - craniofacial injuries; the skull as well as upper and middle areas of face (subcranial and frontobasal fractures) were affected (fractured). II group (80 patients) - severe traumatic injuries of upper and especially middle zones of the face, accompanied with closed craniocerebral trauma, no need in neurosurgery. III group (62 patients) -on the background of serious head traumas, the injuries of face bones were less severe (injury of one or two anatomic areas with displacement of fractured fragments but without bone tissue defects) According to the obtained results a priority was always given to the neurosurgery (vital testimony).The reconstructive surgeries on face skeleton was conducted in combination involving neurosurgeons (I group patients). Reconstructive surgeries of facial bones were conducted in the patients of II group, immediately or at primary deferred period of time but in the patients of III group the surgical procedures for removal of early secondary or traumatic residual fractures have been performed. Reposition of the fractured facial bone fragments was performed in an open way and fixation was carried out by titanium plates and mesh cage (at bone tissue defect). For prevention and elimination of post-traumatic inflammatory processes, the final stage of surgical intervention was: sanation of nasal accessory sinuses and catheterization (5-7 days) of external carotid arteries for administration of antibiotics and other medical preparations. Early and differentiated approach to face injuries, worsening in the course of craniocephalic trauma was not revealed in any patient

  3. Children and Facial Trauma

    MedlinePlus

    ... up after Facial trauma: A prospective study. Otolaryngol Head Neck Surg 1997: 117:72-75 Kim MK, Buchman ... trauma in children: An urban hospital’s experience. Otolaryngoly–Head Neck Surgery 2000: 123: 439-43 Patient Health Home ...

  4. Thromboprophylaxis for trauma patients

    PubMed Central

    Lozano, Luis Manuel Barrera; Perel, Pablo; Ker, Katharine; Cirocchi, Roberto; Farinella, Eriberto; Morales, Carlos Hernando

    2014-01-01

    This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of thromboprophylaxis in trauma patients on mortality and incidence of DVT and PE. To compare the effects of different thromboprophylaxis interventions and their relative effects according to the type of trauma. PMID:25267908

  5. Treating childhood trauma.

    PubMed

    Terr, Lenore C

    2013-01-01

    This review begins with the question "What is childhood trauma?" Diagnosis is discussed next, and then the article focuses on treatment, using 3 basic principles-abreaction, context, and correction. Treatment modalities and complications are discussed, with case vignettes presented throughout to illustrate. Suggestions are provided for the psychiatrist to manage countertransference as trauma therapy proceeds.

  6. Advances in forefoot trauma.

    PubMed

    Clements, J Randolph; Schopf, Robert

    2013-07-01

    Forefoot traumas, particularly involving the metatarsals, are commonly occurring injuries. There have been several advances in management of these injuries. These advances include updates in operative technique, internal fixation options, plating constructs, and external fixation. In addition, the advances of soft tissue management have improved outcomes. This article outlines these injuries and provides an update on techniques, principles, and understanding of managing forefoot trauma.

  7. Ultrasound in trauma.

    PubMed

    Rippey, James C R; Royse, Alistair G

    2009-09-01

    Point-of-care ultrasound is well suited for use in the emergency setting for assessment of the trauma patient. Currently, portable ultrasound machines with high-resolution imaging capability allow trauma patients to be imaged in the pre-hospital setting, emergency departments and operating theatres. In major trauma, ultrasound is used to diagnose life-threatening conditions and to prioritise and guide appropriate interventions. Assessment of the basic haemodynamic state is a very important part of ultrasound use in trauma, but is discussed in more detail elsewhere. Focussed assessment with sonography for Trauma (FAST) rapidly assesses for haemoperitoneum and haemopericardium, and the Extended FAST examination (EFAST) explores for haemothorax, pneumothorax and intravascular filling status. In regional trauma, ultrasound can be used to detect fractures, many vascular injuries, musculoskeletal injuries, testicular injuries and can assess foetal viability in pregnant trauma patients. Ultrasound can also be used at the bedside to guide procedures in trauma, including nerve blocks and vascular access. Importantly, these examinations are being performed by the treating physician in real time, allowing for immediate changes to management of the patient. Controversy remains in determining the best training to ensure competence in this user-dependent imaging modality.

  8. Trauma-induced coagulopathy.

    PubMed

    Katrancha, Elizabeth D; Gonzalez, Luis S

    2014-08-01

    Coagulopathy is the inability of blood to coagulate normally; in trauma patients, it is a multifactorial and complex process. Seriously injured trauma patients experience coagulopathies during the acute injury phase. Risk factors for trauma-induced coagulopathy include hypothermia, metabolic acidosis, hypoperfusion, hemodilution, and fluid replacement. In addition to the coagulopathy induced by trauma, many patients may also be taking medications that interfere with hemostasis. Therefore, medication-induced coagulopathy also is a concern. Traditional laboratory-based methods of assessing coagulation are being supported or even replaced by point-of-care tests. The evidence-based management of trauma-induced coagulopathy should address hypothermia, fluid resuscitation, blood components administration, and, if needed, medications to reverse identified coagulation disorders. ©2014 American Association of Critical-Care Nurses.

  9. Trauma: the seductive hypothesis.

    PubMed

    Reisner, Steven

    2003-01-01

    In much of contemporary culture, "trauma" signifies not so much terrible experience as a particular context for understanding and responding to a terrible experience. In therapy, in the media, and in international interventions, the traumatized are seen not simply as people who suffer and so are deserving of concern and aid; they are seen also as people who suffer for us, who are given special dispensation. They are treated with awe if they tell a certain kind of trauma story, and are ignored or vilified if they tell another. Trauma has become not simply a story of pain and its treatment, but a host of sub-stories involving the commodification of altruism, the justification of violence and revenge, the entry point into "true experience," and the place where voyeurism and witnessing intersect. Trauma is today the stuff not only of suffering but of fantasy. Historically, trauma theory and treatment have shown a tension, exemplified in the writings of Freud and Janet, between those who view trauma as formative and those who view it as exceptional. The latter view, that trauma confers exceptional status deserving of special privilege, has gained ground in recent years and has helped to shape the way charitable dollars are distributed, how the traumatized are presented in the media, how governments justify and carry out international responses to trauma, and how therapists attend to their traumatized patients. This response to trauma reflects an underlying, unarticulated belief system derived from narcissism; indeed, trauma has increasingly become the venue, in society and in treatment, where narcissism is permitted to prevail.

  10. Pattern of ocular trauma.

    PubMed

    Hossain, M M; Mohiuddin, A A; Akhanda, A H; Hossain, M I; Islam, M F; Akonjee, A R; Ali, M

    2011-07-01

    This prospective observational study was conducted in the department of Ophthalmology Mymensingh Medical College Hospital during the period of November, 2009 to October, 2010. Two hundred & fifty (250) patients of both sexes and all ages with ocular trauma were selected randomly for this study. A detailed history of patients, duration of trauma, relation of trauma with work, visual status prior to injury, any surgery prior to injury & patients were alcoholic or not were taken. Male patients were 190(76%) and female patients were 60(24%). Majority of patients were 11-20 years group (39.2%). Most of patients (40%) attended into hospital within 60 hours of ocular trauma. Accidental occupational trauma were more common (51.2%) and assault injury were less common (12.8%). Greater number of ocular trauma was caused by sharp objects (59.2%) and less number of ocular trauma was caused by chemical injuries (2.4%). Open globe injuries were more common (62%) than closed globe injury (38%). Visual acuity on admission between 6/60 to PL comprises highest number (64%) and also on discharge between 6/60 to PL comprises highest number of cases (50%). Most of the patients came from poor socioeconomic group (60%).

  11. Nuances in pediatric trauma.

    PubMed

    Kenefake, Mary Ella; Swarm, Matthew; Walthall, Jennifer

    2013-08-01

    Pediatric trauma evaluation mimics adult stabilization in that it is best accomplished with a focused and systematic approach. Attention to developmental differences, anatomic and physiologic nuances, and patterns of injury equip emergency physicians to stabilize and manage pediatric injury.

  12. Trauma program development.

    PubMed

    Althausen, Peter L

    2014-07-01

    The development of a strong trauma program is clearly one of the most important facets of successful business development. Several recent publications have demonstrated that well run trauma services can generate significant profits for both the hospital and the surgeons involved. There are many aspects to this task that require constant attention and insight. Top notch patient care, efficiency, and cost-effective resource utilization are all important components that must be addressed while providing adequate physician compensation within the bounds of hospital financial constraints and the encompassing legal issues. Each situation is different but many of the components are universal. This chapter addresses all aspects of trauma program development to provide the graduating fellow with the tools to create a new trauma program or improve an existing program in order to provide the best patient care while optimizing financial reward and improving care efficiency.

  13. Acquired Cerebral Trauma: Epilogue.

    ERIC Educational Resources Information Center

    Bigler, Erin D., Ed.

    1988-01-01

    The article summarizes a series of articles concerning acquired cerebral trauma. Reviewed are technological advances, treatment, assessment, potential innovative therapies, long-term outcome, family impact of chronic brain injury, and prevention. (DB)

  14. [Pediatric multiple trauma].

    PubMed

    Auner, B; Marzi, I

    2014-05-01

    Multiple trauma in children is rare so that even large trauma centers will only treat a small number of cases. Nevertheless, accidents are the most common cause of death in childhood whereby the causes are mostly traffic accidents and falls. Head trauma is the most common form of injury and the degree of severity is mostly decisive for the prognosis. Knowledge on possible causes of injury and injury patterns as well as consideration of anatomical and physiological characteristics are of great importance for treatment. The differences compared to adults are greater the younger the child is. Decompression and stopping bleeding are the main priorities before surgical fracture stabilization. The treatment of a severely injured child should be carried out by an interdisciplinary team in an approved trauma center with expertise in pediatrics. An inadequate primary assessment involves a high risk of early mortality. On the other hand children have a better prognosis than adults with comparable injuries.

  15. Trauma-Informed Schools.

    PubMed

    Wiest-Stevenson, Courtney; Lee, Cindy

    2016-01-01

    Violence has impacted every aspect of daily life. These tragedies have shocked the world. This has resulted in school communities being fractured. Additionally, The National Survey of Children Exposed to Violence found that 60% of the children surveyed have been exposed to some form of trauma, either in or out of school. Traumatology research has shown most people respond to a wide range of traumatic events in similar ways. The common responses include traumatic responses, posttraumatic stress responses, and posttraumatic stress disorder (PTSD). In this article the authors outline the impact of trauma on children within school systems; discuss the mental health services schools are providing; present a trauma-informed school model; identifies tools which can be utilized in schools; and provide resources needed for a trauma-informed school, along with additional tools and resources. The authors discuss future recommendations for the community and schools as traumatic events continue to grow and impact a large number of children.

  16. Linear abdominal trauma.

    PubMed

    Danto, L A; Wolfman, E F

    1976-03-01

    Three cases of blunt abdominal trauma are presented to exemplify the mechanism of trauma and the problems of diagnosis associated with any linear blow to the abdomen. The mechanisms of visceral injury are reviewed, and special attention is directed to the abdominal wall injury that can be present in these patients. This injury has special implications in directing the operative approach and repair. An unusual aortic occlusion is described which is peculiar to this type of injury.

  17. [Sports and genitourinary traumas].

    PubMed

    Sacco, E; Marangi, F; Pinto, F; D'Addessi, A; Racioppi, M; Gulino, G; Volpe, A; Gardi, M; Bassi, P F

    2010-01-01

    Statistical data referring to sports-related traumas of the urinary tract are quite scarce; nevertheless, it is possible to draw general data on the relationship between sports and urological traumas. Literature review of peer-reviewed articles published by May 2009. Urological traumas account for about 10% of all traumas, and about 13% of them is sports-related. Genitourinary traumas are among the most common cause of abdominal injuries in sports. Blunt injuries are more common than penetrating ones and renal injuries are by far the most common, followed by testicular injuries; ureters, bladder and penis injuries are much more infrequent. Considering chronic microtraumas, injuries of bulbar urethra are also common in sports that involve riding. Overall, the incidence of genitourinary trauma due to sports is low. Renal traumas in sports injuries usually consist of grade I-II lesions and usually do not require surgical treatment. Cycling is the sporting activity most commonly associated with genitourinary injuries, followed by winter sports, horse riding and contact/collision sports. Literature data suggest that significant injuries are rare also in athletes with only one testicle or kidney. General preventive measures against sport-related injuries, along with the use of protective cups for male external genitalia, are generally sufficient to reduce the incidence of urogenital trauma. Overall, studies show that urogenital injuries are uncommon in team and individual sports, and that most of them are low-grade injuries. Participation in sports that involve the potential for contact or collision needs to be carefully assessed in the athletes with only one testicle or kidney, even though urogenital injuries should not preclude sports participation to an appropriately informed and counseled patient. Further research is needed to acquire more knowledge on genitourinary injuries according to age, sports type and technical skill.

  18. Quality of trauma care and trauma registries.

    PubMed

    Pino Sánchez, F I; Ballesteros Sanz, M A; Cordero Lorenzana, L; Guerrero López, F

    2015-03-01

    Traumatic disease is a major public health concern. Monitoring the quality of services provided is essential for the maintenance and improvement thereof. Assessing and monitoring the quality of care in trauma patient through quality indicators would allow identifying opportunities for improvement whose implementation would improve outcomes in hospital mortality, functional outcomes and quality of life of survivors. Many quality indicators have been used in this condition, although very few ones have a solid level of scientific evidence to recommend their routine use. The information contained in the trauma registries, spread around the world in recent decades, is essential to know the current health care reality, identify opportunities for improvement and contribute to the clinical and epidemiological research. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  19. Hypothermia in trauma.

    PubMed

    Moffatt, Samuel Edwin

    2013-12-01

    Hypovolaemic shock that results through traumatically inflicted haemorrhage can have disastrous consequences for the victim. Initially the body can compensate for lost circulating volume, but as haemorrhage continues compensatory mechanisms fail and the patient's condition worsens significantly. Hypovolaemia results in the lethal triad, a combination of hypothermia, acidosis and coagulopathy, three factors that are interlinked and serve to worsen each other. The lethal triad is a form of vicious cycle, which unless broken will result in death. This report will focus on the role of hypothermia (a third of the lethal triad) in trauma, examining literature to assess how prehospital temperature control can impact on the trauma patient. Spontaneous hypothermia following trauma has severely deleterious consequences for the trauma victim; however, both active warming of patients and clinically induced hypothermia can produce particularly positive results and improve patient outcome. Possible coagulopathic side effects of clinically induced hypothermia may be corrected with topical haemostatic agents, with the benefits of an extended golden hour given by clinically induced hypothermia far outweighing these risks. Active warming of patients, to prevent spontaneous trauma induced hypothermia, is currently the only viable method currently available to improve patient outcome. This method is easy to implement requiring simple protocols and contributes significantly to interrupting the lethal triad. However, the future of trauma care appears to lie with clinically induced therapeutic hypothermia. This new treatment provides optimism that in the future the number of deaths resulting from catastrophic haemorrhaging may be significantly lessened.

  20. Noninvasive ventilation in trauma

    PubMed Central

    Karcz, Marcin K; Papadakos, Peter J

    2015-01-01

    Trauma patients are a diverse population with heterogeneous needs for ventilatory support. This requirement depends mainly on the severity of their ventilatory dysfunction, degree of deterioration in gaseous exchange, any associated injuries, and the individual feasibility of potentially using a noninvasive ventilation approach. Noninvasive ventilation may reduce the need to intubate patients with trauma-related hypoxemia. It is well-known that these patients are at increased risk to develop hypoxemic respiratory failure which may or may not be associated with hypercapnia. Hypoxemia in these patients is due to ventilation perfusion mismatching and right to left shunt because of lung contusion, atelectasis, an inability to clear secretions as well as pneumothorax and/or hemothorax, all of which are common in trauma patients. Noninvasive ventilation has been tried in these patients in order to avoid the complications related to endotracheal intubation, mainly ventilator-associated pneumonia. The potential usefulness of noninvasive ventilation in the ventilatory management of trauma patients, though reported in various studies, has not been sufficiently investigated on a large scale. According to the British Thoracic Society guidelines, the indications and efficacy of noninvasive ventilation treatment in respiratory distress induced by trauma have thus far been inconsistent and merely received a low grade recommendation. In this review paper, we analyse and compare the results of various studies in which noninvasive ventilation was applied and discuss the role and efficacy of this ventilator modality in trauma. PMID:25685722

  1. Toxicological screening in trauma

    PubMed Central

    Carrigan, T; Field, H; Illingworth, R; Gaffney, P; Hamer, D

    2000-01-01

    Objectives—To determine the prevalence and patterns of alcohol and drug use in patients with major trauma. Methods—Consecutive trauma patient enrolment, 24 hours a day, was envisaged with anonymised patient data on gender, age band, and mechanism of injury collected. The study group had surplus plasma quantitatively analysed for ethanol concentration, and urine samples were initially screened, via immunoassay, for opiates, cannabinoids, amphetamines, benzodiazepines, cocaine, and methadone. Confirmation and specification of individual positive results was then performed using thin layer or gas-liquid chromatography. Drugs of treatment given in the resuscitation room, if subsequently detected in the urine samples, were excluded from the final results. Results—There were 116 eligible trauma patients assessed and treated in the resuscitation room over a six month period, of which 93 (80%) were enrolled. Altogether 27% of this trauma population had plasma ethanol concentrations greater than 80 mg/dl. There was a significantly higher prevalence of alcohol intoxication in the group not involved in a road traffic accident (RTA) compared with the group who were involved in a RTA. Initial screening of urine for drugs revealed a prevalence of 51%. After 12 exclusions due to iatrogenic administration of opiates, the final confirmed prevalence was 35% in this trauma population. The individual drug prevalence was 13% for cannabinoids, 11% for codeine, 8% for morphine, 6% for amphetamine, 6% for benzodiazepines, 3% for cocaine, 1% for dihydrocodeine, and 1% for methadone. Conclusions—There is a notable prevalence of drug and alcohol use in this British accident and emergency trauma population. A significantly higher prevalence for alcohol intoxication was found in the non-RTA group compared with the RTA group. The patterns of drug usage detected reflect local influences and less cocaine use is seen compared with American studies. The association between alcohol, drugs

  2. Trauma in pregnancy.

    PubMed

    Brown, Haywood L

    2009-07-01

    Acute traumatic injury during pregnancy is a significant contributor to maternal and fetal morbidity and mortality in the United States. Motor vehicle accidents are the leading cause of injury-related maternal death, followed by violence and assault. Lack of seat belts or other restraints increases the risks of both maternal and fetal morbidity and mortality. The American College of Obstetricians and Gynecologists recommends proper seat belt use by all pregnant women and screening for domestic abuse. Maternal injury and death from physical abuse is prevalent, and in some communities, homicide is a major cause of pregnancy-associated maternal death. Blunt trauma most often occurs as a result of motor vehicle accidents, whereas penetrating trauma results from gunshots or stabbings. Blunt trauma to the abdomen increases the risk for placental abruption, and direct fetal injury is more likely with penetrating trauma. Management strategies in acute maternal trauma must focus on a thorough assessment of the mother. A coordinated team effort that includes the obstetrician is essential to ensure optimal maternal and fetal outcomes. Imaging studies should not be delayed because of concerns of fetal radiation exposure, because the risk is minimal with usual imaging procedures, especially in mid-to-late pregnancy. The obstetrician should serve in a consultative role if nonobstetric surgical care is required and must also be prepared to intervene on behalf of the mother and the fetus if trauma care is compromised by the pregnancy. Perimortem cesarean delivery should be considered early in the resuscitation of a pregnant trauma victim, especially when fetal viability is a concern. Once the mother is stabilized in the emergency setting, she should be transported for appropriate maternal and fetal observation until both mother and fetus are clear of danger. It is essential that the clinician and staff maintain thorough and accurate documentation and recording of the chronology of

  3. Male genital trauma

    SciTech Connect

    Jordan, G.H.; Gilbert, D.A.

    1988-07-01

    We have attempted to discuss genital trauma in relatively broad terms. In most cases, patients present with relatively minimal trauma. However, because of the complexity of the structures involved, minimal trauma can lead to significant disability later on. The process of erection requires correct functioning of the arterial, neurologic, and venous systems coupled with intact erectile bodies. The penis is composed of structures that are compliant and distensible to the limits of their compliance. These structures therefore tumesce in equal proportion to each other, allowing for straight erection. Relatively minimal trauma can upset this balance of elasticity, leading to disabling chordee. Likewise, relatively minimal injuries to the vascular erectile structures can lead to significantly disabling spongiofibrosis. The urethra is a conduit of paramount importance. Whereas the development of stricture is generally related to the nature of the trauma, the extent of stricture and of attendant complications is clearly a function of the immediate management. Overzealous debridement can greatly complicate subsequent reconstruction. A delicate balance between aggressive initial management and maximal preservation of viable structures must be achieved. 38 references.

  4. Ultrasonography in ocular trauma.

    PubMed

    Dastevska-Djosevska, Emilija

    2013-01-01

    Ultrasonography is a non-invasive, simple and effective diagnostic method which enables visualization and evaluation of intraocular injury degree in cloudy eye media. The basic aim of this investigation was to find out the frequency of various types of ocular injuries using ultrasonography and to make an analysis of their frequency in relation to gender and age. This retrospective study included 182 patients hospitalized at the Clinic of Ophthalmology in Skopje due to mechanical eye trauma. The patients underwent ultrasonography on the Alcon Ultrascan Imagining System apparatus and Sonomed EZ Scan AB 5500+. B scan technique was used primarily, while the A scan had a positive and correlative role. Ocular trauma was more present in males (85.2%) compared to females (14.8%). 49.5% of the patients had open, and 50.5% had closed globe injuries. The most represented age group in ocular injuries was the age ranged from 51 to 60 years. There was no significant difference between the type of mechanical injury and the age (Chi-Squares=5.52 p=0.47895025). Ultrasonography showed that the most frequent pathologic result, both in open and closed globe injuries, was vitreous hemorrhage. Ultrasonography has an irreplaceable role in the clinical evaluation and management of ocular trauma. It showed that the most frequent finding in ocular trauma was vitreous haemorrhage, and the male gender was more frequently exposed to ocular trauma.

  5. Epidemiology of severe trauma.

    PubMed

    Alberdi, F; García, I; Atutxa, L; Zabarte, M

    2014-12-01

    Major injury is the sixth leading cause of death worldwide. Among those under 35 years of age, it is the leading cause of death and disability. Traffic accidents alone are the main cause, fundamentally in low- and middle-income countries. Patients over 65 years of age are an increasingly affected group. For similar levels of injury, these patients have twice the mortality rate of young individuals, due to the existence of important comorbidities and associated treatments, and are more likely to die of medical complications late during hospital admission. No worldwide, standardized definitions exist for documenting, reporting and comparing data on severely injured trauma patients. The most common trauma scores are the Abbreviated Injury Scale (AIS), the Injury Severity Score (ISS) and the Trauma and Injury severity Score (TRISS). Documenting the burden of injury also requires evaluation of the impact of post-trauma impairments, disabilities and handicaps. Trauma epidemiology helps define health service and research priorities, contributes to identify disadvantaged groups, and also facilitates the elaboration of comparable measures for outcome predictions.

  6. Trauma quiz. Terribly troublesome, trauma teeth.

    PubMed

    Feiglin, B

    1998-08-01

    Unfortunately, we come across many traumatised teeth during our practising career. Some of these traumatic injuries are rather simple to treat whereas others provide us with a real challenge. It is absolutely essential that the diagnosis of the injury be known before any treatment is attempted. When it comes to trauma, however, defining the exact form of treatment can often be very difficult. In this paper I will discuss some of the cases that I have managed and leave it up to YOU to decide whether my treatment has been correct, incorrect or whether there is some other form of treatment that we have at our disposal that could have been attempted.

  7. Trauma-induced coagulopathy.

    PubMed

    Godier, A; Susen, S

    2013-01-01

    Hemorrhage is the leading cause of death in trauma patients who arrive alive at hospital. This type of hemorrhage has a "coagulopathic" component, specific to major trauma and associated with poor outcomes. Over the last decade, a better understanding of this trauma-induced coagulopathy lead to a new therapeutic approach requiring earlier and more aggressive management. This hemostatic resuscitation includes early activation of massive transfusion protocols with: 1) immediate delivery of blood packs with high ratios for RBC units: fresh frozen plasma: platelet-concentrates; 2) antifibrinolytics; 3) substitution of coagulation factors. However, early identification of coagulopathic patients requiring aggressive hemostatic resuscitation remains challenging, with an increasing role of point of care devices for hemostatic diagnosis and monitoring. Efforts have to be focused on the early diagnosis of coagulopathy for immediate delivery of blood products and coagulation factors to the right, accurately screened patients through pre-established protocols within the golden hour. Copyright © 2013. Published by Elsevier SAS.

  8. Mucormycosis in trauma patients.

    PubMed

    Cocanour, C S; Miller-Crotchett, P; Reed, R L; Johnson, P C; Fischer, R P

    1992-01-01

    Cutaneous mucormycosis is a rare but often fatal infection in trauma patients. We retrospectively reviewed a 9-year experience with mucormycosis among injured patients. Eleven patients had biopsy- or culture-proven mucormycosis. Nine patients were victims of blunt trauma, two patients had burns measuring greater than 50% TBSA. No patient was at increased risk because of underlying disease or immunosuppression prior to injury. All 11 patients had open wounds on admission. Four patients died of mucormycosis. All nonsurvivors had phycomycotic gangrenous cellulitis of the head, the trunk, or both. In contrast, survivors had involvement of only the extremities. Because of underlying disease, contaminating wounds, antibiotic use, or immunocompromise secondary to shock and sepsis, trauma patients are at risk of developing mucormycosis. To successfully treat mucormycosis, diagnosis must be prompt and accompanied by aggressive debridement and parenteral administration of amphotericin B.

  9. Transfusion practices in trauma

    PubMed Central

    Ramakrishnan, V Trichur; Cattamanchi, Srihari

    2014-01-01

    Resuscitation of a severely traumatised patient with the administration of crystalloids, or colloids along with blood products is a common transfusion practice in trauma patients. The determination of this review article is to update on current transfusion practices in trauma. A search of PubMed, Google Scholar, and bibliographies of published studies were conducted using a combination of key-words. Recent articles addressing the transfusion practises in trauma from 2000 to 2014 were identified and reviewed. Trauma induced consumption and dilution of clotting factors, acidosis and hypothermia in a severely injured patient commonly causes trauma-induced coagulopathy. Early infusion of blood products and early control of bleeding decreases trauma-induced coagulopathy. Hypothermia and dilutional coagulopathy are associated with infusion of large volumes of crystalloids. Hence, the predominant focus is on damage control resuscitation, which is a combination of permissive hypotension, haemorrhage control and haemostatic resuscitation. Massive transfusion protocols improve survival in severely injured patients. Early recognition that the patient will need massive blood transfusion will limit the use of crystalloids. Initially during resuscitation, fresh frozen plasma, packed red blood cells (PRBCs) and platelets should be transfused in the ratio of 1:1:1 in severely injured patients. Fresh whole blood can be an alternative in patients who need a transfusion of 1:1:1 thawed plasma, PRBCs and platelets. Close monitoring of bleeding and point of care coagulation tests are employed, to allow goal-directed plasma, PRBCs and platelets transfusions, in order to decrease the risk of transfusion-related acute lung injury. PMID:25535424

  10. Paediatric Blunt Torso Trauma

    PubMed Central

    Bhatti, Khalid M.; Taqi, Kadhim M.; Al-Harthy, Ahmed Z. S.; Hamid, Rana S.; Al-Balushi, Zainab N.; Sankhla, Dilip K.; Al-Qadhi, Hani A.

    2016-01-01

    Objectives: Trauma is the greatest cause of morbidity and mortality in paediatric/adolescent populations worldwide. This study aimed to describe trauma mechanisms, patterns and outcomes among children with blunt torso trauma admitted to the Sultan Qaboos University Hospital (SQUH) in Muscat, Oman. Methods: This retrospective single-centre study involved all children ≤12 years old with blunt torso trauma admitted for paediatric surgical care at SQUH between January 2009 and December 2013. Medical records were analysed to collect demographic and clinical data. Results: A total of 70 children were admitted with blunt torso trauma during the study period, including 39 (55.7%) male patients. The mean age was 5.19 ± 2.66 years. Of the cohort, 35 children (50.0%) received their injuries after having been hit by cars as pedestrians, while 19 (27.1%) were injured by falls, 12 (17.1%) during car accidents as passengers and four (5.7%) by falling heavy objects. According to computed tomography scans, thoracic injuries were most common (65.7%), followed by abdominal injuries (42.9%). The most commonly involved solid organs were the liver (15.7%) and spleen (11.4%). The majority of the patients were managed conservatively (92.9%) with a good outcome (74.3%). The mortality rate was 7.1%. Most deaths were due to multisystem involvement. Conclusion: Among children with blunt torso trauma admitted to SQUH, the main mechanism of injury was motor vehicle accidents. As a result, parental education and enforcement of infant car seat/child seat belt laws are recommended. Conservative management was the most successful approach. PMID:27226913

  11. A novel trauma model: naturally occurring canine trauma.

    PubMed

    Hall, Kelly E; Sharp, Claire R; Adams, Cynthia R; Beilman, Gregory

    2014-01-01

    In human trauma patients, most deaths result from hemorrhage and brain injury, whereas late deaths, although rare, are the result of multiple organ failure and sepsis. A variety of experimental animal models have been developed to investigate the pathophysiology of traumatic injury and evaluate novel interventions. Similar to other experimental models, these trauma models cannot recapitulate conditions of naturally occurring trauma, and therefore therapeutic interventions based on these models are often ineffective. Pet dogs with naturally occurring traumatic injury represent a promising translational model for human trauma that could be used to assess novel therapies. The purpose of this article was to review the naturally occurring canine trauma literature to highlight the similarities between canine and human trauma. The American College of Veterinary Emergency and Critical Care Veterinary Committee on Trauma has initiated the establishment of a national network of veterinary trauma centers to enhance uniform delivery of care to canine trauma patients. In addition, the Spontaneous Trauma in Animals Team, a multidisciplinary, multicenter group of researchers has created a clinical research infrastructure for carrying out large-scale clinical trials in canine trauma patients. Moving forward, these national resources can be utilized to facilitate multicenter prospective studies of canine trauma to evaluate therapies and interventions that have shown promise in experimental animal models, thus closing the critical gap in the translation of knowledge from experimental models to humans and increasing the likelihood of success in phases 1 and 2 human clinical trials.

  12. Trauma-Focused CBT for Youth who Experience Ongoing Traumas

    PubMed Central

    Cohen, Judith A.; Mannarino, Anthony P.; Murray, Laura A.

    2011-01-01

    Many youth experience ongoing trauma exposure, such as domestic or community violence. Clinicians often ask whether evidence-based treatments containing exposure components to reduce learned fear responses to historical trauma are appropriate for these youth. Essentially the question is, if youth are desensitized to their trauma experiences, will this in some way impair their responding to current or ongoing trauma? The paper addresses practical strategies for implementing one evidence-based treatment, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for youth with ongoing traumas. Collaboration with local therapists and families participating in TF-CBT community and international programs elucidated effective strategies for applying TF-CBT with these youth. These strategies included: 1) enhancing safety early in treatment; 2) effectively engaging parents who experience personal ongoing trauma; and 3) during the trauma narrative and processing component focusing on a) increasing parental awareness and acceptance of the extent of the youths’ ongoing trauma experiences; b) addressing youths’ maladaptive cognitions about ongoing traumas; and c) helping youth differentiate between real danger and generalized trauma reminders. Case examples illustrate how to use these strategies in diverse clinical situations. Through these strategies TF-CBT clinicians can effectively improve outcomes for youth experiencing ongoing traumas. PMID:21855140

  13. Trauma-Focused CBT for Youth Who Experience Ongoing Traumas

    ERIC Educational Resources Information Center

    Cohen, Judith A.; Mannarino, Anthony P.; Murray, Laura K.

    2011-01-01

    Many youth experience ongoing trauma exposure, such as domestic or community violence. Clinicians often ask whether evidence-based treatments containing exposure components to reduce learned fear responses to historical trauma are appropriate for these youth. Essentially the question is, if youth are desensitized to their trauma experiences, will…

  14. Trauma-Focused CBT for Youth Who Experience Ongoing Traumas

    ERIC Educational Resources Information Center

    Cohen, Judith A.; Mannarino, Anthony P.; Murray, Laura K.

    2011-01-01

    Many youth experience ongoing trauma exposure, such as domestic or community violence. Clinicians often ask whether evidence-based treatments containing exposure components to reduce learned fear responses to historical trauma are appropriate for these youth. Essentially the question is, if youth are desensitized to their trauma experiences, will…

  15. Coagulopathy of Trauma.

    PubMed

    Cohen, Mitchell J; Christie, S Ariane

    2017-01-01

    Coagulopathy is common after injury and develops independently from iatrogenic, hypothermic, and dilutional causes. Despite considerable research on the topic over the past decade, trauma-induced coagulopathy (TIC) continues to portend poor outcomes, including decreased survival. We review the current evidence regarding the diagnosis and mechanisms underlying trauma induced coagulopathy and summarize the debates regarding optimal management strategy including product resuscitation, potential pharmacologic adjuncts, and targeted approaches to hemostasis. Throughout, we will identify areas of continued investigation and controversy in the understanding and management of TIC. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Chest Wall Trauma.

    PubMed

    Majercik, Sarah; Pieracci, Fredric M

    2017-05-01

    Chest wall trauma is common, and contributes significantly to morbidity and mortality of trauma patients. Early identification of major chest wall and concomitant intrathoracic injuries is critical. Generalized management of multiple rib fractures and flail chest consists of adequate pain control (including locoregional modalities); management of pulmonary dysfunction by invasive and noninvasive means; and, in some cases, surgical fixation. Multiple studies have shown that patients with flail chest have substantial benefit (decreased ventilator and intensive care unit days, improved pulmonary function, and improved long-term functional outcome) when they undergo surgery compared with nonoperative management. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Advances in prehospital trauma care

    PubMed Central

    Williamson, Kelvin; Ramesh, Ramaiah; Grabinsky, Andreas

    2011-01-01

    Prehospital trauma care developed over the last decades parallel in many countries. Most of the prehospital emergency medical systems relied on input or experiences from military medicine and were often modeled after the existing military procedures. Some systems were initially developed with the trauma patient in mind, while other systems were tailored for medical, especially cardiovascular, emergencies. The key components to successful prehospital trauma care are the well-known ABCs of trauma care: Airway, Breathing, Circulation. Establishing and securing the airway, ventilation, fluid resuscitation, and in addition, the quick transport to the best-suited trauma center represent the pillars of trauma care in the field. While ABC in trauma care has neither been challenged nor changed, new techniques, tools and procedures have been developed to make it easier for the prehospital provider to achieve these goals in the prehospital setting and thus improve the outcome of trauma patients. PMID:22096773

  18. Structured Sensory Trauma Interventions

    ERIC Educational Resources Information Center

    Steele, William; Kuban, Caelan

    2010-01-01

    This article features the National Institute of Trauma and Loss in Children (TLC), a program that has demonstrated via field testing, exploratory research, time series studies, and evidence-based research studies that its Structured Sensory Intervention for Traumatized Children, Adolescents, and Parents (SITCAP[R]) produces statistically…

  19. Laparoscopy in Abdominal Trauma.

    PubMed

    Uranüs, Selman; Dorr, Katrin

    2010-02-01

    The decision in favor of surgery or nonoperative conservative treatment in blunt and penetrating abdominal trauma requires a precise diagnosis that is not always possible with imaging techniques, whereby there is great danger that an injury to the diaphragm or intestines may be overlooked. To avoid such oversights, indications for exploratory laparotomy have traditionally been generous, to the extent that up to 41% of exploratory laparotomies turn out to be nontherapeutic and could be, or could have been, avoided with laparoscopy. A diagnostic laparoscopy with therapeutic option should only be attempted in stable patients. Three trocars are usually used and the abdomen is explored systematically, beginning with the right upper quadrant and continuing clockwise. Hollow viscus injuries and injuries to the diaphragm and mesentery can be detected and sutured laparoscopically. Injuries to parenchymal organs are not a primary focus of laparoscopy, but with a laparoscopic approach, they usually no longer bleed in stable patients and can be sealed with tissue adhesive and collagen tamponade to prevent re-bleeding. The routine use of laparoscopy can achieve a sensitivity of 90-100% in abdominal trauma. This can reduce the number of unnecessary laparotomies and the related morbidity. Laparoscopy can be performed safely and effectively in stable patients with abdominal trauma. The most important advantages are reduction of the nontherapeutic laparotomy rate, morbidity, shortening of hospitalization, and cost-effectiveness. In the future, new developments in and the miniaturization of equipment can be expected to increase the use of minimally invasive techniques in abdominal trauma cases.

  20. Early Childhood Trauma

    ERIC Educational Resources Information Center

    National Child Traumatic Stress Network, 2010

    2010-01-01

    Early childhood trauma generally refers to the traumatic experiences that occur to children aged 0-6. Because infants' and young children's reactions may be different from older children's, and because they may not be able to verbalize their reactions to threatening or dangerous events, many people assume that young age protects children from the…

  1. Ultrasound in cardiac trauma.

    PubMed

    Saranteas, Theodosios; Mavrogenis, Andreas F; Mandila, Christina; Poularas, John; Panou, Fotios

    2017-04-01

    In the perioperative period, the emergency department or the intensive care unit accurate assessment of variable chest pain requires meticulous knowledge, diagnostic skills, and suitable usage of various diagnostic modalities. In addition, in polytrauma patients, cardiac injury including aortic dissection, pulmonary embolism, acute myocardial infarction, and pericardial effusion should be immediately revealed and treated. In these patients, arrhythmias, mainly tachycardia, cardiac murmurs, or hypotension must alert physicians to suspect cardiovascular trauma, which would potentially be life threatening. Ultrasound of the heart using transthoracic and transesophageal echocardiography are valuable diagnostic tools that can be used interchangeably in conjunction with other modalities such as the electrocardiogram and computed tomography for the diagnosis of cardiovascular abnormalities in trauma patients. Although ultrasound of the heart is often underused in the setting of trauma, it does have the advantages of being easily accessible, noninvasive, and rapid bedside assessment tool. This review article aims to analyze the potential cardiac injuries in trauma patients, and to provide an elaborate description of the role of echocardiography for their accurate diagnosis.

  2. Structured Sensory Trauma Interventions

    ERIC Educational Resources Information Center

    Steele, William; Kuban, Caelan

    2010-01-01

    This article features the National Institute of Trauma and Loss in Children (TLC), a program that has demonstrated via field testing, exploratory research, time series studies, and evidence-based research studies that its Structured Sensory Intervention for Traumatized Children, Adolescents, and Parents (SITCAP[R]) produces statistically…

  3. Obesity in pediatric trauma.

    PubMed

    Witt, Cordelie E; Arbabi, Saman; Nathens, Avery B; Vavilala, Monica S; Rivara, Frederick P

    2017-04-01

    The implications of childhood obesity on pediatric trauma outcomes are not clearly established. Anthropomorphic data were recently added to the National Trauma Data Bank (NTDB) Research Datasets, enabling a large, multicenter evaluation of the effect of obesity on pediatric trauma patients. Children ages 2 to 19years who required hospitalization for traumatic injury were identified in the 2013-2014 NTDB Research Datasets. Age and gender-specific body mass indices (BMI) were calculated. Outcomes included injury patterns, operative procedures, complications, and hospital utilization parameters. Data from 149,817 pediatric patients were analyzed; higher BMI percentiles were associated with significantly more extremity injuries, and fewer injuries to the head, abdomen, thorax and spine (p values <0.001). On multivariable analysis, higher BMI percentiles were associated with significantly increased likelihood of death, deep venous thrombosis, pulmonary embolus and pneumonia; although there was no difference in risk of overall complications. Obese children also had significantly longer lengths of stay and more frequent ventilator requirement. Among children admitted after trauma, increased BMI percentile is associated with increased risk of death and potentially preventable complications. These findings suggest that obese children may require different management than nonobese counterparts to prevent complications. Level III; prognosis study. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Early Childhood Trauma

    ERIC Educational Resources Information Center

    National Child Traumatic Stress Network, 2010

    2010-01-01

    Early childhood trauma generally refers to the traumatic experiences that occur to children aged 0-6. Because infants' and young children's reactions may be different from older children's, and because they may not be able to verbalize their reactions to threatening or dangerous events, many people assume that young age protects children from the…

  5. The trauma report nurse: a trauma triage process improvement project.

    PubMed

    Jelinek, Lisa; Fahje, Carol; Immermann, Carol; Elsbernd, Terri

    2014-09-01

    Accurate trauma triage is imperative to facilitate appropriate resource mobilization for severely injured trauma patients. A critical window of opportunity exists to prevent secondary injury or death. Timely assessment with a multidisciplinary trauma team is essential to facilitate rapid diagnosis and treatment. However, consistent and accurate trauma triage proved daunting at our institution, resulting in instances of undertriage. A process improvement strategy aimed at improving trauma triage accuracy was implemented. An innovative role, the trauma report nurse (TRN), was created and became the trauma nurse expert. The TRN was responsible for assigning a trauma triage level to all incoming adult and pediatric trauma patients. In parallel, improvements were made to the prehospital report format, increasing standardization and clarifying hand-off verbiage. Undertriage rates dropped from 14% to 4.8%. Qualitative data demonstrated acceptance and support of the TRN role among physicians, nurses and nursing and ancillary staff. Designating trauma triage to an ED registered nurse proved to reduce undertriage rates. By providing staff education, infrastructure improvements, and leadership support, the role continues to thrive, resulting in improved care for severely injured trauma patients. Copyright © 2014 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  6. Analysis of 126 hospitalized elder maxillofacial trauma victims in central China

    PubMed Central

    Zhang, Rui; Li, Wenlu; Pei, Fei; He, Wei

    2015-01-01

    Background The aim of this study was to analyzed the characteristics and treatment of maxillofacial injuries in the elder patients with maxillofacial injuries in central China. Material and Methods We retrospectively analyzed the characteristics and treatment of maxillofacial injuries in the patients over the age of 60 to analyze the trends and clinical characteristics of maxillofacial trauma in elder patients from the First Affiliated Hospital of Zhengzhou University (from 2010 to 2013) in central China and to present recommendations on prevention and management. Results Of the 932 patients with maxillofacial injuries, 126 aged over 60 years old accounting for 13.52% of all the patients (male:female, 1.74:1; mean age, 67.08 years old). Approximately 52% of the patients were injured by falls. The most frequently observed type of injuries was soft tissue injuries (100%), followed by facial fractures (83.05%). Of the patients with soft tissue injuries, the abrasions accounted the most, followed by lacerations. The numbers of patients of midface fracture (60 patients) were almost similar to the number of lower face fractures (66 patients). Eighty two patients (65.08%%) demonstrated associated injuries, of which craniocerebral injuries were the most prevalent. One hundred and four patients (82.54%) had other systemic medical conditions, with cardiovascular diseases the most and followed by metabolic diseases and musculoskeletal conditions. Furthermore, the study indicated a relationship between maxillofacial fractures and musculoskeletal conditions. Only 13 patients (10.32%) sustained local infections, of whom had other medical conditions. Most of the facial injuries (85.71%) in older people were operated including debridement, fixing loose teeth, reduction, intermaxillary fixation and open reduction and internal fixation (ORIF). Conclusions Our analysis of the characteristics of maxillofacial injuries in the elder patents may help to promote clinical research to

  7. Blunt chest trauma.

    PubMed

    Adegboye, V O; Ladipo, J K; Brimmo, I A; Adebo, A O

    2002-12-01

    A retrospective study was conducted at the cardiothoracic surgical unit of the University College Hospital, Ibadan on all consecutive, blunt chest injury patients treated between May 1975 and April 1999. The period of study was divided into 2 periods: May 1975-April 1987, May 1987-April 1999. The aim was to determine the pattern of injury, the management and complications of the injury among the treated. Blunt chest trauma patients were 69% (1331 patients) of all chest injury patients (1928 patients) treated. Mean age for the 2 periods was 38.3 +/- 15 years and 56.4 +/- 6.2 years, the male:female ratio was 4:1 and 2:1 respectively. The incidence of blunt chest trauma tripled in the second period. Blunt chest trauma was classified as involving bony chest wall or without the involvement of bony chest wall. Majority of the blunt chest injuries were minor chest wall injuries (68%, 905 patients), 7.6% (101 patients) had major but stable chest wall injuries, 10.8% (144 patients) had flail chest injuries. Thoracic injuries without fractures of bony chest wall occurred in 181 patients (13.6%). Seven hundred and eighty-seven patients (59.1%) had associated extra-thoracic injuries, in 426 patients (54.1%) two or more extra-thoracic systems were involved. While orthopaedic injury was the most frequent extra-thoracic injury (69.5%) associated with blunt chest trauma, craniospinal injury (31.9%) was more common injury among the patients with severe or life threatening chest trauma. The most common extra-thoracic operation was laparotomy (221 patients). Nine hundred and seventy patients (72.9%) had either closed thoracostomy drainage or clinical observation, 361 patients (27.1%) had major thoracic surgical intervention (emergent in 134 patients, late in 227 patients). Most of the severe lung contusion that needed ventilatory care (85 patients) featured among patients with bony chest wall injury, 15 were without chest wall injury. Majority of patients 63.2% (835 patients) had no

  8. Trauma Tactics: Rethinking Trauma Education for Professional Nurses.

    PubMed

    Garvey, Paula; Liddil, Jessica; Eley, Scott; Winfield, Scott

    2016-01-01

    According to the National Trauma Institute (2015), trauma accounts for more than 180,000 deaths each year in the United States. Nurses play a significant role in the care of trauma patients and therefore need appropriate education and training (L. ). Although several courses exist for trauma education, many nurses have not received adequate education in trauma management (B. ; L. ). Trauma Tactics, a 2-day course that focuses on high-fidelity human patient simulation, was created to meet this educational need. This descriptive study was conducted retrospectively to assess the effectiveness of the Trauma Tactics course. Pre- and postsurveys, tests, and simulation performance were used to evaluate professional nurses who participated in Trauma Tactics over a 10-month period. Fifty-five nurses were included in the study. Pre- and postsurveys revealed an increase in overall confidence, test scores increased by an average of 2.5 points, and simulation performance scores increased by an average of 16 points. Trauma Tactics is a high-quality course that provides a valuable and impactful educational experience for nurses. Further research is needed to evaluate the long-term effects of Trauma Tactics and its impacts on quality of care and patient outcomes.

  9. Needle Thoracotomy in Trauma.

    PubMed

    Rottenstreich, Misgav; Fay, Shmuel; Gendler, Sami; Klein, Yoram; Arkovitz, Marc; Rottenstreich, Amihai

    2015-12-01

    Tension pneumothorax is one of the leading causes of preventable death in trauma patients. Needle thoracotomy (NT) is the currently accepted first-line intervention but has not been well validated. In this review, we have critically discussed the evidence for NT procedure, re-examined the recommendations by the Advanced Trauma Life Support organization and investigated the safest and most effective way of NT. The current evidence to support the use of NT is limited. However, when used, it should be applied in the 2nd intercostal space at midclavicular line using a catheter length of at least 4.5 cm. Alternative measures should be studied for better prehospital management of tension pneumothorax.

  10. Substance Abuse and Trauma.

    PubMed

    Simmons, Shannon; Suárez, Liza

    2016-10-01

    There is a strong, bidirectional link between substance abuse and traumatic experiences. Teens with cooccurring substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) have significant functional and psychosocial impairment. Common neurobiological foundations point to the reinforcing cycle of trauma symptoms, substance withdrawal, and substance use. Treatment of teens with these issues should include a systemic and integrated approach to both the SUD and the PTSD.

  11. Calcinosis cutis following trauma.

    PubMed

    Larralde, Margarita; Giachetti, Ana; Cáceres, María Rodríguez; Rodríguez, Marcela; Casas, José

    2005-01-01

    We report an 8-year-old boy who developed dystrophic calcinosis cutis that occurred following trauma. Multiple abrasions were observed in the inguinal folds after a soccer game. Subsequently, multiple papules with soft centers and white particles appeared in the same area. A biopsy specimen showed calcinosis cutis with transepidermal elimination of calcium. The causes of the underlying tissue damage associated with dystrophic calcinosis are discussed.

  12. Endovascular Therapy in Trauma

    DTIC Science & Technology

    2014-11-23

    Vascular Surgery . J Vasc Surg. 2011;53:187–92. 12. Piffaretti G, Benedetto F, Menegolo M, et al. Outcomes of end- ovascular repair for blunt thoracic...techniques to manage various forms: vascular injury, bleeding, and shock; including injury patterns in which an endovascular approach is established...and scenarios in which it is nascent and evolving. Keywords Vascular trauma · Endovascular repair · Catheter-based approach · Endovascular balloon

  13. Thromboembolic Complications Following Trauma

    DTIC Science & Technology

    2009-12-01

    intracranial hemorrhage following hypertension and ischemia due to hypoperfusion during shock. Cerebrovas- cular injury is only one mechanism, and a...artery injury with delayed onset of neurologic symptoms have also been reported, although few large series have been published.23 Kuehne and...into the study, and it again fails to represent the total trauma popu- lation. For example, skull fractures, intracranial injuries, and extremity

  14. Trauma in pregnancy.

    PubMed

    Bremer, C; Cassata, L

    1986-12-01

    The pregnant woman is exposed to the same risks as the non-pregnant woman for sustaining a traumatic injury, but because of the multiple physiologic changes that occur during pregnancy, the assessment and treatment of such patients must be adapted accordingly. This article discusses these normal physiologic changes, their effect on response to trauma, and the comprehensive care of the patient using the nursing process.

  15. Cervical spine trauma

    PubMed Central

    Torretti, Joel A; Sengupta, Dilip K

    2007-01-01

    Cervical spine trauma is a common problem with a wide range of severity from minor ligamentous injury to frank osteo-ligamentous instability with spinal cord injury. The emergent evaluation of patients at risk relies on standardized clinical and radiographic protocols to identify injuries; elucidate associated pathology; classify injuries; and predict instability, treatment and outcomes. The unique anatomy of each region of the cervical spine demands a review of each segment individually. This article examines both upper cervical spine injuries, as well as subaxial spine trauma. The purpose of this article is to provide a review of the broad topic of cervical spine trauma with reference to the classic literature, as well as to summarize all recently available literature on each topic. Identification of References for Inclusion: A Pubmed and Ovid search was performed for each topic in the review to identify recently published articles relevant to the review. In addition prior reviews and classic references were evaluated individually for inclusion of classic papers, classifications and previously unidentified references. PMID:21139776

  16. Imaging of laryngeal trauma.

    PubMed

    Becker, Minerva; Leuchter, Igor; Platon, Alexandra; Becker, Christoph D; Dulguerov, Pavel; Varoquaux, Arthur

    2014-01-01

    External laryngeal trauma is a rare but potentially life-threatening situation in the acutely injured patient. Trauma mechanism and magnitude, maximum focus of the applied force, and patient related factors, such as age and ossification of the laryngeal cartilages influence the spectrum of observed injuries. Their correct diagnosis and prompt management are paramount in order to avoid patient death or long-term impairment of breathing, swallowing and speaking. The current review provides a comprehensive approach to the radiologic interpretation of imaging studies performed in patients with suspected laryngeal injury. It describes the key anatomic structures that are relevant in laryngeal trauma and discusses the clinical role of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the acute emergency situation. The added value of two-dimensional multiplanar reconstructions (2D MPR), three-dimensional volume rendering (3D VR) and virtual endoscopy (VE) for the non-invasive evaluation of laryngeal injuries and for treatment planning is discussed. The clinical presentation, biomechanics of injury, diagnostic pitfalls and pearls, common and uncommon findings are reviewed with emphasis of fracture patterns, involvement of laryngeal joints, intra- and extralaryngeal soft tissue injuries, and complications seen in the acute emergency situation. The radiologic appearance of common and less common long-term sequelae, as well as treatment options are equally addressed. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  17. Rethinking historical trauma.

    PubMed

    Kirmayer, Laurence J; Gone, Joseph P; Moses, Joshua

    2014-06-01

    Recent years have seen the rise of historical trauma as a construct to describe the impact of colonization, cultural suppression, and historical oppression of Indigenous peoples in North America (e.g., Native Americans in the United States, Aboriginal peoples in Canada). The discourses of psychiatry and psychology contribute to the conflation of disparate forms of violence by emphasizing presumptively universal aspects of trauma response. Many proponents of this construct have made explicit analogies to the Holocaust as a way to understand the transgenerational effects of genocide. However, the social, cultural, and psychological contexts of the Holocaust and of post-colonial Indigenous "survivance" differ in many striking ways. Indeed, the comparison suggests that the persistent suffering of Indigenous peoples in the Americas reflects not so much past trauma as ongoing structural violence. The comparative study of genocide and other forms of massive, organized violence can do much to illuminate both common mechanisms and distinctive features, and trace the looping effects from political processes to individual experience and back again. The ethics and pragmatics of individual and collective healing, restitution, resilience, and recovery can be understood in terms of the self-vindicating loops between politics, structural violence, public discourse, and embodied experience. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  18. The trauma team--a system of initial trauma care.

    PubMed Central

    Adedeji, O. A.; Driscoll, P. A.

    1996-01-01

    Trauma remains the leading cause of death under the age of 35 years. England and Wales lost 252,000 working years from accidental deaths, including poison, in 1992. In this country, preventable deaths from trauma are inappropriately high. In many hospitals there are not enough personnel; in the majority, there are no recognisable trauma care systems, which can reduce preventable deaths to a minimum. The appropriateness of trauma centres for this country is being assessed in Stoke-on-Trent, and a report is due out later this year. Even if the recommendation is made to establish such centres, it is unlikely that many will be set up. Consequently most hospitals will have to rely on their own resources to set up and run a trauma team. This type of trauma care system is the subject of this article. PMID:8977939

  19. Long Term Effects of Soft Splints on Stroke Patients and Patients With Disorders of Consciousness

    ClinicalTrials.gov

    2017-06-01

    Brain Injuries; Disorder of Consciousness; Stroke; Spasticity as Sequela of Stroke; Contracture; Hypertonic Disorder; Central Nervous System Diseases; Pathologic Processes; Craniocerebral Trauma; Trauma, Nervous System; Neurocognitive Disorders

  20. Childhood trauma and compulsive buying.

    PubMed

    Sansone, Randy A; Chang, Joy; Jewell, Bryan; Rock, Rachel

    2013-02-01

    Childhood trauma has been empirically associated with various types of self-regulatory difficulties in adulthood. However, according to the extant literature, no study has examined relationships between various types of childhood trauma and compulsive buying behavior in adulthood. Using a self-report survey methodology in a cross-sectional consecutive sample of 370 obstetrics/gynecology patients, we examined five types of childhood trauma before the age of 12 years (i.e. witnessing violence, physical neglect, emotional abuse, physical abuse, sexual abuse) in relationship to compulsive buying as assessed by the Compulsive Buying Scale (CBS). All forms of trauma demonstrated statistically significant correlations with the CBS. Using a linear regression analysis, both witnessing violence and emotional abuse significantly contributed to CBS scores. Further analyses indicated that race did not moderate the relationship between childhood trauma and compulsive buying. Findings indicate that various forms of childhood trauma are correlated with compulsive buying behavior, particularly witnessing violence and emotional abuse.

  1. Trauma surgery: discipline in crisis.

    PubMed

    Green, Steven M

    2009-02-01

    Throughout the past quarter century, there have been slow but dramatic changes in the nature and practice of trauma surgery, and this field increasingly faces potent economic, logistic, political, and workforce challenges. Patients and emergency physicians have much to lose by this budding crisis in our partner discipline. This article reviews the specific issues confronting trauma surgery, their historical context, and the potential directions available to this discipline. Implications of these issues for emergency physicians and for trauma care overall are discussed.

  2. Trauma and the endocrine system.

    PubMed

    Mesquita, Joana; Varela, Ana; Medina, José Luís

    2010-12-01

    The endocrine system may be the target of different types of trauma with varied consequences. The present article discusses trauma of the hypothalamic-pituitary axes, adrenal glands, gonads, and pancreas. In addition to changes in circulating hormone levels due to direct injury to these structures, there may be an endocrine response in the context of the stress caused by the trauma. Copyright © 2010 SEEN. Published by Elsevier Espana. All rights reserved.

  3. Pediatric trauma: preparation and management.

    PubMed

    Brown, R C; Ioli, J G; Ferlise, M

    1993-01-01

    1. Trauma causes more than 50% of the deaths in children. The leading cause of pediatric injury is motor vehicle accidents involving children as passengers, pedestrians, or bicycle riders. 2. Trauma is always unexpected; therefore, the most vital aspect of any trauma system is that the system itself never be caught unprepared. Anticipation and preparation are the best first-line defenses against traumatic injury. 3. Because of a child's smaller size, vital organs are in close proximity to one another; multiple organ injuries are common. 4. The team who responds to a pediatric trauma should include nurses and physicians trained in principles of pediatric resuscitation.

  4. [Clinical features and course of schizophrenia developing in patients during remote periods following cranio-cerebral injuries].

    PubMed

    Kornilov, A A

    1980-01-01

    By means of clinical and follow up studies 340 patients were examined in the late period of brain trauma. Among this group 90 patients were distinguished who had an increasing endogenization of psychotic conditions and transformation of post-traumatic personality changes with emerging negative disorders, inherent to schizophrenia. In analysing the psychotic attacks attention was drawn to the depressive content of verbal hallucinosis, the rudimentary ideas fof self-accusation in an acute paranoid state, to the elements of the Kandinsky-Clerambault syndrome in delirious states, to the prevalence of low energy level in depressions and to the short psychotic episodes in remissions of the schizoaffective psychosis.

  5. Acute brain trauma

    PubMed Central

    Martin, GT

    2016-01-01

    In the 20th century, the complications of head injuries were controlled but not eliminated. The wars of the 21st century turned attention to blast, the instant of impact and the primary injury of concussion. Computer calculations have established that in the first 5 milliseconds after the impact, four independent injuries on the brain are inflicted: 1) impact and its shockwave, 2) deceleration, 3) rotation and 4) skull deformity with vibration (or resonance). The recovery, pathology and symptoms after acute brain trauma have always been something of a puzzle. The variability of these four modes of injury, along with a variable reserve of neurones, explains some of this problem. PMID:26688392

  6. Penetrating thoracic trauma.

    PubMed

    Bastos, Renata; Baisden, Clinton E; Harker, Lori; Calhoon, John H

    2008-01-01

    The initial approach to penetrating thoracic trauma is directed towards the pathophysiologic syndrome upon presentation. Most patients are successfully treated with drainage tubes. The unstable patient may necessitate thoracotomy at the emergency room to drain cardiac tamponade, provide cardiac massage and control bleeding. The guidelines for this procedure are reviewed. Need for further work-up of potential injuries to other mediastinal organs is frequently screened by computerized tomography. Surgery might still be needed, on a less emergent basis, in order to repair injuries to the trachea/esophagus, retained hemothorax, or to rule out diaphragmatic injury. Laparoscopic and thoracoscopic procedures may be used in specific situations.

  7. Management of Pediatric Trauma.

    PubMed

    2016-08-01

    Injury is still the number 1 killer of children ages 1 to 18 years in the United States (http://www.cdc.gov/nchs/fastats/children.htm). Children who sustain injuries with resulting disabilities incur significant costs not only for their health care but also for productivity lost to the economy. The families of children who survive childhood injury with disability face years of emotional and financial hardship, along with a significant societal burden. The entire process of managing childhood injury is enormously complex and varies by region. Only the comprehensive cooperation of a broadly diverse trauma team will have a significant effect on improving the care of injured children.

  8. Radiology of skeletal trauma

    SciTech Connect

    Rogers, L.F.

    1982-01-01

    This 1000-page book contains over 1700 illustrations, is presented in two volumes and subdivided into 23 chapters. After brief chapters of Introduction and General Anatomy, a section on Skeletal Biomechanics is presented. The Epidemiology of Fractures chapter examines, among other things, the effects of age on the frequency and distribution of fractures. In the chapter on Classifications of Fractures, the author describes the character of traumatic forces such as angulating, torsional, avulsive, and compressive, and then relates these to the resultant fracture configurations. The Fracture Treatment chapter presents an overview of treatment principles. Other chapters deal with specific problems in pediatric trauma, fracture healing and nonhealing, and fracture complications.

  9. Acute brain trauma.

    PubMed

    Martin, G T

    2016-01-01

    In the 20th century, the complications of head injuries were controlled but not eliminated. The wars of the 21st century turned attention to blast, the instant of impact and the primary injury of concussion. Computer calculations have established that in the first 5 milliseconds after the impact, four independent injuries on the brain are inflicted: 1) impact and its shockwave, 2) deceleration, 3) rotation and 4) skull deformity with vibration (or resonance). The recovery, pathology and symptoms after acute brain trauma have always been something of a puzzle. The variability of these four modes of injury, along with a variable reserve of neurones, explains some of this problem.

  10. Rural Trauma: Is Trauma Designation Associated with Better Hospital Outcomes?

    ERIC Educational Resources Information Center

    Bowman, Stephen M.; Zimmerman, Frederick J.; Sharar, Sam R.; Baker, Margaret W.; Martin, Diane P.

    2008-01-01

    Context: While trauma designation has been associated with lower risk of death in large urban settings, relatively little attention has been given to this issue in small rural hospitals. Purpose: To examine factors related to in-hospital mortality and delayed transfer in small rural hospitals with and without trauma designation. Methods: Analysis…

  11. Trauma-Focused CBT for Youth with Complex Trauma

    ERIC Educational Resources Information Center

    Cohen, Judith A.; Mannarino, Anthony P.; Kliethermes, Matthew; Murray, Laura A.

    2012-01-01

    Objectives: Many youth develop complex trauma, which includes regulation problems in the domains of affect, attachment, behavior, biology, cognition, and perception. Therapists often request strategies for using evidence-based treatments (EBTs) for this population. This article describes practical strategies for applying Trauma-Focused Cognitive…

  12. Trauma-focused CBT for youth with complex trauma

    PubMed Central

    Mannarino, Anthony P.; Kliethermes, Matthew; Murray, Laura A.

    2013-01-01

    Objectives Many youth develop complex trauma, which includes regulation problems in the domains of affect, attachment, behavior, biology, cognition, and perception. Therapists often request strategies for using evidence-based treatments (EBTs) for this population. This article describes practical strategies for applying Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for youth with complex trauma. Methods TF-CBT treatment phases are described and modifications of timing, proportionality and application are described for youth with complex trauma. Practical applications include a) dedicating proportionally more of the model to the TF-CBT coping skills phase; b) implementing the TF-CBT Safety component early and often as needed throughout treatment; c) titrating gradual exposure more slowly as needed by individual youth; d) incorporating unifying trauma themes throughout treatment; and e) when indicated, extending the TF-CBT treatment consolidation and closure phase to include traumatic grief components and to generalize ongoing safety and trust. Results Recent data from youth with complex trauma support the use of the above TF-CBT strategies to successfully treat these youth. Conclusions The above practical strategies can be incorporated into TF-CBT to effectively treat youth with complex trauma. Practice implications Practical strategies include providing a longer coping skills phase which incorporates safety and appropriate gradual exposure; including relevant unifying themes; and allowing for an adequate treatment closure phase to enhance ongoing trust and safety. Through these strategies therapists can successfully apply TF-CBT for youth with complex trauma. PMID:22749612

  13. Trauma-Focused CBT for Youth with Complex Trauma

    ERIC Educational Resources Information Center

    Cohen, Judith A.; Mannarino, Anthony P.; Kliethermes, Matthew; Murray, Laura A.

    2012-01-01

    Objectives: Many youth develop complex trauma, which includes regulation problems in the domains of affect, attachment, behavior, biology, cognition, and perception. Therapists often request strategies for using evidence-based treatments (EBTs) for this population. This article describes practical strategies for applying Trauma-Focused Cognitive…

  14. Rural Trauma: Is Trauma Designation Associated with Better Hospital Outcomes?

    ERIC Educational Resources Information Center

    Bowman, Stephen M.; Zimmerman, Frederick J.; Sharar, Sam R.; Baker, Margaret W.; Martin, Diane P.

    2008-01-01

    Context: While trauma designation has been associated with lower risk of death in large urban settings, relatively little attention has been given to this issue in small rural hospitals. Purpose: To examine factors related to in-hospital mortality and delayed transfer in small rural hospitals with and without trauma designation. Methods: Analysis…

  15. Trauma, narcissism and the two attractors in trauma.

    PubMed

    Gerzi, Shmuel

    2005-08-01

    In this paper, the author sets out to distinguish anew between two concepts that have become sorely entangled--'trauma' and 'narcissism'. Defining 'narcissism' in terms of an interaction between the selfobject and the self that maintains a protective shield, and 'trauma' as attacks on this protective shield, perpetrated by bad objects, he introduces two attractors present in trauma--'the hole attractor' and the structure enveloping it, 'the narcissistic envelope'. The hole attractor pulls the trauma patient, like a 'black hole', into a realm of emotional void, of hole object transference, devoid of memories and where often in an analyst's countertransference there are no reverberations of the trauma patient's experience. In the narcissistic envelope, on the other hand, motion, the life and death drive and fragments of memory do survive. Based on the author's own clinical experience with Holocaust survivors, and on secondary sources, the paper concludes with some clinical implications that take the two attractors into account.

  16. [Cervical spine trauma].

    PubMed

    Yilmaz, U; Hellen, P

    2016-08-01

    In the emergency department 65 % of spinal injuries and 2-5 % of blunt force injuries involve the cervical spine. Of these injuries approximately 50 % involve C5 and/or C6 and 30 % involve C2. Older patients tend to have higher spinal injuries and younger patients tend to have lower injuries. The anatomical and development-related characteristics of the pediatric spine as well as degenerative and comorbid pathological changes of the spine in the elderly can make the radiological evaluation of spinal injuries difficult with respect to possible trauma sequelae in young and old patients. Two different North American studies have investigated clinical criteria to rule out cervical spine injuries with sufficient certainty and without using imaging. Imaging of cervical trauma should be performed when injuries cannot be clinically excluded according to evidence-based criteria. Degenerative changes and anatomical differences have to be taken into account in the evaluation of imaging of elderly and pediatric patients.

  17. Clinical management of abdominal trauma.

    PubMed

    Fang, Guo-en; Luo, Tian-hang; DU, Cheng-hui; Bi, Jian-wei; Xue, Xu-chao; Wei, Guo; Weng, Zhao-zhang; Ma, Li-ye; Hua, Ji-de

    2008-08-01

    To improve the prognosis of patients with abdominal trauma. Between January 1993 and December 2005, 415 patients were enrolled in this research. The patients consisted of 347 males and 68 females with mean age of 36 years (ranging from 3-82 years). All abdominal traumas consisted of closed traumas (360 cases, 86.7%) and open traumas (55 cases, 13.3%). A total of 407 cases (98.1%) were fully recovered from trauma and the other 8 cases (1.9%) died of multiple injuries. The mean injury severity score (ISS) of all patients was 22 while the mean ISS of the patients who died in hospital was 42. Postoperative complications were seen in 9 patients such as infection of incisional wounds (6 cases), pancreatic fistula (2 cases) and intestinal fistula (1 case). All these postoperative complications were cured by the conservative treatment. Careful case history inquisition and physical examination are the basic methods to diagnose abdominal trauma. Focused abdominal ultrasonography is always the initial imaging examination because it is non-invasive and can be performed repeatedly with high accuracy. The doctors should consider the severity of local injuries and the general status of patients during the assessment of abdominal trauma. The principle of treatment is to save lives at first, then to cure the injuries. Unnecessary laparotomy should be avoided to reduce additional surgical trauma.

  18. Coagulopathy after severe pediatric trauma.

    PubMed

    Christiaans, Sarah C; Duhachek-Stapelman, Amy L; Russell, Robert T; Lisco, Steven J; Kerby, Jeffrey D; Pittet, Jean-François

    2014-06-01

    Trauma remains the leading cause of morbidity and mortality in the United States among children aged 1 to 21 years. The most common cause of lethality in pediatric trauma is traumatic brain injury. Early coagulopathy has been commonly observed after severe trauma and is usually associated with severe hemorrhage and/or traumatic brain injury. In contrast to adult patients, massive bleeding is less common after pediatric trauma. The classical drivers of trauma-induced coagulopathy include hypothermia, acidosis, hemodilution, and consumption of coagulation factors secondary to local activation of the coagulation system after severe traumatic injury. Furthermore, there is also recent evidence for a distinct mechanism of trauma-induced coagulopathy that involves the activation of the anticoagulant protein C pathway. Whether this new mechanism of posttraumatic coagulopathy plays a role in children is still unknown. The goal of this review is to summarize the current knowledge on the incidence and potential mechanisms of coagulopathy after pediatric trauma and the role of rapid diagnostic tests for early identification of coagulopathy. Finally, we discuss different options for treating coagulopathy after severe pediatric trauma.

  19. Sexual Trauma, Spirituality, and Psychopathology

    ERIC Educational Resources Information Center

    Krejci, Mark J.; Thompson, Kevin M.; Simonich, Heather; Crosby, Ross D.; Donaldson, Mary Ann; Wonderlich, Stephen A.; Mitchell, James E.

    2004-01-01

    This study assessed the association between spirituality and psychopathology in a group of sexual abuse victims and controls with a focus on whether spirituality moderated the association between sexual trauma and psychopathology. Seventy-one sexual trauma victims were compared to 25 control subjects on spiritual well-being, the Eating Disorder…

  20. Occlusal trauma--periodontal concerns.

    PubMed

    Hallmon, W W

    2001-10-01

    While there is evidence that suggests that occlusal trauma is a risk factor for periodontal destruction, there is no evidence that indicates that occlusal trauma will initiate periodontal destruction. Effective plaque control and compliance with periodontal maintenance recommendations are key and essential factors necessary to assure successful treatment and control of periodontal disease.

  1. Sexual Trauma, Spirituality, and Psychopathology

    ERIC Educational Resources Information Center

    Krejci, Mark J.; Thompson, Kevin M.; Simonich, Heather; Crosby, Ross D.; Donaldson, Mary Ann; Wonderlich, Stephen A.; Mitchell, James E.

    2004-01-01

    This study assessed the association between spirituality and psychopathology in a group of sexual abuse victims and controls with a focus on whether spirituality moderated the association between sexual trauma and psychopathology. Seventy-one sexual trauma victims were compared to 25 control subjects on spiritual well-being, the Eating Disorder…

  2. Prehospital Trauma Care in Singapore.

    PubMed

    Ho, Andrew Fu Wah; Chew, David; Wong, Ting Hway; Ng, Yih Yng; Pek, Pin Pin; Lim, Swee Han; Anantharaman, Venkataraman; Hock Ong, Marcus Eng

    2015-01-01

    Prehospital emergency care in Singapore has taken shape over almost a century. What began as a hospital-based ambulance service intended to ferry medical cases was later complemented by an ambulance service under the Singapore Fire Brigade to transport trauma cases. The two ambulance services would later combine and come under the Singapore Civil Defence Force. The development of prehospital care systems in island city-state Singapore faces unique challenges as a result of its land area and population density. This article defines aspects of prehospital trauma care in Singapore. It outlines key historical milestones and current initiatives in service, training, and research. It makes propositions for the future direction of trauma care in Singapore. The progress Singapore has made given her circumstances may serve as lessons for the future development of prehospital trauma systems in similar environments. Key words: Singapore; trauma; prehospital emergency care; emergency medical services.

  3. Trauma patient outcome after the Prehospital Trauma Life Support program.

    PubMed

    Ali, J; Adam, R U; Gana, T J; Williams, J I

    1997-06-01

    We have previously demonstrated a significant improvement in trauma patient outcome after the Advanced Trauma Life Support (ATLS) program in Trinidad and Tobago. In January of 1992, a Prehospital Trauma Life Support (PHTLS) program was also instituted. This study assessed trauma patient outcome after the PHTLS program. Morbidity (length of stay and degree of disability), mortality, injury severity score, mechanism of injury, age, and sex among all adult trauma patients transported by ambulance to the major trauma hospital were assessed between July of 1990 to December of 1991 (pre-PHTLS, n = 332) and January of 1994 to June of 1995 (post-PHTLS, n = 350). Age, sex distribution, percentage blunt injury, and injury severity score were similar for both groups. Mortality pre-PHTLS (15.7%) was greater than post-PHTLS (10.6%). Length of stay and disability were statistically significantly decreased post-PHTLS. Age, injury severity score, and mechanism of injury were positively correlated with mortality in both periods. The previously reported post-ATLS mortality was similar to the pre-PHTLS mortality. Post-PHTLS mortality and morbidity were significantly decreased, suggesting a positive impact of the PHTLS program on trauma patient outcome.

  4. Predicting significant torso trauma.

    PubMed

    Nirula, Ram; Talmor, Daniel; Brasel, Karen

    2005-07-01

    Identification of motor vehicle crash (MVC) characteristics associated with thoracoabdominal injury would advance the development of automatic crash notification systems (ACNS) by improving triage and response times. Our objective was to determine the relationships between MVC characteristics and thoracoabdominal trauma to develop a torso injury probability model. Drivers involved in crashes from 1993 to 2001 within the National Automotive Sampling System were reviewed. Relationships between torso injury and MVC characteristics were assessed using multivariate logistic regression. Receiver operating characteristic curves were used to compare the model to current ACNS models. There were a total of 56,466 drivers. Age, ejection, braking, avoidance, velocity, restraints, passenger-side impact, rollover, and vehicle weight and type were associated with injury (p < 0.05). The area under the receiver operating characteristic curve (83.9) was significantly greater than current ACNS models. We have developed a thoracoabdominal injury probability model that may improve patient triage when used with ACNS.

  5. CT in aortic trauma

    SciTech Connect

    Heiberg, E.; Wolverson, M.K.; Sundaram, M.; Shields, J.B.

    1983-06-01

    A diagnosis of aortic transection was made at computed tomography (CT) in four of 10 patients with acute multiple trauma suspected of having thoracic aortic injuries. There were no false-negative or false-positive examinations. The CT findings of an injured aorta were (1) false aneurysm, (2) linear lucency within the opacified aortic lumen caused by the torn edge of the aortic wall, (3) marginal irregularity of the opacified aortic lumen, (4) periaortic or intramural aortic hematoma, and (5) dissection. The extent of associated mediastinal hemorrhage and the amount of blood in the pleural space were not useful as indicators of aortic injury. Similarly, shift of the trachea and esophagus or absence thereof was found in patients with or without aortic tear.

  6. Orthopedic trauma in pregnancy.

    PubMed

    Desai, Pratik; Suk, Michael

    2007-11-01

    Trauma sustained during pregnancy can trigger uncertainty and anxiety for patient and orthopedic surgeon alike. In particular, orthopedic-related injuries raise concerns about preoperative, intraoperative, and postoperative care. In this article, we review common concerns about radiation exposure, leukemia, pain management, anticoagulation, and anesthesia. One finding is that radiation risk is minimal when obtaining x-rays for operative planning, provided that the cumulative dose is within 5 rad. We also address safety concerns about patient positioning and staff radiation exposure. In addition, we found that most anesthetics used in pregnancy are category C (ie, safe). Perioperative opioid use for pain management is recommended with little risk. Regarding anticoagulation, low-molecular-weight heparin and fondaparinux are the safest choices. Last, pregnancy is not a contraindication to operative management of pelvic and acetabular fractures.

  7. Vascular trauma historical notes.

    PubMed

    Rich, Norman M

    2011-03-01

    This article provides a brief historical review of treatment of vascular trauma. Although methods for ligation came into use in the second century, this knowledge was lost during the Dark Ages and did not come back until the Renaissance. Many advances in vascular surgery occurred during the Balkan Wars, World War I, and World War II, although without antibiotics and blood banking, the philosophy of life over limb still ruled. Documenting and repairing both arteries and veins became more common during the Korean and Vietnam conflicts. Increased documentation has revealed that the current conflicts have resulted in more arterial injuries than in previous wars, likely because of improved body armor, improvised explosive device attacks, tourniquet use, and improved medical evacuation time. This brief review emphasizes the great value of mentorship and the legacy of the management of arterial and venous injuries to be passed on.

  8. Trauma and religiousness.

    PubMed

    Gostečnik, Christian; Repič Slavič, Tanja; Lukek, Saša Poljak; Cvetek, Robert

    2014-06-01

    Victims of traumatic events who experience re-traumatization often develop a highly ambivalent relationship to God and all religiosity as extremely conflictual. On the one hand, they may choose to blame God for not having protected them, for having left them to feel so alone, for having been indifferent to them or they may even turn their wrath upon God, as the source of cruelty. Often though, the traumas experienced by individuals prompt them to turn to God and religion in search of help. This gives reason for the need of new and up-to-date research that can help elucidate why some people choose to seek help in religion and others turn away from it.

  9. Tournament water skiing trauma.

    PubMed Central

    Roberts, S N; Roberts, P M

    1996-01-01

    Tournament water skiing is an increasingly popular and internationally successful sport in Great Britain, despite the climate. The kinematics and injury patterns of the three disciplines will be unfamiliar to most clinicians and are described, with estimation of the stresses. Advances in equipment over the last 15 years have reduced the risk of severe injury in the tricks event, while high speed impacts are responsible for the majority of trauma in slalom and jump. There is a surprisingly high incidence of injury to the lumbar spine during the high impact jump event. Comparison with findings in other sports suggests that the spine may be damaged by overuse, particularly before skeletal maturity. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 PMID:8799590

  10. Lightweight Trauma Module - LTM

    NASA Technical Reports Server (NTRS)

    Hatfield, Thomas

    2008-01-01

    Current patient movement items (PMI) supporting the military's Critical Care Air Transport Team (CCATT) mission as well as the Crew Health Care System for space (CHeCS) have significant limitations: size, weight, battery duration, and dated clinical technology. The LTM is a small, 20 lb., system integrating diagnostic and therapeutic clinical capabilities along with onboard data management, communication services and automated care algorithms to meet new Aeromedical Evacuation requirements. The Lightweight Trauma Module is an Impact Instrumentation, Inc. project with strong Industry, DoD, NASA, and Academia partnerships aimed at developing the next generation of smart and rugged critical care tools for hazardous environments ranging from the battlefield to space exploration. The LTM is a combination ventilator/critical care monitor/therapeutic system with integrated automatic control systems. Additional capabilities are provided with small external modules.

  11. Penetrating neck traumas

    PubMed Central

    Kaczmarski, Jacek; Brzeziński, Daniel; Cieślik-Wolski, Bartosz; Kozak, Józef

    2014-01-01

    Aim of the study Aim of the study is to present our own experiences in the treatment of people suffering from penetrating neck traumas. Material and methods In the years 1996-2012, 10 patients with penetrating neck traumas were treated, including 3 women and 7 men. The patients’ age ranged from 16 to 55 (the average age being 40.7 years). In 9 cases the wound was caused by cutting or stabbing, while in one case it was inflicted by a gunshot. In 8 patients it was a single cut wound, while one patient suffered from 34 stab wounds to the neck, chest and stomach. Two cut wounds resulted from a suicide attempt. The remaining injuries were the result of a crime. Results All patients underwent immediate surgery, which involved revision of the neck wounds in 8 cases, one longitudinal sternotomy and one left-sided thoracotomy. The indications for surgery included increased subcutaneous emphysema in 5 patients, bleeding from the wound in 3 patients, and mediastinal hematoma in 2 patients. The damage assessed intraoperatively included tracheal damage in 6 patients, damage to carotid vessels in 3 patients, larynx in 2 patients, thoracic vessels in 2 patients, oesophagus in 1 patient and thyroid gland in 1 patient. In 9 patients, the treatment yielded positive results. The patient with a gunshot wound died during the surgery due to massive bleeding from the aorta. Conclusions In patients with penetrating neck wounds, early and rapid diagnostics allows one to determine the indications for surgery and prevent serious fatal complications. PMID:26336390

  12. EAU Guidelines on Urethral Trauma.

    PubMed

    Martínez-Piñeiro, Luis; Djakovic, Nenad; Plas, Eugen; Mor, Yoram; Santucci, Richard A; Serafetinidis, Efraim; Turkeri, Levent N; Hohenfellner, Markus

    2010-05-01

    These guidelines were prepared on behalf of the European Association of Urology (EAU) to assist urologists in the management of traumatic urethral injuries. To determine the optimal evaluation and management of urethral injuries by review of the world's literature on the subject. A working group of experts on Urological Trauma was convened to review and summarize the literature concerning the diagnosis and treatment of genitourinary trauma, including urethral trauma. The Urological Trauma guidelines have been based on a review of the literature identified using on-line searches of MEDLINE and other source documents published before 2009. A critical assessment of the findings was made, not involving a formal appraisal of the data. There were few high-powered, randomized, controlled trials in this area and considerable available data was provided by retrospective studies. The Working Group recognizes this limitation. The full text of these guidelines is available through the EAU Central Office and the EAU website (www.uroweb.org). This article comprises the abridged version of a section of the Urological Trauma guidelines. Updated and critically reviewed Guidelines on Urethral Trauma are presented. The aim of these guidelines is to provide support to the practicing urologist since urethral injuries carry substantial morbidity. The diversity of urethral injuries, associated injuries, the timing and availability of treatment options as well as their relative rarity contribute to the controversies in the management of urethral trauma. Copyright © 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  13. Individual differences in trauma disclosure.

    PubMed

    Bedard-Gilligan, Michele; Jaeger, Jeff; Echiverri-Cohen, Aileen; Zoellner, Lori A

    2012-06-01

    Findings on disclosure and adjustment following traumatic events have been mixed. Better understanding of individual differences in disclosure may help us better understand reactions following trauma exposure. In particular, studying disclosure patterns for those with and without psychopathology and for different types of emotional experiences may help clarify the relationship between disclosure, event emotionality, trauma exposure, and PTSD. In this study, 143 men and women with (n=67) and without (n=43) chronic PTSD and without trauma exposure (n=33) provided information on disclosure for a traumatic/severe life event, a negative event, and a positive event. Individuals with PTSD reported greater difficulty disclosing their traumatic event compared to those with trauma exposure no PTSD and those with no-trauma exposure. However, individuals with PTSD reported disclosing the traumatic event a similar number of times and with similar levels of detail to those with trauma exposure but no PTSD. Both sexual and childhood trauma were associated with greater disclosure difficulty. Although control event types (positive, negative) were selected to control for the passage of time and for general disclosure style, they do not control for salience of the event and results may be limited by control events that were not highly salient. The present findings point to a dynamic conceptualization of disclosure, suggesting that the differential difficulty of disclosing traumatic events seen in individuals with PTSD is not simply a function of the amount of disclosure or the amount of details provided. Copyright © 2011 Elsevier Ltd. All rights reserved.

  14. Improved trauma management with advanced trauma life support (ATLS) training.

    PubMed Central

    Williams, M J; Lockey, A S; Culshaw, M C

    1997-01-01

    OBJECTIVE: To determine the value of advanced trauma life support (ATLS) training for medical staff in a major incident situation, based upon performance in a simulated exercise. METHODS: A major incident exercise was used to assess the management of trauma victims arriving in hospital suffering from multiple or life threatening injuries. The effect of ATLS training, or exposure to an abbreviated form of ATLS training, on the management of patients with simulated life threatening traumatic injuries was examined. The treatment offered by medical staff of different grades and varying exposure to ATLS training was compared. RESULTS: Medical staff who had undertaken ATLS training attained a higher number of ATLS key treatment objectives when treating the simulated trauma victims. CONCLUSION: Medical staff who have either undertaken the full ATLS course or an abbreviated form of the course were more effective in their management of the simulated trauma cases. PMID:9132197

  15. Improved trauma management with advanced trauma life support (ATLS) training.

    PubMed

    Williams, M J; Lockey, A S; Culshaw, M C

    1997-03-01

    To determine the value of advanced trauma life support (ATLS) training for medical staff in a major incident situation, based upon performance in a simulated exercise. A major incident exercise was used to assess the management of trauma victims arriving in hospital suffering from multiple or life threatening injuries. The effect of ATLS training, or exposure to an abbreviated form of ATLS training, on the management of patients with simulated life threatening traumatic injuries was examined. The treatment offered by medical staff of different grades and varying exposure to ATLS training was compared. Medical staff who had undertaken ATLS training attained a higher number of ATLS key treatment objectives when treating the simulated trauma victims. Medical staff who have either undertaken the full ATLS course or an abbreviated form of the course were more effective in their management of the simulated trauma cases.

  16. Secondary Trauma in Children and School Personnel

    ERIC Educational Resources Information Center

    Motta, Robert W.

    2012-01-01

    A review of childhood secondary trauma is presented. Secondary trauma involves the transfer and acquisition of negative affective and dysfunctional cognitive states due to prolonged and extended contact with others, such as family members, who have been traumatized. As such, secondary trauma refers to a spread of trauma reactions from the victim…

  17. Secondary Trauma in Children and School Personnel

    ERIC Educational Resources Information Center

    Motta, Robert W.

    2012-01-01

    A review of childhood secondary trauma is presented. Secondary trauma involves the transfer and acquisition of negative affective and dysfunctional cognitive states due to prolonged and extended contact with others, such as family members, who have been traumatized. As such, secondary trauma refers to a spread of trauma reactions from the victim…

  18. Tennessee trauma care system plan, Part II.

    PubMed

    Phillips, Joseph B; Barker, Donald; Enderson, Blaine

    2005-04-01

    Tennessee implemented a statewide trauma care system in 1988. This system serves the state of Tennessee and supports eight neighboring states. The demographics and geography of Tennessee have ensured that nearly all residents have rapid access to the trauma care system. However, since 1988, many changes have occurred in healthcare in general, and trauma care in particular, that point out problems and issues with the Tennessee trauma care system. Therefore, the Tennessee Trauma Care Advisory Council has developed this Trauma Care System Plan to look at needs and opportunities for the future of trauma care in Tennessee. This plan will be presented in four segments: History, Administrative Components, Operational Components, and Clinical Components.

  19. Tennessee trauma care system plan, Part 1.

    PubMed

    Phillips, Joseph B; Barker, Donald; Dunn, Julie; Enderson, Blaine

    2005-03-01

    Tennessee implemented a statewide trauma care system in 1988. This system serves the state of Tennessee and supports eight neighboring states. The demographics and geography of Tennessee have ensured that nearly all residents have rapid access to the trauma care system. However, since 1988, many changes have occurred in healthcare in general, and trauma care in particular, that point out problems and issues with the Tennessee trauma care system. Therefore, the Tennessee Trauma Care Advisory Council has developed this Trauma Care System Plan to look at needs and opportunities for the future of trauma care in Tennessee. This plan will be presented in four segments: History, Administrative Components, Operational Components, and Clinical Components.

  20. Tennessee Trauma Care System Plan, part III.

    PubMed

    Phillips, Joseph B; Barker, Donald; Enderson, Blaine

    2005-05-01

    Tennessee implemented a statewide trauma care system in 1988. This system serves the state of Tennessee and supports eight neighboring states. The demographics and geography of Tennessee have ensured that nearly all residents have rapid access to the trauma care system. However, since 1988, many changes have occurred in healthcare in general, and trauma care in particular, that point out problems and issues with the Tennessee trauma care system. Therefore, the Tennessee Trauma Care Advisory Council has developed this Trauma Care System Plan to look at needs and opportunities for the future of trauma care in Tennessee. This plan will be presented in four segments: History, Administrative Components, Operational Components, and Clinical Components.

  1. Age, physical trauma and care.

    PubMed Central

    Robinson, A

    1995-01-01

    To cast light on the effects of aging on the metabolic responses to physical trauma an Ottawa researcher has studied strength and blood glucose metabolism in elderly people. He finds that because older people have less lean body mass, particularly muscle mass, than younger people, they are less able to tolerate trauma. They weaken faster and to a greater extent than younger patients who have experienced similar trauma, and they recover more slowly. At the same time, elderly people are less able to tolerate glucose, which is often given as part of their nutritional support. These findings have implications for care: the elderly trauma patient will be weaker than a younger counterpart, and nutrition will need to be provided early, with the glucose intolerance of elderly people borne in mind. Images p1454-a PMID:7728694

  2. Mental Findings in Trauma Victims

    PubMed Central

    CAN, İsmail Özgür; DEMİROĞLU UYANIKER, Zehra; ULAŞ, Halis; KARABAĞ, Gökmen; CİMİLLİ, Can; SALAÇİN, Serpil

    2013-01-01

    Introduction In medico-legal evaluation of trauma patients, the bio-psychological effects of the trauma and the severity of the injuries require to be evaluated. In this study, assuming the fact that psychiatric assessment is not taken into consideration in physical trauma cases, we planned to show the presence of psychological trauma in our medico-legally evaluated patients who presented with different types of traumas and to review the mental findings and diagnoses in trauma victims. Method We retrospectively analyzed the hospital records of 1975 patients aged 18 years or older who presented to the Department of Forensic Medicine at Dokuz Eylül University School of Medicine for medico-legal evaluation between 1999 and 2009. Psychiatric assessment was performed in 142 patients by the Department of Psychiatry. The data contained in medico-legal reports and patient records were then examined with respect to patients’ age, gender, nature of traumatic events, psychiatric diagnoses, descriptive characteristics of the patients, severity of trauma and past history of mental disorder and trauma experience. Results of the medicolegal evaluations were also analyzed. Result Of the 142 patients, 80 (56.3%) were female and their average age was 40.30±17.17 years. The most frequent traumatic events were traffic accidents (29.6%) and violence-related blunt force trauma (28.9%). When the distribution of the most common psychiatric diagnoses was examined, it was found that anxiety disorders were found in 69 cases (48.6%), adjustment disorders were found in 16 cases (11.3%) and mood disorders were found in 12 cases (8.5%). Among anxiety disorders, acute stress disorder (n=39) and post-traumatic stress disorder (PTSD) (n=27) were the most common ones. In 27 cases of the 142, it was determined that, psychiatric symptoms and findings did not meet the diagnostic criteria of any psychiatric disorder. Diagnosis of psychiatric disorder was not significantly related with traumatic

  3. Helicopter overtriage in pediatric trauma.

    PubMed

    Michailidou, Maria; Goldstein, Seth D; Salazar, Jose; Aboagye, Jonathan; Stewart, Dylan; Efron, David; Abdullah, Fizan; Haut, Elliot R

    2014-11-01

    Helicopter Emergency Medical Services (HEMS) have been designed to provide faster access to trauma center care in cases of life-threatening injury. However, the ideal recipient population is not fully characterized, and indications for helicopter transport in pediatric trauma vary dramatically by county, state, and region. Overtriage, or unnecessary utilization, can lead to additional patient risk and expense. In this study we perform a nationwide descriptive analysis of HEMS for pediatric trauma and assess the incidence of overtriage in this group. We reviewed records from the American College of Surgeons National Trauma Data Bank (2008-11) and included patients less than 16 years of age who were transferred from the scene of injury to a trauma center via HEMS. Overtriage was defined as patients meeting all of the following criteria: Glasgow Coma Scale (GCS) equal to 15, absence of hypotension, an Injury Severity Score (ISS) less than 9, no need for procedure or critical care, and a hospital length of stay of less than 24 hours. A total of 19,725 patients were identified with a mean age of 10.5 years. The majority of injuries were blunt (95.6%) and resulted from motor vehicle crashes (48%) and falls (15%). HEMS transported patients were predominately normotensive (96%), had a GCS of 15 (67%), and presented with minor injuries (ISS<9, 41%). Overall, 28 % of patients stayed in the hospital for less than 24 hours, and the incidence of overtriage was 17%. Helicopter overtriage is prevalent among pediatric trauma patients nationwide. The ideal model to predict need for HEMS must consider clinical outcomes in the context of judicious resource utilization. The development of guidelines for HEMS use in pediatric trauma could potentially limit unnecessary transfers while still identifying children who require trauma center care in a timely fashion. Copyright © 2014. Published by Elsevier Inc.

  4. Nasal septal trauma in children.

    PubMed

    Olsen, K D; Carpenter, R J; Kern, E B

    1979-07-01

    If the septal component of a nasal injury is adequately managed, usually the entire nasal injury will be well managed. Major or minor nasal trauma can cause cartilage fracture, deviation, dislocation, hematoma, or abscess formation, and the various associated sequelae, some of them life-threatening. A negative x-ray report should never be used as a substitute for a complete intranasal examination in any child with nasal trauma. Any nasal abnormality should be referred for immediate evaluation and treatment.

  5. [Airbag-associated ocular trauma].

    PubMed

    Muallem, M; Garzozi, H

    1997-12-15

    Airbags have received widespread recognition as an effective means of enhancing automobile safety. They are particularly effective in frontal and front angle collisions which otherwise would be fatal or cause serious injuries. Inflation of the bag helps protect the driver and front-seat-passenger from hitting the steering wheel, dashboard or windshield. In frontal crashes airbags have reduced driver deaths, hospital admission rates, and incidence of brain injury. On the other hand, an increasing variety of airbag-associated organ injuries has been reported, including blunt ocular and chemical trauma, 2 cases of ocular trauma due to airbags which resulted in choroidal rupture with disastrous outcome in terms of visual acuity are presented. Since the very first report in May 1991 of airbag-associated ocular trauma until June 1996, there has apparently been only 1 case of choroidal rupture due to airbag-associated trauma, presented in 1 sentence of a brief report. Although airbag-related eye trauma may be relatively infrequent, the severity of the injuries incurred, especially when the posterior segment of the eye was involved, warrants research on new airbag design that minimizes the risk of ocular injury. Meanwhile all cases of airbag-associated ocular trauma should be reported, so that medical staff, the general population and car manufacturers will become more aware of this medical issue.

  6. EAU guidelines on iatrogenic trauma.

    PubMed

    Summerton, Duncan J; Kitrey, Noam D; Lumen, Nicolaas; Serafetinidis, Efraim; Djakovic, Nenad

    2012-10-01

    The European Association of Urology (EAU) Trauma Guidelines Panel presents an updated iatrogenic trauma section of their guidelines. Iatrogenic injuries are known complications of surgery to the urinary tract. Timely and adequate intervention is key to their management. To assess the optimal evaluation and management of iatrogenic injuries and present an update of the iatrogenic section of the EAU Trauma Guidelines. A systematic search of the literature was conducted, consulting Medline and the Cochrane Register of Systematic reviews. No time limitations were applied, although the focus was on more recent publications. The expert panel developed statements and recommendations. Statements were rated according to their level of evidence, and recommendations received a grade following a rating system modified from the Oxford Centre for Evidence-based Medicine. Currently, only limited high-powered studies are available addressing iatrogenic injuries. Because the reporting of complications or sequelae of interventions is now increasingly becoming a standard requirement, this situation will likely change in the future. This section of the trauma guidelines presents an updated overview of the treatment of iatrogenic trauma that will be incorporated in the trauma guidelines available at the EAU Web site (http://www. uroweb.org/guidelines/online-guidelines/). Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  7. Blunt abdominal trauma in children.

    PubMed

    Schonfeld, Deborah; Lee, Lois K

    2012-06-01

    This review will examine the current evidence regarding pediatric blunt abdominal trauma and the physical exam findings, laboratory values, and radiographic imaging associated with the diagnosis of intra-abdominal injuries (IAI), as well as review the current literature on pediatric hollow viscus injuries and emergency department disposition after diagnosis. The importance of the seat belt sign on physical examination and screening laboratory data remains controversial, although screening hepatic enzymes are recommended in the evaluation of nonaccidental trauma to identify occult abdominal organ injuries. Focused Assessment with Sonography for Trauma (FAST) has modest sensitivity for hemoperitoneum and IAI in the pediatric trauma patient. Patients with concern for undiagnosed IAI, including bowel injury, may be considered for hospital admission and serial abdominal exams without an increased risk of complications, if an exploratory laparotomy is not performed emergently. Although the FAST exam is not recommended as the sole screening tool to rule out IAI in hemodynamically stable trauma patients, it may be used in conjunction with the physical exam and laboratory findings to identify children at risk for IAI. Children with a normal physical exam and normal abdominal CT may not require routine hospitalization after blunt abdominal trauma.

  8. Telematics in acute trauma care.

    PubMed

    Juhra, C; Vordemvenne, T; Hartensuer, R; Uckert, F; Raschke, M J

    2009-01-01

    Each year, 20,000 people in Germany die because of a traffic accident. Altogether, yearly productivity loss caused by these injuries is estimated to be around 5 billion Euros. International and national studies revealed the trauma center level of the primary hospital as the major predictor for trauma related mortality. In 2006 the German Society for Trauma Surgery (DGU) called its members to form regionally based networks for the exchange of data among hospitals engaged in trauma care. In April 2008 the north-west region of Germany with 49 hospitals, three hospitals in the Netherlands, and local emergency services founded the "TraumaNetwork NorthWest (TNNW). The major goals of the TNNW are: 1) to shorten the time between accident and admission to the appropriate hospital, 2) to create effective means of communication, and 3) to implement common pre- and in-hospital standards for trauma care. Since the needed application software is not commercially available, a team of computer and medical specialists has been formed for its development. Once the software is in place, a pre- and post-analysis will be performed to study the consequences of the application on transportation time and injury-related mortality within the region. The project is recognized as a pilot project by the DGU and if it is successful is meant to be adapted across Germany.

  9. Renal Trauma: The Rugby Factor

    PubMed Central

    Freeman, Catherine M.; Kelly, Michael E.; Nason, Gregory J.; McGuire, Barry B.; Kilcoyne, Aoife; Ryan, John; Lennon, Gerald; Galvin, David; Quinlan, David; Mulvin, David

    2015-01-01

    Introduction Renal trauma accounts for 5% of all trauma cases. Rare mechanisms of injuries including sports participation are increasingly common. Rugby-related trauma poses a conundrum for physicians and players due to the absence of clear guidelines and a paucity of evidence. Our series highlights traumatic rugby-related renal injuries in our institution, and emphasize the need for international guidelines on management. Methods A retrospective review of all abdominal traumas between January 2006 and April 2013, specifically assessing for renal related trauma that were secondary to rugby injuries was performed. All patients' demographics, computerized tomography results, hematological and biochemical results and subsequent management were recorded. Results Five male patients presented with rugby-related injuries. Mean age was 21 years old. All patients were hemodynamically stable and managed conservatively in acute setting. One patient was detected to have an unknown pre-existing atrophic kidney that had been subsequently injured, and was booked for an elective nephrectomy an 8-week interval. Conclusion Rugby-related trauma has generated essential attention. This paper serves to highlight this type of injury and the need for defined guidelines on role of imaging and international consensus on timing of return to contact sport, in both professional and amateur settings. PMID:26889132

  10. International trauma teleconference: evaluating trauma care and facilitating quality improvement.

    PubMed

    Parra, Michael W; Castillo, Roberto C; Rodas, Edgar B; Suarez-Becerra, Jose M; Puentes-Manosalva, Fabian E; Wendt, Luke M

    2013-09-01

    Evaluation, development, and implementation of trauma systems in Latin America are challenging undertakings as no model is currently in place that can be easily replicated throughout the region. The use of teleconferencing has been essential in overcoming other challenges in the medical field and improving medical care. This article describes the use of international videoconferencing in the field of trauma and critical care as a tool to evaluate differences in care based on local resources, as well as facilitating quality improvement and system development in Latin America. In February 2009, the International Trauma and Critical Care Improvement Project was created and held monthly teleconferences between U.S. trauma surgeons and Latin American general surgeons, emergency physicians, and intensivists. In-depth discussions and prospective evaluations of each case presented were conducted by all participants based on resources available. Care rendered was divided in four stages: (1) pre-hospital setting, (2) emergency room or trauma room, (3) operating room, and (4) subsequent postoperative care. Furthermore, the participating institutions completed an electronic survey of trauma resources based on World Health Organization/International Association for Trauma and Surgical Intensive Care guidelines. During a 17-month period, 15 cases in total were presented from a Level I and a Level II U.S. hospital (n=3) and five Latin American hospitals (n=12). Presentations followed the Advanced Trauma Life Support sequence in all U.S. cases but in only 3 of the 12 Latin American cases. The following deficiencies were observed in cases presented from Latin America: pre-hospital communication was nonexistent in all cases; pre-hospital services were absent in 60% of cases presented; lack of trauma team structure was evident in the emergency departments; during the initial evaluation and resuscitation, the Advanced Trauma Life Support protocol was followed one time and the Clinical

  11. Trauma of the midface

    PubMed Central

    Kühnel, Thomas S.; Reichert, Torsten E.

    2015-01-01

    Fractures of the midface pose a serious medical problem as for their complexity, frequency and their socio-economic impact. Interdisciplinary approaches and up-to-date diagnostic and surgical techniques provide favorable results in the majority of cases though. Traffic accidents are the leading cause and male adults in their thirties are affected most often. Treatment algorithms for nasal bone fractures, maxillary and zygomatic fractures are widely agreed upon whereas trauma to the frontal sinus and the orbital apex are matter of current debate. Advances in endoscopic surgery and limitations of evidence based gain of knowledge are matters that are focused on in the corresponding chapter. As for the fractures of the frontal sinus a strong tendency towards minimized approaches can be seen. Obliteration and cranialization seem to decrease in numbers. Some critical remarks in terms of high dose methylprednisolone therapy for traumatic optic nerve injury seem to be appropriate. Intraoperative cone beam radiographs and preshaped titanium mesh implants for orbital reconstruction are new techniques and essential aspects in midface traumatology. Fractures of the anterior skull base with cerebrospinal fluid leaks show very promising results in endonasal endoscopic repair. PMID:26770280

  12. Trauma and termination.

    PubMed

    Ferraro, F

    1995-02-01

    The author suggests a particular reading of the thesis put forward by Freud in 'Analysis terminable and interminable' that an effective and more definitive conclusion may be expected in analyses of cases with traumatic aetiology. This reading shifts the emphasis from the patient's history to the possibility of its crystallising in focal nuclei emerging within the analytic relationship under the pressure of the termination. The revival of separation anxieties which cannot be worked through, and their crystallisation in precipitating traumatic events, may give rise to decisive psychic work allowing the analysis to be brought to a conclusion. Two case histories are presented to show how the end of the analysis assumes the form of a new trauma, which reactivates in the present, traumatic anxieties from the patient's own infantile history. In the first case a premature birth and in the second a miscarriage, originally experienced as isolated automatic events without time or history, are relived in the terminal phase as vicissitudes of the transference, so that new meaning can be assigned to them and they can be withdrawn from the somatic cycle of repetition. The powerful tendency to act out and the intense countertransference pressure on the analyst are discussed in the light of the specificities of this phase, which is crucial to the success of the analysis. This leads to a re-examination, in the concluding notes, of some theoretical questions inherent in the problem of the termination and, in particular, to a discussion of the ambiguous concept of a natural ending.

  13. Trauma-Informed Care in the Massachusetts Child Trauma Project.

    PubMed

    Bartlett, Jessica Dym; Barto, Beth; Griffin, Jessica L; Fraser, Jenifer Goldman; Hodgdon, Hilary; Bodian, Ruth

    2016-05-01

    Child maltreatment is a serious public health concern, and its detrimental effects can be compounded by traumatic experiences associated with the child welfare (CW) system. Trauma-informed care (TIC) is a promising strategy for addressing traumatized children's needs, but research on the impact of TIC in CW is limited. This study examines initial findings of the Massachusetts Child Trauma Project, a statewide TIC initiative in the CW system and mental health network. After 1 year of implementation, Trauma-Informed Leadership Teams in CW offices emerged as key structures for TIC systems integration, and mental health providers' participation in evidence-based treatment (EBT) learning collaboratives was linked to improvements in trauma-informed individual and agency practices. After approximately 6 months of EBT treatment, children had fewer posttraumatic symptoms and behavior problems compared to baseline. Barriers to TIC that emerged included scarce resources for trauma-related work in the CW agency and few mental providers providing EBTs to young children. Future research might explore variations in TIC across service system components as well as the potential for differential effects across EBT models disseminated through TIC. © The Author(s) 2015.

  14. The Queensland Trauma Plan project.

    PubMed

    Fitzgerald, Gerry; Tippett, Vivienne; Schuetz, Michael; Pollard, Cliff

    2008-09-01

    The aim of this paper is to outline the development of 'A Trauma Plan for Queensland'. Injury is one of Australia's National Health Priorities. The full impact of injury, including early death, reduction in quality of life and the social and emotional costs to individuals and the community are immeasurable. The direct health-care costs alone amounted to A dollars 4.13 bn in 2000-2001. Queensland has one of the highest rates of injury in Australia. An estimated 1500 Queenslanders die each year as a result of major traumatic injury and it is the single most common cause of death between the ages of 1 and 35 years. The Queensland Trauma Plan was based on a detailed analysis of the management and outcome of trauma in Queensland and used an extensive process of stakeholder consultation to identify proposals for system improvement. Sequential workshops helped identify the issues and strategies for system improvement. These proposals were condensed into a high-level strategic plan, which has now been endorsed by the Queensland Government. The Trauma Plan identifies service enhancements and the improved coordination required to support ongoing policy development, research and education. The Plan outlines a future direction for the development of trauma services and the system and structures required to support that development. The Trauma Plan holds potential as a model for the development of future trauma services and injury prevention programmes. The process shows the value of engagement of clinicians and others into the policy development and planning processes. The outcome reinforces the value of taking a whole of community, coordinated and collaborative approach to injury prevention and management.

  15. Trauma Training and Workload: A National Survey.

    PubMed

    McSorley, K; Quinlan, J

    2015-09-01

    Trauma is a major source of mortality and morbidity throughout Ireland. Training in trauma is dependant on experience gained by trainees within specific posts. Trauma services are a topical issue at present with much discussion about delivery and restructuring. With this in mind we conducted an online survey of trainees in emergency medicine, orthopaedic and general surgery to assess current experience and opinions with regard to trauma. The survey was vetted and distributed by the relevant training bodies. 59(98.33%) respondents believed smaller units should be bypassed for major trauma and 55 (91.67%) believed that larger hospitals receiving major trauma should have a trauma theatre available 24-hours a day. 55 (91.67%) also foresaw themselves covering major trauma as consultants, consequently these trainees will be the consultants developing, moulding and working in this restructured trauma service.

  16. Warfare facial trauma: who will treat?

    PubMed

    Holmes, D K

    1996-09-01

    Most of the facial trauma in the United States is treated in trauma centers in large urban or university medical centers, with limited trauma care taking place in our military medical treatment facilities. In many cases, active duty facial trauma surgeons may lack the current experience necessary for the optimal care of facial wounds of our inquired military personnel in the early stages of the conflict. Consequently, the skills of the reservist trauma surgeons who staff our civilian trauma centers and who care for facial trauma victims daily will be critical in caring for our wounded. These "trauma-current" reservists may act as a cadre of practiced surgeons to aid those with less experience. A plan for refresher training of active duty facial trauma surgeons is presented.

  17. The Canadian Forces trauma care system

    PubMed Central

    Tien, Homer

    2011-01-01

    According to the Trauma Association of Canada, a trauma system is a preplanned, organized and coordinated injury-control effort in a defined geographic area. An effective trauma system engages in comprehensive injury surveillance and prevention programs; delivers trauma care from the time of injury to recovery; engages in research, training and performance improvement; and establishes linkages with an all-hazards emergency preparedness program. To support Canada’s combat mission in Afghanistan, the Canadian Forces (CF) developed a comprehensive trauma system based around its trauma hospital — the Role 3 Multinational Medical Unit (R3MMU) at Kandahar Airfield. This article reviews the essential components of a modern trauma system, outlines the evidence that trauma systems improve care to injury victims and describes how the current CF trauma system was developed. PMID:22099323

  18. National inventory of hospital trauma centers.

    PubMed

    MacKenzie, Ellen J; Hoyt, David B; Sacra, John C; Jurkovich, Gregory J; Carlini, Anthony R; Teitelbaum, Sandra D; Teter, Harry

    2003-03-26

    Trauma centers benefit thousands of injured individuals every day and play a critical role in responding to disasters. The last full accounting of the number and distribution of trauma centers identified 471 trauma centers in the United States in 1991. To determine the number and configuration of trauma centers and identify gaps in coverage. Interviews with trauma center directors (September 2001 to April 2002), data from the American Hospital Association's Annual Survey of Hospitals (2000), and the US Health Resources Administration's Area Resource File (2001) were used to determine characteristics of trauma center hospitals and the geographic areas they serve in all 50 states and in the District of Columbia. Characteristics of trauma centers were examined by level of care and compared with nontrauma centers. Hospitals are designated or certified as trauma centers by a state or regional authority or verified as trauma centers by the American College of Surgeons Committee on Trauma. Trauma centers that treat only children (n = 31) were excluded. Total number of trauma centers and number of trauma centers per million population. In 2002, there were 1154 trauma centers in the United States, including 190 level I centers and 263 level II centers. Several states have categorized every hospital with an emergency department at some level of trauma care while others have designated a limited number of level I and level II centers only. The number of level I and II centers per million population ranges from 0.19 to 7.8 by state. When compared with nontrauma center hospitals, trauma centers are larger, more likely to be teaching hospitals, and more likely to offer specialized services. Although the availability of trauma centers has improved, challenges remain to ensure the optimal number, distribution, and configuration of trauma centers. These challenges must be addressed, especially in light of the recent emphasis on hospital preparedness and homeland security.

  19. Peritraumatic dissociative experiences, trauma narratives, and trauma pathology.

    PubMed

    Zoellner, Lori A; Alvarez-Conrad, Jennifer; Foa, Edna B

    2002-02-01

    Peritraumatic dissociation, i.e., dissociation during or immediately after a traumatic event, has been associated with persistence of trauma-related pathology. Peritraumatic dissociation may interfere with encoding of traumatic memories and this style may impede recovery. This study examines this hypothesis by analyzing trauma narratives from 28 female sexual and nonsexual assault victims who reported either high or low peritraumatic dissociation. Participants were asked to recount their assault. Narratives were videotaped, transcribed, and coded. Narratives of individuals with high peritraumatic dissociation had higher grade levels and a trend toward lower reading ease than those with low peritraumatic dissociation. Both higher grade levels and lower reading ease of prethreat sections of trauma narratives were related to posttreatment reexperiencing and anxiety symptoms.

  20. [24 hours at Johannesburg Hospital Trauma Unit].

    PubMed

    Østerballe, Lene; Asbury, Sarah; Boffard, Kenneth D

    2011-05-02

    This paper describes the hectic work as a doctor at the Trauma Unit of Charlotte Maxeke Johannesburg Academic Hospital, a highly regarded and well-visited trauma unit worldwide. A trauma junior doctor is followed on a 24-hour-call through a full casualty to urgent operations and complicated postoperative management of the trauma patient. In a diary fashion the paper describes the evidence-based guidelines of management of certain trauma cases brought into the trauma unit during the 24-hour-shift.

  1. Psychological care in trauma patients.

    PubMed

    Mohta, Medha; Sethi, A K; Tyagi, Asha; Mohta, Anup

    2003-01-01

    The clinician manages trauma patients in the emergency room, operation theatre, intensive care unit and trauma ward with an endeavour to provide best possible treatment for physical injuries. At the same time, it is equally important to give adequate attention to behavioural and psychological aspects associated with the event. Knowledge of the predisposing factors and their management helps the clinician to prevent or manage these psychological problems. Various causes of psychological disturbances in trauma patients have been highlighted. These include pain, the sudden and unexpected nature of events and the procedures and interventions necessary to resuscitate and stabilise the patient. The ICU and trauma ward environment, sleep and sensory deprivation, impact of injury on CNS, medications and associated pre-morbid conditions are also significant factors. Specific problems that concern the traumatised patients are helplessness, humiliation, threat to body image and mental symptoms. The patients react to these stressors by various defence mechanisms like conservation withdrawal, denial, regression, anger, anxiety and depression. Some of them develop delirium or even more severe problems like acute stress disorder or post-traumatic stress disorder. Physical, pharmacological or psychological interventions can be performed to prevent or minimise these problems in trauma patients. These include adequate pain relief, prevention of sensory and sleep deprivation, providing familiar surroundings, careful explanations and reassurance to the patient, psychotherapy and pharmacological treatment whenever required.

  2. The study of psychic trauma.

    PubMed

    Bacciagaluppi, Marco

    2011-01-01

    This article starts from the DSM definition of psychic trauma. A central source in this field is the 1992 book by Judith Herman. One line of investigation is the sexual abuse of women and children. In an early phase, both Janet and Freud described dissociation as a reaction to trauma. In 1897, Freud disputed the reality of sexual trauma, a position countered later by Ferenczi. In a later phase, this subject was investigated by the American feminist movement. Studies of physical abuse are then described, followed by mental abuse and neglect. Another line of investigation is combat neurosis. The two lines converged in the definition of PTSD and its incorporation into the DSM in 1980. The views on trauma of John Bowlby and Alice Miller are also discussed. The integration of the relational model in psychoanalysis with the trauma literature is presented. The most recent advances are located in neurobiology. The discussion makes a preliminary investigation of the remote causes of war and sexual violence.

  3. Appendicitis following blunt abdominal trauma.

    PubMed

    Cobb, Travis

    2017-09-01

    Appendicitis is a frequently encountered surgical problem in the Emergency Department (ED). Appendicitis typically results from obstruction of the appendiceal lumen, although trauma has been reported as an infrequent cause of acute appendicitis. Intestinal injury and hollow viscus injury following blunt abdominal trauma are well reported in the literature but traumatic appendicitis is much less common. The pathophysiology is uncertain but likely results from several mechanisms, either in isolation or combination. These include direct compression/crush injury, shearing injury, or from indirect obstruction of the appendiceal lumen by an ileocecal hematoma or traumatic impaction of stool into the appendix. Presentation typically mirrors that of non-traumatic appendicitis with nausea, anorexia, fever, and right lower quadrant abdominal tenderness and/or peritonitis. Evaluation for traumatic appendicitis requires a careful history and physical exam. Imaging with ultrasound or computed tomography is recommended if the history and physical do not reveal an acute surgical indication. Treatment includes intravenous antibiotics and surgical consultation for appendectomy. This case highlights a patient who developed acute appendicitis following blunt trauma to the abdomen sustained during a motor vehicle accident. Appendicitis must be considered as part of the differential diagnosis in any patient who presents to the ED with abdominal pain, including those whose pain begins after sustaining blunt trauma to the abdomen. Because appendicitis following trauma is uncommon, timely diagnosis requires a high index of suspicion. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Trauma, attachment, and intimate relationships.

    PubMed

    Zurbriggen, Eileen L; Gobin, Robyn L; Kaehler, Laura A

    2012-01-01

    Intimate relationships can both affect and be affected by trauma and its sequelae. This special issue highlights research on trauma, attachment, and intimate relationships. Several themes emerged. One theme is the exploration of the associations between a history of trauma and relational variables, with an emphasis on models using these variables as mediators. Given the significance of secure attachment for healthy relationships, it is not surprising that attachment emerges as another theme of this issue. Moreover, a key component of relationships is trust, and so a further theme of this issue is betrayal trauma (J. J. Freyd, 1996 ). As the work included in this special issue makes clear, intimate relationships of all types are important for the psychological health of those exposed to traumatic events. In order to best help trauma survivors and those close to them, it is imperative that research exploring these issues be presented to research communities, clinical practitioners, and the public in general. This special issue serves as one step toward that objective.

  5. Management of paediatric liver trauma.

    PubMed

    van As, A B; Millar, Alastair J W

    2017-04-01

    Of all the intra-abdominal solid organs, the liver is the most vulnerable to blunt abdominal trauma. The majority of liver ruptures present in combination with other abdominal or extra-abdominal injuries. Over the last three decades, the management of blunt liver trauma has evolved from obligatory operative to non-operative management in over 90% of cases. Penetrating liver injuries more often require operative intervention and are managed according to adult protocols. The greatest clinical challenge remains the timely identification of the severely damaged liver with immediate and aggressive resuscitation and expedition to laparotomy. The operative management can be taxing and should ideally be performed in a dedicated paediatric surgical centre with experience in dealing with such trauma. Complications can occur early or late and include haemobilia, intrahepatic duct rupture with persistent biliary fistula, bilaemia, intrahepatic haematoma, post-traumatic cysts, vascular outflow obstruction, and gallstones. The prognosis is generally excellent.

  6. Transfusion Practice in Trauma Resuscitation.

    PubMed

    Eckel, Ashley M; Hess, John R

    2017-08-01

    Recognition of the acute coagulopathy of trauma and the limits of reconstituting whole blood with conventional blood components has led to a radical change in the way trauma patients with severe injuries are resuscitated. Massive transfusion protocols (MTP) have evolved toward the administration of conventional blood components in fixed ratios. Administration of a 1:1:1 unit ratio of fresh frozen plasma to whole-blood-derived platelets to packed red blood cells is now the most common strategy and the stated goal of directors of >80% of the level I trauma centers in the United States. Various physiologic scoring systems exist to guide early activation of an MTP. After activation of an MTP, more goal-directed therapy follows as soon as laboratory results are available. Hemostatic resuscitation using defined blood component ratios modified by early laboratory results can lead to more efficient blood product usage and improved patient outcomes.

  7. Pancreatic trauma: A concise review

    PubMed Central

    Debi, Uma; Kaur, Ravinder; Prasad, Kaushal Kishor; Sinha, Saroj Kant; Sinha, Anindita; Singh, Kartar

    2013-01-01

    Traumatic injury to the pancreas is rare and difficult to diagnose. In contrast, traumatic injuries to the liver, spleen and kidney are common and are usually identified with ease by imaging modalities. Pancreatic injuries are usually subtle to identify by different diagnostic imaging modalities, and these injuries are often overlooked in cases with extensive multiorgan trauma. The most evident findings of pancreatic injury are post-traumatic pancreatitis with blood, edema, and soft tissue infiltration of the anterior pararenal space. The alterations of post-traumatic pancreatitis may not be visualized within several hours following trauma as they are time dependent. Delayed diagnoses of traumatic pancreatic injuries are associated with high morbidity and mortality. Imaging plays an important role in diagnosis of pancreatic injuries because early recognition of the disruption of the main pancreatic duct is important. We reviewed our experience with the use of various imaging modalities for diagnosis of blunt pancreatic trauma. PMID:24379625

  8. Management of Carotid Artery Trauma

    PubMed Central

    Lee, Thomas S.; Ducic, Yadranko; Gordin, Eli; Stroman, David

    2014-01-01

    With increased awareness and liberal screening of trauma patients with identified risk factors, recent case series demonstrate improved early diagnosis of carotid artery trauma before they become problematio. There remains a need for unified screening criteria for both intracranial and extracranial carotid trauma. In the absence of contraindications, antithrombotic agents should be considered in blunt carotid artery injuries, as there is a significant risk of progression of vessel injury with observation alone. Despite CTA being used as a common screening modality, it appears to lack sufficient sensitivity. DSA remains to be the gold standard in screening. Endovascular techniques are becoming more widely accepted as the primary surgical modality in the treatment of blunt extracranial carotid injuries and penetrating/blunt intracranial carotid lessions. Nonetheless, open surgical approaches are still needed for the treatment of penetrating extracranial carotid injuries and in patients with unfavorable lesions for endovascular intervention. PMID:25136406

  9. Accidental hypothermia in severe trauma.

    PubMed

    Vardon, Fanny; Mrozek, Ségolène; Geeraerts, Thomas; Fourcade, Olivier

    2016-10-01

    Hypothermia, along with acidosis and coagulopathy, is part of the lethal triad that worsen the prognosis of severe trauma patients. While accidental hypothermia is easy to identify by a simple measurement, it is no less pernicious if it is not detected or treated in the initial phase of patient care. It is a multifactorial process and is a factor of mortality in severe trauma cases. The consequences of hypothermia are many: it modifies myocardial contractions and may induce arrhythmias; it contributes to trauma-induced coagulopathy; from an immunological point of view, it diminishes inflammatory response and increases the chance of pneumonia in the patient; it inhibits the elimination of anaesthetic drugs and can complicate the calculation of dosing requirements; and it leads to an over-estimation of coagulation factor activities. This review will detail the pathophysiological consequences of hypothermia, as well as the most recent principle recommendations in dealing with it.

  10. Transfusion medicine in trauma patients

    PubMed Central

    Murthi, Sarah B; Dutton, Richard P; Edelman, Bennett B; Scalea, Thomas M; Hess, John R

    2011-01-01

    Injured patients stress the transfusion service with frequent demands for uncrossmatched red cells and plasma, occasional requirements for large amounts of blood products and the need for new and better blood products. Transfusion services stress trauma centers with demands for strict accountability for individual blood component units and adherence to indications in a clinical field where research has been difficult, and guidance opinion-based. New data suggest that the most severely injured patients arrive at the trauma center already coagulopathic and that these patients benefit from prompt, specific, corrective treatment. This research is clarifying trauma system requirements for new blood products and blood-product usage patterns, but the inability to obtain informed consent from severely injured patients remains an obstacle to further research. PMID:21083009

  11. Vascular Shunts in Civilian Trauma

    PubMed Central

    Abou Ali, Adham N.; Salem, Karim M.; Alarcon, Louis H.; Bauza, Graciela; Pikoulis, Emmanuel; Chaer, Rabih A.; Avgerinos, Efthymios D.

    2017-01-01

    Experience with temporary intravascular shunts (TIVS) for vessel injury comes from the military sector and while the indications might be clear in geographically isolated and under resourced war zones, this may be an uncommon scenario in civilian trauma. Data supporting TIVS use in civilian trauma have been extrapolated from the military literature where it demonstrated improved life and limb salvage. Few non-comparative studies from the civilian literature have also revealed similar favorable outcomes. Still, TIVS placement in civilian vascular injuries is uncommon and by some debatable given the absence of clear indications for placement, the potential for TIVS-related complications, the widespread resources for immediate and definitive vascular repair, and the need for curtailing costs and optimizing resources. This article reviews the current evidence and the role of TIVS in contemporary civilian trauma management. PMID:28775985

  12. [Obstetric trauma. A current problem?].

    PubMed

    Barrientos, G; Cervera, P; Navascués, J; Sánchez, R; Romero, R; Pérez-Sheriff, V; Cerdá, J; Soleto, J; Vázquez, J

    2000-10-01

    Advances in obstetric practice have decreased birth traumas in the last years, although they are still an important chapter in neonatal age. Between 1993-1998 a total of 21,375 stillborns were registered with a total of 309 birth injuries in 303 neonates (1.44%). The diagnoses were: 2 liver subcapsular hematomas, 105 cephalohematomas, 16 parietal fractures, 11 subdural hemorrhages, 107 clavicular fractures, 10 miscellaneous fractures, 8 soft tissue injuries, 25 facial nerve injuries and 25 braquial palsy. About relation between type of labor and birth trauma was found that clavicular fracture and cephalic vaginal delivery were associated in 50% of the cases, cephalohematoma and forceps in 51%, braquial palsy and vaginal delivery in 44% and forceps in 36%. High weight at birth was another risk factor for entities such as clavicular fracture and braquial palsy. We conclude that birth trauma is a pathology with a relevant incidence and their epidemiology factor had to be known.

  13. Vascular Injury in Orthopedic Trauma.

    PubMed

    Mavrogenis, Andreas F; Panagopoulos, George N; Kokkalis, Zinon T; Koulouvaris, Panayiotis; Megaloikonomos, Panayiotis D; Igoumenou, Vasilios; Mantas, George; Moulakakis, Konstantinos G; Sfyroeras, George S; Lazaris, Andreas; Soucacos, Panayotis N

    2016-07-01

    Vascular injury in orthopedic trauma is challenging. The risk to life and limb can be high, and clinical signs initially can be subtle. Recognition and management should be a critical skill for every orthopedic surgeon. There are 5 types of vascular injury: intimal injury (flaps, disruptions, or subintimal/intramural hematomas), complete wall defects with pseudoaneurysms or hemorrhage, complete transections with hemorrhage or occlusion, arteriovenous fistulas, and spasm. Intimal defects and subintimal hematomas with possible secondary occlusion are most commonly associated with blunt trauma, whereas wall defects, complete transections, and arteriovenous fistulas usually occur with penetrating trauma. Spasm can occur after either blunt or penetrating trauma to an extremity and is more common in young patients. Clinical presentation of vascular injury may not be straightforward. Physical examination can be misleading or initially unimpressive; a normal pulse examination may be present in 5% to 15% of patients with vascular injury. Detection and treatment of vascular injuries should take place within the context of the overall resuscitation of the patient according to the established principles of the Advanced Trauma Life Support (ATLS) protocols. Advances in the field, made mostly during times of war, have made limb salvage the rule rather than the exception. Teamwork, familiarity with the often subtle signs of vascular injuries, a high index of suspicion, effective communication, appropriate use of imaging modalities, sound knowledge of relevant technique, and sequence of surgical repairs are among the essential factors that will lead to a successful outcome. This article provides a comprehensive literature review on a subject that generates significant controversy and confusion among clinicians involved in the care of trauma patients. [Orthopedics. 2016; 39(4):249-259.].

  14. [Polyvagal theory and emotional trauma].

    PubMed

    Leikola, Anssi; Mäkelä, Jukka; Punkanen, Marko

    2016-01-01

    According to the polyvagal theory, the autonomic nervous system can, in deviation from the conventional theory, be divided in three distinct parts that are in hierarchical relationship with each other. The most-primitive autonomic control results in depression of vital functions, the more evolved one in fighting or escape and the most evolved one in social involvement. Practical application of the polyvagal theory has resulted in positive results above all in the treatment of emotional trauma. in Finland, therapy of complex trauma is founded on the theory of structural dissociation of the personality, which together with the polyvagal theory forms a practical frame of reference for psychotherapeutic work.

  15. Cruciform position for trauma resuscitation.

    PubMed

    Mitra, Biswadev; Fitzgerald, Mark C; Olaussen, Alexander; Thaveenthiran, Prasanthan; Bade-Boon, Jordan; Martin, Katherine; Smit, De Villiers; Cameron, Peter A

    2017-04-01

    Multiply injured patients represent a particularly demanding subgroup of trauma patients as they require urgent simultaneous clinical assessments using physical examination, ultrasound and invasive monitoring together with critical management, including tracheal intubation, thoracostomies and central venous access. Concurrent access to multiple body regions is essential to facilitate the concept of 'horizontal' resuscitation. The current positioning of trauma patient, with arms adducted, restricts this approach. Instead, the therapeutic cruciform positioning, with arms abducted at 90°, allows planning and performing of multiple life-saving interventions simultaneously. This positioning also provides a practical surgical field with improved sterility and procedural access.

  16. Male genital trauma in sports.

    PubMed

    Hunter, Stanley R; Lishnak, Timothy S; Powers, Andria M; Lisle, David K

    2013-04-01

    Male genital trauma is a rare but potentially serious sports injury. Although such an injury can occur by many different mechanisms, including falls, collisions, straddle injuries, kicks, and equipment malfunction, the clinical presentation is typically homogeneous, characterized by pain and swelling. Almost all sports-related male genital injury comes from blunt force trauma, with involvement of scrotal structures far more common than penile structures. Most injuries can be treated conservatively, but catastrophic testicular injury must first be ruled out. Despite being relatively uncommon compared with other sports injuries, more than half of all testicular injuries are sustained during sports.

  17. Issues in Pediatric Craniofacial Trauma.

    PubMed

    Chandra, Srinivasa R; Zemplenyi, Karen S

    2017-11-01

    Pediatric maxillofacial fractures are rare owing to anatomic differences between juvenile and adult skulls. Children's bone is less calcified, allowing for "greenstick fractures." The overall ratio of cranial to facial volume decreases with age. In children, tooth buds comprise the majority of mandibular volume. The most common pediatric craniomaxillofacial fractures for children ages 0 to 18 years old are mandible, nasal bone, and maxilla and zygoma. Growth potential must be considered when addressing pediatric trauma and often a less-is-more approach is best when considering open versus closed treatment. Regardless of treatment, pediatric trauma cases must be followed through skeletal maturity. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Acoustic trauma caused by lightning.

    PubMed

    Mora-Magaña, I; Collado-Corona, M A; Toral-Martiñòn, R; Cano, A

    1996-03-01

    Lesions produced by exposure to noise are frequent in everyday life. Injuries may be found in all systems of the human body, from the digestive to the endocrine, from the cardiovascular to the nervous system. Many organs may be damaged, the ear being one of them. It is known that noise produced by factories, airports, musical instruments and even toys can cause auditory loss. Noises in nature can also cause acoustic trauma. This report is the case history of acoustic trauma caused by lightning. The patient was studied with CAT scan, electroencephalogram, and brain mapping, impedance audiometry with tympanogram and acoustic reflex, audiometry and evoked otoacoustics emissions: distortion products and transients.

  19. Trauma systems: improving trauma outcomes in North Carolina.

    PubMed

    Becher, Robert D; Meredith, J Wayne

    2010-01-01

    Since the 1970s, there has been a tremendous improvement in the outcomes for injured patients in North Carolina; the scope, significance, and virtue of this achievement are remarkable. This commentary reviews how the state has consistently decreased the burden of injury through its integrated, systems-based approach to trauma care.

  20. Abusive Head Trauma (Shaken Baby Syndrome)

    MedlinePlus

    ... to a child's brain as a result of child abuse. Abusive head trauma (AHT) can be caused by ... trauma is the leading cause of death in child abuse cases in the United States. Because the anatomy ...

  1. Coping with Unexpected Events: Depression and Trauma

    MedlinePlus

    ... DBSAlliance.org better! Go! Coping With Unexpected Events: Depression and Trauma Responding to Traumatic Events When we ... immediately. back to top How to Cope with Depression After Trauma The healing process after a traumatic ...

  2. Management of ocular, orbital, and adnexal trauma

    SciTech Connect

    Spoor, T.C.; Nesi, F.A.

    1988-01-01

    This book contains 20 chapters. Some of the chapter titles are: The Ruptured Globe: Primary Care; Corneal Trauma, Endophthalmitis; Antibiotic Usage; Radiology of Orbital Trauma; Maxillofacial Fractures; Orbital Infections; and Basic Management of Soft Tissue Injury.

  3. Facial nerve palsy due to birth trauma

    MedlinePlus

    Seventh cranial nerve palsy due to birth trauma; Facial palsy - birth trauma; Facial palsy - neonate; Facial palsy - infant ... infant's facial nerve is also called the seventh cranial nerve. It can be damaged just before or at ...

  4. Dental traumas during the military service.

    PubMed

    Immonen, Matti; Anttonen, Vuokko; Patinen, Pertti; Kainulainen, Marco-Juhan; Päkkilä, Jari; Tjäderhane, Leo; Oikarinen, Kyösti

    2014-06-01

    Dental traumas are most frequent during the first three decades of life and more frequent among males than females. Approximately 80% (n = 28 000) of the male age cohort performs military service annually in Finland. As little is known of dental, head, and neck traumas during the military service, our aim was to study the etiology, number and occurrence of traumas of the Finnish conscripts during one calendar year. Our hypothesis was that above-mentioned traumas comprise a remarkable proportion of military accidents. The data comprised of all the Finnish conscripts' trauma cases in the year 2009 (mean age 20.1 years, SD 1.1). The frequency, mechanism, and time of the incidences were analyzed. Of the total 1432 trauma cases, 303 (23%) involved head, neck, or dentition. The occurrence rate of dental traumas was 6.5 cases/1000 persons/year. Dental traumas comprised 14.3% of all traumas. The most common mechanism for dental traumas was a blow-type force. First 4 months of the service and winter time were periods of increased risk of dental traumas. Two-thirds of the dental traumas, one-third of the body traumas and a quarter of the head and neck traumas occurred during military field exercises. Most dental traumas required a visit to a military dental clinic and also needed follow-up care. Head, neck, and dental injuries are common during the military service in Finland. Prevention of dental traumas and need for first aid dental skills of the personnel should be emphasized. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  5. The role of the trauma nurse leader in a pediatric trauma center.

    PubMed

    Wurster, Lee Ann; Coffey, Carla; Haley, Kathy; Covert, Julia

    2009-01-01

    The trauma nurse leader role was developed by a group of trauma surgeons, hospital administrators, and emergency department and trauma leaders at Nationwide Children's Hospital who recognized the need for the development of a core group of nurses who provided expert trauma care. The intent was to provide an experienced group of nurses who could identify and resolve issues in the trauma room. Through increased education, exposure, mentoring, and professional development, the trauma nurse leader role has become an essential part of the specialized pediatric trauma care provided at Nationwide Children's Hospital.

  6. [Japan Trauma Data Bank (JTDB) managed by Japan Trauma Care and Research (JTCR)].

    PubMed

    Yokota, Junichiro

    2016-02-01

    Japan Trauma Care and Research (JTCR) was founded for operating the trauma care education and research in 2005. Japan Advanced Trauma Evaluation and Care (JATEC) is an educational program of trauma care established by The Japanese Association for The Surgery of Trauma (JAST) and the Japanese Association of Acute Medicine (JAAM), managed by JTCR. The Japan Trauma Data Bank (JTDB) is the only database organization of Japan trauma registry that was also established by JAST and JAAM, and managed by JTCR. Registry data that is collected from the JTDB is compiled annually and disseminated in the forms of hospital benchmark reports, data quality reports, and research data sets.

  7. Addressing Trauma in Substance Abuse Treatment

    ERIC Educational Resources Information Center

    Giordano, Amanda L.; Prosek, Elizabeth A.; Stamman, Julia; Callahan, Molly M.; Loseu, Sahar; Bevly, Cynthia M.; Cross, Kaitlin; Woehler, Elliott S.; Calzada, Richard-Michael R.; Chadwell, Katie

    2016-01-01

    Trauma is prevalent among clients with substance abuse issues, yet addictions counselors' training in trauma approaches is limited. The purpose of the current article is to provide pertinent information regarding trauma treatment including the use of assessments, empirically supported clinical approaches, self-help groups and the risk of vicarious…

  8. Coronary artery dissection after blunt chest trauma

    PubMed Central

    Shamsi, Fahad; Tai, Javed Majid; Bokhari, Saira

    2014-01-01

    Blunt thoracic trauma may result in cardiac injuries ranging from simple arrhythmias to fatal cardiac rupture. Coronary artery dissection culminating in acute myocardial infarction (AMI) is rare after blunt chest trauma. Here we report a case of a 37-year-old man who had an AMI secondary to coronary dissection resulting from blunt chest trauma after involvement in a physical fight. PMID:25246456

  9. Helpers in Distress: Preventing Secondary Trauma

    ERIC Educational Resources Information Center

    Whitfield, Natasha; Kanter, Deborah

    2014-01-01

    Those in close contact with trauma survivors are themselves at risk for trauma (e.g., Bride, 2007; Figley, 1995). Family, friends, and professionals who bear witness to the emotional retelling and re-enacting of traumatic events can experience what is called "secondary trauma" (Elwood, Mott, Lohr, & Galovski, 2011). The literature…

  10. Addressing Trauma in Substance Abuse Treatment

    ERIC Educational Resources Information Center

    Giordano, Amanda L.; Prosek, Elizabeth A.; Stamman, Julia; Callahan, Molly M.; Loseu, Sahar; Bevly, Cynthia M.; Cross, Kaitlin; Woehler, Elliott S.; Calzada, Richard-Michael R.; Chadwell, Katie

    2016-01-01

    Trauma is prevalent among clients with substance abuse issues, yet addictions counselors' training in trauma approaches is limited. The purpose of the current article is to provide pertinent information regarding trauma treatment including the use of assessments, empirically supported clinical approaches, self-help groups and the risk of vicarious…

  11. Bladder trauma: multidetector computed tomography cystography.

    PubMed

    Ishak, Charbel; Kanth, Nalini

    2011-08-01

    Multidetector computed tomography (MDCT) cystography is rapidly becoming the most recommended study for evaluation of the bladder for suspected trauma. This article reviews the bladder trauma with emphasis on the application of MDCT cystography to traumatic bladder injuries using a pictorial essay based on images collected in our level I trauma center.

  12. Panamerican Trauma Society: The first three decades.

    PubMed

    Ivatury, Rao R; Aboutanos, Michel

    2017-05-01

    Panamerican Trauma Society was born 30 years ago with the mission of improving trauma care in the Americas by exchange of ideas and concepts and expanding knowledge of trauma and acute illness. The authors, immediate-past leaders of the organization, review the evolution of this assembly of diverse cultures and nationalities.

  13. Cultural Differences in Autobiographical Memory of Trauma

    ERIC Educational Resources Information Center

    Jobson, Laura; O'Kearney, Richard

    2006-01-01

    This study investigated cultural differences in autobiographical memory of trauma. Australian and Asian international students provided self-defining memories, narratives of everyday and trauma memories and self-reports assessing adjustment to the trauma. No cultural distinction was found in how Australian or Asian subjects remembered a personal…

  14. Cultural Differences in Autobiographical Memory of Trauma

    ERIC Educational Resources Information Center

    Jobson, Laura; O'Kearney, Richard

    2006-01-01

    This study investigated cultural differences in autobiographical memory of trauma. Australian and Asian international students provided self-defining memories, narratives of everyday and trauma memories and self-reports assessing adjustment to the trauma. No cultural distinction was found in how Australian or Asian subjects remembered a personal…

  15. Pneumomediastinum, an unusual complication of facial trauma.

    PubMed

    Monksfield, Peter; Whiteside, Olivia; Jaffé, Susan; Steventon, Nick; Milford, Chris

    2005-05-01

    Pneumomediastinum is often an incidental finding following a blunt or penetrating trauma to the neck or chest. We report a rare case of pneumomediastinum following an isolated facial trauma that was diagnosed on imaging. We also review the clinical signs of this condition, its radiologic characteristics, and the 18 previously reported cases of pneumomediastinum following facial trauma.

  16. Helpers in Distress: Preventing Secondary Trauma

    ERIC Educational Resources Information Center

    Whitfield, Natasha; Kanter, Deborah

    2014-01-01

    Those in close contact with trauma survivors are themselves at risk for trauma (e.g., Bride, 2007; Figley, 1995). Family, friends, and professionals who bear witness to the emotional retelling and re-enacting of traumatic events can experience what is called "secondary trauma" (Elwood, Mott, Lohr, & Galovski, 2011). The literature…

  17. Penetrating trauma to the extremity.

    PubMed

    Manthey, David E; Nicks, Bret A

    2008-02-01

    Penetrating trauma to the extremities is a complex disease that foremost requires the evaluation for vascular injury. This monograph will address an algorithm to assess for associated vascular injury that includes current evaluation techniques. Approaches to wound management and use of antibiotics in the ED are also addressed.

  18. The morbidity of trauma nephrectomy.

    PubMed

    Edwards, Norma M; Claridge, Jeffrey A; Forsythe, Raquel M; Weinberg, Jordan A; Croce, Martin A; Fabian, Timothy C

    2009-11-01

    Mortality has been shown to be high in patients after trauma nephrectomy (TN). However, there are little data regarding morbidity in survivors. The objective of this study was to determine the morbidity rates associated with TN with attention directed to renal failure (RF) and formation of intra-abdominal abscess (IAA). Patients who underwent TN over a 9-year period (1996 to 2004) were identified from the trauma registry. Records were reviewed for all complications after TN in patients surviving at least 48 hours. Eighty-nine patients were identified with TN; 61 per cent resulted after penetrating trauma. Overall mortality was 34 per cent. Seventy-one patients survived greater than 48 hours; 51 (72%) experienced at least one morbidity. There was no difference in morbidity rates between patients undergoing blunt trauma and those undergoing penetrating trama. Patients with morbidities were significantly older, more severely injured, and had higher mortality rates and longer hospital courses. Infectious complications were seen in 52 per cent, respiratory in 48 per cent, gastrointestinal in 30 per cent, coagulopathy in 25 per cent, and RF and IAA were each seen in 14 per cent of patients. Patients undergoing TN are severely injured with significant morbidity. The results from this study allow us to establish benchmarks to assess complication rates for patients who undergo TN, which can provide prognostic information and goals to improve patient outcomes.

  19. The Trauma-Sensitive Teacher

    ERIC Educational Resources Information Center

    Craig, Susan E.

    2016-01-01

    According to the National Center for Mental Health Promotion and Youth Violence Prevention, about one quarter of children in the United States will witness or experience a traumatic event before the age of four. In this article, Susan E. Craig explains how these early trauma histories prime a child's brain to expect certain experiences,…

  20. Neuropathology of Acquired Cerebral Trauma.

    ERIC Educational Resources Information Center

    Bigler, Erin D.

    1987-01-01

    To help educators understand the cognitive and behavioral sequelae of cerebral injury, the neuropathology of traumatic brain injury and the main neuropathological features resulting from trauma-related brain damage are reviewed. A glossary with definitions of 37 neurological terms is appended. (Author/DB)

  1. Transforming Cultural Trauma into Resilience

    ERIC Educational Resources Information Center

    Brokenleg, Martin

    2012-01-01

    One of the biggest challenges facing Aboriginal populations increasingly is being called "intergenerational trauma." Restoring the cultural heritage is a central theme in the book, "Reclaiming Youth at Risk." That work describes the Circle of Courage model for positive development which blends Native child and youth care…

  2. Transforming Cultural Trauma into Resilience

    ERIC Educational Resources Information Center

    Brokenleg, Martin

    2012-01-01

    One of the biggest challenges facing Aboriginal populations increasingly is being called "intergenerational trauma." Restoring the cultural heritage is a central theme in the book, "Reclaiming Youth at Risk." That work describes the Circle of Courage model for positive development which blends Native child and youth care…

  3. Medicating Relational Trauma in Youth

    ERIC Educational Resources Information Center

    Foltz, Robert

    2008-01-01

    Children who have experienced relational trauma present a host of problems and are often diagnosed with psychiatric disorders and then medicated. But there is evidence that commonly used drugs interfere with oxytocin or vasopressin, the human trust and bonding hormones. Thus, psychotropic drugs may impair interpersonal relationships and impede…

  4. The Trauma-Sensitive Teacher

    ERIC Educational Resources Information Center

    Craig, Susan E.

    2016-01-01

    According to the National Center for Mental Health Promotion and Youth Violence Prevention, about one quarter of children in the United States will witness or experience a traumatic event before the age of four. In this article, Susan E. Craig explains how these early trauma histories prime a child's brain to expect certain experiences,…

  5. The management of liver trauma.

    PubMed Central

    Macfarlane, R.

    1985-01-01

    Despite advances in the management of liver trauma during the past 40 years, haemorrhage has remained the commonest cause of death. This article outlines the diversity of opinion between the desire to determine the extent of damage and resect devitalised tissue with its attendant risk of exacerbating haemorrhage, and the alternative of a more conservative approach. PMID:3895205

  6. Neuropathology of Acquired Cerebral Trauma.

    ERIC Educational Resources Information Center

    Bigler, Erin D.

    1987-01-01

    To help educators understand the cognitive and behavioral sequelae of cerebral injury, the neuropathology of traumatic brain injury and the main neuropathological features resulting from trauma-related brain damage are reviewed. A glossary with definitions of 37 neurological terms is appended. (Author/DB)

  7. Medicating Relational Trauma in Youth

    ERIC Educational Resources Information Center

    Foltz, Robert

    2008-01-01

    Children who have experienced relational trauma present a host of problems and are often diagnosed with psychiatric disorders and then medicated. But there is evidence that commonly used drugs interfere with oxytocin or vasopressin, the human trust and bonding hormones. Thus, psychotropic drugs may impair interpersonal relationships and impede…

  8. Hypothermia and the trauma patient

    PubMed Central

    Kirkpatrick, Andrew W.; Chun, Rosaleen; Brown, Ross; Simons, Richard K.

    Hypothermia has profound effects on every system in the body, causing an overall slowing of enzymatic reactions and reduced metabolic requirements. Hypothermic, acutely injured patients with multisystem trauma have adverse outcomes when compared with normothermic control patients. Trauma patients are inherently predisposed to hypothermia from a variety of intrinsic and iatrogenic causes. Coagulation and cardiac sequelae are the most pertinent physiological concerns. Hypothermia and coagulopathy often mandate a simplified approach to complex surgical problems. A modification of traditional classification systems of hypothermia, applicable to trauma patients is suggested. There are few controlled investigations, but clinical opinion strongly supports the active prevention of hypothermia in the acutely traumatized patient. Preventive measures are simple and inexpensive, but the active reversal of hypothermia is much more complicated, often invasive and controversial. The ideal method of rewarming is unclear but must be individualized to the patient and is institution specific. An algorithm reflecting newer approaches to traumatic injury and technical advances in equipment and techniques is suggested. Conversely, hypothermia has selected clinical benefits when appropriately used in cases of trauma. Severe hypothermia has allowed remarkable survivals in the course of accidental circulatory arrest. The selective application of mild hypothermia in severe traumatic brain injury is an area with promise. Deliberate circulatory arrest with hypothermic cerebral protection has also been used for seemingly unrepairable injuries and is the focus of ongoing research. PMID:10526517

  9. Trauma Center Staffing, Infrastructure, and Patient Characteristics that Influence Trauma Center Need

    PubMed Central

    Faul, Mark; Sasser, Scott M.; Lairet, Julio; Mould-Millman, Nee-Kofi; Sugerman, David

    2015-01-01

    Introduction The most effective use of trauma center resources helps reduce morbidity and mortality, while saving costs. Identifying critical infrastructure characteristics, patient characteristics and staffing components of a trauma center associated with the proportion of patients needing major trauma care will help planners create better systems for patient care. Methods We used the 2009 National Trauma Data Bank-Research Dataset to determine the proportion of critically injured patients requiring the resources of a trauma center within each Level I–IV trauma center (n=443). The outcome variable was defined as the portion of treated patients who were critically injured. We defined the need for critical trauma resources and interventions (“trauma center need”) as death prior to hospital discharge, admission to the intensive care unit, or admission to the operating room from the emergency department as a result of acute traumatic injury. Generalized Linear Modeling (GLM) was used to determine how hospital infrastructure, staffing Levels, and patient characteristics contributed to trauma center need. Results Nonprofit Level I and II trauma centers were significantly associated with higher levels of trauma center need. Trauma centers that had a higher percentage of transferred patients or a lower percentage of insured patients were associated with a higher proportion of trauma center need. Hospital infrastructure characteristics, such as bed capacity and intensive care unit capacity, were not associated with trauma center need. A GLM for Level III and IV trauma centers showed that the number of trauma surgeons on staff was associated with trauma center need. Conclusion Because the proportion of trauma center need is predominantly influenced by hospital type, transfer frequency, and insurance status, it is important for administrators to consider patient population characteristics of the catchment area when planning the construction of new trauma centers or

  10. Multidetector CT of blunt thoracic trauma.

    PubMed

    Kaewlai, Rathachai; Avery, Laura L; Asrani, Ashwin V; Novelline, Robert A

    2008-10-01

    Thoracic injuries are significant causes of morbidity and mortality in trauma patients. These injuries account for approximately 25% of trauma-related deaths in the United States, second only to head injuries. Radiologic imaging plays an important role in the diagnosis and management of blunt chest trauma. In addition to conventional radiography, multidetector computed tomography (CT) is increasingly being used, since it can quickly and accurately help diagnose a wide variety of injuries in trauma patients. Furthermore, multiplanar and volumetric reformatted CT images provide improved visualization of injuries, increased understanding of trauma-related diseases, and enhanced communication between the radiologist and the referring clinician. (c) RSNA, 2008.

  11. Nonpathologizing trauma interventions in abnormal psychology courses.

    PubMed

    Hoover, Stephanie M; Luchner, Andrew F; Pickett, Rachel F

    2016-01-01

    Because abnormal psychology courses presuppose a focus on pathological human functioning, nonpathologizing interventions within these classes are particularly powerful and can reach survivors, bystanders, and perpetrators. Interventions are needed to improve the social response to trauma on college campuses. By applying psychodynamic and feminist multicultural theory, instructors can deliver nonpathologizing interventions about trauma and trauma response within these classes. We recommend class-based interventions with the following aims: (a) intentionally using nonpathologizing language, (b) normalizing trauma responses, (c) subjectively defining trauma, (d) challenging secondary victimization, and (e) questioning the delineation of abnormal and normal. The recommendations promote implications for instructor self-reflection, therapy interventions, and future research.

  12. The family of the trauma victim.

    PubMed

    Solursh, D S

    1990-03-01

    Emergency room and trauma unit work offers unique challenges to the nurse, both professionally and personally. One of these challenges is understanding and dealing with the behavior of victims' families. Some of the factors that impact on the behavior of families include (1) the sudden and unpredictable nature of trauma; (2) the nature of the relationship of the specific family member and the trauma victim; (3) the issues of responsibility, anger, and guilt; (4) religious beliefs; and (5) trauma sequelae. The development of organ and tissue donor programs and of psychotraumatology as ways to help ease the plight of trauma victims' families are also discussed.

  13. [Standardised primary care of multiple trauma patients. Prehospital Trauma Life Support und Advanced Trauma Life Support].

    PubMed

    Wölfl, C G; Gliwitzky, B; Wentzensen, A

    2009-10-01

    Standardised management improves treatment results in seriously injured patients. For conditions like stroke or acute coronary syndrome (ACS) there are set treatment pathways which have been established for prehospital and primary hospital care. The treatment of critical trauma patients, however, follows varying procedures in both the prehospital and primary hospital phases. From an analysis of the trauma register of the German Society for Trauma Surgery (DGU), we know that a seriously injured patient remains on the road for 70 min on average before transferral to hospital. This requires improvement. With the 2003 introduction of the ATLS programme in Germany, the initial clinical phase could be improved upon simply by means of standardised training. PHTLS und ATLS complement one another. PHTLS und ATLS represent training concepts which teach standardised, priority-based prehospital and hospital trauma management. The aim is to make an initial rapid and accurate assessment of the patient's condition, thereby identifying the"critical" patient. The concepts also make priority-based treatment possible and facilitate decision-making as to whether patients can receive further on-the-spot treatment or whether immediate transport is necessary. The procedure is identical in the shock room. The primary consideration is to prevent secondary damage, not to lose track of time and to ensure consistent quality of care. The courses teach systematic knowledge, techniques, skills and conduct in diagnosis and therapy. The courses are oriented to all medical specialities associated with trauma care. With the support of the German Society for Trauma Surgery (DGU) and the German Society for Anesthesiology and Intensive Medicine (DGAI), the German Professional Organisation of Rescue Services (DBRD) has adopted the PHTLS course system on licence from the National Association of Emergency Medical Technicians (NAEMT) and the American College of Surgeons (ACS) and has been offering it in

  14. The biology of trauma: implications for treatment.

    PubMed

    Solomon, Eldra P; Heide, Kathleen M

    2005-01-01

    During the past 20 years, the development of brain imaging techniques and new biochemical approaches has led to increased understanding of the biological effects of psychological trauma. New hypotheses have been generated about brain development and the roots of antisocial behavior. We now understand that psychological trauma disrupts homeostasis and can cause both short and long-term effects on many organs and systems of the body. Our expanding knowledge of the effects of trauma on the body has inspired new approaches to treating trauma survivors. Biologically informed therapy addresses the physiological effects of trauma, as well as cognitive distortions and maladaptive behaviors. The authors suggest that the most effective therapeutic innovation during the past 20 years for treating trauma survivors has been Eye Movement Desensitization and Reprocessing (EMDR), a therapeutic approach that focuses on resolving trauma using a combination of top-down (cognitive) and bottom-up (affect/body) processing.

  15. Laparotomy for blunt abdominal trauma in a civilian trauma service.

    PubMed

    Howes, N; Walker, T; Allorto, N L; Oosthuizen, G V; Clarke, D L

    2012-03-29

    This report looks at the group of patients who required a laparotomy for blunt torso trauma at a busy metropolitan trauma service in South Africa. Methods. A prospective trauma registry is maintained by the surgical services of the Pietermaritzburg metropolitan complex. This registry is interrogated retrospectively. All patients who required admission for blunt torso trauma over the period September 2006 - September 2007 were included for review. Proformas documenting mechanism of injury, age, vital signs, blood gas, delay in presentation, length of hospital stay, intensive care unit stay and operative details were completed. Results. A total of 926 patients were treated for blunt trauma by the Pietermaritzburg metropolitan services during the period under consideration. A cohort of 65 (8%) required a laparotomy for blunt trauma during this period. There were 17 females in this group. The mechanisms of injury were motor vehicle accident (MVA) (27), pedestrian vehicle accident (PVA) (21), assault (5), fall from a height (3), bicycle accident (6), quad bike accident (1) and tractor-related accident (2). The following isolated injuries were discovered at laparotomy: liver (9), spleen (5), diaphragm (1), duodenum (2), small bowel (8), mesentery (8) bladder (10), gallbladder (1), stomach (2), colon/rectum (2) and retrohepatic vena cava (1). The following combined injuries were discovered: liver and diaphragm (2), spleen and pancreas (1), spleen and liver (2), spleen, aorta and diaphragm (1), spleen and bladder (1) and small bowel and bladder (2). Eighteen patients in the series (26%) required relaparotomy. In 10 patients temporary abdominal containment was needed. The mortality rate was 26% (18 patients). There were 6 deaths from massive bleeding, all within 6 hours of operation, and 3 deaths from renal failure; the remaining 9 patients died of multiple organ failure. There were 8 negative laparotomies (7%). In the negative laparotomy group false-positive computed

  16. Outcome after vascular trauma in a deployed military trauma system.

    PubMed

    Stannard, A; Brown, K; Benson, C; Clasper, J; Midwinter, M; Tai, N R

    2011-02-01

    Military injuries to named blood vessels are complex limb- and life-threatening wounds that pose significant difficulties in prehospital and surgical management. The aim of this study was to provide a comprehensive description of the epidemiology, treatment and outcome of vascular injury among service personnel deployed on operations in Afghanistan and Iraq. Data from the British Joint Theatre Trauma Registry were combined with hospital records to review all cases of vascular trauma in deployed service personnel over a 5-year interval ending in January 2008. Of 1203 injured service personnel, 110 sustained injuries to named vessels; 66 of them died before any surgical intervention. All 25 patients who sustained an injury to a named vessel in the abdomen or thorax died; 24 did not survive to undergo surgery and one casualty in extremis underwent a thoracotomy, but died. Six of 17 patients with cervical vascular injuries survived to surgical intervention; two died after surgery. Of 76 patients with extremity vascular injuries, 37 survived to surgery with one postoperative death. Interventions on 38 limbs included 19 damage control procedures (15 primary amputations, 4 vessel ligations) and 19 definitive limb revascularization procedures (11 interposition vein grafts, 8 direct repairs), four of which failed necessitating three amputations. In operable patients with extremity injury, amputation or ligation is often required for damage control and preservation of life. Favourable limb salvage rates are achievable in casualties able to withstand revascularization. Despite marked progress in contemporary battlefield trauma care, torso vascular injury is usually not amenable to surgical intervention.

  17. Trauma attenuating backing improves protection against behind armor blunt trauma.

    PubMed

    Sondén, Anders; Rocksén, David; Riddez, Louis; Davidsson, Johan; Persson, Jonas K; Gryth, Dan; Bursell, Jenny; Arborelius, Ulf P

    2009-12-01

    Body armor is used by military personnel, police officers, and security guards to protect them from fatal gunshot injuries to the thorax. The protection against high-velocity weapons may, however, be insufficient. Complementary trauma attenuating backings (TAB) have been suggested to prevent morbidity and mortality in high-velocity weapon trauma. Twenty-four Swedish landrace pigs, protected by a ceramid/aramid body armor without (n = 12) or with TAB (n = 12) were shot with a standard 7.62-mm assault rifle. Morphologic injuries, cardiorespiratory, and electroencephalogram changes as well as physical parameters were registered. The bullet impact caused a reproducible behind armor blunt trauma (BABT) in both the groups. The TAB significantly decreased size of the lung contusion and prevented hemoptysis. The postimpact apnea, desaturation, hypotension, and rise in pulmonary artery pressure were significantly attenuated in the TAB group. Moreover, TAB reduced transient peak pressures in thorax by 91%. Our results indicate that ordinary body armor should be complemented by a TAB to prevent thoracic injuries when the threat is high-velocity weapons.

  18. The Focused Assessment With Sonography For Trauma (FAST) Examination And Pelvic Trauma: Indications And Limitations.

    PubMed

    Shaukat, Nadia Maria; Copeli, Nikolai; Desai, Poonam

    2016-03-01

    Pelvic trauma accounts for only 3% of all skeletal injuries but may have mortality as high as 45% in cases of severe trauma. Significant high-grade-mechanism trauma to the pelvis must always take the abdomen into consideration for evaluation. The focused assessment with sonography for trauma (FAST) examination has been shown to be a valuable tool in assessing the unstable trauma patient with blunt abdominal injury, though its diagnostic utility is much less well-defined than in primary pelvic trauma. This systematic review explores the utility and limitations of the FAST examination in patients with blunt pelvic trauma and discusses the timing for the examination during the trauma survey. Newer techniques for emergency department management of the unstable trauma patient are also addressed.

  19. A proposed algorithm for multimodal liver trauma management from a surgical trauma audit in a western European trauma center.

    PubMed

    Di Saverio, S; Sibilio, A; Coniglio, C; Bianchi, E; Biscardi, A; Villani, S; Gordini, G; Tugnoli, G

    2014-11-01

    Management of liver trauma is challenging and may vary widely given the heterogeneity of liver injuries' anatomical configuration, the hemodynamic status, the settings and resources available. Perhaps the use of non-operative management (NOM) may have potential drawbacks and the role of damage control surgery (DCS) and angioembolization represents a major evolving concept.1 Most severe liver trauma in polytrauma patients accounts for a significant morbidity and mortality. Major liver trauma with extensive parenchymal injury and uncontrollable bleeding is therefore a challenge for the trauma team. However a safe and effective surgical hemostasis and a carefully planned multidisciplinary approach can improve the outcome of severe liver trauma. The technique of perihepatic packing, according to DCS approach, is often required to achieve fast, early and effective control of hemorrhage in the highest grades of liver trauma and in unstable patients. A systematic and standardized technique of perihepatic packing may contribute to improve hemostatic efficacy and overall outcomes if wisely combined in a stepwise "sandwich" multimodal approach. DCS philosophy evolved alongside with damage control resuscitation (DCR) in the management of trauma patients, requiring close interaction between surgery and resuscitation. Therefore, as a result of a combined surgical and critical care clinical audit activity in our western European trauma center, a practical algorithm for multimodal sequential management of liver trauma has been developed based on a historical cohort of 253 liver trauma patients and subsequently validated on a prospective cohort of 135 patients in the period 2010-2013.

  20. Burden of Maxillofacial Trauma at Level 1 Trauma Center

    PubMed Central

    Kaul, Ruchi Pathak; Sagar, Sushma; Singhal, Maneesh; Kumar, Abhishek; Jaipuria, Jiten; Misra, Mahesh

    2014-01-01

    There is an upward trend in facial injuries following changes in population pattern, increasing industrialization and urbanization, hence maxillofacial trauma is becoming a burden and a leading medical problem in emergency rooms worldwide. This study was performed to evaluate the pattern of maxillofacial fractures, associated injuries, and treatment used at Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India, between January 2007 and June 2010. The study provides basis for establishment of trauma as major etiology of maxillofacial injuries and planning for preventive strategies. A retrospective study of patients seen and treated at JPNATC, AIIMS, New Delhi, between January 2007 and June 2010 was performed. Data extracted from patient records included etiology, age, sex, types and sites of fractures, treatment modality, and concomitant injuries. There were 795 fractures of the maxillofacial skeleton and 86 concomitant injuries from 542 patients. Road traffic accident (RTA) (56.8%) was the most common etiologic factor, followed by falls (22.3%) and fights (18.5%). The age range was from 3 to 75 years (mean, 34.7 years) with a peak incidence in the third decade with a male-to-female ratio of 3.7:1. The most common location of maxillofacial fractures was the mandible 615 (77%) and middle third 180 (23%). With regard to mandibular fractures, the body (29.6%) was the most common site, followed by the angle (24.4%), ramus (19.5%), dentoalveolar (14.6%), symphysis (11.0%), condyle (0.8%) while in the middle third, the nasal bone (36.7%) was the most common, followed by zygomatic bone (27.8), Lefort II (14.4), Lefort I (7.8%), dentoalveolar (10.0%), and Lefort III (3.3%). Majority of the patients were treated by open reduction and internal fixation (70.6). Concomitant injuries were 84 (10.8%) with orthopedic injuries accounting for the majority (63.9%). Head injury was associated in 16.3% of cases. RTA was the

  1. Burden of maxillofacial trauma at level 1 trauma center.

    PubMed

    Kaul, Ruchi Pathak; Sagar, Sushma; Singhal, Maneesh; Kumar, Abhishek; Jaipuria, Jiten; Misra, Mahesh

    2014-06-01

    There is an upward trend in facial injuries following changes in population pattern, increasing industrialization and urbanization, hence maxillofacial trauma is becoming a burden and a leading medical problem in emergency rooms worldwide. This study was performed to evaluate the pattern of maxillofacial fractures, associated injuries, and treatment used at Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India, between January 2007 and June 2010. The study provides basis for establishment of trauma as major etiology of maxillofacial injuries and planning for preventive strategies. A retrospective study of patients seen and treated at JPNATC, AIIMS, New Delhi, between January 2007 and June 2010 was performed. Data extracted from patient records included etiology, age, sex, types and sites of fractures, treatment modality, and concomitant injuries. There were 795 fractures of the maxillofacial skeleton and 86 concomitant injuries from 542 patients. Road traffic accident (RTA) (56.8%) was the most common etiologic factor, followed by falls (22.3%) and fights (18.5%). The age range was from 3 to 75 years (mean, 34.7 years) with a peak incidence in the third decade with a male-to-female ratio of 3.7:1. The most common location of maxillofacial fractures was the mandible 615 (77%) and middle third 180 (23%). With regard to mandibular fractures, the body (29.6%) was the most common site, followed by the angle (24.4%), ramus (19.5%), dentoalveolar (14.6%), symphysis (11.0%), condyle (0.8%) while in the middle third, the nasal bone (36.7%) was the most common, followed by zygomatic bone (27.8), Lefort II (14.4), Lefort I (7.8%), dentoalveolar (10.0%), and Lefort III (3.3%). Majority of the patients were treated by open reduction and internal fixation (70.6). Concomitant injuries were 84 (10.8%) with orthopedic injuries accounting for the majority (63.9%). Head injury was associated in 16.3% of cases. RTA was the

  2. Musculoskeletal trauma: the baseball bat.

    PubMed Central

    Bryant, D. D.; Greenfield, R.; Martin, E.

    1992-01-01

    Between July 1987 and December 1990 in Washington, DC, 116 patients sustained 146 fractures and seven dislocations due to an assault with a baseball bat. The ulna was the most common site of trauma (61 fractures), followed by the hand (27 injuries) and the radius (14 injuries). Forty-two of the 146 fractures were significantly displaced and required open reduction and internal fixation to restore satisfactory alignment. Twenty-nine of the 146 fractures were open fractures. Treatment protocol for open fractures consisted of irrigation and debridement, antibiotic therapy, and bone stabilization with either internal or external fixation, or casting. Recognition of the severity of the soft tissue and bone damage is important in the management of musculoskeletal trauma secondary to the baseball bat. Images Figure 1 Figure 2 Figure 3 PMID:1460683

  3. Hypotensive Resuscitation among Trauma Patients

    PubMed Central

    Carrick, Matthew M.; Leonard, Jan; Slone, Denetta S.; Mains, Charles W.

    2016-01-01

    Hemorrhagic shock is a principal cause of death among trauma patients within the first 24 hours after injury. Optimal fluid resuscitation strategies have been examined for nearly a century, more recently with several randomized controlled trials. Hypotensive resuscitation, also called permissive hypotension, is a resuscitation strategy that uses limited fluids and blood products during the early stages of treatment for hemorrhagic shock. A lower-than-normal blood pressure is maintained until operative control of the bleeding can occur. The randomized controlled trials examining restricted fluid resuscitation have demonstrated that aggressive fluid resuscitation in the prehospital and hospital setting leads to more complications than hypotensive resuscitation, with disparate findings on the survival benefit. Since the populations studied in each randomized controlled trial are slightly different, as is the timing of intervention and targeted vitals, there is still a need for a large, multicenter trial that can examine the benefit of hypotensive resuscitation in both blunt and penetrating trauma patients. PMID:27595109

  4. Computed tomography of pancreatic trauma

    SciTech Connect

    Jeffrey, R.B. Jr.; Federle, M.P.; Crass, R.A.

    1983-05-01

    In a review of over 300 CT scans of abdominal trauma, we encountered 13 patients with surgically proved pancreatic injuries. CT correctly diagnosed pancreatic fractures, contusions, or posttraumatic pseudocysts in 11 of these patients. There were two false positive and two false negative diagnoses. The CT diagnosis of pancreatic trauma may be difficult in selected patients who are scanned soon after injury. Acutely, the actual plane of a pancreatic fracture may be difficult to identify with CT, and the peripancreatic soft-tissue changes of traumatic pancreatitis are often subtle. Eight of 11 correctly diagnosed pancreatic injuries showed thickening of the left anterior renal fascia on CT scans. This sign should prompt a critical evaluation of the pancreas of the traumatized patient.

  5. Pediatric thoracic trauma: Current trends.

    PubMed

    Pearson, Erik G; Fitzgerald, Caitlin A; Santore, Matthew T

    2017-02-01

    Pediatric thoracic trauma is relatively uncommon but results in disproportionately high levels of morbidity and mortality when compared with other traumatic injuries. These injuries are often more devastating due to differences in children׳s anatomy and physiology relative to adult patients. A high index of suspicion is of utmost importance at the time of presentation because many significant thoracic injuries will have no external signs of injury. With proper recognition and management of these injuries, there is an associated improved long-term outcome. This article reviews the current literature and discusses the initial evaluation, current management practices, and future directions in pediatric thoracic trauma. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Pearls of Mandibular Trauma Management

    PubMed Central

    Koshy, John C.; Feldman, Evan M.; Chike-Obi, Chuma J.; Bullocks, Jamal M.

    2010-01-01

    Mandibular trauma is a common problem seen by plastic surgeons. When fractures occur, they have the ability to affect the patient's occlusion significantly, cause infection, and lead to considerable pain. Interventions to prevent these sequelae require either closed or open forms of reduction and fixation. Physicians determining how to manage these injuries should take into consideration the nature of the injury, background information regarding the patient's health, and the patient's comorbidities. Whereas general principles guide the management of the majority of injuries, special consideration must be paid to the edentulous patient, complex and comminuted fractures, and pediatric patients. These topics are discussed in this article, with a special emphasis on pearls of mandibular trauma management. PMID:22550460

  7. Planned reoperation for severe trauma.

    PubMed Central

    Hirshberg, A; Mattox, K L

    1995-01-01

    OBJECTIVE: The authors review the physiologic basis, indications, techniques, and results of the planned reoperation approach to severe trauma. SUMMARY BACKGROUND DATA: Multivisceral trauma and exsanguinating hemorrhage lead to hypothermia, coagulopathy, and acidosis. Formal resections and reconstructions in these unstable patients often result in irreversible physiologic insult. A new surgical strategy addresses these physiologic concerns by staged control and repair of the injuries. METHOD: The authors review the literature. RESULTS: Indications for planned reoperation include avoidance of irreversible physiologic insult and inability to obtain direct hemostasis or formal abdominal closure. The three phases of the strategy include initial control, stabilization, and delayed reconstruction. Various techniques are used to obtain rapid temporary control of bleeding and hollow visceral spillage. Hypothermia, coagulopathy, and the abdominal compartment syndrome are major postoperative concerns. Definitive repair of the injuries is undertaken after stabilization. CONCLUSION: Planned reoperation offers a simple and effective alternative to the traditional surgical management of complex or multiple injuries in critically wounded patients. PMID:7618965

  8. Evaluation of trauma service orientation.

    PubMed

    Schott, Eric

    2010-02-01

    Orientation of residents to clinical services may be criticized as cumbersome, dull, and simplytoo much information. With the mandated resident-hour restrictions, the question arose: Do residents perceive the orientation to our trauma service as worthwhile? Residents attend a standardized orientation lecture on the first day of the rotation. Three weeks later, an eight-item, five-point Likert-scale survey is distributed to assess the residents' perceptions of the value of the orientation. Responses to each item were examined. Fifty-four (92%) of the residents completed the questionnaire between September 2005 and August 2006. Most indicated that orientation was helpful (85%), the Trauma Resuscitation DVD was informative (82%), the review of procedures was helpful (82%), and the instructor's knowledge was adequate (94%). Most (92%) disagreed with the statement that orientation should not be offered. Careful attention to orientation content and format is important to the perception that the orientation is worthwhile.

  9. Transfusion Practice in Military Trauma

    DTIC Science & Technology

    2008-01-01

    15 patients including several who were shot, others who were severely injured in other ways and four who ultimately died. Despite the small number...their most profound social consequences in the loss of young adults from the working population. Injury is the most common cause of the loss of years...who have an injury severity score of > 15 and must have a trauma surgeon, anaesthesiologist, orthopaedic surgeon, thoracic surgeon and neurosurgeon

  10. Effective teamwork in trauma management.

    PubMed

    Frakes, Patricia; Neely, Iain; Tudoe, Robert

    2009-12-01

    The emergency department (ED) education team at the Queen's Medical Centre, Nottingham, has developed a process to promote effective teamwork in major trauma management. To introduce this process to ED staff, the team developed a multiprofessional education and training programme. This article describes the development process, explains how and why it was undertaken, and provides details of the education and training programme. It also highlights the challenges met by the education team during implementation.

  11. Head trauma after instrumental births.

    PubMed

    Doumouchtsis, Stergios K; Arulkumaran, Sabaratnam

    2008-03-01

    Instrumental vaginal delivery involves the use of the vacuum extractor or obstetric forceps to facilitate delivery of the fetus. It is associated with substantial risk of head injury, including hemorrhage, fractures, and, rarely, brain damage or fetal death. This review article describes the different types, etiology, pathophysiology, risk factors, and clinical features of head trauma after instrumental birth, along with their management and prevention strategies.

  12. Medical Simulation for Trauma Management

    DTIC Science & Technology

    1996-10-01

    animals , the investigator(s) adhered to the "Guide for the Care and Use of Laboratory Animals ," prepared by the Committee on Care and use of Laboratory... Animals of the Institute of Laboratory Resources, national Research Council (NIH Publication No. 86-23, Revised 1985). N For the protection of human...sufficiently large number of proctors with adequate surgical skills to teach trauma procedures. Other approaches include practice on animals , but animal

  13. Fibrinogen Metabolic Responses to Trauma

    DTIC Science & Technology

    2009-01-13

    intravascular coagulation (DIC), and thrombotic complications [8,10-12]. Based on the limited data avail- able at present, changes in fibrinogen...water at 4°C [48]. Temperature of 32°C was used based on the fact that 100% mortality was observed when the temperature in trauma patients dropped...study. The amount of fibrinogen transfused was calculated based on fibrinogen amount within each blood product, such as fresh whole blood

  14. Current Epidemiology of Genitourinary Trauma

    PubMed Central

    McGeady, James B.; Breyer, Benjamin N.

    2013-01-01

    Synopsis This article reviews recent publications evaluating the current epidemiology of urologic trauma. It begins by providing a brief explanation of databases that have been recently used to study this patient population, then proceeds to discuss each genitourinary organ individually, discussing the most relevant and up to date information published for each one. The conclusion of the article briefly discusses possible future research and development areas pertaining to the topic. PMID:23905930

  15. Blunt pancreatic trauma in children.

    PubMed

    Klin, Baruch; Abu-Kishk, Ibrahim; Jeroukhimov, Igor; Efrati, Yigal; Kozer, Eran; Broide, Efrat; Brachman, Yuri; Copel, Laurian; Scapa, Eitan; Eshel, Gideon; Lotan, Gad

    2011-07-01

    To report our experience with blunt pancreatic trauma in pediatric patients and evaluate several various management strategies. Ten children admitted over the last 10 years with pancreatic blunt trauma were included in the present series. The average time from injury to hospital admission was 2.4 days. All injuries resulted from accidents: bicycle handlebar injuries (5), being kicked by a horse (2), falls from a height (2), and injury sustained during closure of an electric gate (1). Additional systemic and abdominal injuries were recorded in 7 patients. The amylase levels at the time of patient admission were normal in 3 patients, mildly raised in 4 patients, and elevated in 3 patients. Abdominal computed tomography was performed in 10 patients, ultrasonography in 5, and endoscopic retrograde cholangiopancreatography (ERCP) in 4. Pancreatic injuries comprised 4 grade I, 3 grade II, and 3 grade III injuries. Grade I and II injuries were successfully managed by conservative treatment. The 3 children with grade III trauma and pancreatic ductal injury in the neck (1), body (1), and tail (1) of the gland were surgically treated, having an uneventful postoperative stay of 8-14 days and no complications during the 1-year follow-up period. The present study supports early ERCP as an essential part of the initial patient evaluation when pancreatic transection is highly suspected.

  16. Radionuclide evaluation of lung trauma

    SciTech Connect

    Lull, R.J.; Tatum, J.L.; Sugerman, H.J.; Hartshorne, M.F.; Boll, D.A.; Kaplan, K.A.

    1983-07-01

    Nuclear medicine imaging procedures can play a significant role in evaluating the pulmonary complications that are seen in trauma patients. A quantitative method for measuring increased pulmonary capillary permeability that uses Tc-99m HSA allows early diagnosis of acute respiratory distress syndrome (ARDS) and accurately differentiates this condition from pneumonia or cardiogenic pulmonary edema. This technique may be of great value in following the response to therapy. The use of 133Xe to diagnose inhalation injury remains an important diagnostic tool, particularly at hospitals with specialized burn units. Regional decreases in ventilation-perfusion images reliably localize aspirated foreign bodies. Radionuclide techniques that are used to demonstrate gastropulmonary aspiration remain controversial and require further clinical evaluation. Pulmonary perfusion imaging, although nonspecific, may provide the earliest clue for correct diagnosis of fat embolism, air embolism, contusion, or laceration. Furthermore, the possibility of perfusion abnormality due to these uncommon conditions must be remembered whenever trauma patients are evaluated for pulmonary thromboembolism with scintigraphy. Occasionally, liver or spleen scintigraphy may be the most appropriate procedure when penetrating chest trauma also involves these subdiaphragmatic organs.

  17. Secondary reconstruction of maxillofacial trauma.

    PubMed

    Castro-Núñez, Jaime; Van Sickels, Joseph E

    2017-08-01

    Craniomaxillofacial trauma is one of the most complex clinical conditions in contemporary maxillofacial surgery. Vital structures and possible functional and esthetic sequelae are important considerations following this type of trauma and intervention. Despite the best efforts of the primary surgery, there are a group of patients that will have poor outcomes requiring secondary reconstruction to restore form and function. The purpose of this study is to review current concepts on secondary reconstruction to the maxillofacial complex. The evaluation of a posttraumatic patient for a secondary reconstruction must include an assessment of the different subunits of the upper face, middle face, and lower face. Virtual surgical planning and surgical guides represent the most important innovations in secondary reconstruction over the past few years. Intraoperative navigational surgery/computed-assisted navigation is used in complex cases. Facial asymmetry can be corrected or significantly improved by segmentation of the computerized tomography dataset and mirroring of the unaffected side by means of virtual surgical planning. Navigational surgery/computed-assisted navigation allows for a more precise surgical correction when secondary reconstruction involves the replacement of extensive anatomical areas. The use of technology can result in custom-made replacements and prebent plates, which are more stable and resistant to fracture because of metal fatigue. Careful perioperative evaluation is the key to positive outcomes of secondary reconstruction after trauma. The advent of technological tools has played a capital role in helping the surgical team perform a given treatment plan in a more precise and predictable manner.

  18. Trauma care in India and Germany.

    PubMed

    Oestern, Hans-Joerg; Garg, Bhavuk; Kotwal, Prakash

    2013-09-01

    Road traffic accidents are among the leading causes of death worldwide in individuals younger than 45 years. In both India and Germany, there has been an increase in registered motor vehicles over the last decades. However, while the number of traffic accident victims steadily dropped in Germany, there has been a sustained increase in India. We analyze this considering the sustained differences in rescue and trauma system status. We compared India and Germany in terms of (1) vehicular infrastructure and causes of road traffic accident-related trauma, (2) burden of trauma, and (3) current trauma care and prevention, and (4) based on these observations, we suggested how India and other countries can enhance trauma care and prevention. Data for Germany were obtained from federal statistical databases, German Automobile Club, and German Trauma Registry. Data from India were available from the Ministry of Road Transport and Highways. We also performed a standardized literature search of PubMed for India and Germany using the following key words: "road traffic accidents", "prevention", "prehospital trauma care", "trauma system", "trauma registry", "trauma centers", and "development of vehicles." The total number of registered motor vehicles increased 473-fold in India and 100-fold in Germany from 1951 to 2011. The number of road traffic deaths increased in both countries until 1970, but thereafter decreased in Germany (3606 in 2012) while continuing to increase in India (142,485 in 2011). The differences between Germany and India relate to the relative sizes and populations of the countries (1:9 and 1:15, respectively), and differences in prevention and prehospital care (nationwide versus big cities) and hospital trauma systems (nationwide versus exceptional). Improvement requires attention to three major issues: (1) prevention through infrastructure, traffic laws, mandatory licensing; (2) establishment of a prehospital care system; and (3) establishment of regional

  19. Trauma-Informed HIV Prevention and Treatment.

    PubMed

    Sales, Jessica M; Swartzendruber, Andrea; Phillips, Ashley L

    2016-12-01

    The high prevalence of trauma and its negative impact on health and health-promoting behaviors underscore the need for multi-level interventions to address trauma and its associated sequelae to improve physical and mental well-being in both HIV-infected and HIV-uninfected populations. Growing global awareness of the intersection of trauma and HIV has resulted in development and testing of interventions to address trauma in the context of HIV treatment and HIV prevention in the USA and globally. Despite increasing recognition of the widespread nature of trauma and the importance of trauma to HIV transmission around the globe, several gaps remain. Through a survey of the literature, we identified eight studies (published in the past 5 years) describing interventions to address the effects of trauma on HIV-related outcomes. In particular, this study focused on the levels of intervention, populations the interventions were designed to benefit, and types of trauma addressed in the interventions in the context of both HIV prevention and treatment. Remarkably absent from the HIV prevention, interventions reviewed were interventions designed to address violence experienced by men or transgender individuals, in the USA or globally. Given the pervasive nature of trauma experienced generally, but especially among individuals at heightened risk for HIV, future HIV prevention interventions universally should consider becoming trauma-informed. Widespread acknowledgement of the pervasive impact of gender-based violence on HIV outcomes among women has led to multiple calls for trauma-informed care (TIC) approaches to improve the effectiveness of HIV services for HIV-infected women. TIC approaches may be relevant for and should also be tested among men and all groups with high co-occurring epidemics of HIV and trauma (e.g., men who have sex with men (MSM), transgendered populations, injection drug users, sex workers), regardless of type of trauma experience.

  20. Finnish Trauma Audit 2004: current state of trauma management in Finnish hospitals.

    PubMed

    Handolin, L; Leppäniemi, A; Vihtonen, K; Lakovaara, M; Lindahl, J

    2006-07-01

    There is great variation in the organisation of trauma care in European countries. The state of trauma care in Finnish hospitals has not been appropriately reviewed in the past. The aim of the present study conducted by the Finnish Trauma Association (FTA) was to assess the number of Finnish hospitals admitting severe trauma patients, and to evaluate the organisation and training of trauma care in those hospitals. In 2004, a telephone survey to all the Finnish hospitals was conducted, and information on the number of severe trauma patients treated per month, the organisation of acute trauma care, and the existence of multidisciplinary trauma care training was collected. Thirty-six Finnish hospitals admitted trauma patients. The range of estimated number of severely injured trauma patients treated in individual hospitals per month varied from 0.5 to 12, resulting in an estimated number of 1000-1300 patients with severe trauma treated in Finland every year (19-25/100.000 inhabitants). About 20% of the hospitals had a trauma team, and 25% had a systematic trauma education program. Only one hospital had established multidisciplinary and systematic trauma team training. The case load of severe trauma patients is low in most Finnish hospitals making it difficult to obtain and maintain sufficient experience. Too many hospitals admit too few patients, and only a few hospitals have been working on updating their trauma management protocols and education. There is an obvious need for leadership, discussion, legislation and initiatives by the professional organisations and the government to establish a modern trauma system in Finland.

  1. Establishing Standards for Trauma Nursing Education: The Central Ohio Trauma System's Approach.

    PubMed

    Haley, Kathy; Martin, Stacey; Kilgore, Jane; Lang, Carrie; Rozzell, Monica; Coffey, Carla; Eley, Scott; Light, Andrea; Hubartt, Jeff; Kovach, Sherri; Deppe, Sharon

    Trauma nursing requires mastering a highly specialized body of knowledge. Expert nursing care is expected to be offered throughout the hospital continuum, yet identifying the necessary broad-based objectives for nurses working within this continuum has often been difficult to define. Trauma nurse leaders and educators from 7 central and southeastern Ohio trauma centers and 1 regional trauma organization convened to establish an approach to standardizing trauma nursing education from a regional perspective. Forty-two trauma nursing educational objectives were identified. The Delphi method was used to narrow the list to 3 learning objectives to serve as the framework for a regional trauma nursing education guideline. Although numerous trauma nursing educational needs were identified across the continuum of care, a lack of clearly defined standards exists. Recognizing and understanding the educational preparation and defined standards required for nurses providing optimal trauma care are vital for a positive impact on patient outcomes. This regional trauma nursing education guideline is a novel model and can be used to assist trauma care leaders in standardizing trauma education within their hospital, region, or state. The use of this model may also lead to the identification of gaps within trauma educational systems.

  2. Implementing Major Trauma Audit in Ireland.

    PubMed

    Deasy, Conor; Cronin, Marina; Cahill, Fiona; Geary, Una; Houlihan, Patricia; Woodford, Maralyn; Lecky, Fiona; Mealy, Ken; Crowley, Philip

    2016-01-01

    There are 27 receiving trauma hospitals in the Republic of Ireland. There has not been an audit system in place to monitor and measure processes and outcomes of care. The National Office of Clinical Audit (NOCA) is now working to implement Major Trauma Audit (MTA) in Ireland using the well-established National Health Service (NHS) UK Trauma Audit and Research Network (TARN). The aim of this report is to highlight the implementation process of MTA in Ireland to raise awareness of MTA nationally and share lessons that may be of value to other health systems undertaking the development of MTA. The National Trauma Audit Committee of the Royal College of Surgeons in Ireland, consisting of champions and stakeholders in trauma care, in 2010 advised on the adaptation of TARN for Ireland. In 2012, the Emergency Medicine Program endorsed TARN and in setting up the National Emergency Medicine Audit chose MTA as the first audit project. A major trauma governance group was established representing stakeholders in trauma care, a national project co-ordinator was recruited and a clinical lead nominated. Using Survey Monkey, the chief executives of all trauma receiving hospitals were asked to identify their hospital's trauma governance committee, trauma clinical lead and their local trauma data co-ordinator. Hospital Inpatient Enquiry systems were used to identify to hospitals an estimate of their anticipated trauma audit workload. There are 25 of 27 hospitals now collecting data using the TARN trauma audit platform. These hospitals have provided MTA Clinical Leads, allocated data co-ordinators and incorporated MTA reports formally into their clinical governance, quality and safety committee meetings. There has been broad acceptance of the NOCA escalation policy by hospitals in appreciation of the necessity for unexpected audit findings to stimulate action. Major trauma audit measures trauma patient care processes and outcomes of care to drive quality improvement at hospital and

  3. The role of palliative care in trauma.

    PubMed

    Owens, Darrell

    2012-01-01

    Trauma remains a leading cause of morbidity and mortality in the United States. Despite the aggressive and heroic nature of trauma care, including trauma surgery, 10% to 20% of patients admitted to trauma intensive care units die. As the population continues to age, it is predicted that by 2050, approximately 40% of those experiencing traumatic injury will be older than 65 years. For multiple reasons, people in this age group who experience trauma are at greater risk for death. Palliative care is the specialty of health care that provides care for patients with serious, life-threatening, or life-limiting illness or injury, regardless of the stage of disease or treatment. The goal of palliative care is to reduce or alleviate suffering through expert pain and symptom management, as well as assistance with decision making. The integration of palliative and trauma care can assist and support patients and families through stressful, often life-changing times, regardless of the final outcome.

  4. Thyroid crisis in the maxillofacial trauma patient.

    PubMed

    Weinstock, Robert J; Lewis, Tashorn; Miller, Jared; Clarkson, Earl I

    2014-11-01

    Thyroid crisis, also known as thyroid storm, is a rare complication of thyrotoxicosis that results in a hypermetabolic and hyperadrenergic state. This condition requires prompt recognition and treatment because the mortality from thyroid crisis approaches 30%. Thyrotoxicosis alone will usually not progress to thyroid crisis. Thyroid crisis will typically be precipitated by some concomitant event such as infection, iodine-containing contrast agents, medications such as amiodarone, pregnancy, or surgery. Trauma is a rare precipitator of thyroid crisis. Several published studies have reported thyroid crisis resulting from blunt or penetrating neck trauma. Significant systemic trauma, such as motor vehicle accidents, has also been reported to precipitate thyroid crisis. It is very unusual for minor trauma to precipitate thyroid crisis. In the present study, we report the case of a patient who had incurred relatively minor maxillofacial trauma and developed thyroid crisis 2 weeks after the initial trauma.

  5. The Trauma Collaborative Care Study (TCCS).

    PubMed

    Wegener, Stephen T; Pollak, Andrew N; Frey, Katherine P; Hymes, Robert A; Archer, Kristin R; Jones, Clifford B; Seymour, Rachel B; OʼToole, Robert V; Castillo, Renan C; Huang, Yanjie; Scharfstein, Daniel O; MacKenzie, Ellen J

    2017-04-01

    Previous research suggests that the care provided to trauma patients could be improved by including early screening and management of emotional distress and psychological comorbidity. The Trauma Collaborative Care (TCC) program, which is based on the principles of well-established models of collaborative care, was designed to address this gap in trauma center care. This article describes the TCC program and the design of a multicenter study to evaluate its effectiveness for improving patient outcomes after major, high-energy orthopaedic trauma at level 1 trauma centers. The TCC program was evaluated by comparing outcomes of patients treated at 6 intervention sites (n = 481) with 6 trauma centers where care was delivered as usual (control sites, n = 419). Compared with standard treatment alone, it is hypothesized that access to the TCC program plus standard treatment will result in lower rates of poor patient-reported function, depression, and posttraumatic stress disorder.

  6. Social contexts of trauma and healing.

    PubMed

    Ajdukovic, Dean

    2004-01-01

    The social contexts in which the mass trauma of thousands of people occur and in which their recovery should progress have qualities that distinguish it in important ways from individualised trauma in which a person is a victim of a violent attack, rape or a traffic accident. Organised violence, such as wars, oppression by dictatorships and massive terrorist attacks are extreme cases in which hundreds or thousands of people are exposed to trauma in a short period of time. As such, it has multiple consequences that extend beyond the affected individuals and the symptoms they suffer. Although the symptoms may be similar, the social contexts in which individual victimisation and exposure to organised violence happen are very different. The social milieu in which the survivors of individual trauma and survivors of mass trauma are embedded is likewise different, with important consequences for recovery. Understanding the social context of the trauma helps create the right social intervention for healing at social and personal levels.

  7. The SCID PTSD module's trauma screen: validity with two samples in detecting trauma history.

    PubMed

    Elhai, Jon D; Franklin, C Laurel; Gray, Matt J

    2008-01-01

    We investigated the posttraumatic stress disorder (PTSD) module's trauma screen of the Structured Clinical Interview for DSM-IV (SCID), a single-item traumatic event history query. Compared to the Stressful Life Events Screening Questionnaire (SLESQ), the SCID trauma screen was 76% sensitive in identifying trauma histories in 199 medical patients (correctly ruling out 67%) but only 66% sensitive in 253 college students (ruling out 87%). A modified, more behaviorally specific SCID trauma screen (M-SCID) yielded poorer results in identifying trauma among 245 additional college students. Based on probable PTSD diagnoses (PTSD Symptom Scale), using the SCID screen instead of the SLESQ, 3% (M-SCID screen) to 11-14% (standard SCID) of PTSD cases were missed due to not having a trauma history. Our results lend support to previous research establishing the SCID trauma screen as a useful screening device in settings where a more comprehensive trauma screen is not possible.

  8. Specific trauma subtypes improve the predictive validity of the Harvard Trauma Questionnaire in Iraqi refugees.

    PubMed

    Arnetz, Bengt B; Broadbridge, Carissa L; Jamil, Hikmet; Lumley, Mark A; Pole, Nnamdi; Barkho, Evone; Fakhouri, Monty; Talia, Yousif Rofa; Arnetz, Judith E

    2014-12-01

    Trauma exposure contributes to poor mental health among refugees, and exposure often is measured using a cumulative index of items from the Harvard Trauma Questionnaire (HTQ). Few studies, however, have asked whether trauma subtypes derived from the HTQ could be superior to this cumulative index in predicting mental health outcomes. A community sample of recently arrived Iraqi refugees (N = 298) completed the HTQ and measures of posttraumatic stress disorder (PTSD) and depression symptoms. Principal components analysis of HTQ items revealed a 5-component subtype model of trauma that accounted for more item variance than a 1-component solution. These trauma subtypes also accounted for more variance in PTSD and depression symptoms (12 and 10%, respectively) than did the cumulative trauma index (7 and 3%, respectively). Trauma subtypes provided more information than cumulative trauma in the prediction of negative mental health outcomes. Therefore, use of these subtypes may enhance the utility of the HTQ when assessing at-risk populations.

  9. Nationwide Procedural Trends for Renal Trauma Management.

    PubMed

    Colaco, Marc; Navarrete, Roberto A; MacDonald, Susan M; Stitzel, Joel D; Terlecki, Ryan P

    2017-08-29

    To characterize national trends in procedural management of renal trauma. Management of renal trauma has evolved to favor a more conservative approach. For patients requiring intervention, there is a paucity of information to characterize the nature of procedural therapy administered. A retrospective cross-sectional analysis was performed using data contained within the National Trauma Data Bank. The National Trauma Data Bank is a voluntary data repository managed by the American College of Surgeons, containing data regarding trauma admissions at 747 level I to V trauma centers throughout the United States and Canada. Participants included any patient with renal trauma requiring intervention from 2002 to 2012. They were identified according to International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes, with codes 866.00 through 866.03 for blunt renal trauma, and codes 866.10 through 866.13 for penetrating trauma. Cases were separated into those requiring nephrectomy, renorrhaphy, or endovascular repair based on ICD-9 procedure code. The number of cases performed each year and yearly trends as measured by linear regression. A total of 4296 cases were reported during the study period. Of these cases, 2635 involved blunt trauma and 1661 involved penetrating injury. There was a significant increase in the percentage of cases managed by endovascular means for both blunt and penetrating trauma (R = 0.92, P < 0.01; and R = 0.86, P < 0.01, respectively). This was primarily at the expense of nephrectomy, with cases showing significant decline in both groups. National trends for procedural management of renal trauma are toward less invasive interventions. These trends suggest favorable change towards renal preservation and decreased morbidity, potentially facilitated, in part, by improved radiographic staging and endovascular techniques, and also increased provider awareness of the safety and value of conservative management.

  10. WSES classification and guidelines for liver trauma.

    PubMed

    Coccolini, Federico; Catena, Fausto; Moore, Ernest E; Ivatury, Rao; Biffl, Walter; Peitzman, Andrew; Coimbra, Raul; Rizoli, Sandro; Kluger, Yoram; Abu-Zidan, Fikri M; Ceresoli, Marco; Montori, Giulia; Sartelli, Massimo; Weber, Dieter; Fraga, Gustavo; Naidoo, Noel; Moore, Frederick A; Zanini, Nicola; Ansaloni, Luca

    2016-01-01

    The severity of liver injuries has been universally classified according to the American Association for the Surgery of Trauma (AAST) grading scale. In determining the optimal treatment strategy, however, the haemodynamic status and associated injuries should be considered. Thus the management of liver trauma is ultimately based on the anatomy of the injury and the physiology of the patient. This paper presents the World Society of Emergency Surgery (WSES) classification of liver trauma and the management Guidelines.

  11. Hyaluronidase for reducing perineal trauma.

    PubMed

    Zhou, Fan; Wang, Xiao Dong; Li, Jing; Huang, Gui Qiong; Gao, Bing Xin

    2014-02-05

    Perineal hyaluronidase (HAase) injection was widely used to reduce the occurrence of perineal trauma, pain and need for episiotomy in the 1950s to 1960s. Reports suggested that the administration of HAase was a simple, low risk, low cost and effective way to decrease perineal trauma without adverse effects. The objective of this review was to assess the effectiveness and safety of perineal HAase injection for reducing spontaneous perineal trauma, episiotomy and perineal pain in vaginal deliveries. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2013), the International Clinical Trials Registry Platform (ICTRP) and the Networked Digital Library of Theses and Dissertations (both on 1 April 2013), and reference lists of retrieved studies. We also contacted relevant organisations. Published and unpublished randomised and quasi-randomised controlled trials comparing perineal HAase injection with placebo injection or no intervention in vaginal deliveries. Two review authors independently assessed trials for inclusion, extracted data and evaluated methodological quality. Data were checked for accuracy. The search strategy identified six potentially eligible studies. Two studies were excluded. We included four randomised controlled trials that randomised a total of 599 women (data were available for 595 women).Two trials (283 women) compared the effects of perineal HAase injection during the second stage of labour with placebo injection and were at low risk of bias. Three trials (one three-armed trial was analysed twice) (373 women) compared the effects of perineal HAase injection during second stage of labour with no intervention and two out of the three trials were at high risk of bias. Data from four trials involving 599 women suggested that perineal HAase injection during second stage of labour had a lower incidence of perineal trauma (average risk ratio (RR) 0.69, 95% confidence interval (CI) 0.50 to 0.95,Tau² = 0.08, I² = 82

  12. [First aid and management of multiple trauma: in-hospital trauma care].

    PubMed

    Boschin, Matthias; Vordemvenne, Thomas

    2012-11-01

    Injuries remain the leading cause of death in children and young adults. Management of multiple trauma patients has improved in recent years by quality initiatives (trauma network, S3 guideline "Polytrauma"). On this basis, strong links with preclinical management, structured treatment algorithms, training standards (ATLS®), clear diagnostic rules and an established risk- and quality management are the important factors of a modern emergency room trauma care. We describe the organizational components that lead to successful management of trauma in hospital.

  13. [The radiologist physician in major trauma evaluation].

    PubMed

    Motta-Ramírez, Gaspar Alberto

    2016-01-01

    Trauma is the most common cause of death in young adults. A multidisciplinary trauma team consists of at least a surgical team, an anesthesiology team, radiologic team, and an emergency department team. Recognize the integration of multidisciplinary medical team in managing the trauma patient and which must include the radiologist physician responsible for the institutional approach to the systematization of the trauma patient regarding any radiological and imaging study with emphasis on the FAST (del inglés, Focused Assessment with Sonography in Trauma)/USTA, Whole body computed tomography. Ultrasound is a cross-sectional method available for use in patients with major trauma. Whole-body multidetector computed tomography became the imaging modality of choice in the late 1990s. In patients with major trauma, examination FAST often is the initial imaging examination, extended to extraabdominal regions. Patients who have multitrauma from blunt mechanisms often require multiple diagnostic examinations, including Computed Tomography imaging of the torso as well as abdominopelvic Computed Tomography angiography. Multiphasic Whole-body trauma imaging is feasible, helps detect clinically relevant vascular injuries, and results in diagnostic image quality in the majority of patients. Computed Tomography has gained importance in the early diagnostic phase of trauma care in the emergency room. With a single continuous acquisition, whole-body computed tomography angiography is able to demonstrate all potentially injured organs, as well as vascular and bone structures, from the circle of Willis to the symphysis pubis.

  14. The Selfie Wrist - Selfie induced trauma.

    PubMed

    Lyona, R F; Kelly, J C; Murphy, C G

    2017-06-09

    The selfie phenomenon has exploded worldwide over the past two years. Selfies have been linked to a large number of mortalities and significant morbidity worldwide. However, trauma associated with selfies including fractures, is rarely publicised. Here we present a case series of upper extremity trauma secondary to selfies across all age groups during the summer period. Four cases of distal radius and ulna trauma in all age groups were reported. This case series highlights the dangers associated with taking selfies and the trauma that can result.

  15. Red blood cell storage duration and trauma.

    PubMed

    Sparrow, Rosemary L

    2015-04-01

    Numerous retrospective clinical studies suggest that transfusion of longer stored red blood cells (RBCs) is associated with an independent risk of poorer outcomes for certain groups of patients, including trauma, intensive care, and cardiac surgery patients. Large multicenter randomized controlled trials are currently underway to address the concern about RBC storage duration. However, none of these randomized controlled trials focus specifically on trauma patients with hemorrhage. Major trauma, particularly due to road accidents, is the leading cause of critical injury in the younger-than-40-year-old age group. Severe bleeding associated with major trauma induces hemodynamic dysregulation that increases the risk of hypoxia, coagulopathy, and potentially multiorgan failure, which can be fatal. In major trauma, a multitude of stress-associated changes occur to the patient's RBCs, including morphological changes that increase cell rigidity and thereby alter blood flow hemodynamics, particularly in the microvascular vessels, and reduce RBC survival. Initial inflammatory responses induce deleterious cellular interactions, including endothelial activation, RBC adhesion, and erythrophagocytosis that are quickly followed by profound immunosuppressive responses. Stored RBCs exhibit similar biophysical characteristics to those of trauma-stressed RBCs. Whether transfusion of RBCs that exhibit storage lesion changes exacerbates the hemodynamic perturbations already active in the trauma patient is not known. This article reviews findings from several recent nonrandomized studies examining RBC storage duration and clinical outcomes in trauma patients. The rationale for further research on RBC storage duration in the trauma setting is provided. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Trauma and adult attention deficit hyperactivity disorder.

    PubMed

    Kaya, A; Taner, Y; Guclu, B; Taner, E; Kaya, Y; Bahcivan, H G; Benli, I T

    2008-01-01

    This study investigated the relationship between adult attention deficit hyperactivity disorder (ADHD) and trauma. Fifty-eight adults admitted to hospital with musculoskeletal trauma were evaluated using scales that determine the presence of ADHD in childhood and adulthood. Each patient was also interviewed by an adult psychiatrist and a child and adolescent psychiatrist. The control group consisted of 30 adult patients with complaints other than trauma who did not have a history of repetitive traumas. There were 36 (62.2%) cases of ADHD in the patient group compared with four (13.3%) in the control group; this difference was statistically significant. When the level of trauma was evaluated, ADHD was identified in 23 of the 26 (88.5%) patients with high energy traumas compared with 14 of the 32 (43.8%) patients with low energy traumas; this difference was also statistically significant. This study shows that patients with adult ADHD are more prone to injuries, particularly high energy traumas such as motor vehicle accidents. Patients who have repeated high energy traumas should be evaluated by a psychiatrist for ADHD.

  17. Trauma system: the backbone of disaster preparedness.

    PubMed

    Cryer, H Gill; Hiatt, Jonathan R

    2009-08-01

    To describe the Los Angeles County trauma system response to disasters. Review of trauma system structure and multicasualty events. The Los Angeles County trauma system is made up of 13 level I and II trauma centers with defined catchment areas that serve 10 million people in 88 cites over 4,000 square miles and receive more than 20,000 trauma activations annually. There is an organized disaster plan, which is orchestrated through the Medical Alert Center that coordinates the distribution of casualties from the scene of a multicasualty event, with the most critically injured patients going to level I centers by air, severe injuries to level I and II centers by ground and air and less severe injuries to local community hospitals by ground. The plan has been used in several multicasualty events over the last 25 years, the most recent of which occurred 6 hours after this paper was presented. The system allows for all critically injured patients to be distributed to several trauma centers, so that all can be cared for in a timely fashion without overwhelming any one trauma center and without critically injured patients being taken to nontrauma centers where they cannot receive optimal care. The answer to disaster preparedness in our country is to develop this kind of trauma system in every state. Doing so will improve access of our population to excellent care on a daily basis and will provide a network of trauma centers that can be mobilized to most effectively care for victims of multicasualty events.

  18. Trauma Exposure and Posttraumatic Symptoms in Hawaii

    PubMed Central

    Klest, Bridget; Freyd, Jennifer J.; Foynes, Melissa Ming

    2013-01-01

    Eight-hundred thirty-three members of an ethnically diverse longitudinal cohort study in Hawaii were surveyed about their personal exposure to several types of traumatic events, socioeconomic resources, and mental health symptoms. Results replicated findings from prior research that while men and women are exposed to similar rates of trauma overall, women report more exposure to traumas high in betrayal (HB), while men report exposure to more traumas lower in betrayal (LB). Trauma exposure was predictive of mental health symptoms, with neglect, household dysfunction, and HB traumas predicting symptoms of depression, anxiety, PTSD, dissociation, and sleep disturbance, and LB traumas predicting PTSD and dissociation symptoms. Native Hawaiian ethnicity and poorer socioeconomic status were predictive of greater trauma exposure and symptoms. Results suggest that more inclusive definitions of trauma are important for gender equity, and that ethnic group variation in symptoms is better explained by factors such as differential trauma exposure and economic and social status differences, rather than minority status per se. PMID:24660048

  19. Preparing Global Trauma Nurses for Leadership Roles in Global Trauma Systems.

    PubMed

    Muñiz, Sol Angelica; Lang, Richard W; Falcon, Lisa; Garces-King, Jasmine; Willard, Suzanne; Peck, Gregory L

    Trauma leads to 5.7 million annual deaths globally, accounting for 25%-33% of global unintentional deaths and 90% of the global trauma burden in low- and middle-income countries. The Lancet Commission on Global Surgery and the World Health Organization assert that emergent and essential surgical capacity building and trauma system improvement are essential to address the global burden of trauma. In response, the Rutgers Global Surgery program, the School of Nursing and Medicine, and the Robert Wood Johnson University Hospital faculty collaborated in the first Interprofessional Models in Global Injury Care and Education Symposium in June 2016. This 2-week symposium combined lectures, high-fidelity simulation, small group workshops, site visits to Level I trauma centers, and a 1-day training course from the Panamerican Trauma Society. The aim was to introduce global trauma nurses to trauma leadership and trauma system development. After completing the symposium, 10 nurses from China, Colombia, Kenya, Puerto Rico, and Uruguay were surveyed. Overall, 88.8% of participants reported high levels of satisfaction with the program and 100% stated being very satisfied with trauma lectures. Symposia, such as that developed and offered by Rutgers University, prepare nurses to address trauma within system-based care and facilitate trauma nursing leadership in their respective countries.

  20. Workplace trauma and the law.

    PubMed

    Tehrani, Noreen

    2002-12-01

    The law places increasing responsibilities on organizations to protect its workforce from psychological injury. This paper looks at the development of British law relating to traumatic stress and explores a growing concern of clinicians that the law and the legal processes themselves may increase the psychological injury of victims of traumatic stress. The statutory requirement for organizations to provide effective support for employees following a traumatic incident is enshrined in law. However organizations are confused by the conflicting statements on the effectiveness of debriefing and trauma counselling.

  1. Tension pneumocranium in childhood trauma.

    PubMed

    Gill, Hardeep Singh; van As, Arjan Bastiaan

    2008-08-01

    To report a case of fatal tension pneumocephalus in a 9-year-old boy following a severe motor vehicle accident. A young boy with a serious closed head injury was resuscitated in the emergency room and underwent CT scan of the head and orbits. The CT-scan revealed a fracture of the orbital roof with extensive bilateral pneumocephalus. A high index of suspicion for tension pneumocephalus is required in patients with severe head injuries presenting with periorbital swelling and perioccular trauma. A prompt CT scan and neurosurgical intervention are indicated.

  2. Surgical Management of Musculoskeletal Trauma.

    PubMed

    Stinner, Daniel J; Edwards, Dafydd

    2017-10-01

    Musculoskeletal injuries cause a significant burden to society and can have a considerable impact on patient morbidity and mortality. It was initially thought that these patients were too sick to undergo surgery and later believed that they were too sick not to undergo surgery. The pendulum has subsequently swung back and forth between damage control orthopedics and early total care for polytrauma patients with extremity injuries and has settled on providing early appropriate care (EAC). The decision-making process in providing EAC is reviewed in an effort to optimize patient outcomes following severe extremity trauma. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

  3. [Thoracic drainage in trauma emergencies].

    PubMed

    Bergaminelli, C; De Angelis, P; Gauthier, P; Salzano, A; Vecchio, G

    1999-10-01

    A group of 191 cases of emergency tube thoracostomy for acute trauma reviewed retrospectively from March 1993 to March 1998 is reported. Of this group 169 were men and 22 were women. Their ages ranged from 16 to 73 years. The causes were as follows: 89 cases (46%) road accident; 33 cases (17%) accidental trauma; 33 cases (17%) someone else violence (assault, gunshot or stab wound); 15 cases (8%) work accident; 11 cases (6%) domestic accident and 5 cases (3%) iatrogenic trauma. In 32 patients a diagnosis of pneumothorax was made (2 tension, 11 for penetrating chest injuries, 19 after blunt trauma). In 2 cases of tension pneumothorax and in 3 cases of open pneumothorax a chest tube (24-28 Fr) in the third space in the mid-clavicular line was introduced. In the other patients it was decided to place a chest tube in the mid-axillary line in the fifth intercostal space to drain pneumothorax. Only in 7 cases suction was necessary. Fifty-four hemothorax (3 bilateral) were treated in 11 cases using thoracentesis, while the remaining cases were treated using the insertion of multiple drainage holes in the intercostal space (fifth in the mid-axillary line directed inferiorly and posteriorly). One hundred and three were the cases of hemopneumothorax: 24 of them received 2 chest tubes, the first (20-26 Fr) apically in the second intercostal space in the mid-clavicular line, the second (32-38 Fr) in the fifth intercostal space in the mid-axillary line. All the other cases were treated using a single thoracostomy. In 14 cases suction was applied. Two cases of chylothorax resolved by a large tube positioned in the chest (fifth intercostal space in the mid-axillary line) with a constant negative pressure were also observed. Duration of tube drainage ranged from 4 and 18 days, with an average of 11 days. Five infections of thoracostomy site and 1 empyema resolved by rethoracotomy were observed. Moreover, there were 3 complications: 2 subcutaneous placements and 1 little laceration

  4. Imaging of Urinary System Trauma.

    PubMed

    Gross, Joel A; Lehnert, Bruce E; Linnau, Ken F; Voelzke, Bryan B; Sandstrom, Claire K

    2015-07-01

    Computed tomography (CT) imaging of the kidney, ureter, and bladder permit accurate and prompt diagnosis or exclusion of traumatic injuries, without the need to move the patient to the fluoroscopy suite. Real-time review of imaging permits selective delayed imaging, reducing time on the scanner and radiation dose for patients who do not require delays. Modifying imaging parameters to obtain thicker slices and noisier images permits detection of contrast extravasation from the kidneys, ureters, and bladder, while reducing radiation dose on the delayed or cystographic imaging. The American Association for the Surgery of Trauma grading system is discussed, along with challenges and limitations.

  5. A national trauma capacity assessment of Haiti.

    PubMed

    McCullough, Chelsea; DeGennaro, Vincent; Bagley, Joel K; Sharma, Jyotirmay; Saint-Fort, Mackenson; Henrys, Jean Hugues

    2016-03-01

    Trauma systems in high-income countries have been shown to reduce trauma-related morbidity and mortality; however, these systems are infrequently implemented in low- and middle-income countries. Haiti currently lacks a well-resourced and structured trauma system and in turn loses an estimated 800,000 y of healthy life to injuries annually. In the present study, we perform a nationwide trauma capacity assessment, and using the World Health Organization's Guidelines for Essential Trauma Care as a framework, we attempt to identify achievable steps that can be taken toward improving trauma care in Haiti. This cross-sectional study was performed at 12 facilities nationally using a survey tool assessing the areas of infrastructure, supplies and equipment, personnel and training, and procedural capabilities. Additionally, the total number of trauma cases presenting to each facility was tabulated from emergency room logbooks. A total of six secondary and six tertiary facilities were surveyed. Secondary facilities received an average of 35 trauma cases per week, whereas tertiary facilities received an average of 65 cases per week. Survey results demonstrated a shortage of airway, breathing, and circulation equipment and supplies in both facility levels, particularly in emergency rooms. All facilities lacked access to essential surgical personnel and trauma training. This study makes recommendations for improvements in trauma care in Haiti in the areas of infrastructure and administration, physical resources, and training and human resources. These recommendations represent feasible steps that can be taken toward the construction of a national trauma system in Haiti. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Is informed consent effective in trauma patients?

    PubMed

    Bhangu, A; Hood, E; Datta, A; Mangaleshkar, S

    2008-11-01

    Informed consent in the modern era is a common and important topic both for the well-informed patient and to prevent unnecessary litigation. However, the effectiveness of informed consent in trauma patients is an under-researched area. This paper aims to assess the differences in patient recall of the consent process and desire for information by performing a comparative analysis between orthopaedic trauma and elective patients. Information from 41 consecutive elective operations and 40 consecutive trauma operations was collected on the first post-operative day. 100% of elective patients and 90% of trauma patients knew what operation they had received (p = 0.06). Overall recall of complications was poor, but was significantly lower in trauma patients compared with elective patients (62% vs 22%, p<0.001). 30% of trauma patients desired more information about their operation compared to 12% of elective patients (p = 0.049), although only 35% of trauma patients wanted written as well as verbal explanations, compared to 85% of elective patients p<0.001). Overall 100% of elective and 90% of trauma patients were happy with the consent process (p = 0.06). Subset analysis of neck of femur compared to other trauma patients showed that the above factors were not significantly different between the two groups. Recall of complications in the trauma patients is significantly lower than in elective patients, although both groups scored poorly overall. Repeated verbal explanations should be reinforced with the option of additional information leaflets for trauma operations. Further research into the usefulness of DVDs for commonly performed operations is warranted, although official internet resources may be more cost-effective.

  7. Vicarious Trauma Among Sexual Assault Nurse Examiners.

    PubMed

    Raunick, Cara Berg; Lindell, Deborah F; Morris, Diana Lynn; Backman, Theresa

    2015-01-01

    Vicarious trauma (VT), the phenomenon of changes in cognition and worldview that result from empathic response and repeated exposure to narratives of trauma, is a risk for helping professionals. This descriptive, correlational study sought to examine levels of VT among sexual assault nurse examiners (SANEs) as compared with other women's health nurses. It also explored whether levels of VT are different for nurses who have experienced primary trauma alone, VT alone, or both personal trauma and VT. VT was assessed through an anonymous online survey using the nurses' total scores on the Trauma and Attachment Belief Scale. Trauma and Attachment Belief Scale scores were significantly higher for SANEs (M = 178.5, SD = 42.6) than for women's health nurses (M = 168.1, SD = 41.4; p = 0.025), indicating higher levels of trauma-related cognitive disruption in the SANE group. Scores were also significantly higher for both groups with personal trauma histories at the p < 0.05 level compared with the women's health nurses with no personal history. SANEs who had no personal history of trauma did not differ significantly from either group of nurses who did, suggesting that VT from working as an SANE is associated with levels of cognitive disruption similar to oneself having experienced trauma. Nurses should be aware of this phenomenon and its sequelae when choosing to pursue the specialty of sexual assault nursing. Hospitals and other organizations employing SANEs should also be aware of VT and provide a support system with resources in place to mitigate these effects. Future research should further explore effects of primary trauma versus VT, clinical manifestations and significance of varying levels of VT, and interventions and strategies for dealing with VT.

  8. The cost of trauma center readiness.

    PubMed

    Taheri, Paul A; Butz, David A; Lottenberg, Larry; Clawson, Art; Flint, Lewis M

    2004-01-01

    Trauma centers and the services they provide are a unique and necessary component of our health system. By design trauma centers treat all injured patients regardless of their clinical or economic needs. The purpose of this study was to quantify the costs associated with the preparation of the capacity to provide trauma care at trauma centers within the State of Florida. Utilizing a survey tool and multiple retreats, we assessed the capability of 20 verified trauma centers throughout the State of Florida. The survey focused on general attributes of each hospital, the costs associated with physician on call coverage, costs associated with verification, and lastly the costs associated with administration, outreach, and prevention. Data were acquired from 10 trauma centers. Ninety percent of the respondents pay on-call coverage. The median annual physician compensation for on-call coverage was approximately 2.1 million US dollars. The total medial cost of readiness for each trauma center approximated 2.7 million US dollars annually. Trauma centers like fire departments and police services are required to be available 24 hours a day, 7 days a week. This level of commitment by trauma centers and the reciprocal expectation from the community force trauma centers to make considerable investments in readiness. This cost of readiness is expended regardless of the patient volume or insurance status. Thus trauma centers have a large component of costs that are not captured by the traditional billing and cost accounting mechanisms within health systems and this fixed expense is extraordinarily difficult to recover given the current reimbursement environment.

  9. Evaluation of geriatric patients with trauma scores after motor vehicle trauma.

    PubMed

    Cevik, Yunsur; Doğan, Nurettin Özgür; Daş, Murat; Karakayali, Onur; Delice, Orhan; Kavalci, Cemil

    2013-10-01

    The aim of this study was to investigate the factors affecting in-hospital mortality among geriatric trauma patients who presented to the emergency department (ED) following a motor vehicle collision. A retrospective cohort study was carried out in a high-volume tertiary care facility in the central Anatolian Region. Clinical data were extracted from hospital databases for all eligible geriatric patients (either driver, passenger or pedestrian) with entries dated between January 1, 2007, and December 31, 2009. Multivariate logistic regression analysis was used to assess the in-hospital mortality effects of variables including demographic characteristics, trauma mechanisms, injured body parts and various trauma scores. There were 395 geriatric motor vehicle trauma presentations to the ED during the 3-year period. Of these patients, 371 (93.9%) survived, and 24 (6.1%) died in the ED, operating room or intensive care unit. The multivariate logistic regression model included the following variables: heart failure, cranial trauma, abdominal trauma, thoracic trauma, pelvic trauma, Glasgow Coma Score and Injury Severity Score (ISS). These variables were chosen because univariate analysis indicated that they were potential predictors of mortality. The multivariate logistic regression showed that the presence of heart failure (OR: 20.2), cranial trauma (OR: 3.6), abdominal trauma (OR: 26.9), pelvic trauma (OR: 9.9) and ISS (OR: 1.2) were predictors of in-hospital mortality in the study population. In our study, heart failure, cranial trauma, abdominal trauma, pelvic trauma, and ISS were found to be the most important predictors of in-hospital mortality among geriatric motor vehicle trauma patients. © 2013.

  10. Trauma Management of the Auricle.

    PubMed

    Steffen, Armin; Frenzel, Henning

    2015-08-01

    Smaller injuries of the auricle, such as lacerations without tissue loss, have more or less standardized treatment protocols that require thorough wound closure of each affected layer. Even extended lacerations of larger parts of the ear quite often heal with only minor irregularities. New in vivo diagnostic tools have aided the understanding of this outstanding "skin flap behavior." At the other end of the trauma severity spectrum are partial or complete amputations of the ear. Here, the debate has become more intense over the last decade. There were numerous reports of successful microvascular reattachments in the 1990s. Consequently, pocket methods and their variations have received increasing attention because the results seem to be convincing. Nevertheless, the pressure damage due to banking larger parts of the elastic cartilage in the mastoid region is tremendous, and the tissue for secondary reconstruction is severely injured. Particularly in cases of acute trauma with relevant concomitant injuries to the patient and in cases in which the amputated area is in a critical state, direct wound closure is a straightforward and safe option. Subsequent thoughtfully planned secondary reconstruction using ear or rib cartilage, or even allogenous material as an ear framework, can achieve excellent aesthetic results.

  11. Imaging following acute knee trauma.

    PubMed

    Kijowski, R; Roemer, F; Englund, M; Tiderius, C J; Swärd, P; Frobell, R B

    2014-10-01

    Joint injury has been recognized as a potent risk factor for the onset of osteoarthritis. The vast majority of studies using imaging technology for longitudinal assessment of patients following joint injury have focused on the injured knee joint, specifically in patients with anterior cruciate ligament injury and meniscus tears where a high risk for rapid onset of post-traumatic osteoarthritis is well known. Although there are many imaging modalities under constant development, magnetic resonance (MR) imaging is the most important instrument for longitudinal monitoring after joint injury. MR imaging is sensitive for detecting early cartilage degeneration and can evaluate other joint structures including the menisci, bone marrow, tendons, and ligaments which can be sources of pain following acute injury. In this review, focusing on imaging following acute knee trauma, several studies were identified with promising short-term results of osseous and soft tissue changes after joint injury. However, studies connecting these promising short-term results to the development of osteoarthritis were limited which is likely due to the long follow-up periods needed to document the radiographic and clinical onset of the disease. Thus, it is recommended that additional high quality longitudinal studies with extended follow-up periods be performed to further investigate the long-term consequences of the early osseous and soft tissue changes identified on MR imaging after acute knee trauma.

  12. Pediatric vs adult vascular trauma: a National Trauma Databank review.

    PubMed

    Barmparas, Galinos; Inaba, Kenji; Talving, Peep; David, Jean-Stephane; Lam, Lydia; Plurad, David; Green, Donald; Demetriades, Demetrios

    2010-07-01

    The purpose of this study was to examine nationwide data on vascular injuries in children and to compare pediatric and adult patients with respect to the incidence, injury mechanisms, and outcomes. This is a National Trauma Databank analysis based on dataset version 7.0 (spanning a 5-year period ending December 2006). Pediatric patients under the age of 16 with at least one reported diagnosis of a vascular injury were compared to the adult cohort aged 16 and greater with a vascular injury. During the study period, of 251,787 injured patients younger than 16 years, 1138 (0.6%) had a vascular injury. The incidence in patients 16 years or older was significantly higher, at 1.6% (P < .01). Compared to the adult vascular patients, pediatric patients had a significantly lower Injury Severity Score (16.8 +/- 14.9 vs 26.3 +/- 16.7, P < .001) and encountered less frequently penetrating injuries (41.8% vs 51.2%, P < .001). The most commonly injured vessels in the pediatric population were vessels of the upper extremity (424 patients or 37.9%). The overall incidence of thoracic aortic injuries in children was seven-fold lower compared to the incidence in adults (0.03% vs 0.21%). After adjusting for confounding factors, pediatric patients demonstrated improved survival following vascular injuries (adjusted odds ratio, 0.60; 95% CI, 0.45-0.79; P < .001). No significant difference was identified in the rate of amputation between pediatric and adult patients who had sustained upper or lower extremity vascular injuries. Vascular trauma in the pediatric population is uncommon, occurring in only 0.6% of all pediatric trauma patients. Although less frequent than adults, a significant proportion was due to penetrating injury. Vessels of the upper extremity were the most commonly injured and were associated with low mortality. Injuries of the thoracic aorta are rare. Overall, pediatric patients had an improved adjusted mortality when compared to adults. Copyright 2010 Elsevier Inc. All

  13. Bicycle trauma and alcohol intoxication.

    PubMed

    Harada, Megan Y; Gangi, Alexandra; Ko, Ara; Liou, Douglas Z; Barmparas, Galinos; Li, Tong; Hotz, Heidi; Stewart, Donovan; Ley, Eric J

    2015-12-01

    As bicycling has become more popular, admissions after bicycle trauma are on the rise. The impact of alcohol use on bicycle trauma has not been well studied. The aim of this study was to examine the effect of alcohol intoxication on injury burden following bicycle-related crashes. A retrospective review of trauma patients presenting to a Level I trauma center after bicycle-related crashes from January 2002 to December 2011 was conducted. Demographics, injury data, alcohol intoxication, helmet use, and clinical outcomes were reviewed. Blood alcohol level (BAL) was considered positive if >0.01 g/dL. Variables were compared between patients based on BAL: negative, 0.01-0.16 g/dL, and >0.16 g/dL. During the 10 year study period, 563 patients met study criteria; mean age was 33.5 ± 16.5 years, 87% were male, and mortality was 1%. On average, bicycle crashes increased over the study period by 4.4 collisions per year. BAL was tested in 211 (38%) patients. Mean BAL was 0.24 g/dL, with 37% of these patients being intoxicated (BAL ≥ 0.010 g/dL). Intoxicated patients were significantly less likely to wear a helmet (4.7% vs. 22.2%, p = 0.002) and to be involved in motor vehicle crash (59.0% vs. 81.2%, p < 0.001). There was no difference noted in the injury burden including ISS ≥ 16 (14.3% vs. 19.5%, p = 0.335) and AIS Head ≥ 3 (17.9% vs. 21.8%, p = 0.502). When comparing patients according to their BAL, there was a decreasing risk of motor vehicle collision with increasing BAL (81.2% for undetected, 76.5% for BAL ≤ 0.16 g/dL and 54.1% for BAL >0.16 g/dL, p < 0.001). The risk for a severe head injury (AIS Head ≥ 3) was significantly lower in helmeted patients (8.4% vs. 15.8%, p = 0.035). The incidence of bicycle-related crashes is increasing and more than a third of patients tested for alcohol after bicycle-related crashes are found to be intoxicated. The injury burden in intoxicated patients, including head trauma, was not different compared to non

  14. Trauma among Street-Involved Youth

    ERIC Educational Resources Information Center

    Bender, Kimberly A.; Thompson, Sanna J.; Ferguson, Kristin M.; Yoder, Jamie R.; Kern, Leah

    2014-01-01

    Previous research documents that street-involved youth experience rates of trauma and posttraumatic stress disorder (PTSD) that are significantly higher than their housed counterparts. Trauma and PTSD are of particular concern for homeless youth as they can negatively affect youths' ability to function adaptively and to transition off the streets.…

  15. Healing Trauma, Building Resilience: SITCAP in Action

    ERIC Educational Resources Information Center

    Steele, William; Kuban, Caelan

    2014-01-01

    Childhood trauma is marked by an overwhelming sense of terror and powerlessness. Loss of loving relationships is yet another type of trauma that produces the pain of sadness and grief. The resulting symptoms only reflect the neurological, biological, and emotional coping systems mobilized in the struggle to survive. These young people need new…

  16. Trauma-Focused Training Program for Teachers

    ERIC Educational Resources Information Center

    Davis, Marilyn Diane

    2016-01-01

    Teachers have reported that they have difficulty providing support to traumatized children and youth because of a lack of training in how to identify and respond to the needs of these children. The program, "Amazing Help Skills for Teachers to Unmask Trauma in Children and Youth" (AHSUM), is a trauma-focused training program, designed…

  17. Trauma-Informed Forensic Child Maltreatment Investigations

    ERIC Educational Resources Information Center

    Pence, Donna M.

    2011-01-01

    Trauma-informed child welfare systems (CWSs) are the focus of several recent national and state initiatives. Since 2005 social work publications have focused on systemic and practice changes within CW which seek to identify and reduce trauma to children and families experiencing child maltreatment or other distressing events, as well as to the…

  18. Supporting Students Who Have Experienced Trauma

    ERIC Educational Resources Information Center

    Wright, Travis

    2017-01-01

    Travis Wright presents an important understanding of trauma that leads to a new perspective of "challenging" behaviors in the classroom. "Trauma is not an event in itself, but is instead the reaction to extremely stressful life circumstances... When children operate in overwhelming states of stress, the stress response system may…

  19. Healing Trauma, Building Resilience: SITCAP in Action

    ERIC Educational Resources Information Center

    Steele, William; Kuban, Caelan

    2014-01-01

    Childhood trauma is marked by an overwhelming sense of terror and powerlessness. Loss of loving relationships is yet another type of trauma that produces the pain of sadness and grief. The resulting symptoms only reflect the neurological, biological, and emotional coping systems mobilized in the struggle to survive. These young people need new…

  20. Trauma-Informed Forensic Child Maltreatment Investigations

    ERIC Educational Resources Information Center

    Pence, Donna M.

    2011-01-01

    Trauma-informed child welfare systems (CWSs) are the focus of several recent national and state initiatives. Since 2005 social work publications have focused on systemic and practice changes within CW which seek to identify and reduce trauma to children and families experiencing child maltreatment or other distressing events, as well as to the…

  1. Trauma-Focused Training Program for Teachers

    ERIC Educational Resources Information Center

    Davis, Marilyn Diane

    2016-01-01

    Teachers have reported that they have difficulty providing support to traumatized children and youth because of a lack of training in how to identify and respond to the needs of these children. The program, "Amazing Help Skills for Teachers to Unmask Trauma in Children and Youth" (AHSUM), is a trauma-focused training program, designed…

  2. Trauma among Street-Involved Youth

    ERIC Educational Resources Information Center

    Bender, Kimberly A.; Thompson, Sanna J.; Ferguson, Kristin M.; Yoder, Jamie R.; Kern, Leah

    2014-01-01

    Previous research documents that street-involved youth experience rates of trauma and posttraumatic stress disorder (PTSD) that are significantly higher than their housed counterparts. Trauma and PTSD are of particular concern for homeless youth as they can negatively affect youths' ability to function adaptively and to transition off the streets.…

  3. Trauma and Learning in America's Classrooms

    ERIC Educational Resources Information Center

    Terrasi, Salvatore; de Galarce, Patricia Crain

    2017-01-01

    Whether they work in a rural, urban, or suburban district, all teachers should expect to confront children who have had adverse childhood experiences involving trauma. All teachers should understand how trauma affects students' social, emotional, and academic growth. The more that teachers understand how traumatic experiences affect student…

  4. Trauma-Inspired Prosocial Leadership Development

    ERIC Educational Resources Information Center

    Williams, Jenifer Wolf; Allen, Stuart

    2015-01-01

    Though trauma survivors sometimes emerge as leaders in prosocial causes related to their previous negative or traumatic experiences, little is known about this transition, and limited guidance is available for survivors who hope to make prosocial contributions. To understand what enables trauma-inspired prosocial leadership development, the…

  5. Tips for Teachers during Times of Trauma.

    ERIC Educational Resources Information Center

    Adkins, Myrna Ann; Harper, Eric

    This guide for teachers in times of trauma was updated after the events of September 11, 2001--the terrorist attacks on the World Trade Center and the Pentagon. These traumatic events could cause refugees to experience trauma or become re-traumatized. For many refugees, their English-as-a-Second-Language (ESL) programs are the places where they…

  6. Anabolic steroid accelerated multicompartment syndrome following trauma

    PubMed Central

    Bahia, H; Platt, A; Hart, N; Baguley, P

    2000-01-01

    The case is reported of a 23 year old male body builder who was involved in a road traffic accident after taking anabolic steroids. The resulting trauma caused a severe life threatening acute multicompartment syndrome resulting in the need for urgent multiple fasciotomies. Key Words: anabolic steroids; body builder; trauma; multicompartment syndrome PMID:10953907

  7. Major trauma in Australia: a regional analysis.

    PubMed

    Cameron, P; Dziukas, L; Hadj, A; Clark, P; Hooper, S

    1995-09-01

    This study was undertaken to evaluate the frequency, distribution, cause, pattern, and outcome of patients suffering from major trauma in the State of Victoria over a 1-year period. No previous study in Australia has attempted a comprehensive regional analysis of major trauma. All major trauma admissions resulting from blunt, penetrating, and burns injury were identified, and data collected from emergency departments and intensive care log books at 25 major metropolitan and rural hospitals from the January 3, 1992 to February 28, 1993 by onsite data collectors. The total number of patients admitted into the study was 2,944. There were 1,076 major trauma cases with an Injury Severity Score greater than 15 in a population of 4.2 million people. The type of injury was predominantly blunt (87.5%), with only a small percentage of penetrating injuries (6.4%) and burns (6%). Major trauma in pediatric cases is less common (132 cases). The most common causes of injury were road transport (56%) and falls (22%). The overall outcome of the group was favorable when compared with the Major Trauma Outcome Study group (Z = 1.4, M = 0.93, W = 0.52). There was an unexpectedly low number of patients suffering from major trauma. Outcome using Trauma and Injury Severity Score methodology was favorable when compared with North America.

  8. Dental and General Trauma in Team Handball.

    PubMed

    Petrović, Mateja; Kühl, Sebastian; Šlaj, Martina; Connert, Thomas; Filippi, Andreas

    Handball has developed into a much faster and high-impact sport over the past few years because of rule changes. Fast sports with close body contact are especially prone to orofacial trauma. Handball belongs to a category of sports with medium risk for dental trauma. Even so, there is only little literature on this subject. The aim of this study was to examine the prevalence and the type of injuries, especially the occurrence of orofacial trauma, habits of wearing mouthguards, as well as degree of familiarity with the tooth rescue box. For this purpose, 77.1% (n=542/703) of all top athletes and coaches from the two highest Swiss leagues (National League A and National League B), namely 507 professional players and 35 coaches, were personally interviewed using a standardized questionnaire. 19.7% (n=100/507) of the players experienced dental trauma in their handball careers, with 40.8% (n=51/125) crown fractures being the most frequent by far. In spite of the relatively high risk of lip or dental trauma, only 5.7% (n=29/507) of the players wear mouthguards. The results of this study show that dental trauma is common among Swiss handball players. In spite of the high risk of dental trauma, the mouthguard as prevention is not adequately known, and correct procedure following dental trauma is rarely known at all.

  9. The Biology of Trauma: Implications for Treatment

    ERIC Educational Resources Information Center

    Solomon, Eldra P.; Heide, Kathleen M.

    2005-01-01

    During the past 20 years, the development of brain imaging techniques and new biochemical approaches has led to increased understanding of the biological effects of psychological trauma. New hypotheses have been generated about brain development and the roots of antisocial behavior. We now understand that psychological trauma disrupts homeostasis…

  10. Training Journalism Students To Deal with Trauma.

    ERIC Educational Resources Information Center

    Maxson, Jan

    The School of Communications at the University of Washington initiated the Journalism and Trauma program in 1994 so that all of its journalism graduates would be informed about trauma and would consider how to interview and write about victims without doing further harm to them. The program adapts learning objectives of the pioneer Victims and the…

  11. The Biology of Trauma: Implications for Treatment

    ERIC Educational Resources Information Center

    Solomon, Eldra P.; Heide, Kathleen M.

    2005-01-01

    During the past 20 years, the development of brain imaging techniques and new biochemical approaches has led to increased understanding of the biological effects of psychological trauma. New hypotheses have been generated about brain development and the roots of antisocial behavior. We now understand that psychological trauma disrupts homeostasis…

  12. Partner preferences among survivors of betrayal trauma.

    PubMed

    Gobin, Robyn L

    2012-01-01

    Betrayal trauma theory suggests that social and cognitive development may be affected by early trauma such that individuals develop survival strategies, particularly dissociation and lack of betrayal awareness, that may place them at risk for further victimization. Several experiences of victimization in the context of relationships predicated on trust and dependence may contribute to the development of relational schema whereby abuse is perceived as normal. The current exploratory study investigates interpersonal trauma as an early experience that might impact the traits that are desired in potential romantic partners. Participants in the current study were asked to rate the desirability of several characteristics in potential romantic partners. Although loyalty was desirable to most participants regardless of their trauma history, those who reported experiences of high betrayal trauma rated loyalty less desirable than those who reported experiences of traumas that were low and medium in betrayal. Participants who reported experiences of revictimization (defined as the experience of trauma perpetrated by a close other during 2 different developmental periods) differed from participants who only reported 1 experience of high betrayal trauma in their self-reported desire for a romantic partner who possessed the traits of sincerity and trustworthiness. Preference for a partner who uses the tactic of verbal aggression was also associated with revictimization status. These preliminary findings suggest that victimization perpetrated by close others may affect partner preferences.

  13. Superman play and pediatric blunt abdominal trauma.

    PubMed

    Machi, J M; Gyuro, J; Losek, J D

    1996-01-01

    Two pediatric patients with life-threatening intra-abdominal injuries associated with Superman play are presented. The cases illustrate the importance of knowing the mechanism of injury in the assessment of children with blunt abdominal trauma. The diagnostic value of liver enzymes and the controversies surrounding the radiographic assessment of pediatric blunt abdominal trauma are presented.

  14. Quantifying Discretization Effects on Brain Trauma Simulations

    DTIC Science & Technology

    2016-01-01

    analyzed in each case were the variations in stress magnitude, spatial distribution, and wave patterns that arise inside the brain. The effects of...ARL-CR-0792 ● JAN 2016 US Army Research Laboratory Quantifying Discretization Effects on Brain Trauma Simulations prepared by...originator. ARL-CR-0792● JAN 2016 US Army Research Laboratory Quantifying Discretization Effects on Brain Trauma Simulations

  15. Complications of tube thoracostomy using Advanced Trauma Life Support technique in chest trauma.

    PubMed

    Iribhogbe, P E; Uwuigbe, O

    2011-01-01

    Tube thoracostomy (TT) is central in the management of chest trauma sufficing in over 80% of cases. As a result the procedure is commonly performed in most emergency departments. The aim of this study was to assess the efficacy and complications of TT using Advanced Trauma Life Support (ATLS) technique in chest trauma. This prospective study was done at the Trauma Unit of the University of Benin Teaching Hospital in Nigeria. All patients with chest trauma who needed tube thoracostomy between February 2006 and February 2009 were studied. Data recorded for each patient included injury, mechanism of injury, Glasgow Coma score, revised trauma score, and indications for tube thoracostomy. Chest radiographs were obtained preinsertion, post insertion and post extubation for all the cases. Patients were monitored for tube thoracostomy complications. Of 9415 trauma patients seen during the period 105 patients had tube thoracostomy but only 70 (56 male, 14 female) had adequate data for analysis. Seventy-four tubes were passed in the 70 patients with unilateral tubes in 66 (94.3%) and bilateral tubes in 4 (5.7%). Blunt chest trauma occurred in 32 (45.7%) and penetrating chest trauma in 38 (54.3%) of the patients. Simple haemothorax and haemopneumothorax were the commonest indications for tube thoracostomy. Complications recorded include four cases of kinked tubes, four of superficial wound infection and 10 cases of residual haemothorax. Tube thoracostomy in the emergency department using advanced trauma life support principles is effective in chest trauma and associated with few complications.

  16. Trauma Type and Posttraumatic Stress Disorder as Predictors of Parenting Stress in Trauma-Exposed Mothers.

    PubMed

    Wilson, Christina K; Padrón, Elena; Samuelson, Kristin W

    2017-02-01

    Trauma exposure is associated with various parenting difficulties, but few studies have examined relationships between trauma, posttraumatic stress disorder (PTSD), and parenting stress. Parenting stress is an important facet of parenting and mediates the relationship between parental trauma exposure and negative child outcomes (Owen, Thompson, & Kaslow, 2006). We examined trauma type (child maltreatment, intimate partner violence, community violence, and non-interpersonal traumas) and PTSD symptoms as predictors of parenting stress in a sample of 52 trauma-exposed mothers. Community violence exposure and PTSD symptom severity accounted for significant variance in parenting stress. Further analyses revealed that emotional numbing was the only PTSD symptom cluster accounting for variance in parenting stress scores. Results highlight the importance of addressing community violence exposure and emotion regulation difficulties with trauma-exposed mothers.

  17. [Modern concepts of trauma care and multiple trauma management in oral and maxillofacial region].

    PubMed

    Tan, Yinghui

    2015-06-01

    Multiple trauma management requires the application of modem trauma care theories. Optimal treatment results can be achieved by reinforcing cooperation and stipulating a treatment plan together with other disciplines. Based on modem theories in trauma care and our understanding of the theoretical points, this paper analyzes the injury assessment strategies and methods in oral and maxillofacial multiple trauma management. Moreover, this paper discusses operating time and other influencing factors as well as proposed definitive surgical timing and indications in comprehensive management of oral and maxillofacial multiple trauma patients associated with injuries in other body parts. We hope that this paper can help stomatological physicians deepen their understanding of modem trauma care theories and improve their capacity and results in the treatment of oral and maxillofacial multiple trauma.

  18. OOSTT: a Resource for Analyzing the Organizational Structures of Trauma Centers and Trauma Systems

    PubMed Central

    Utecht, Joseph; Judkins, John; Otte, J. Neil; Colvin, Terra; Rogers, Nicholas; Rose, Robert; Alvi, Maria; Hicks, Amanda; Ball, Jane; Bowman, Stephen M.; Maxson, Robert T.; Nabaweesi, Rosemary; Pradhan, Rohit; Sanddal, Nels D.; Tudoreanu, M. Eduard; Winchell, Robert J.; Brochhausen, Mathias

    2017-01-01

    Organizational structures of healthcare organizations has increasingly become a focus of medical research. In the CAFÉ project we aim to provide a web-service enabling ontology-driven comparison of the organizational characteristics of trauma centers and trauma systems. Trauma remains one of the biggest challenges to healthcare systems worldwide. Research has demonstrated that coordinated efforts like trauma systems and trauma centers are key components of addressing this challenge. Evaluation and comparison of these organizations is essential. However, this research challenge is frequently compounded by the lack of a shared terminology and the lack of effective information technology solutions for assessing and comparing these organizations. In this paper we present the Ontology of Organizational Structures of Trauma systems and Trauma centers (OOSTT) that provides the ontological foundation to CAFÉ's web-based questionnaire infrastructure. We present the usage of the ontology in relation to the questionnaire and provide the methods that were used to create the ontology. PMID:28217041

  19. OOSTT: a Resource for Analyzing the Organizational Structures of Trauma Centers and Trauma Systems.

    PubMed

    Utecht, Joseph; Judkins, John; Otte, J Neil; Colvin, Terra; Rogers, Nicholas; Rose, Robert; Alvi, Maria; Hicks, Amanda; Ball, Jane; Bowman, Stephen M; Maxson, Robert T; Nabaweesi, Rosemary; Pradhan, Rohit; Sanddal, Nels D; Tudoreanu, M Eduard; Winchell, Robert J; Brochhausen, Mathias

    2016-08-01

    Organizational structures of healthcare organizations has increasingly become a focus of medical research. In the CAFÉ project we aim to provide a web-service enabling ontology-driven comparison of the organizational characteristics of trauma centers and trauma systems. Trauma remains one of the biggest challenges to healthcare systems worldwide. Research has demonstrated that coordinated efforts like trauma systems and trauma centers are key components of addressing this challenge. Evaluation and comparison of these organizations is essential. However, this research challenge is frequently compounded by the lack of a shared terminology and the lack of effective information technology solutions for assessing and comparing these organizations. In this paper we present the Ontology of Organizational Structures of Trauma systems and Trauma centers (OOSTT) that provides the ontological foundation to CAFÉ's web-based questionnaire infrastructure. We present the usage of the ontology in relation to the questionnaire and provide the methods that were used to create the ontology.

  20. [Imaging techniques in modern trauma diagnostics].

    PubMed

    Vogl, T J; Eichler, K; Marzi, I; Wutzler, S; Zacharowski, K; Frellessen, C

    2017-08-17

    Modern trauma room management requires interdisciplinary teamwork and synchronous communication between a team of anaesthesists, surgeons and radiologists. As the length of stay in the trauma room influences morbidity and mortality of a severely injured person, optimizing time is one of the main targets. With the direct involvement of modern imaging techniques the injuries caused by trauma should be detected within a very short period of time in order to enable a priority-orientated treatment. Radiology influences structure and process quality, management and development of trauma room algorithms regarding the use of imaging techniques. For the individual case interventional therapy methods can be added. Based on current data and on the Frankfurt experience the current diagnostic concepts of trauma diagnostics are presented.

  1. [Imaging techniques in modern trauma diagnostics].

    PubMed

    Vogl, T J; Eichler, K; Marzi, I; Wutzler, S; Zacharowski, K; Frellessen, C

    2017-05-01

    Modern trauma room management requires interdisciplinary teamwork and synchronous communication between a team of anaesthesists, surgeons and radiologists. As the length of stay in the trauma room influences morbidity and mortality of a severely injured person, optimizing time is one of the main targets. With the direct involvement of modern imaging techniques the injuries caused by trauma should be detected within a very short period of time in order to enable a priority-orientated treatment. Radiology influences structure and process quality, management and development of trauma room algorithms regarding the use of imaging techniques. For the individual case interventional therapy methods can be added. Based on current data and on the Frankfurt experience the current diagnostic concepts of trauma diagnostics are presented.

  2. [Imaging techniques in modern trauma diagnostics].

    PubMed

    Vogl, T J; Eichler, K; Marzi, I; Wutzler, S; Zacharowski, K; Frellessen, C

    2017-09-21

    Modern trauma room management requires interdisciplinary teamwork and synchronous communication between a team of anaesthesists, surgeons and radiologists. As the length of stay in the trauma room influences morbidity and mortality of a severely injured person, optimizing time is one of the main targets. With the direct involvement of modern imaging techniques the injuries caused by trauma should be detected within a very short period of time in order to enable a priority-orientated treatment. Radiology influences structure and process quality, management and development of trauma room algorithms regarding the use of imaging techniques. For the individual case interventional therapy methods can be added. Based on current data and on the Frankfurt experience the current diagnostic concepts of trauma diagnostics are presented.

  3. Trauma-Informed Social Work Practice.

    PubMed

    Levenson, Jill

    2017-04-01

    Social workers frequently encounter clients with a history of trauma. Trauma-informed care is a way of providing services by which social workers recognize the prevalence of early adversity in the lives of clients, view presenting problems as symptoms of maladaptive coping, and understand how early trauma shapes a client's fundamental beliefs about the world and affects his or her psychosocial functioning across the life span. Trauma-informed social work incorporates core principles of safety, trust, collaboration, choice, and empowerment and delivers services in a manner that avoids inadvertently repeating unhealthy interpersonal dynamics in the helping relationship. Trauma-informed social work can be integrated into all sorts of existing models of evidence-based services across populations and agency settings, can strengthen the therapeutic alliance, and facilitates posttraumatic growth. © 2017 National Association of Social Workers.

  4. Contemporary evaluation and management of renal trauma.

    PubMed

    Chouhan, Jyoti D; Winer, Andrew G; Johnson, Christina; Weiss, Jeffrey P; Hyacinthe, Llewellyn M

    2016-04-01

    Renal trauma occurs in approximately 1%-5% of all trauma cases. Improvements in imaging and management over the last two decades have caused a shift in the treatment of this clinical condition. A systematic search of PubMed was performed to identify relevant and contemporary articles that referred to the management and evaluation of renal trauma. Computed tomography remains a mainstay of radiological evaluation in hemodynamically stable patients. There is a growing body of literature showing that conservative, non-operative management of renal trauma is safe, even for Grade IV-V renal injuries. If surgical exploration is planned due to other injuries, a conservative approach to the kidney can often be utilized. Follow up imaging may be warranted in certain circumstances. Urinoma, delayed bleeding, and hypertension are complications that require follow up. Appropriate imaging and conservative approaches are a mainstay of current renal trauma management.

  5. The relationship of trauma severity and mortality with cardiac enzymes and cytokines at multiple trauma patients.

    PubMed

    Karakuş, Ali; Kekeç, Zeynep; Akçan, Ramazan; Seydaoğlu, Gülşah

    2012-07-01

    In this study, we aimed to determine the effects of trauma severity on cardiac involvement through evaluating the trauma severity score together with diagnostic tests in multiple trauma patients. A trauma score was determined using various trauma severity scales. After obtaining the approval of the ethics committee of the faculty, this prospective study was performed through evaluating 100 multiple trauma patients, aged over 15 years, who applied to our Emergency Department (ED). After determining the trauma severity score using instruments such as the Injury Severity Score (ISS), Glasgow Coma Scale (GCS), and Revised Trauma Score (RTS), the cardiac condition was evaluated using biochemical and radiological diagnostic tests. During the study period, 100 patients were evaluated (78 male, 22 female; mean age: 33.2±15.4; range 15 to 70 years). It was determined that 92 (92%) were blunt trauma cases, and 77 (77%) of them were due to traffic accidents. The majority of cases showed electrocardiogram (ECG) abnormalities (63%) and sinus tachycardia (36%). Abnormal echocardiogram (ECHO) findings, mostly accompanied by ventricular defects (n=24), were determined in 31 of the cases. Nineteen cases with high trauma severity score resulted in death, and 14 of all deaths were secondary to traffic accidents. Trauma scores were found to show a significant difference between the two groups. The ISS trauma scale was determined to be the most effective in terms of indicating heart involvement in patients with multiple traumas. Close follow-up and cardiac monitoring should be applied to patients with high trauma severity scores considering possible cardiac rhythm changes and hemodynamic disturbances due to cardiac involvement.

  6. A novel prospective approach to evaluate trauma recidivism: the concept of the past trauma history.

    PubMed

    McCoy, Andrew M; Como, John J; Greene, Gregory; Laskey, Sara L; Claridge, Jeffrey A

    2013-07-01

    The purpose of this study was to determine the incidence and burden of trauma recidivism at a regional Level 1 trauma center by incorporating the concept of the past trauma history (PTHx) into the general trauma history. All trauma patients who met prehospital trauma criteria and activated the trauma team during a 13-month period were asked about their PTHx, that is, their history of injury in the previous 5 years. A recidivist presented more than once for separate severe injuries. Recurrent recidivists presented multiple times during the study period. Of the 4,971 trauma activations during the study period, 1,246 (25.2%) were identified as recidivists. Recidivists were 75% male, 62% white, 36% unemployed, 26% uninsured, and 90% unmarried. The recidivism rate among admitted patients was 23.4% compared with 29.3% in those discharged from the emergency department. The highest recidivism rates were noted in patients who reported alcohol or illegal drug use on the day of injury and in victims of interpersonal violence (IPV), defined as those who sustained gunshot wounds, stab wounds, or assaults, Those involved in IPV were more likely to have been involved in IPV at the previous trauma than those with other trauma mechanisms. Key risk factors for recidivism among all patients were male sex and single marital status. Seventy-three patients (1.5%) were recurrent recidivists, representing 157 unique encounters. This is the highest trauma recidivism rate reported on a large population of all consecutive trauma activations at a regional Level 1 trauma center. These data illustrate the tremendous burden of recidivism in the modern era, more than previously recognized. Efforts specifically targeting those involved in IPV may reduce recidivism rates. Incorporating the concept of the PTHx into the general history of the trauma patient is feasible and provides valuable information to the provider. Prognostic study, level II.

  7. Epidemiology and outcome of vascular trauma at a British Major Trauma Centre.

    PubMed

    Perkins, Z B; De'Ath, H D; Aylwin, C; Brohi, K; Walsh, M; Tai, N R M

    2012-08-01

    In the United Kingdom, the epidemiology, management strategies and outcomes from vascular trauma are unknown. The aim of this study was to describe the vascular trauma experience of a British Trauma Centre. A retrospective observational study of all patients admitted to hospital with traumatic vascular injury between 2005 and 2010. Vascular injuries were present in 256 patients (4.4%) of the 5823 total trauma admissions. Penetrating trauma caused 135 (53%) vascular injuries whilst the remainder resulted from blunt trauma. Compared to penetrating vascular trauma, patients with blunt trauma were more severely injured (median ISS 29 [18-38] vs. ISS 11 [9-17], p < 0.0001), had greater mortality (26% vs. 10%; OR 3.0, 95% CI 1.5-5.9; p < 0.01) and higher limb amputation rates (12% vs. 0%; p < 0.0001). Blunt vascular trauma patients were also twice as likely to require a massive blood transfusion (48% vs. 25%; p = 0.0002) and had a five-fold longer hospital length of stay (median 35 days (15-58) vs. 7 (4-13), p<0.0001) and critical care stay (median 5 days (0-11) vs. 0 (0-2), p < 0.0001) compared to patients with penetrating trauma. Multivariate regression analysis showed that age, ISS, shock and zone of injury were independent predictors of death following vascular trauma. Traumatic vascular injury accounts for 4% of admissions to a British Trauma Centre. These patients are severely injured with high mortality and morbidity, and place a significant demand on hospital resources. Integration of vascular services with regional trauma systems will be an essential part of current efforts to improve trauma care in the UK. Copyright © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  8. Vascular trauma in geriatric patients: a national trauma databank review.

    PubMed

    Konstantinidis, Agathoklis; Inaba, Kenji; Dubose, Joe; Barmparas, Galinos; Lam, Lydia; Plurad, David; Branco, Bernardino C; Demetriades, Demetrios

    2011-10-01

    The epidemiology of vascular injuries in the geriatric patient population has not been described. The purpose of this study was to examine nationwide data on vascular injuries in the geriatric patients and to compare this with the nongeriatric adult patients with respect to the incidence, injury mechanisms, and outcomes. Geriatric patients aged 65 or older with at least one traumatic vascular injury were compared with an adult cohort aged 16 years to 64 years with a vascular injury using the National Trauma Databank version 7.0. During the study period, 29,736 (1.6%) patients with a vascular injury were identified. Of those, geriatric patients accounted for 7.6% (2,268) and the nongeriatric adult patients accounted for 83.1% (n=24,703). Compared with the nongeriatric adult patients, the geriatric vascular patients had a significantly higher Injury Severity Score (26.6±17.0 vs. 21.3±16.7; p<0.001) and less frequently sustained penetrating injuries (16.1% vs. 54.1%; p<0.001). The most commonly injured vessels in the elderly were vessels of the chest (n=637, 40.2%), including the thoracic aorta and innominate and subclavian vessels. The overall incidence of thoracic aorta injuries was significantly higher in geriatric patients (33.0% vs. 13.9%; p<0.001) and increased linearly with progressing age. After adjusting for confounding factors, geriatric patients demonstrated a fourfold increase in mortality following vascular injuries (adjusted odds ratio, 3.9; 95% confidence interval, 3.32-4.58; p<0.001). Vascular trauma is rare in the geriatric patient population. These injuries are predominantly blunt, with the thoracic aorta being the most commonly injured vessel. Although vascular injuries occur less frequently than in the nongeriatric cohort, in the geriatric patient, vascular injury is associated with a fourfold increase in adjusted mortality.

  9. The trauma ecosystem: The impact and economics of new trauma centers on a mature statewide trauma system.

    PubMed

    Ciesla, David J; Pracht, Etienne E; Leitz, Pablo T; Spain, David A; Staudenmayer, Kristan L; Tepas, Joseph J

    2017-06-01

    Florida serves as a model for the study of trauma system performance. Between 2010 and 2104, 5 new trauma centers were opened alongside 20 existing centers. The purpose of this study was to explore the impact of trauma system expansion on system triage performance and trauma center patients' profiles. A statewide data set was queried for all injury-related discharges from adult acute care hospitals using International Classification of Diseases, Ninth Revision (ICD-9) codes for 2010 and 2014. The data set, inclusion criteria, and definitions of high-risk injury were chosen to match those used by the Florida Department of Health in its trauma registry. Hospitals were classified as existing Level I (E1) or Level II (E2) trauma centers and new E2 (N2) centers. Five N2 centers were established 11.6 to 85.3 miles from existing centers. Field and overall trauma system triage of high-risk patients was less accurate with increased overtriage and no change in undertriage. Annual volume at N2 centers increased but did not change at E1 and E2 centers. In 2014, Patients at E1 and E2 centers were slightly older and less severely injured, while those at N2 centers were substantially younger and more severely injured than in 2010. The injured patient-payer mix changed with a decrease in self-pay and commercial patients and an increase in government-sponsored patients at E1 and E2 centers and an increase in self-pay and commercial patients with a decrease in government-sponsored patients at N2 centers. Designation of new trauma centers in a mature system was associated with a change in established trauma center demographics and economics without an improvement in trauma system triage performance. These findings suggest that the health of an entire trauma system network must be considered in the design and implementation of a regional trauma system. Therapeutic/care management study, level IV; epidemiological, level IV.

  10. Giant sialocele following facial trauma.

    PubMed

    Medeiros Júnior, Rui; Rocha Neto, Alípio Miguel da; Queiroz, Isaac Vieira; Cauby, Antônio de Figueiredo; Gueiros, Luiz Alcino Monteiro; Leão, Jair Carneiro

    2012-01-01

    Injuries in the parotid and masseter region can cause serious impairment secondary to damage of important anatomical structures. Sialocele is observed as facial swelling associated with parotid duct rupture due to trauma. The aim of this paper is to report a case of a giant traumatic sialocele in the parotid gland, secondary to a knife lesion in a 40-year-old woman. Conservative measures could not promote clinical resolution and a surgical intervention for the placement of a vacuum drain was selected. Under local anesthesia, a small incision was performed adjacent to parotid duct papilla, followed by muscular divulsion and draining of significant amount of saliva. An active vacuum suction drain was placed for 15 days, aiming to form a new salivary duct. This technique was shown to be a safe, effective and low-cost option, leading to complete resolution and no recurrence after 28 months of follow up.

  11. Anesthesia for trauma during wartime.

    PubMed

    Barton, C R; Beeson, M

    1997-02-01

    Trauma during wartime has been the scourge of the ages. Conventional anesthesia with ether has been available since 1846 when it was demonstrated in Boston by a dentist named William Morton. Subsequently, ether was used during the Mexican-American War in 1847, and chloroform was used during the Crimean War from 1854 to 1856. Nurse anesthetists have made substantial contributions to care of the war-injured by initiating acute airway management and resuscitation efforts and by the administration of anesthesia care for critically injured war casualties undergoing surgical procedures. They have further contributed to goodwill in war-torn areas by providing anesthesia care to many civilian children and adults living in these areas of conflict. The evolution of nurse anesthesia contributions to the treatment of traumatized war casualties is the central focus of this article.

  12. Trauma from occlusion. Restorative concerns.

    PubMed

    Neff, P

    1995-04-01

    Trauma from occlusion and restorative concerns may affect the tooth itself, the supporting structures inside and around the tooth's immediate structures, and the total articulating system, which includes the neuromuscular system, the temporomandibular joints, and other systems such as the impairment of hearing or vision and many other peripheral conditions. A thorough examination and a differential diagnosis procedure is essential to restore the health of the articulating system and reverse peripheral condition. This includes the ability to restore the individual tooth in its best anatomic position as a complement to the articulating system using all individual disciplines of dentistry in the finest abilities of treatment and the ability to share and distinguish the possible parafunctional habits and the need for behavioral understanding, support, and management to limit or lessen the wear and destruction of the individual tissues and to restore a healthier physical support.

  13. Arrow trauma to cervical spine.

    PubMed

    Geissinger, Gregory; Magid, Gail A; McMahon, Robert C

    2009-07-01

    A 50-year-old man was the victim of an accidental arrow shooting while hunting. The arrow entered his posterolateral neck and came to rest in the space between the C1/C2 vertebrae in his cervical spine. He was able to maintain his own cervical immobilization. His hunting partners drove him to meet emergency medical technicians, who stabilized the arrow shaft, transferred him to a backboard and gurney, and continued manual cervical immobilization en route to a local hospital. Cervical spine X-ray results compelled an air ambulance transfer to a trauma center where he underwent surgical intervention to remove the arrow. Following approximately 12 months of physical and occupational therapy, he returned to work full-time. Adherence to training and utilization of proven techniques involving pre-hospital transfers and positioning of cervically injured patients proved imperative to the patient's ultimate recovery.

  14. Helical CT of abdominal trauma.

    PubMed

    Novelline, R A; Rhea, J T; Bell, T

    1999-05-01

    CT has revolutionized the diagnostic work-up of trauma patients with suspected abdominal injuries. A wide range of intraperitoneal and retroperitoneal organ injuries can be quickly and accurately diagnosed with CT. Today, helical CT technology permits even faster examinations, with improved intravenous contrast opacification of parenchymal organs and vascular structures and reduced CT artifacts caused by patient motion, respiration, and arterial pulsation. Severely injured and potentially unstable patients, who might not have been able to tolerate the long CT examinations of the past, may be quickly evaluated today with helical CT. Accurate diagnosis requires high quality CT examinations that are performed with optimum CT protocols. This article reviews the currently recommended helical CT protocols for evaluating patients with suspected abdominal injuries, and the CT findings when injuries are present.

  15. Computed tomography in hepatic trauma

    SciTech Connect

    Moon, K.L. Jr.; Federle, M.P.

    1983-08-01

    Twenty-five patients with hepatic injury from blunt upper abdominal trauma were examined by computed tomography (CT). The spectrum of CT findings was recorded, and the size of the hepatic laceration and the associated hemoperitoneum were correlated with the mode of therapy used in each case (operative vs nonoperative). While the need for surgery correlated roughly with the size of the hepatic laceration, the size of the associated hemoperitoneum was an important modifying factor. Fifteen patients with hepatic lacerations but little or no hemoperitoneum were managed nonoperatively. CT seems to have significant advantages over hepatic scintigraphy, angiography, and diagnostic peritoneal lavage. By combining inforamtion on the clinical state of the patient and CT findings, therapy of hepatic injury can be individualized and the incidence of nontherapeutic laparotomies decreased.

  16. Marine trauma, envenomations, and intoxications.

    PubMed

    Brown, C K; Shepherd, S M

    1992-05-01

    When humans encounter marine creatures a variety of maladies may occur, ranging from dermatitis to life-threatening trauma, allergy, envenomations, or intoxications. The emergency physician should be prepared to recognize quickly and address appropriately the potential life threats, which are primarily neurologic, respiratory, and cardiovascular. A high degree of suspicion for these illnesses is needed. Intoxications may be especially confusing. Although most of the syndromes are self-limited and treatment supportive, time is of the essence if neuromuscular paralysis, hypotension, or respiratory compromise is present. Much folklore exists regarding detection and prevention of these entities and should be regarded as such. The last several decades have seen a marked increase in our knowledge base regarding these fascinating envenomations and intoxications. Research in the next several decades probably will produce a variety of diagnostic and therapeutic tools, which will further our understanding of, and ability to specifically manage, these syndromes.

  17. Paediatric horse-related trauma.

    PubMed

    Theodore, Jane E; Theodore, Sigrid G; Stockton, Kellie A; Kimble, Roy M

    2017-06-01

    This retrospective cohort study reported on the epidemiology of horse-related injuries for patients presenting to the only tertiary paediatric trauma hospital in Queensland. The secondary outcome was to examine the use of helmets and adult supervision. Traumatic brain injury (TBI) was examined in relation to helmet use. Morbidity and mortality were also recorded. Included were all patients presenting with any horse-related trauma to the Royal Children's Hospital in Brisbane from January 2008 to August 2014. Data were retrospectively collected on patient demographics, hospital length of stay (LOS), mechanism of injury (MOI), safety precautions taken, diagnoses and surgical procedures performed. Included in the analysis were 187 incidents involving 171 patients. Most patients were aged 12-14 years (36.9%) and female (84.5%). The most common MOI were falls while riding horses (97.1%). Mild TBI (24.6%) and upper limb fractures (20.9%) were common injuries sustained. Patients who wore helmets had significantly reduced hospital LOS and severity of TBI when compared with those who did not wear helmets (P < 0.001 and P = 0.028, respectively). Morbidity was reported in 7.5% of patients. There were three deaths in Queensland. Helmet use is recommended for non-riders when handling horses, in addition to being a compulsory requirement whilst horse riding. Prompts in documentation may assist doctors to record the use of safety attire and adult supervision. This will allow future studies to further investigate these factors in relation to clinical outcomes. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  18. Characterization of blunt chest trauma in a long-term porcine model of severe multiple trauma

    PubMed Central

    Horst, K.; Simon, T. P.; Pfeifer, R.; Teuben, M.; Almahmoud, K.; Zhi, Q.; Santos, S. Aguiar; Wembers, C. Castelar; Leonhardt, S.; Heussen, N.; Störmann, P.; Auner, B.; Relja, B.; Marzi, I.; Haug, A. T.; van Griensven, M.; Kalbitz, M.; Huber-Lang, M.; Tolba, R.; Reiss, L. K.; Uhlig, S.; Marx, G.; Pape, H. C.; Hildebrand, F.

    2016-01-01

    Chest trauma has a significant relevance on outcome after severe trauma. Clinically, impaired lung function typically occurs within 72 hours after trauma. However, the underlying pathophysiological mechanisms are still not fully elucidated. Therefore, we aimed to establish an experimental long-term model to investigate physiological, morphologic and inflammatory changes, after severe trauma. Male pigs (sus scrofa) sustained severe trauma (including unilateral chest trauma, femur fracture, liver laceration and hemorrhagic shock). Additionally, non-injured animals served as sham controls. Chest trauma resulted in severe lung damage on both CT and histological analyses. Furthermore, severe inflammation with a systemic increase of IL-6 (p = 0.0305) and a local increase of IL-8 in BAL (p = 0.0009) was observed. The pO2/FiO2 ratio in trauma animals decreased over the observation period (p < 0.0001) but not in the sham group (p = 0.2967). Electrical Impedance Tomography (EIT) revealed differences between the traumatized and healthy lung (p < 0.0001). In conclusion, a clinically relevant, long-term model of blunt chest trauma with concomitant injuries has been developed. This reproducible model allows to examine local and systemic consequences of trauma and is valid for investigation of potential diagnostic or therapeutic options. In this context, EIT might represent a radiation-free method for bedside diagnostics. PMID:28000769

  19. Trauma-related Therapeutic Procedures at Shohada Trauma Center in Tabriz

    PubMed Central

    Sadeghi-Bazargani, Homayoun; Azami-Aghdash, Saber; Ziapour, Behrad; Deljavan, Reza

    2013-01-01

    Background To decrease the burden of injuries it is essential to have an overview of trauma patterns and its management at regional trauma centers. Objectives The aim of this study was to investigate some patterns of trauma and trauma-related therapeutic interventions at our trauma center. Materials and Methods In a cross-sectional study, 19530 trauma cases admitted to the emergency department and hospital wards of Shohada University Hospital during 2007-2008 were assessed. Results Of the 19530 trauma cases, 14960(76.7%) were males. Mean (SD) of age was 31(19.9) years. The elderly aged 65 and above, comprised 10% (1953) of the participants; while 44 were infants. Falls and traffic injuries were the most common cause of injuries among trauma patients. Most of the mortalities were men comprising 74% of the 57 deaths. Reduction of fractures and dislocations were the most common types of operations among trauma patients. Conclusions Young men form the target group for possible interventions to decrease the burden of trauma following falls and traffic accidents. PMID:24350134

  20. Comparison of quality control for trauma management between Western and Eastern European trauma center.

    PubMed

    Calderale, Stefano Massimiliano; Sandru, Raluca; Tugnoli, Gregorio; Di Saverio, Salomone; Beuran, Mircea; Ribaldi, Sergio; Coletti, Massimo; Gambale, Giorgio; Paun, Sorin; Russo, Livio; Baldoni, Franco

    2008-11-19

    Quality control of trauma care is essential to define the effectiveness of trauma center and trauma system. To identify the troublesome issues of the system is the first step for validation of the focused customized solutions. This is a comparative study of two level I trauma centers in Italy and Romania and it has been designed to give an overview of the entire trauma care program adopted in these two countries. This study was aimed to use the results as the basis for recommending and planning changes in the two trauma systems for a better trauma care. We retrospectively reviewed a total of 182 major trauma patients treated in the two hospitals included in the study, between January and June 2002. Every case was analyzed according to the recommended minimal audit filters for trauma quality assurance by The American College of Surgeons Committee on Trauma (ACSCOT). Satisfactory yields have been reached in both centers for the management of head and abdominal trauma, airway management, Emergency Department length of stay and early diagnosis and treatment. The main significant differences between the two centers were in the patients' transfers, the leadership of trauma team and the patients' outcome. The main concerns have been in the surgical treatment of fractures, the outcome and the lacking of documentation. The analyzed hospitals are classified as Level I trauma center and are within the group of the highest quality level centers in their own countries. Nevertheless, both of them experience major lacks and for few audit filters do not reach the mmum standard requirements of ACS Audit Filters. The differences between the western and the eastern European center were slight. The parameters not reaching the minimum requirements are probably occurring even more often in suburban settings.

  1. The associations of earlier trauma exposures and history of mental disorders with PTSD after subsequent traumas.

    PubMed

    Kessler, R C; Aguilar-Gaxiola, S; Alonso, J; Bromet, E J; Gureje, O; Karam, E G; Koenen, K C; Lee, S; Liu, H; Pennell, B-E; Petukhova, M V; Sampson, N A; Shahly, V; Stein, D J; Atwoli, L; Borges, G; Bunting, B; de Girolamo, G; Gluzman, S F; Haro, J M; Hinkov, H; Kawakami, N; Kovess-Masfety, V; Navarro-Mateu, F; Posada-Villa, J; Scott, K M; Shalev, A Y; Ten Have, M; Torres, Y; Viana, M C; Zaslavsky, A M

    2017-09-19

    Although earlier trauma exposure is known to predict posttraumatic stress disorder (PTSD) after subsequent traumas, it is unclear whether this association is limited to cases where the earlier trauma led to PTSD. Resolution of this uncertainty has important implications for research on pretrauma vulnerability to PTSD. We examined this issue in the World Health Organization (WHO) World Mental Health (WMH) Surveys with 34 676 respondents who reported lifetime trauma exposure. One lifetime trauma was selected randomly for each respondent. DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) PTSD due to that trauma was assessed. We reported in a previous paper that four earlier traumas involving interpersonal violence significantly predicted PTSD after subsequent random traumas (odds ratio (OR)=1.3-2.5). We also assessed 14 lifetime DSM-IV mood, anxiety, disruptive behavior and substance disorders before random traumas. We show in the current report that only prior anxiety disorders significantly predicted PTSD in a multivariate model (OR=1.5-4.3) and that these disorders interacted significantly with three of the earlier traumas (witnessing atrocities, physical violence victimization and rape). History of witnessing atrocities significantly predicted PTSD after subsequent random traumas only among respondents with prior PTSD (OR=5.6). Histories of physical violence victimization (OR=1.5) and rape after age 17 years (OR=17.6) significantly predicted only among respondents with no history of prior anxiety disorders. Although only preliminary due to reliance on retrospective reports, these results suggest that history of anxiety disorders and history of a limited number of earlier traumas might usefully be targeted in future prospective studies as distinct foci of research on individual differences in vulnerability to PTSD after subsequent traumas.Molecular Psychiatry advance online publication, 19 September 2017; doi:10.1038/mp.2017.194.

  2. Prevalence of Domestic Violence Among Trauma Patients.

    PubMed

    Joseph, Bellal; Khalil, Mazhar; Zangbar, Bardiya; Kulvatunyou, Narong; Orouji, Tahereh; Pandit, Viraj; O'Keeffe, Terence; Tang, Andrew; Gries, Lynn; Friese, Randall S; Rhee, Peter; Davis, James W

    2015-12-01

    Domestic violence is an extremely underreported crime and a growing social problem in the United States. However, the true burden of the problem remains unknown. To assess the reported prevalence of domestic violence among trauma patients. A 6-year (2007-2012) retrospective analysis of the prospectively maintained National Trauma Data Bank. Trauma patients who experienced domestic violence and who presented to trauma centers participating in the National Trauma Data Bank were identified using International Classification of Diseases, Ninth Revision diagnosis codes (995.80-995.85, 995.50, 995.52-995.55, and 995.59) and E codes (E967.0-E967.9). Patients were stratified by age into 3 groups: children (≤18 years), adults (19-54 years), and elderly patients (≥55 years). Trend analysis was performed on April 10, 2014, to assess the reported prevalence of domestic violence over the years. Trauma patients presenting to trauma centers participating in the National Trauma Data Bank. To assess the reported prevalence of domestic violence among trauma patients. A total of 16 575 trauma patients who experienced domestic violence were included. Of these trauma patients, 10 224 (61.7%) were children, 5503 (33.2%) were adults, and 848 (5.1%) were elderly patients. The mean (SD) age was 15.9 (20.6), the mean (SD) Injury Severity Score was 10.9 (9.6), and 8397 (50.7%) were male patients. Head injuries (46.8% of patients) and extremity fractures (31.2% of patients) were the most common injuries. A total of 12 515 patients (75.1%) were discharged home, and the overall mortality rate was 5.9% (n = 980). The overall reported prevalence of domestic violence among trauma patients was 5.7 cases per 1000 trauma center discharges. The prevalence of domestic violence increased among children (14.0 cases per 1000 trauma center discharges in 2007 to 18.5 case per 1000 trauma center discharges in 2012; P = .001) and adults (3.2 cases per 1000 discharges in 2007 to 4.5 cases per

  3. Key performance indicators in British military trauma.

    PubMed

    Stannard, Adam; Tai, Nigel R; Bowley, Douglas M; Midwinter, Mark; Hodgetts, Tim J

    2008-08-01

    Key performance indicators (KPI) are tools for assessing process and outcome in systems of health care provision and are an essential component in performance improvement. Although KPI have been used in British military trauma for 10 years, they remain poorly defined and are derived from civilian metrics that do not adjust for the realities of field trauma care. Our aim was to modify current trauma KPI to ensure they more faithfully reflect both the military setting and contemporary evidence in order to both aid accurate calibration of the performance of the British Defence Medical Services and act as a driver for performance improvement. A workshop was convened that was attended by senior, experienced doctors and nurses from all disciplines of trauma care in the British military. "Speciality-specific" KPI were developed by interest groups using evidence-based data where available and collective experience where this was lacking. In a final discussion these were streamlined into 60 KPI covering each phase of trauma management. The introduction of these KPI sets a number of important benchmarks by which British military trauma can be measured. As part of a performance improvement programme, these will allow closer monitoring of our performance and assist efforts to develop, train, and resource British military trauma providers.

  4. Coagulopathy after severe pediatric trauma: A review

    PubMed Central

    Russell, Robert T.; Lisco, Steven J.; Kerby, Jeffrey D.; Pittet, Jean-François

    2014-01-01

    Trauma remains the leading cause of morbidity and mortality in the United States among children from the age 1 year to 21 years old. The most common cause of lethality in pediatric trauma is traumatic brain injury (TBI). Early coagulopathy has been commonly observed after severe trauma and is usually associated with severe hemorrhage and/or traumatic brain injury. In contrast to adult patients, massive bleeding is less common after pediatric trauma. The classical drivers of trauma-induced coagulopathy (TIC) include hypothermia, acidosis, hemodilution and consumption of coagulation factors secondary to local activation of the coagulation system following severe traumatic injury. Furthermore, there is also recent evidence for a distinct mechanism of TIC that involves the activation of the anticoagulant protein C pathway. Whether this new mechanism of posttraumatic coagulopathy plays a role in children is still unknown. The goal of this review is to summarize the current knowledge on the incidence and potential mechanisms of coagulopathy after pediatric trauma and the role of rapid diagnostic tests for early identification of coagulopathy. Finally, we discuss different options for treating coagulopathy after severe pediatric trauma. PMID:24569507

  5. Alcohol withdrawal syndrome in admitted trauma patients.

    PubMed

    Jawa, Randeep S; Stothert, Joseph C; Shostrom, Valerie K; Yetter, Diane L; Templin, Heather R; Cemaj, Samuel K; Lander, Lina; Forse, Armour R; Young, David H

    2014-11-01

    As alcohol use is highly prevalent in trauma patients, we hypothesized that a significant proportion of hospitalized trauma patients would demonstrate alcohol withdrawal (AW). The trauma registries at a joint trauma center system from 1999 to 2008 were evaluated for patients aged at least 16 years. Of 19,369 trauma admissions, 159 patients had AW. Blood alcohol concentration (BAC) testing was performed in 31.5% of the patients. BAC was significantly higher in AW patients versus other traumas (205.7 ± 130.1 vs 102.9 ± 121.7 mg/dL). BAC was 0 in 14.4% of AW patients. As compared with other trauma patients, patients with AW had a significantly greater age (50.2 vs 42.1 years), hospital length of stay (10 vs 3 days), intensive care unit length of stay (2 vs 0 days), need for mechanical ventilation (34% vs 12.7%), and pneumonia (12% vs 2.3%). AW patients were less frequently discharged to home (59.8% vs 69.9%). Mortality was not different. AW was diagnosed in few patients. Of note, it occurred in patients with an initial BAC of 0. AW is associated with adverse outcomes. Published by Elsevier Inc.

  6. Changes in neuroticism following trauma exposure.

    PubMed

    Ogle, Christin M; Rubin, David C; Siegler, Ilene C

    2014-04-01

    Using longitudinal data, the present study examined change in midlife neuroticism following trauma exposure. Our primary analyses included 670 participants (M(age) = 60.55; 65.22% male, 99.70% Caucasian) who completed the NEO Personality Inventory at ages 42 and 50 and reported their lifetime exposure to traumatic events approximately 10 years later. No differences in pre- and post-trauma neuroticism scores were found among individuals who experienced all of their lifetime traumas in the interval between the personality assessments. Results were instead consistent with normative age-related declines in neuroticism throughout adulthood. Furthermore, longitudinal changes in neuroticism scores did not differ between individuals with and without histories of midlife trauma exposure. Examination of change in neuroticism following life-threatening traumas yielded a comparable pattern of results. Analysis of facet-level scores largely replicated findings from the domain scores. Overall, our findings suggest that neuroticism does not reliably change following exposure to traumatic events in middle adulthood. Supplemental analyses indicated that individuals exposed to life-threatening traumas in childhood or adolescence reported higher midlife neuroticism than individuals who experienced severe traumas in adulthood. Life-threatening traumatic events encountered early in life may have a more pronounced impact on adulthood personality than recent traumatic events.

  7. Trauma in early childhood: a neglected population.

    PubMed

    De Young, Alexandra C; Kenardy, Justin A; Cobham, Vanessa E

    2011-09-01

    Infants, toddlers and preschoolers are a high risk group for exposure to trauma. Young children are also vulnerable to experiencing adverse outcomes as they are undergoing a rapid developmental period, have limited coping skills and are strongly dependent on their primary caregiver to protect them physically and emotionally. However, although millions of young children experience trauma each year, this population has been largely neglected. Fortunately, over the last 2 decades there has been a growing appreciation of the magnitude of the problem with a small but expanding number of dedicated researchers and clinicians working with this population. This review examines the empirical literature on trauma in young children with regards to the following factors: (1) how trauma reactions typically manifest in young children; (2) history and diagnostic validity of posttraumatic stress disorder (PTSD) in preschoolers; (3) prevalence, comorbidity and course of trauma reactions; (4) developmental considerations; (5) risk and protective factors; and (6) treatment. The review highlights that there are unique developmental differences in the rate and manifestation of trauma symptomatology, the current Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV-TR) PTSD criteria is not developmentally sensitive and the impact of trauma must be considered within the context of the parent-child relationship. Recommendations for future research with this population are also discussed.

  8. Blunt pancreatic trauma: A persistent diagnostic conundrum?

    PubMed Central

    Kumar, Atin; Panda, Ananya; Gamanagatti, Shivanand

    2016-01-01

    Blunt pancreatic trauma is an uncommon injury but has high morbidity and mortality. In modern era of trauma care, pancreatic trauma remains a persistent challenge to radiologists and surgeons alike. Early detection of pancreatic trauma is essential to prevent subsequent complications. However early pancreatic injury is often subtle on computed tomography (CT) and can be missed unless specifically looked for. Signs of pancreatic injury on CT include laceration, transection, bulky pancreas, heterogeneous enhancement, peripancreatic fluid and signs of pancreatitis. Pan-creatic ductal injury is a vital decision-making parameter as ductal injury is an indication for laparotomy. While lacerations involving more than half of pancreatic parenchyma are suggestive of ductal injury on CT, ductal injuries can be directly assessed on magnetic resonance imaging (MRI) or encoscopic retrograde cholangio-pancreatography. Pancreatic trauma also shows temporal evolution with increase in extent of injury with time. Hence early CT scans may underestimate the extent of injures and sequential imaging with CT or MRI is important in pancreatic trauma. Sequential imaging is also needed for successful non-operative management of pancreatic injury. Accurate early detection on initial CT and adopting a multimodality and sequential imaging strategy can improve outcome in pancreatic trauma. PMID:26981225

  9. Deep Vein Thrombosis Prophylaxis in Trauma Patients

    PubMed Central

    Toker, Serdar; Hak, David J.; Morgan, Steven J.

    2011-01-01

    Deep vein thrombosis (DVT) and pulmonary embolism (PE) are known collectively as venous thromboembolism (VTE). Venous thromboembolic events are common and potentially life-threatening complications following trauma with an incidence of 5 to 63%. DVT prophylaxis is essential in the management of trauma patients. Currently, the optimal VTE prophylaxis strategy for trauma patients is unknown. Traditionally, pelvic and lower extremity fractures, head injury, and prolonged immobilization have been considered risk factors for VTE; however it is unclear which combination of risk factors defines a high-risk group. Modalities available for trauma patient thromboprophylaxis are classified into pharmacologic anticoagulation, mechanical prophylaxis, and inferior vena cava (IVC) filters. The available pharmacologic agents include low-dose heparin (LDH), low molecular weight heparin (LMWH), and factor Xa inhibitors. Mechanical prophylaxis methods include graduated compression stockings (GCSs), pneumatic compression devices (PCDs), and A-V foot pumps. IVCs are traditionally used in high risk patients in whom pharmacological prophylaxis is contraindicated. Both EAST and ACCP guidelines recommend primary use of LMWHs in trauma patients; however there are still controversies regarding the definitive VTE prophylaxis in trauma patients. Large randomized prospective clinical studies would be required to provide level I evidence to define the optimal VTE prophylaxis in trauma patients. PMID:22084663

  10. Changes in Neuroticism Following Trauma Exposure

    PubMed Central

    Ogle, Christin M.; Rubin, David C.; Siegler, Ilene C.

    2014-01-01

    Objective Using longitudinal data, the present study examined change in midlife neuroticism following trauma exposure. Method Our primary analyses included 670 participants (M age = 60.55, 65.22% male, 99.70% Caucasian) who completed the NEO Personality Inventory at mean age 42 and 50 and reported their lifetime exposure to traumatic events approximately 10 years later. Results No differences in pre-and post-trauma neuroticism scores were found among individuals who experienced all of their lifetime traumas in the interval between the personality assessments. Results were instead consistent with normative age-related declines in neuroticism throughout adulthood. Furthermore, longitudinal changes in neuroticism scores did not differ between individuals with and without histories of midlife trauma exposure. Examination of change in neuroticism following life-threatening traumas yielded a comparable pattern of results. Analysis of facet-level scores largely replicated findings from the domain scores. Supplemental analyses indicated that individuals exposed to life-threatening traumas in childhood or adolescence reported higher midlife neuroticism than individuals who experienced severe traumas in adulthood. Conclusions Overall, our findings suggest that neuroticism does not reliably change following exposure to traumatic events in middle adulthood. Life-threatening traumatic events encountered early in life may have a more pronounced impact on adulthood personality than recent traumatic events. PMID:23550961

  11. Variations in pediatric trauma transfer patterns in Northern California pediatric trauma centers (2001-2009).

    PubMed

    Vogel, Lara D; Vongsachang, Hurnan; Pirrotta, Elizabeth; Holmes, James F; Holmes, James M; Sherck, John; Newton, Christopher; D'Souza, Peter; Spain, David A; Wang, N Ewen

    2014-09-01

    Due to the scarcity of specialized resources for pediatric trauma, "regionalization," or a system designed to get "the right child, to the right place, at the right time," is vital to quality pediatric trauma care. In Northern California, four pediatric trauma centers serve 3.9 million children within a geographically diverse area of 113,630 square miles. A significant proportion of children with trauma is initially triaged to nontrauma hospitals and may require subsequent transfer to a specialty center. Trauma transfer patterns to a pediatric trauma center may provide insight into regional primary triage practices. Transfers from hospitals in close proximity to pediatric trauma centers might suggest that some children could have avoided transfer with minimal additional transport time. While pediatric trauma centers are scarce and serve as regional resources, transfers from beyond the regular catchment area of a trauma center could be an indication of clinical need. The objective of this study was to gain an understanding of patterns of pediatric trauma transfer to all pediatric trauma centers within the region as a first step in assessing the efficacy and efficiency of trauma triage. The authors examined three groups of transfer patients: transfers from within the same county as the pediatric trauma center (near transfers), transfers from counties adjacent to the pediatric trauma center (catchment transfers), and transfers from more distant counties (far transfers). The hypothesis was that catchment transfers would form the bulk of transfers, near transfers would compose < 10% of total transfers, and far transfers would be younger and more severely injured than catchment transfers. This was a retrospective analysis of institutional trauma registry data of children < 18 years from all pediatric trauma centers in Northern California from 2001 through 2009. Transfers were characterized by the location of the transfer hospital relative to the location of the

  12. Comparison of modified Kampala trauma score with trauma mortality prediction model and trauma-injury severity score: A National Trauma Data Bank Study.

    PubMed

    Akay, Serhat; Ozturk, Ahmet Mucteba; Akay, Huriye

    2017-08-01

    Mortality prediction of trauma patients relies on anatomical, physiological or combined scores. The purpose of this study is to compare the diagnostic accuracy of the modified Kampala Trauma Score (M-KTS) with the Trauma Mortality Prediction Model (TMPM), and Trauma-Injury Severity Score (TRISS) using data from a large dataset from a developed registry, the National Trauma Data Bank (NTDB). Using 2011 and 2012 data from NTDB, patient based trauma scores (M-KTS, TMPM, and TRISS) were calculated and predictive ability of M-KTS for mortality was compared with other trauma scores using receiver operating characteristics (ROC) curves. A total of 841089 patients were included in the study. TRISS outperformed other scores (AUC=0.922, %95 CI 0.920-0.924) with M-KTS as the second best score (AUC=0.901, %95 CI 0.899-0.903) followed by TMPM (AUC=0.887, 95% CI 0.844-0.889). For blunt trauma, TRISS (AUC=0.917, 95% CI 0.915-0.919) performed better than M-KTS (AUC=0.891, %95 CI 0.889-0.893) and TMPM (AUC=0.874, 95% CI 0.871-0.877). For penetrating trauma, M-KTS (AUC=0.956, 95% CI 0.954-0.959) and TMPM (AUC=0.955, 95% CI 0.951-0.958) had similar performance after TRISS (AUC=0.969, 95% CI 0.967-0.971). M-KTS performed worse than TRISS although its' main advantage is simple use in resource-limited settings. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Multicenter prospective evaluation of dogs with trauma.

    PubMed

    Hall, Kelly E; Holowaychuk, Marie K; Sharp, Claire R; Reineke, Erica

    2014-02-01

    To determine hospital admission variables for dogs with trauma including values determined with scoring systems (animal trauma triage [ATT], modified Glasgow coma scale [MGCS], and acute patient physiologic and laboratory evaluation [APPLE] scores) and the usefulness of such variables for the prediction of outcome (death vs survival to hospital discharge). Prospective, multicenter, cohort study. 315 client-owned dogs. By use of a Web-based data capture system, trained personnel prospectively recorded admission ATT, MGCS, and APPLE scores; clinical and laboratory data; and outcome (death vs survival to discharge) for dogs with trauma at 4 veterinary teaching hospitals during an 8-week period. Cause of injury was most commonly blunt trauma (173/315 [54.9%]) followed by penetrating trauma (107/315 [34.0%]), or was unknown (35/315 [11.1%]). Of the 315 dogs, 285 (90.5%) survived to hospital discharge. When 16 dogs euthanized because of cost were excluded, dogs with blunt trauma were more likely to survive, compared with dogs with penetrating trauma (OR, 8.5). The ATT (OR, 2.0) and MGCS (OR, 0.47) scores and blood lactate concentration (OR, 1.5) at the time of hospital admission were predictive of outcome. Surgical procedures were performed for 157 (49.8%) dogs; surgery was associated with survival to discharge (OR, 7.1). Results indicated ATT and MGCS scores were useful for prediction of outcome for dogs evaluated because of trauma. Penetrating trauma, low blood lactate concentration, and performance of surgical procedures were predictive of survival to hospital discharge. The methods enabled collection of data for a large number of dogs in a short time.

  14. Patterns of Errors Contributing to Trauma Mortality

    PubMed Central

    Gruen, Russell L.; Jurkovich, Gregory J.; McIntyre, Lisa K.; Foy, Hugh M.; Maier, Ronald V.

    2006-01-01

    Objective: To identify patterns of errors contributing to inpatient trauma deaths. Methods: All inpatient trauma deaths at a high-volume level I trauma center from 1996 to 2004 inclusive were audited. Data were collected with daily trauma registry chart abstraction, weekly morbidity and mortality reports, hospital quality assurance reports, and annual trauma registry analyses of risk of death using TRISS and HARM methodology. Deaths that met criteria for low to medium probability of mortality or those with quality of care concerns were analyzed for errors and then subjected to 3-stage peer review at weekly departmental, monthly hospital, and annual regional forums. Patterns of errors were constructed from the compiled longitudinal data. Results: In 9 years, there were 44,401 trauma patient admissions and 2594 deaths (5.8%), of which 601 met low to medium mortality risks. Sixty-four patients (0.14% admissions, 2.47% deaths) had recognized errors in care that contributed to their death. Important error patterns included: failure to successfully intubate, secure or protect an airway (16%), delayed operative or angiographic control of acute abdominal/pelvic hemorrhage (16%), delayed intervention for ongoing intrathoracic hemorrhage (9%), inadequate DVT or gastrointestinal prophylaxis (9%), lengthy initial operative procedures rather than damage control surgery in unstable patients (8%), over-resuscitation with fluids (5%), and complications of feeding tubes (5%). Resulting data-directed institutional and regional trauma system policy changes have demonstrably reduced the incidence of associated error-related deaths. Conclusions: Preventable deaths will occur even in mature trauma systems. This review has identified error patterns that are likely common in all trauma systems, and for which policy interventions can be effectively targeted. PMID:16926563

  15. Vascular Radiology in Trauma: A Review

    SciTech Connect

    Nicholson, Anthony A.

    2004-03-15

    It's been 30 years since an endovascular technique to control traumatic hemorrhage was first described. Despite major technical advances in both diagnostic and therapeutic technology, and a great deal of experience since then, endovascular techniques are rarely considered as part of frontline management for vascular trauma. This review considers the literature and calls for better planning and implementation of diagnostic and image=guided therapeutic facilities. Endovascular techniques should be an essential part of vascular trauma management along with endovascular specialists, partners in trauma teams.

  16. Psychologic trauma, posttraumatic stress disorder, and dermatology.

    PubMed

    Gupta, Madhulika A; Lanius, Ruth A; Van der Kolk, Bessel A

    2005-10-01

    Psychologic trauma refers to events (such as sexual assault, major earthquake, or plane crashes) that overwhelm an individual's capacity to cope. Psychologic trauma can result in chronic and recurring dermatologic symptoms that persist after the trauma subsides. Examples are cutaneous sensory flashbacks (which may be fragments of the sensory component of the traumatic experience), autonomic hyperarousal (with symptoms such as profuse sweating or flare-up of an underlying stress-reactive dermatosis), conversion symptoms (such as numbness, pain, or other medically unexplained cutaneous symptoms), and cutaneous self-injury (manifesting in many forms, including trichotillomania, dermatitis artefacta, and neurotic excoriations--tension-reducing behaviors in patients who have posttraumatic stress disorder).

  17. Abdominal Trauma Evaluation for the Pediatric Surgeon.

    PubMed

    Drexel, Sabrina; Azarow, Kenneth; Jafri, Mubeen A

    2017-02-01

    Trauma is the leading cause of pediatric mortality and abdominal injury is a significant contributor to morbidity. The assessment of abdominal trauma in children must be conducted expeditiously and thoroughly. Physical examination, laboratory testing, and imaging are central to trauma evaluation. In children with minor injury, protocols may help to limit the use of ionizing radiation. Children with significant abdominal injury who are unstable should be resuscitated with blood products and undergo emergent surgical intervention. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Waiting for surgery after orthopaedic trauma.

    PubMed

    Beringer, Antonia; Hagan, Liz; Goodman, Hannah

    2009-04-01

    Nursing staff on a paediatric surgical ward were concerned about delays experienced by children waiting to go to theatre following orthopaedic trauma, and their families. A facilitated action research approach was used which involved describing the issue, gathering information from a range of sources and introducing changes to the process of care. A flowchart was developed to clarify the stages and the staff involved in admitting a child with orthopaedic trauma for surgery. A white board was introduced to record information on 'trauma' patients. A facilitated action research process offers a flexible and accessible way for staff to develop a range of transferable research and change management skills.

  19. The dedicated orthopedic trauma operating room.

    PubMed

    Min, William; Wolinsky, Philip R

    2011-08-01

    The development and implementation of a dedicated orthopedic trauma operating room (OTOR) that is used for the treatment of orthopedic trauma patients has changed and improved the practice of orthopedic trauma surgery. Advantages noted with OTOR implementation include improvements in morbidity and complication rates, enhancements in the professional and personal lifestyles of the on-call surgeon, and increased physician recruitment and retention in orthopedic traumatology. However, the inappropriate use of the OTOR, which can waste valuable resources and delay the treatment of emergent cases, must be monitored and avoided.

  20. Trauma advanced practice nurses: implementing the role.

    PubMed

    Martin, Kathleen D; Molitor-Kirsch, Shirley; Elgart, Heidi; Ruffolo, Daria C; Sicoutris, Corinna; Meredith, Denise

    2004-01-01

    The need for advanced practice nurses (APN) has expanded over the past several decades as a result of the changing healthcare environment. Increased patient acuity and decreased resident work hours have lead to a need for additional clinical expertise at the bedside. APNs are becoming an integral part of the acute care delivery team in many trauma programs and intensive care units. To date little has been published regarding the role of the APN in Trauma Centers. This article outlines the wide variety of responsibilities and services provided by a select group of nurse practitioners who work in trauma centers throughout the United States.

  1. Functional Endoscopic Surgery After Facial Trauma.

    PubMed

    Petrocelli, Marzia; Sbordone, Carolina; Salzano, Giovanni; Cassandro, Francesco Maria; Chiarella, Giuseppe; Scarpa, Alfonso; Romano, Antonio; Iaconetta, Giorgio; Califano, Luigi; Cassandro, Ettore

    2017-06-01

    The present study describes 3 patients of previous facial trauma who have subsequently been treated with functional endoscopic sinus surgery. The authors want pay attention on the possible correlation between facial trauma and sinusitis. Such fractures can be the cause of onset of paranasal sinusitis or of worsening of a previous sinusitis. The correlation between these 2 pathologies could be due to the fact that facial fractures concern the anatomic structures of paranasal sinuses. The damage to these structures during the facial trauma and tissue regeneration after injury or surgical treatment subverts the anatomy and function of the sinuses in a basically compromised situation.

  2. Physical Trauma as an Etiological Agent in Mental Retardation.

    ERIC Educational Resources Information Center

    Angle, Carol R., Ed.; Bering, Edgar A., Jr., Ed.

    The conference on Physical Trauma as a Cause of Mental Retardation dealt with two major areas of etiological concern - postnatal and perinatal trauma. Following two introductory statements on the problem of and issues related to mental retardation (MR) after early trauma to the brain, five papers on the epidemiology of head trauma cover…

  3. Migration, Trauma, PTSD: A Gender Study in Morrison's Jazz

    ERIC Educational Resources Information Center

    Motlagh, Leila Tafreshi; Yahya, Wan Roselezam Wan

    2014-01-01

    Toni Morrison is an acknowledged master of trauma literature, however trauma theory and a gender response to trauma remain largely unaccounted for her migration literature, specifically "Jazz" (1992). In her novel, two migrant women are affected by the same trauma, a crime of passion. But they choose different reactions and coping…

  4. The growth and development of a level II trauma center.

    PubMed

    Webster, Arvie M

    2007-01-01

    Attaining verification as a Level II Trauma Center requires dedication, flexibility, and continuous education. This article contains the history, birth, and growth of a Level II Trauma Center through a trauma resource clinician's experiences. It is intended to share the thoughts, processes, and technological advances of establishing a Level II Trauma Center.

  5. A Decade Evaluation of a State Trauma System: Has Access to Inpatient Trauma Care at Designated Trauma Centers Improved?

    PubMed

    Ashley, Dennis W; Pracht, Etienne E; Medeiros, Regina S; Atkins, Elizabeth V; Nesmith, Elizabeth G; Johns, Tracy J; Dunne, James R; Nicholas, Jeffrey M

    2017-07-01

    Recently, the trauma center component of the Georgia trauma system was evaluated demonstrating a 10 per cent probability of increased survival for severely injured patients treated at designated trauma centers (DTCs) versus nontrauma centers. The purpose of this study was to determine the effectiveness of a state trauma system to provide access to inpatient trauma care at DTCs for its residents. We reviewed 371,786 patients from the state's discharge database and identified 255,657 treated at either a DTC or a nontrauma center between 2003 and 2012. Injury severity was assigned using the International Classification Injury Severity Score method. Injury was categorized as mild, moderate, or severe. Patients were also categorized by age and injury type. Access improved over time in all severity levels, age groups, and injury types. Although elderly had the largest improvement in access, still only 70 per cent were treated at a DTC. During the study period, increases were noted for all age groups, injury severity levels, and types of injury. A closer examination of the injured elderly population is needed to determine the cause of lower utilization by this age group. Overall, the state's trauma system continues to mature by providing patients with increased access to treatment at DTCs.

  6. Fibrinogen depletion in trauma: early, easy to estimate and central to trauma-induced coagulopathy

    PubMed Central

    2013-01-01

    Fibrinogen is fundamental to hemostasis and falls rapidly in trauma hemorrhage, although levels are not routinely measured in the acute bleeding episode. Prompt identification of critically low levels of fibrinogen and early supplementation has the potential to correct trauma-induced coagulation and improve outcomes. Early estimation of hypofibrinogenemia is possible using surrogate markers of shock and hemorrhage; for example, hemoglobin and base excess. Rapid replacement with fibrinogen concentrate or cryoprecipitate should be considered a clinical priority in major trauma hemorrhage. PMID:24063404

  7. Fibrinogen depletion in trauma: early, easy to estimate and central to trauma-induced coagulopathy.

    PubMed

    Davenport, Ross; Brohi, Karim

    2013-09-24

    Fibrinogen is fundamental to hemostasis and falls rapidly in trauma hemorrhage, although levels are not routinely measured in the acute bleeding episode. Prompt identification of critically low levels of fibrinogen and early supplementation has the potential to correct trauma-induced coagulation and improve outcomes. Early estimation of hypofibrinogenemia is possible using surrogate markers of shock and hemorrhage; for example, hemoglobin and base excess. Rapid replacement with fibrinogen concentrate or cryoprecipitate should be considered a clinical priority in major trauma hemorrhage.

  8. Benchmarking of trauma care worldwide: the potential value of an International Trauma Data Bank (ITDB).

    PubMed

    Haider, Adil H; Hashmi, Zain G; Gupta, Sonia; Zafar, Syed Nabeel; David, Jean-Stephane; Efron, David T; Stevens, Kent A; Zafar, Hasnain; Schneider, Eric B; Voiglio, Eric; Coimbra, Raul; Haut, Elliott R

    2014-08-01

    National trauma registries have helped improve patient outcomes across the world. Recently, the idea of an International Trauma Data Bank (ITDB) has been suggested to establish global comparative assessments of trauma outcomes. The objective of this study was to determine whether global trauma data could be combined to perform international outcomes benchmarking. We used observed/expected (O/E) mortality ratios to compare two trauma centers [European high-income country (HIC) and Asian lower-middle income country (LMIC)] with centers in the North American National Trauma Data Bank (NTDB). Patients (≥16 years) with blunt/penetrating injuries were included. Multivariable logistic regression, adjusting for known predictors of trauma mortality, was performed. Estimates were used to predict the expected deaths at each center and to calculate O/E mortality ratios for benchmarking. A total of 375,433 patients from 301 centers were included from the NTDB (2002-2010). The LMIC trauma center had 806 patients (2002-2010), whereas the HIC reported 1,003 patients (2002-2004). The most important known predictors of trauma mortality were adequately recorded in all datasets. Mortality benchmarking revealed that the HIC center performed similarly to the NTDB centers [O/E = 1.11 (95% confidence interval (CI) 0.92-1.35)], whereas the LMIC center showed significantly worse survival [O/E = 1.52 (1.23-1.88)]. Subset analyses of patients with blunt or penetrating injury showed similar results. Using only a few key covariates, aggregated global trauma data can be used to adequately perform international trauma center benchmarking. The creation of the ITDB is feasible and recommended as it may be a pivotal step towards improving global trauma outcomes.

  9. The incidence, spectrum and outcome of paediatric trauma managed by the Pietermaritzburg Metropolitan Trauma Service.

    PubMed

    Manchev, V; Bruce, J L; Oosthuizen, G V; Laing, G L; Clarke, D L

    2015-05-01

    The Pietermaritzburg Metropolitan Trauma Service (PMTS) has run a systematic quality improvement programme since 2006. A key component included the development and implementation of an effective surveillance system in the form of an electronic surgical registry (ESR). This study used data from the ESR to review the incidence, spectrum and outcome of paediatric trauma in Pietermaritzburg, South Africa. The ESR was reviewed, and all cases of paediatric trauma managed between 1 January 2012 and 30 July 2014 were retrieved for analysis. During the study period, 1,041 paediatric trauma patients (724 male, 69.5%) were managed by the PMTS, averaging a monthly admission of 36. The mean age was 10.9 years (standard deviation: 5.4 years). The mechanism of injury (MOI) was blunt trauma in 753 patients (72.3%) and penetrating trauma in 170 (16.3%). Pedestrian vehicle collisions accounted for 21% of cases and motor vehicle collisions for a further 11%. Intentional trauma accounted for 282 patients (27.1%) and self-inflicted trauma for 14 cases (1.3%). Ninety patients admitted to the intensive care unit and fifty-one required high dependency unit admission. There were 17 deaths, equating to an in-hospital mortality rate of 1.7%. A total of 172 children died on the scene of an incident. There were 35 road traffic related deaths, 26 suicides by hanging, 27 deaths from blunt assault and 23 deaths from penetrating assault. The overall mortality rate for paediatric trauma was 18.2%. The ESR has proved to be an effective surveillance system and has enabled the accurate quantification of the burden of paediatric trauma in Pietermaritzburg. This has improved our understanding of the mechanisms and patterns of injury, and has identified a high incidence of intentional and penetrating trauma as well as road traffic collisions. These data can be used to guide strategies to reduce the burden of paediatric trauma in our environment.

  10. Construct Validity of the Childbirth Trauma Index for Adolescents

    PubMed Central

    Anderson, Cheryl

    2011-01-01

    The potentially traumatic nature of childbirth for adult mothers has been confirmed in research; however, adolescent childbirth trauma is unexplored. This article presents research on the construct validity of the Childbirth Trauma Index by providing a conceptual analysis of psychological childbirth trauma, factor validity of the Childbirth Trauma Index, and discussion of testing the Childbirth Trauma Index via contrasted-groups approach. Childbirth trauma can result in an acute stress reaction or actual posttraumatic stress disorder. Using subjective reports, the Impact of Event Scale, and the Childbirth Trauma Index, an appraisal of birth trauma, trauma impact, and indicators associated with childbirth trauma were revealed among 112 adolescents. Clinical implications and research recommendations are offered. PMID:22379356

  11. Electronic documentation of trauma resuscitations at a level 1 pediatric trauma center.

    PubMed

    Wurster, Lee Ann; Groner, Jonathan I; Hoffman, Jeffrey

    2012-01-01

    Although many hospitals across the country have implemented an electronic medical record (EMR) for inpatient care, very few have successfully implemented an EMR for trauma resuscitations. Although there is evidence that the EMR improves patient safety, increases access to all care providers, increases workflow efficiency, and minimizes time spent on documenting thereby improving nursing care, the fast paced, complex nature of trauma resuscitations makes it difficult to implement such a system for trauma documentation. With the support of multiple disciplines with a variety of clinical knowledge, this article describes the design process that has led us to successful development and implementation of an EMR for documentation of trauma resuscitations.

  12. Trauma Collaborative Care Intervention: Effect on Surgeon Confidence in Managing Psychosocial Complications After Orthopaedic Trauma.

    PubMed

    Wegener, Stephen T; Carroll, Eben A; Gary, Joshua L; McKinley, Todd O; OʼToole, Robert V; Sietsema, Debra L; Castillo, Renan C; Frey, Katherine P; Scharfstein, Daniel O; Huang, Yanjie; Collins, Susan C J; MacKenzie, Ellen J

    2017-08-01

    The impact of the Trauma Collaborative Care (TCC) program on surgeon confidence in managing the psychosocial sequelae of orthopaedic trauma was evaluated as part of a larger prospective, multisite, cluster clinical trial. We compared confidence and perceived resource availability among surgeons practicing in trauma centers that implemented the TCC program with orthopaedic trauma surgeons in similar trauma centers that did not implement the TCC. Prospective cohort design. Level-I trauma centers. Attending surgeons and fellows (N = 95 Pre and N = 82 Post). Self-report 10-item measure of surgeon confidence in managing psychosocial issues associated with trauma and perceived availability of support resources. Analyses, performed on the entire sample and repeated on the subset of 52 surgeons who responded to the survey at both times points, found surgeons at intervention sites experienced a significantly greater positive improvement (P < 0.05) in their (1) belief that they have strategies to help orthopaedic trauma patients change their psychosocial situation; (2) confidence in making appropriate referrals for orthopaedic trauma patients with psychosocial problems; and (3) belief that they have access to information to guide the management of psychosocial issues related to recovery. Initial data suggest that the establishment of the TCC program can improve surgeons' perceived availability of resources and their confidence in managing the psychosocial sequelae after injury. Further studies will be required to determine if this translates into beneficial patient effects. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

  13. Age of Trauma Onset and HPA Axis Dysregulation Among Trauma-Exposed Youth.

    PubMed

    Kuhlman, Kate Ryan; Vargas, Ivan; Geiss, Elisa G; Lopez-Duran, Nestor L

    2015-12-01

    The hypothalamic-pituitary-adrenal axis (HPA axis) is a pathway through which childhood trauma may increase risk for negative health outcomes. The HPA axis is sensitive to stress throughout development; however, few studies have examined whether timing of exposure to childhood trauma is related to differences in later HPA axis functioning. Therefore, we examined the association between age of first trauma and HPA axis functioning among adolescents, and whether these associations varied by sex. Parents of 97 youth (aged 9-16 years) completed the Early Trauma Inventory (ETI), and youth completed the Socially-Evaluated Cold-Pressor Task (SECPT). We measured salivary cortisol response to the SECPT, the cortisol awakening response, and diurnal regulation at home across 2 consecutive weekdays. Exposure to trauma during infancy related to delayed cortisol recovery from peak responses to acute stress, d = 0.23 to 0.42. Timing of trauma exposure related to diverging patterns of diurnal cortisol regulation for males, d = 0.55, and females, d = 0.57. Therefore, the HPA axis may be susceptible to developing acute stress dysregulation when exposed to trauma during infancy, whereas the consequences within circadian cortisol regulation may occur in the context of later trauma exposure and vary by sex. Further investigations are warranted to characterize HPA axis sensitivity to exposure to childhood trauma across child development.

  14. The trauma film paradigm as an experimental psychopathology model of psychological trauma: intrusive memories and beyond.

    PubMed

    James, Ella L; Lau-Zhu, Alex; Clark, Ian A; Visser, Renée M; Hagenaars, Muriel A; Holmes, Emily A

    2016-07-01

    A better understanding of psychological trauma is fundamental to clinical psychology. Following traumatic event(s), a clinically significant number of people develop symptoms, including those of Acute Stress Disorder and/or Post Traumatic Stress Disorder. The trauma film paradigm offers an experimental psychopathology model to study both exposure and reactions to psychological trauma, including the hallmark symptom of intrusive memories. We reviewed 74 articles that have used this paradigm since the earliest review (Holmes & Bourne, 2008) until July 2014. Highlighting the different stages of trauma processing, i.e. pre-, peri- and post-trauma, the studies are divided according to manipulations before, during and after film viewing, for experimental as well as correlational designs. While the majority of studies focussed on the frequency of intrusive memories, other reactions to trauma were also modelled. We discuss the strengths and weaknesses of the trauma film paradigm as an experimental psychopathology model of trauma, consider ethical issues, and suggest future directions. By understanding the basic mechanisms underlying trauma symptom development, we can begin to translate findings from the laboratory to the clinic, test innovative science-driven interventions, and in the future reduce the debilitating effects of psychopathology following stressful and/or traumatic events.

  15. Sexual Trauma: Women Veterans Health Care

    MedlinePlus

    ... United States reported experiencing an attempted or completed rape at some time in their lives. Sexual violence, ... the CDC .* Military Sexual Trauma VA refers to sexual assault or repeated, threatening sexual harassment during military service ...

  16. Evaluation and management of acute vascular trauma.

    PubMed

    Salazar, Gloria M M; Walker, T Gregory

    2009-06-01

    With the technical advances and the increasing availability of sophisticated imaging equipment, techniques, and protocols, and with continually evolving transcatheter endovascular therapies, minimally invasive imaging and treatment options are being routinely used for the clinical management of trauma patients. Thus, the primary treatment algorithm for managing acute vascular trauma now increasingly involves the interventional radiologist or other endovascular specialist. Endovascular techniques represent an attractive option for both stabilizing and definitively treating patients who have sustained significant trauma, with resultant vascular injury. Endovascular treatment frequently offers the benefit of a focused definitive therapy, even in the presence of massive hemorrhage that allows for preservation of major vessels or injured solid organs and serves as an alternative to an open surgical intervention. This article presents an overview of various endovascular techniques that can be used for trauma patients presenting with vascular injuries.

  17. Magnetic resonance imaging of pediatric musculoskeletal trauma.

    PubMed

    Seeger, L L; Hall, T R

    1990-12-01

    MRI is an important tool for evaluating acute and chronic injuries to the musculoskeletal system. It is effective in demonstrating abnormalities in the knee and hips and in detecting bone and ligamentous trauma that is not evident radiographically.

  18. Pelvic trauma: WSES classification and guidelines.

    PubMed

    Coccolini, Federico; Stahel, Philip F; Montori, Giulia; Biffl, Walter; Horer, Tal M; Catena, Fausto; Kluger, Yoram; Moore, Ernest E; Peitzman, Andrew B; Ivatury, Rao; Coimbra, Raul; Fraga, Gustavo Pereira; Pereira, Bruno; Rizoli, Sandro; Kirkpatrick, Andrew; Leppaniemi, Ari; Manfredi, Roberto; Magnone, Stefano; Chiara, Osvaldo; Solaini, Leonardo; Ceresoli, Marco; Allievi, Niccolò; Arvieux, Catherine; Velmahos, George; Balogh, Zsolt; Naidoo, Noel; Weber, Dieter; Abu-Zidan, Fikri; Sartelli, Massimo; Ansaloni, Luca

    2017-01-01

    Complex pelvic injuries are among the most dangerous and deadly trauma related lesions. Different classification systems exist, some are based on the mechanism of injury, some on anatomic patterns and some are focusing on the resulting instability requiring operative fixation. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic impairment of pelvic ring function and the associated injuries. The management of pelvic trauma patients aims definitively to restore the homeostasis and the normal physiopathology associated to the mechanical stability of the pelvic ring. Thus the management of pelvic trauma must be multidisciplinary and should be ultimately based on the physiology of the patient and the anatomy of the injury. This paper presents the World Society of Emergency Surgery (WSES) classification of pelvic trauma and the management Guidelines.

  19. Early experience with simulated trauma resuscitation

    PubMed Central

    McLellan, Barry A.

    1999-01-01

    Although trauma resuscitation is best taught through direct exposure with hands-on experience, the opportunities for this type of teaching in Canada are limited by the relatively low incidence of serious injury and the consolidation of trauma care to a small number of centres. Simulators have been used extensively outside the health care environment and more recently have been used by anesthetists to simulate intraoperative crises. In this paper early experience using a realistic mannequin, controlled by a remote computer, that simulates a variety of physiologic and injury specific variables is presented. The resource implications of simulated resuscitation are reviewed, including one-time and operating costs. Simulated trauma resuscitation may be an educational alternative to “real-life” trauma resuscitation, but careful evaluation of the benefits and resource implications of this type of teaching through well-designed research studies will be important. PMID:10372017

  20. Nasal trauma: Primary reconstruction with open rhinoplasty

    PubMed Central

    Konstantinidis, I; Malliari, H; Metaxas, S

    2011-01-01

    Due to the prominent location of the nose, the most common facial traumas are nasal injuries. Although nasal traumas usually require staged intervention at a later period of time, in selected cases, primary reconstruction can be effective. A 20-year-old man who was referred from the emergency department with nasal trauma is presented. He reported a fall after feeling unsteady, which caused a direct nasal injury. Clinical examination revealed septal fracture with obstruction of the left nasal cavity and deformity of the nasal pyramid (inverted V deformity). The patient also had a complete dissection of the columella skin. Epistaxis was self-limited, and an open rhinoplasty procedure was decided because the trauma occurred 1 h before admission and there was no significant edema. Surgical intervention included septal reconstruction combined with restoration of the nasal pyramid and columella. One month later, the patient had patent nasal airways, and he was satisfied with the aesthetic result. PMID:22942663

  1. Primary cutaneous mucormycosis in trauma patients.

    PubMed

    Johnson, P C; Satterwhite, T K; Monheit, J E; Parks, D

    1987-04-01

    Primary cutaneous mucormycosis in trauma patients has been rarely reported. We describe three cases occurring in noncompromised hosts and review the literature. Prompt diagnosis and aggressive treatment with vigorous local care and appropriate antibiotics are recommended.

  2. [Unexpected abdominal trauma from a fireworks explosion].

    PubMed

    Smeulders, Mark J C; Gorter, Ramon R; Cense, Huib A; van Trier, A Toine

    2013-01-01

    Fireworks injuries are common and often affect children. Such injuries should be considered high energy trauma in the emergency room and taken care of according to the principles of the Advanced Trauma Life Support (ATLS). A 7-year-old boy was a victim of an explosion when he set off illegal fireworks. During evaluation in the emergency department he presented with a superficial laceration on the belly and extensive hand injury. Upon examination he had small-intestinal perforation that required immediate resection. The patient recovered well, but suffered permanent damage to the hand. Potentially life threatening injuries may accompany hand injuries after modern illegal fireworks. Hand injuries are serious. Despite prolonged treatment, they often result in permanent disability. The structured approach to trauma according to ATLS was important in detecting an accompanying abdominal trauma in this case.

  3. Late-presenting complications after splenic trauma.

    PubMed

    Freiwald, Sandra

    2010-01-01

    Since the 1970s, the management of blunt splenic trauma has evolved from almost exclusive surgical management to selective use of nonsurgical management in hemodynamically stable patients. Understanding of the spleen's immunologic importance in protection against overwhelming postsplenectomy infection led to development first of surgical techniques for splenic salvage and later to protocols for nonsurgical management of adults with blunt splenic injury. The evolution of nonsurgical management has resulted in new patterns of postsplenic trauma complications.This article describes a pancreatic pseudocyst, one of several described delayed complications of nonsurgical management of blunt splenic trauma. Along with missed splenic injury and delayed rupture, the development of a splenic pseudocyst represents challenges for any multidisciplinary team involved in trauma care. Detection and management of these complications is discussed, as is postsplenectomy vaccination and return to activity.

  4. Hardware Removal in Craniomaxillofacial Trauma

    PubMed Central

    Cahill, Thomas J.; Gandhi, Rikesh; Allori, Alexander C.; Marcus, Jeffrey R.; Powers, David; Erdmann, Detlev; Hollenbeck, Scott T.; Levinson, Howard

    2015-01-01

    Background Craniomaxillofacial (CMF) fractures are typically treated with open reduction and internal fixation. Open reduction and internal fixation can be complicated by hardware exposure or infection. The literature often does not differentiate between these 2 entities; so for this study, we have considered all hardware exposures as hardware infections. Approximately 5% of adults with CMF trauma are thought to develop hardware infections. Management consists of either removing the hardware versus leaving it in situ. The optimal approach has not been investigated. Thus, a systematic review of the literature was undertaken and a resultant evidence-based approach to the treatment and management of CMF hardware infections was devised. Materials and Methods A comprehensive search of journal articles was performed in parallel using MEDLINE, Web of Science, and ScienceDirect electronic databases. Keywords and phrases used were maxillofacial injuries; facial bones; wounds and injuries; fracture fixation, internal; wound infection; and infection. Our search yielded 529 articles. To focus on CMF fractures with hardware infections, the full text of English-language articles was reviewed to identify articles focusing on the evaluation and management of infected hardware in CMF trauma. Each article’s reference list was manually reviewed and citation analysis performed to identify articles missed by the search strategy. There were 259 articles that met the full inclusion criteria and form the basis of this systematic review. The articles were rated based on the level of evidence. There were 81 grade II articles included in the meta-analysis. Result Our meta-analysis revealed that 7503 patients were treated with hardware for CMF fractures in the 81 grade II articles. Hardware infection occurred in 510 (6.8%) of these patients. Of those infections, hardware removal occurred in 264 (51.8%) patients; hardware was left in place in 166 (32.6%) patients; and in 80 (15.6%) cases

  5. Complex trauma of the foot.

    PubMed

    Zwipp, H; Dahlen, C; Randt, T; Gavlik, J M

    1997-12-01

    Following complex foot injuries (incidence up to 52 %) in the multiply-injured patient the ultimate goal remains the same as for all significant foot injuries: the restoration of a painless, stable and plantigrade foot to avoid corrective procedures with moderate results. In the case of a complex trauma of the foot (5 point-score) - e. g. a crush injury - primary amputation in the multiply-injured patient (PTS 3-4) is indicated. Limb salvage (PTS 1-2) depends on the intraoperative aspect during the second look (within 24-48 hours after injury): the debridement has to be radical, the selection of amputation level should be at the most distal point compatible with tissue viability and wound healing. A free tissue transfer should be done early if necessary. Single lesions presenting with a compartment syndrome need an immediate dorsal fasciotomy, in the case of a multiply-injured patient as soon as possible. Open fractures are reduced following radical debridement and temporarily stabilized with K-wires and/or tibiotarsal transfixation with an external fixateur until the definitive ORIF. Dislocation-fractures of the talus type 3 and 4 according to Hawkins' classification need open reduction and internal fixation by screws (titan). Open fractures of the calcaneus are stabilized temporarily by a medial external fixateur after debridement until the definitive treatment. If there is a compartment syndrome an immediate dermatofasciotomy is essential. Like closed, calcanear fractures in multiply-injured patients dislocation-fractures of the Chopart's joint need immediate open reduction only if it is an open fracture or associated with a compartment syndrome. The incidence of a compartment syndrome in the case of dislocation fractures of the Lisfranc's joint is high and therefore a dorsal dermatofasciotomy without delay is critical. Open reduction and internal fixation are achieved either by 1.8 mm K-wires or 3.5 mm cortical screws. To avoid further soft tissue damage a

  6. [Complex trauma of the foot].

    PubMed

    Zwipp, H; Dahlen, C; Randt, T; Gavlik, J M

    1997-12-01

    Following complex foot injuries (incidence up to 52%) in the multiply-injured patient the ultimate goal remains the same as for all significant foot injuries: the restoration of a painless, stable and plantigrade foot to avoid corrective procedures with moderate results. In the case of a complex trauma of the foot (5 point-score)--e.g. a crush injury--primary amputation in the multiply-injured patient (PTS 3-4) is indicated. Limb salvage (PTS 1-2) depends on the intraoperative aspect during the second look (within 24-48 hours after injury): the debridement has to be radical, the selection of amputation level should be at the most distal point compatible with tissue viability and wound healing. A free tissue transfer should be done early if necessary. Single lesions presenting with a compartment syndrome need an immediate dorsal fasciotomy, in the case of a multiply-injured patient as soon as possible. Open fractures are reduced following radical debridement and temporarily stabilized with K-wires and/or tibiotarsal transfixation with an external fixateur until the definitive ORIF. Dislocation-fractures of the talus type 3 and 4 according to Hawkins' classification need open reduction and internal fixation by screws (titan). Open fractures of the calcaneus are stabilized temporarily by a medial external fixateur after debridement until the definitive treatment. If there is a compartment syndrome an immediate dermatofasciotomy is essential. Like closed, calcanear fractures in multiply-injured patients dislocation-fractures of the Chopart's joint need immediate open reduction only if it is an open fracture or associated with a compartment syndrome. The incidence of a compartment syndrome in the case of dislocation fractures of the Lisfranc's joint is high and therefore a dorsal dermatofasciotomy without delay is critical. Open reduction and internal fixation are achieved either by 1.8 mm K-wires or 3.5 mm cortical screws. To avoid further soft tissue damage a delayed

  7. Whats the story? Information needs of trauma teams.

    PubMed

    Sarcevic, Aleksandra; Burd, Randall S

    2008-11-06

    This paper reports on information needs of trauma teams based on an ethnographic study in an urban teaching hospital. We focus on questions posed by trauma team members during ten trauma events. We identify major categories of questions, as well as information seekers and providers. In addition to categories known from other critical care settings, we found categories unique to trauma settings. Based on these findings, we discuss implications for information technology support for trauma teams.

  8. The double jeopardy of blunt thoracoabdominal trauma.

    PubMed

    Berg, Regan J; Okoye, Obi; Teixeira, Pedro G; Inaba, Kenji; Demetriades, Demetrios

    2012-06-01

    To examine the specific injuries, need for operative intervention, and clinical outcomes of patients with blunt thoracoabdominal trauma. Trauma registry and medical record review. Level I trauma center in Los Angeles, California. All patients with thoracoabdominal injuries from January 1996 to December 2010. Injuries, incidence and type of operative intervention, clinical outcomes, and risk factors for mortality. Blunt thoracoabdominal injury occurred in 1661 patients. Overall, 474 (28.5%) required laparotomy, 31 (1.9%) required thoracotomy (excluding resuscitative thoracotomy), and 1146 (69.0%) required no thoracic or abdominal operation. Overall incidence of intraabdominal solid organ injury was 59.7% and hollow viscus injury, 6.0%. Blunt cardiac trauma occurred in 6.3%; major thoracic vessel injury, in 4.6%; and diaphragmatic trauma, in 6.0%. The majority of solid organ injuries were managed nonoperatively (liver, 83.9%; spleen, 68.3%; and kidney, 91.2%). Excluding patients with severe head trauma, mortality ranged from 4.5% with nonoperative management to 18.1% and 66.7% in those requiring laparotomy and dual cavitary exploration, respectively. Age 55 years or older, Injury Severity Score of 25 or more, Glasgow Coma Scale score of 8 or less, initial hypotension, massive transfusion, and liver, cardiac, or abdominal vascular trauma were all independent risk factors for mortality. Most patients with blunt thoracoabdominal trauma are managed nonoperatively. The need for non-resuscitative thoracotomy or combined thoracoabdominal operation is rare. The abdomen contains the overwhelming majority of injuries requiring operative intervention and should be the initial cavity of exploration in the patient requiring emergent surgery without directive radiologic data.

  9. Mechanisms of Coagulation Abnormalities and Trauma

    DTIC Science & Technology

    2013-11-01

    SUPPLEMENTARY NOTES 14. ABSTRACT Background: Trauma remains the leading cause of death and disability in patients under 40. Coagulopathy is common...following trauma and is associated with poor outcome. Our group has identified an Acute Traumatic Coagulopathy , which this grant seeks to characterize...Purpose: Our preliminary human data indicate that there is a close correlation between the development of coagulopathy and the activation of the

  10. Overview of the Essential Trauma Care Project.

    PubMed

    Mock, Charles; Joshipura, Manjul; Goosen, Jacques; Maier, Ronald

    2006-06-01

    The Essential Trauma Care (EsTC) Project represents an effort to set reasonable, affordable, minimum standards for trauma services worldwide and to define the resources necessary to actually provide these services to every injured person, even in the lowest-income countries. An emphasis is improved organization and planning, at minimal cost. The EsTC Project is a collaborative effort of the World Health Organization and the International Association for Trauma Surgery and Intensive Care, an integrated society within the International Society of Surgery-Société Internationale de Chirurgie. A milestone of the project has been the release of Guidelines for Essential Trauma Care. This establishes 11 core Essential Trauma Care services that can be considered "The Rights of the Injured." To assure these services, Guidelines delineates 260 items of human and physical resources that should be in place at the spectrum of health facilities globally. These are delineated in a series of flexible resource tables, to be adjusted based on an individual country's circumstances. Guidelines is intended to serve as both a planning guide and an advocacy statement. It has been used to catalyze improvements in trauma care in several countries. It has stimulated five national-level consultation meetings on trauma care, which constituted the highest governmental attention yet devoted to trauma care in those countries. At these meetings, the EsTC resource templates were adjusted to local circumstances and implementation strategies developed. Future efforts need to emphasize more on-the-ground implementation in individual countries, greater linkages with prehospital care, and wider political endorsement, such as by passage of a World Health Assembly resolution.

  11. Management of trauma to supporting dental structures.

    PubMed

    Elias, Husam; Baur, Dale A

    2009-10-01

    Teeth, periodontium, and supporting alveolar bone are frequently involved in trauma and account for approximately 15% of all emergency room visits. The cause of the dentoalveolar trauma varies in different demographics but generally results from falls, playground accidents, domestic violence, bicycle accidents, motor vehicle accidents, assaults, altercations, and sports injuries. Dentoalveolar injuries should be considered an emergency situation because successful management of the injury requires proper diagnosis and treatment within a limited time to achieve better outcomes.

  12. Classification and management of mild head trauma

    PubMed Central

    Andrade, Almir F; Paiva, Wellingson S; Soares, Matheus S; De Amorim, Robson LO; Tavares, Wagner M; Teixeira, Manoel J

    2011-01-01

    Mild head trauma had been defined in patients with direct impact or deceleration effect admitted with a Glasgow Coma Scale score of 13–15. It is one of the most frequent causes of morbidity in emergency medicine. Although common, several controversies persist about its clinical management. In this paper, we describe the Brazilian guidelines for mild head trauma, based on a critical review of the relevant literature. PMID:21475628

  13. International comparison of prehospital trauma care systems.

    PubMed

    Roudsari, Bahman S; Nathens, Avery B; Cameron, Peter; Civil, Ian; Gruen, Russel L; Koepsell, Thomas D; Lecky, Fiona E; Lefering, Rolf L; Liberman, Moishe; Mock, Charles N; Oestern, Hans-Jörg; Schildhauer, Thomas A; Waydhas, Christian; Rivara, Frederick P

    2007-09-01

    Given the recent emphasis on developing prehospital trauma care globally, we embarked upon a multicentre study to compare trauma patients' outcome within and between countries with technician-operated advanced life support (ALS) and physician-operated (Doc-ALS) emergency medical service (EMS) systems. These environments represent the continuum of prehospital care in high income countries with more advanced prehospital trauma care systems. Five countries with ALS-EMS system and four countries with Doc-ALS EMS system provided us with de-identified patient-level data from their national or local trauma registries. Generalised linear latent and mixed models was used in order to compare emergency department (ED) shock rate (systolic blood pressure (SBP) <90mmHg) and early trauma fatality rate (i.e. death during the first 24h after hospital arrival) between ALS and Doc-ALS EMS systems. Logistic regression was used to compare outcomes of interest among different countries, accounting for within-system correlation in patient outcomes. After adjustment for patient age, sex, type and mechanism of injury, injury severity score and SBP at scene, the ED shock rate did not vary significantly between Doc-ALS and ALS systems (OR: 1.16, 95% CI: 0.73-1.91). However, the early trauma fatality rate was significantly lower in Doc-ALS EMS systems compared with ALS EMS systems (OR: 0.70, 95% CI: 0.54-0.91). Furthermore, we found a considerable heterogeneity in patient outcomes among countries even with similar type of EMS systems. These findings suggest that prehospital trauma care systems that dispatch a physician to the scene may be associated with lower early trauma fatality rates, but not necessarily with significantly better outcomes on other clinical measures. The reasons for these findings deserve further studies.

  14. Thyroid Gland Hematoma After Blunt Neck Trauma

    PubMed Central

    Saylam, Baris; Çomçali, Bülent; Ozer, Mehmet Vasfi; Coskun, Faruk

    2009-01-01

    Hemorrhage of a previously normal thyroid gland as a result of blunt trauma is a very rare condition. We report a case of blunt trauma that caused acute hemorrhage into the thyroid gland and presented with hoarseness. The diagnosis of thyroid gland hematoma was made with a combination of fiberoptic laryngoscopy, cervical computed tomography, and carotid angiography. The patient was treated conservatively, had a favorable course without further complications, and was discharged four days after admission. PMID:20046242

  15. Temporal variation in major trauma admissions

    PubMed Central

    Kieffer, WKM; Michalik, DV; Gallagher, K; McFadyen, I; Bernard, J; Rogers, BA

    2016-01-01

    Introduction Trauma is a significant cause of morbidity and mortality in the UK. Since the inception of the trauma networks, little is known of the temporal pattern of trauma admissions. Methods Trauma Audit and Research Network data for 1 April 2011 to 31 March 2013 were collated from two large major trauma centres (MTCs) in the South East of England: Brighton and Sussex University Hospitals NHS Trust (BSUH) and St George's University Hospitals NHS Foundation Trust (SGU). The number of admissions and the injury severity score by time of admission, by weekdays versus weekend and by month/season were analysed. Results There were 1,223 admissions at BSUH and 1,241 at SGU. There was significant variation by time of admission; there were more admissions in the afternoons (BSUH p<0.001) and evenings (SGU p<0.001). There were proportionally more admissions at the weekends than on weekdays (BSUH p<0.001, SGU p=0.028). There was significant seasonal variation in admissions at BSUH (p<0.001) with more admissions in summer and autumn. No significant seasonal variation was observed at SGU (p=0.543). Conclusions The temporal patterns observed were different for each MTC with important implications for resource planning of trauma care. This study identified differing needs for different MTCs and resource planning should be individualised to the network. PMID:26741676

  16. Trauma management: Chernobyl in Belarus and Ukraine.

    PubMed

    Zhukova, Ekatherina

    2016-06-01

    Although the Chernobyl nuclear disaster happened in the Soviet Union in 1986, we still do not know how the most affected states - Ukraine and Belarus - have managed this tragedy since independence. Drawing on the concept of cultural trauma, this article compares Chernobyl narratives in Belarus and Ukraine over the past 28 years. It shows that national narratives of Chernobyl differ, representing the varying ways in which the state overcomes trauma. Our understanding of post-communist transformations can be improved by analysing trauma management narratives and their importance for new national identity construction. These narratives also bring new insights to our vision of cultural trauma by linking it to ontological insecurity. The article demonstrates how the state can become an arena of trauma process as it commands material and symbolic resources to deal with trauma. In general, it contributes to a better understanding of how the same traumatic event can become a source of solidarity in one community, but a source of hostility in another.

  17. ATLS® and damage control in spine trauma

    PubMed Central

    Schmidt, Oliver I; Gahr, Ralf H; Gosse, Andreas; Heyde, Christoph E

    2009-01-01

    Substantial inflammatory disturbances following major trauma have been found throughout the posttraumatic course of polytraumatized patients, which was confirmed in experimental models of trauma and in vitro settings. As a consequence, the principle of damage control surgery (DCS) has developed over the last two decades and has been successfully introduced in the treatment of severely injured patients. The aim of damage control surgery and orthopaedics (DCO) is to limit additional iatrogenic trauma in the vulnerable phase following major injury. Considering traumatic brain and acute lung injury, implants for quick stabilization like external fixators as well as decided surgical approaches with minimized potential for additional surgery-related impairment of the patient's immunologic state have been developed and used widely. It is obvious, that a similar approach should be undertaken in the case of spinal trauma in the polytraumatized patient. Yet, few data on damage control spine surgery are published to so far, controlled trials are missing and spinal injury is addressed only secondarily in the broadly used ATLS® polytrauma algorithm. This article reviews the literature on spine trauma assessment and treatment in the polytrauma setting, gives hints on how to assess the spine trauma patient regarding to the ATLS® protocol and recommendations on therapeutic strategies in spinal injury in the polytraumatized patient. PMID:19257904

  18. Improving trauma care in Trinidad and Tobago.

    PubMed

    Adam, R; Stedman, M; Winn, J; Howard, M; Williams, J I; Ali, J

    1994-06-01

    Identification of trauma as a major cause of morbidity and mortality in Trinidad and Tobago prompted the establishment of a training programme aimed at improving trauma care in this developing country. An Advanced Trauma Life Support (ATLS) programme for physicians, funded through the Canadian International Development Agency resulted in a statistically significant improvement of in-hospital trauma patient outcome at the Port-of-Spain General Hospital (observed to expected mortality ratio of 3.16 pre-ATLS compared to 1.94 post-ATLS). A recent analysis of all motor vehicle injuries for a shorter period did not confirm this positive impact of the ATLS programme, primarily because a large number of these patients died in the pre-hospital period. Pre-hospital trauma care therefore required urgent attention to complement the positive in-hospital impact of the ATLS programme. A second training programme (the Pre-Hospital Trauma Life Support or PHTLS) for paramedical personnel was thus instituted in 1990. Over 250 physicians have been trained in the ATLS programme and to date over 100 paramedical personnel have been trained in the PHTLS programme. Attempts have also been made to equip the ambulances with more appropriate resuscitative devices in order to improve pre-hospital care. The combination of the PHTLS and the ATLS programme should result in further improvement in the care of patients sustaining major injuries in Trinidad and Tobago.

  19. Coordination and collaboration of violent trauma care.

    PubMed

    King, C A

    1994-10-01

    The STC has the luxury of an all RN staff, capable of functioning in any of the surgical specialities. The PTN is a specialitist at being a generalist to provide care to a critically injured population. The role of the PTN is multifaceted and varied; it can be best described as functioning as a multidisciplinary coordinator and case manager in meeting the demands of the violent trauma patient. The patient often enters the OR severely injured, intubated, and incapable of self-protection or determination. The most important function of perioperative nursing is that of patient advocate. No other member of the trauma team is as focal to the patient's safety and comfort as the nurse. Passage from the scene of violent trauma to the OR requires dynamic assessment skills, critical thinking, and organizational capabilities. As long as interpersonal altercation results in intentional trauma, there will be a need for perioperative trauma nurses with the committement and expertise to mend the wounds of violent trauma victims.

  20. Complications of tube thoracostomy in trauma

    PubMed Central

    Bailey, R

    2000-01-01

    Objective—To assess the complication rate of tube thoracostomy in trauma. To consider whether this rate is high enough to support a selective reduction in the indications for tube thoracostomy in trauma. Methods—A retrospective case series of all trauma patients who underwent tube thoracostomy during a 12 month period at a large UK teaching hospital with an accident and emergency (A&E) department seeing in excess of 125 000 new patients/year. These patients were identified using the hospital audit department computerised retrieval system supplemented by a hand search of both the data collected for the Major Trauma Outcome Study and the A&E admission unit log book. The notes were assessed with regard to the incidence of complications, which were divided into insertional, infective, and positional. Results—Fifty seven chest drains were placed in 47 patients over the 12 month period. Seven patients who died within 48 hours of drain insertion were excluded. The commonest indications for tube thoracostomy were pneumothorax (54%) and haemothorax (20%); 90% of tubes were placed as a result of blunt trauma. The overall complication rate of the procedure was 30%. There were no insertional complications and only one (2%) major complication, which was empyema thoracis. Conclusion—This study reveals no persuasive evidence to support a selective reduction in the indications for tube thoracostomy in trauma. A larger study to confirm or refute these findings must be performed before any change in established safe practice. PMID:10718232

  1. Initial evaluation of the "Trauma surgery course"

    PubMed Central

    Tugnoli, Gregorio; Ribaldi, Sergio; Casali, Marco; Calderale, Stefano M; Coletti, Massimo; Alifano, Marco; Parri, Sergio N Forti; Villani, Silvia; Biscardi, Andrea; Giordano, M Chiara; Baldoni, Franco

    2006-01-01

    Background The consequence of the low rate of penetrating injuries in Europe and the increase in non-operative management of blunt trauma is a decrease in surgeons' confidence in managing traumatic injuries has led to the need for new didactic tools. The aim of this retrospective study was to present the Corso di Chirurgia del Politrauma (Trauma Surgery Course), developed as a model for teaching operative trauma techniques, and assess its efficacy. Method the two-day course consisted of theoretical lectures and practical experience on large-sized swine. Data of the first 126 participants were collected and analyzed. Results All of the 126 general surgeons who had participated in the course judged it to be an efficient model to improve knowledge about the surgical treatment of trauma. Conclusion A two-day course, focusing on trauma surgery, with lectures and life-like operation situations, represents a model for simulated training and can be useful to improve surgeons' confidence in managing trauma patients. Cooperation between organizers of similar initiatives would be beneficial and could lead to standardizing and improving such courses. PMID:16759403

  2. Self-report may underestimate trauma intrusions.

    PubMed

    Takarangi, Melanie K T; Strange, Deryn; Lindsay, D Stephen

    2014-07-01

    Research examining maladaptive responses to trauma routinely relies on spontaneous self-report to index intrusive thoughts, which assumes people accurately recognize and report their intrusive thoughts. However, "mind-wandering" research reveals people are not always meta-aware of their thought content: they often fail to notice shifts in their attention. In two experiments, we exposed subjects to trauma films, then instructed them to report intrusive thoughts during an unrelated reading task. Intermittently, we asked whether they were thinking about the trauma. As expected, subjects often spontaneously reported intrusive thoughts. However, they were also "caught" engaging in unreported trauma-oriented thoughts. The presence and frequency of intermittent probes did not influence self-caught intrusions. Both self-caught and probe-caught intrusions were related to an existing tendency toward intrusive cognition, film-related distress, and thought suppression attempts. Our data suggest people may lack meta-awareness of trauma-related thoughts, which has implications for theory, research and treatment relating to trauma-related psychopathology. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Cost factors in Canadian pediatric trauma

    PubMed Central

    Dueck, Andrew; Poenaru, Dan; Pichora, David R.

    2001-01-01

    Objectives To estimate the costs of Canadian pediatric trauma and identify cost predictors. Design A chart review. Setting A regional trauma centre. Study material The charts of all 221 children who suffered traumatic injuries with an Injury Severity Score (ISS) of 4 or more seen over 6 years at a regional trauma centre. Main outcome measures Patient data, injury data, all hospital-based costs, excluding nursing, food and medication costs. Results Mean (and standard deviation) patient age was 12.8 (5) years. Sixty percent were boys. Motor vehicle accidents (MVAs) accounted for 71% of the injuries, followed by falls (11%). The mean (and SD) total cost of care was Can$7582 (Can$12 370), and the cost of media was Can$2666. Total cost correlated directly with age (r = 0.29, p < 0.001) and Injury Severity Score (ISS) (r = 0.34, p < 0.001) and inversely with the Pediatric Trauma Score (PTS) (r = −0.20, p = 0.003). The presence of extremity injuries correlated significantly with total cost (r = 0.22, p = 0.001) and PTS (r = −0.25, p < 0.001) but not with the ISS. Logistic regression analysis identified runk injury, ISS and PTS as the main determinants of survival. Conclusions The cost of pediatric trauma in Canada can be predicted from admission data and trauma scores. The cost of extremity injuries is significant and can be predicted by the PTS but not the ISS. PMID:11308233

  4. The impact of trauma on neutrophil function.

    PubMed

    Hazeldine, Jon; Hampson, Peter; Lord, Janet M

    2014-12-01

    A well described consequence of traumatic injury is immune dysregulation, where an initial increase in immune activity is followed by a period of immune depression, the latter leaving hospitalised trauma patients at an increased risk of nosocomial infections. Here, we discuss the emerging role of the neutrophil, the most abundant leucocyte in human circulation and the first line of defence against microbial challenge, in the initiation and propagation of the inflammatory response to trauma. We review the findings of the most recent studies to have investigated the impact of trauma on neutrophil function and discuss how alterations in neutrophil biology are being investigated as potential biomarkers by which to predict the outcome of hospitalised trauma patients. Furthermore, with trauma-induced changes in neutrophil biology linked to the development of such post-traumatic complications as multiple organ failure and acute respiratory distress syndrome, we highlight an area of research within the field of trauma immunology that is gaining considerable interest: the manipulation of neutrophil function as a means by which to potentially improve patient outcome.

  5. Trauma-Informed Hospice and Palliative Care.

    PubMed

    Ganzel, Barbara L

    2016-12-07

    This review highlights the need to integrate trauma-informed practices into hospice and palliative care. The pervasiveness of psychological trauma exposure has been established in the general population and among the elderly adults. Moreover, there is emerging evidence for multiple additional opportunities for exposure to psychological trauma at or near the end of life. For example, many people experience intensive medical interventions prior to their admission to hospice and/or palliative care, and there is increasing recognition that these interventions may be traumatic. These and related opportunities for trauma exposure may combine synergistically at the end of life, particularly in the presence of pain, anxiety, delirium, dementia, or ordinary old age. This, in turn, can negatively affect patient mental health, well-being, behavior, and reported experience of pain. This review closes with suggestions for future research and a call for universal assessment of psychological trauma history and symptoms in hospice and palliative care patients, along with the development of palliative trauma intervention strategies appropriate to these populations. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  6. [Anesthesiological management of elderly trauma patients].

    PubMed

    Coburn, M; Röhl, A B; Knobe, M; Stevanovic, A; Stoppe, C; Rossaint, R

    2016-02-01

    The demographic change is accompanied by an increasing number of elderly trauma patients. Geriatric patients with trauma often show several comorbidities and as a result have a high perioperative risk to develop postoperative morbidity and mortality. The 30-day mortality is high. This article presents an overview of the perioperative management of elderly trauma patients in order to improve the perioperative outcome of these high risk patients. A literature search was carried out focusing on the latest developments in the field of elderly trauma patients in order to present guidance on preoperative, intraoperative and postoperative anesthesiological management. Elderly trauma patients should undergo operative interventions as soon as possible. Many of these patients have a high risk profile. This can be estimated using risk scores in order to allow a prognosis for the outcome of patients. The informed consent needs to be discussed accordingly. The perioperative management is ideally addressed in a multidisciplinary approach. An array of questions in perioperative management, such as the mode of anesthesia, the ideal individual transfusion trigger and fluid management have not yet been adequately addressed in studies. The level of evidence in the perioperative management of elderly trauma patients is poor; therefore, there is an urgent need for large prospective studies in order to define uniform standards and guidelines.

  7. Trauma induced hypercoagulablity in pediatric patients.

    PubMed

    Ryan, Mark L; Van Haren, Robert M; Thorson, Chad M; Andrews, David M; Perez, Eduardo A; Neville, Holly L; Sola, Juan E; Proctor, Kenneth G

    2014-08-01

    Coagulation changes in pediatric trauma patients are not well defined. To fill this gap, we tested the hypothesis that trauma evokes a hypercoagulable response. A prospective observational study was conducted in hospitalized patients (age 8months to 14years) admitted for trauma or elective surgery. Informed consent was obtained from the parents and informed assent was obtained in patients 7years of age or older. Coagulation changes were evaluated on fresh whole blood using thromboelastography (TEG) and on stored plasma using assays for special clotting factors. Forty three patients (22 trauma, median injury severity score =9; and 21 uninjured controls) were evaluated. For trauma vs control, prothrombin time (PT) was higher by about 10% (p<0.001), but activated partial thromboplastin time was not altered. TEG clotting time (R;p=0.005) and fibrin cross-linking were markedly accelerated (K time, alpha angle; p<0.001) relative to the control patients. d-Dimer, Prothrombin Fragment 1+2, and Plasminogen Activator Inhibitor-1 were all elevated, whereas Protein S activity was reduced (all p<0.01). Importantly, a large fraction of TEG values and clotting factor assays in the pediatric control group were outside the published reference ranges for adults. A hypercoagulable state is associated with minor trauma in children. More work is needed to determine the functional significance of these changes and to establish normal pediatric reference ranges. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Impact of Sexual Trauma on HIV Care Engagement: Perspectives of Female Patients with Trauma Histories in Cape Town, South Africa.

    PubMed

    Watt, Melissa H; Dennis, Alexis C; Choi, Karmel W; Ciya, Nonceba; Joska, John A; Robertson, Corne; Sikkema, Kathleen J

    2016-11-19

    South African women have disproportionately high rates of both sexual trauma and HIV. To understand how sexual trauma impacts HIV care engagement, we conducted in-depth qualitative interviews with 15 HIV-infected women with sexual trauma histories, recruited from a public clinic in Cape Town. Interviews explored trauma narratives, coping behaviors and care engagement, and transcripts were analyzed using a constant comparison method. Participants reported multiple and complex traumas across their lifetimes. Sexual trauma hindered HIV care engagement, especially immediately following HIV diagnosis, and there were indications that sexual trauma may interfere with future care engagement, via traumatic stress symptoms including avoidance. Disclosure of sexual trauma was limited; no women had disclosed to an HIV provider. Routine screening for sexual trauma in HIV care settings may help to identify individuals at risk of poor care engagement. Efficacious treatments are needed to address the psychological and behavioral sequelae of trauma.

  9. Resilience, trauma, context, and culture.

    PubMed

    Ungar, Michael

    2013-07-01

    This article reviews the relationship between factors associated with resilience, and aspects of the individual's social ecology (environment) that promote and protect against the negative impact of exposure to traumatic events. It is shown that the Environment × Individual interactions related to resilience can be understood using three principles: (1) Resilience is not as much an individual construct as it is a quality of the environment and its capacity to facilitate growth (nurture trumps nature); (2) resilience looks both the same and different within and between populations, with the mechanisms that predict positive growth sensitive to individual, contextual, and cultural variation (differential impact); and (3) the impact that any single factor has on resilience differs by the amount of risk exposure, with the mechanisms that protect against the impact of trauma showing contextual and cultural specificity for particular individuals (cultural variation). A definition of resilience is provided that highlights the need for environments to facilitate the navigations and negotiations of individuals for the resources they need to cope with adversity. The relative nature of resilience is discussed, emphasizing that resilience can manifest as either prosocial behaviors or pathological adaptation depending on the quality of the environment.

  10. [Crush syndrome in severe trauma].

    PubMed

    Poznanović, Marija Rakarić; Sulen, Nina

    2007-01-01

    Crush injury or traumatic rhabdomyolysis is caused by crushing of large muscule mass, usually of the femoral and gluteal compartment. Crush syndrome is general manifestation of crush injury with renal failure (ARF). ARF is caused by deposition of myoglobin in distal tubules. The concentration of serum creatin phosphokinase is an indicator of the extent of injured muscule. The serum concentration of myoglobin is an indicator of the extent of injured muscule and the main cause of development of crush syndrome. In a prospective study the concentration of myoglobin and CPK was measured in 81 patients with injuries of lower extremities and pelvis as a part of severe trauma. The increase of CPK concentration above 1000 U/L was measured in all patients. The increase of CPK concentration above 2000 U/L was measured in 78 (96.3%) patients. The increase of myoglobin concentration of >700 mcg/L was measured in 19 (23.5%) patients. In the group of 19 patients with CPK concentration of >2000 U/L and myoglobin concentration of >700 mcg/L crush syndrome developed in 6 (7.4%) patients with oliguria (urin output <50 ml/h) and the increase of serum potassium, phosphate and creatinine concentrations. The decrease of CPK and myoglobin concentrations was achieved in 5 patients during 10-12 days and 1 patient with associated craniocrebral injury died.

  11. Neuroimaging in repetitive brain trauma.

    PubMed

    Ng, Thomas Sc; Lin, Alexander P; Koerte, Inga K; Pasternak, Ofer; Liao, Huijun; Merugumala, Sai; Bouix, Sylvain; Shenton, Martha E

    2014-01-01

    Sports-related concussions are one of the major causes of mild traumatic brain injury. Although most patients recover completely within days to weeks, those who experience repetitive brain trauma (RBT) may be at risk for developing a condition known as chronic traumatic encephalopathy (CTE). While this condition is most commonly observed in athletes who experience repetitive concussive and/or subconcussive blows to the head, such as boxers, football players, or hockey players, CTE may also affect soldiers on active duty. Currently, the only means by which to diagnose CTE is by the presence of phosphorylated tau aggregations post-mortem. Non-invasive neuroimaging, however, may allow early diagnosis as well as improve our understanding of the underlying pathophysiology of RBT. The purpose of this article is to review advanced neuroimaging methods used to investigate RBT, including diffusion tensor imaging, magnetic resonance spectroscopy, functional magnetic resonance imaging, susceptibility weighted imaging, and positron emission tomography. While there is a considerable literature using these methods in brain injury in general, the focus of this review is on RBT and those subject populations currently known to be susceptible to RBT, namely athletes and soldiers. Further, while direct detection of CTE in vivo has not yet been achieved, all of the methods described in this review provide insight into RBT and will likely lead to a better characterization (diagnosis), in vivo, of CTE than measures of self-report.

  12. Neuroimaging in repetitive brain trauma

    PubMed Central

    2014-01-01

    Sports-related concussions are one of the major causes of mild traumatic brain injury. Although most patients recover completely within days to weeks, those who experience repetitive brain trauma (RBT) may be at risk for developing a condition known as chronic traumatic encephalopathy (CTE). While this condition is most commonly observed in athletes who experience repetitive concussive and/or subconcussive blows to the head, such as boxers, football players, or hockey players, CTE may also affect soldiers on active duty. Currently, the only means by which to diagnose CTE is by the presence of phosphorylated tau aggregations post-mortem. Non-invasive neuroimaging, however, may allow early diagnosis as well as improve our understanding of the underlying pathophysiology of RBT. The purpose of this article is to review advanced neuroimaging methods used to investigate RBT, including diffusion tensor imaging, magnetic resonance spectroscopy, functional magnetic resonance imaging, susceptibility weighted imaging, and positron emission tomography. While there is a considerable literature using these methods in brain injury in general, the focus of this review is on RBT and those subject populations currently known to be susceptible to RBT, namely athletes and soldiers. Further, while direct detection of CTE in vivo has not yet been achieved, all of the methods described in this review provide insight into RBT and will likely lead to a better characterization (diagnosis), in vivo, of CTE than measures of self-report. PMID:25031630

  13. [Trauma, Resilience, and Emotion Regulation].

    PubMed

    Holl, Julia; Pap, Isabel; Südhof, Jonna; Wolff, Elisabeth; Staben, Katharina; Wolff, Sebastian; Höcker, Anja; Hiller, Philipp; Schäfer, Ingo; Barnow, Sven

    2017-02-01

    Background: History of childhood abuse and neglect is considered to be a relevant risk factor for adult psychopathology. A functional emotion regulation (ER) can account for resilience despite of traumatic experiences in childhood. Materials & Methods: This study compares the habitual use of specific ER strategies among mentally healthy individuals with (n=61) and without (n=52) experience of childhood abuse and neglect by using the self-rating instrument Heidelberg Form for Emotion Regulation Strategies (H-FERST). SCID-I, ADP-IV, SCL-27, and BDI-II were used for assessment of psychopathological distress. Results: We found no group difference in the habitual use of ER strategies. Healthy individuals with childhood abuse and neglect showed significantly more subjective distress symptoms. Discussion & Conclusion: Considering the significantly higher psychopathological distress reported by the trauma group, the functional habitual use of ER strategies could serve as a path to explain the resilient development of adult individuals after childhood abuse and neglect. © Georg Thieme Verlag KG Stuttgart · New York.

  14. Depersonalization, mindfulness, and childhood trauma.

    PubMed

    Michal, Matthias; Beutel, Manfred E; Jordan, Jochen; Zimmermann, Michael; Wolters, Susanne; Heidenreich, Thomas

    2007-08-01

    Depersonalization (DP), i.e., feelings of being detached from one's own mental processes or body, can be considered as a form of mental escape from the full experience of reality. This mental escape is thought to be etiologically linked with maltreatment during childhood. The detached state of consciousness in DP contrasts with certain aspects of mindfulness, a state of consciousness characterized by being in touch with the present moment. Against this background, the present article investigates potential connections between DP severity, mindfulness, and childhood trauma in a mixed sample of nonpatients and chronic nonmalignant pain patients. We found a strong inverse correlation between DP severity and mindfulness in both samples, which persisted after partialing out general psychological distress. In the nonpatient sample, we additionally found significant correlations between emotional maltreatment on the one hand and DP severity (positive) and mindfulness (negative) on the other. We conclude that the results first argue for an antithetical relationship between DP and certain aspects of mindfulness and thus encourage future studies on mindfulness-based interventions for DP and second throw light on potential developmental factors contributing to mindfulness.

  15. Major trauma: the unseen financial burden to trauma centres, a descriptive multicentre analysis.

    PubMed

    Curtis, Kate; Lam, Mary; Mitchell, Rebecca; Dickson, Cara; McDonnell, Karon

    2014-02-01

    This research examines the existing funding model for in-hospital trauma patient episodes in New South Wales (NSW), Australia and identifies factors that cause above-average treatment costs. Accurate information on the treatment costs of injury is needed to guide health-funding strategy and prevent inadvertent underfunding of specialist trauma centres, which treat a high trauma casemix. Admitted trauma patient data provided by 12 trauma centres were linked with financial data for 2008-09. Actual costs incurred by each hospital were compared with state-wide Australian Refined Diagnostic Related Groups (AR-DRG) average costs. Patient episodes where actual cost was higher than AR-DRG cost allocation were examined. There were 16693 patients at a total cost of AU$178.7million. The total costs incurred by trauma centres were $14.7million above the NSW peer-group average cost estimates. There were 10 AR-DRG where the total cost variance was greater than $500000. The AR-DRG with the largest proportion of patients were the upper limb injury categories, many of whom had multiple body regions injured and/or a traumatic brain injury (P<0.001). AR-DRG classifications do not adequately describe the trauma patient episode and are not commensurate with the expense of trauma treatment. A revision of AR-DRG used for trauma is needed. WHAT IS KNOWN ABOUT THIS TOPIC? Severely injured trauma patients often have multiple injuries, in more than one body region and the determination of appropriate AR-DRG can be difficult. Pilot research suggests that the AR-DRG do not accurately represent the care that is required for these patients. WHAT DOES THIS PAPER ADD? This is the first multicentre analysis of treatment costs and coding variance for major trauma in Australia. This research identifies the limitations of the current AR-DRGS and those that are particularly problematic. The value of linking trauma registry and financial data within each trauma centre is demonstrated. WHAT ARE THE

  16. Effects of Prior Psychosocial Trauma on Subsequent Immune Response After Experimental Thorax Trauma.

    PubMed

    Langgartner, Dominik; Palmer, Annette; Rittlinger, Anne; Reber, Stefan O; Huber-Lang, Markus

    2017-08-25

    Overshooting inflammation during the early phase after blunt thorax trauma promotes the development of acute respiratory distress syndrome, multiple organ failure and subsequent mortality. Given that individuals diagnosed with stress-related disorders are characterized by chronic low-grade inflammation, we hypothesize that "psychosocial traumatic preload" poses a risk factor for the above mentioned complications following thorax trauma.Here, we employed the chronic subordinate colony housing (CSC) paradigm to induce "psychosocial traumatic preload" and systemic low-grade immune activation in male mice, indicated by elevated plasma concentrations of different inflammatory mediators. Subsequent thorax trauma was induced in anaesthetized mice by a single blast wave centered on the thorax; SHAM animals were exposed to anesthesia only. Mice were sacrificed 2 h, 6 h, and 24 h after thorax trauma or SHAM treatment.Independent of thorax trauma, CSC caused an increase in adrenal weight, and a decrease in thymus weight, indicating that the stress paradigm worked reliably. Moreover, CSC exposure aggravated the early immune response after thorax trauma, indicated by elevated myeloperoxidase lung concentrations in thorax trauma-exposed CSC versus thorax trauma-exposed single housed control (SHC) mice (2 h), but no histological differences. Furthermore, thorax trauma caused an increase in total bronchoalveolar lavage fluid (BAL) protein (24 h), BAL C5a (2 h), BAL cell counts (24 h) and BAL keratinocyte chemoattractant (6 h, 24 h) in CSC but not SHC mice.Our data indicate that repeated psychosocial traumatization during adulthood moderately aggravates the local immune response towards thorax trauma, but overall may be considered as a rather minor risk factor in terms of thorax trauma-associated complications.

  17. Successful Incorporation of Performance Based Payments for Trauma Center Readiness Costs into the Georgia Trauma System.

    PubMed

    Ashley, Dennis W; Nicholas, Jeffrey M; Dente, Christopher J; Johns, Tracy J; Garlow, Laura E; Solomon, Gina; Abston, Dena; Ferdinand, Colville H

    2017-09-01

    As quality and outcomes have moved to the fore front of medicine in this era of healthcare reform, a state trauma system Performance Based Payments (PBP) program has been incorporated into trauma center readiness funding. The purpose of this study was to evaluate the impact of a PBP on trauma center revenue. From 2010 to 2016, a percentage of readiness costs funding to trauma centers was placed in a PBP and withheld until the PBP criteria were completed. To introduce the concept, only three performance criteria and 10 per cent of readiness costs funding were tied to PBP in 2010. The PBP has evolved over the last several years to now include specific criteria by level of designation with an increase to 50 per cent of readiness costs funding being tied to PBP criteria. Final PBP distribution to trauma centers was based on the number of performance criteria completed. During 2016, the PBP criteria for Level I and II trauma centers included participation in official state meetings/conference calls, required attendance to American College of Surgeons state chapter meetings, Trauma Quality Improvement Program, registry reports, and surgeon participation in Peer Review Committee and trauma alert response times. Over the seven-year study period, $36,261,469 was available for readiness funds with $11,534,512 eligible for the PBP. Only $636,383 (6%) was withheld from trauma centers. A performance-based program was successfully incorporated into trauma center readiness funding, supporting state performance measures without adversely affecting the trauma center revenue. Future PBP criteria may be aligned to designation standards and clinical quality performance metrics.

  18. The syndemic illness of HIV and trauma: implications for a trauma-informed model of care.

    PubMed

    Brezing, Christina; Ferrara, Maria; Freudenreich, Oliver

    2015-01-01

    People living with HIV infection are disproportionately burdened by trauma and the resultant negative health consequences, making the combination of HIV infection and trauma a syndemic illness. Despite the high co-occurrence and negative influence on health, trauma and posttraumatic sequelae in people living with HIV infection often go unrecognized and untreated because of the current gaps in medical training and lack of practice guidelines. We set out to review the current literature on HIV infection and trauma and propose a trauma-informed model of care to target this syndemic illness. We searched PubMed, PsycINFO, and Cochrane review databases for articles that contained the following search terms: HIV AND either trauma (specifically violent trauma), PTSD, intimate partner violence (IPV), abuse, or trauma-informed care. Articles were limited to primary clinical research or metanalyses published in English. Articles were excluded if they referred to HIV-associated posttraumatic stress disorder or HIV-associated posttraumatic growth. We confirm high, but variable, rates of trauma in people living with HIV infection demonstrated in multiple studies, ranging from 10%-90%. Trauma is associated with (1) increased HIV-risk behavior, contributing to transmission and acquisition of the virus; (2) negative internal and external mediators also associated with poor health and high-risk HIV behavior; (3) poor adherence to treatment; (4) poor HIV-related and other health outcomes; and (5) particularly vulnerable special populations. Clinicians should consider using a model of trauma-informed care in the treatment of people living with HIV infection. Its adoption in different settings needs to be matched to available resources. Copyright © 2015 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

  19. Kinetic therapy in multiple trauma patients with severe blunt chest trauma: an analysis at a level-1 trauma center.

    PubMed

    Zeckey, C; Wendt, K; Mommsen, P; Winkelmann, M; Frömke, C; Weidemann, J; Stübig, T; Krettek, C; Hildebrand, F

    2015-01-01

    Chest trauma is a relevant risk factor for mortality after multiple trauma. Kinetic therapy (KT) represents a potential treatment option in order to restore pulmonary function. Decision criteria for performing kinetic therapy are not fully elucidated. The purpose of this study was to investigate the decision making process to initiate kinetic therapy in a well defined multiple trauma cohort. A retrospective analysis (2000-2009) of polytrauma patients (age > 16 years, ISS ⩾ 16) with severe chest trauma (AIS(Chest) ⩾ 3) was performed. Patients with AIS(Head) ⩾ 3 were excluded. Patients receiving either kinetic (KT+) or lung protective ventilation strategy (KT-) were compared. Chest trauma was classified according to the AIS(Chest), Pulmonary Contusion Score (PCS), Wagner Jamieson Score and Thoracic Trauma Severity Score (TTS). There were multiple outcome parameters investigated included mortality, posttraumatic complications and clinical data. A multivariate regression analysis was performed. Two hundred and eighty-three patients were included (KT+: n=160; KT-: n=123). AIS(Chest), age and gender were comparable in both groups. There were significant higher values of the ISS, PCS, Wagner Jamieson Score and TTS in group KT+. The incidence of posttraumatic complications and mortality was increased compared to group KT- (p< 0.05). Despite that, kinetic therapy failed to be an independent risk factor for mortality in multivariate logistic regression analysis. Kinetic therapy is an option in severely injured patients with severe chest trauma. Decision making is not only based on anatomical aspects such as the AIS(Chest), but on overall injury severity, pulmonary contusions and physiological deterioration. It could be assumed that the increased mortality in patients receiving KT is primarily caused by these factors and does not reflect an independent adverse effect of KT. Furthermore, KT was not shown to be an independent risk factor for mortality.

  20. Evaluating trauma team performance in a Level I trauma center: Validation of the trauma team communication assessment (TTCA-24).

    PubMed

    DeMoor, Stephanie; Abdel-Rehim, Shady; Olmsted, Richard; Myers, John G; Parker-Raley, Jessica

    2017-07-01

    Nontechnical skills (NTS), such as team communication, are well-recognized determinants of trauma team performance and good patient care. Measuring these competencies during trauma resuscitations is essential, yet few valid and reliable tools are available. We aimed to demonstrate that the Trauma Team Communication Assessment (TTCA-24) is a valid and reliable instrument that measures communication effectiveness during activations. Two tools with adequate psychometric strength (Trauma Nontechnical Skills Scale [T-NOTECHS], Team Emergency Assessment Measure [TEAM]) were identified during a systematic review of medical literature and compared with TTCA-24. Three coders used each tool to evaluate 35 stable and 35 unstable patient activations (defined according to Advanced Trauma Life Support criteria). Interrater reliability was calculated between coders using the intraclass correlation coefficient. Spearman rank correlation coefficient was used to establish concurrent validity between TTCA-24 and the other two validated tools. Coders achieved an intraclass correlation coefficient of 0.87 for stable patient activations and 0.78 for unstable activations scoring excellent on the interrater agreement guidelines. The median score for each assessment showed good team communication for all 70 videos (TEAM, 39.8 of 54; T-NOTECHS, 17.4 of 25; and TTCA-24, 87.4 of 96). A significant correlation between TTTC-24 and T-NOTECHS was revealed (p = 0.029), but no significant correlation between TTCA-24 and TEAM (p = 0.77). Team communication was rated slightly better across all assessments for stable versus unstable patient activations, but not statistically significant. TTCA-24 correlated with T-NOTECHS, an instrument measuring nontechnical skills for trauma teams, but not TEAM, a tool that assesses communication in generic emergency settings. TTCA-24 is a reliable and valid assessment that can be a useful adjunct when evaluating interpersonal and team communication during trauma

  1. Comparative Effectiveness of Family Problem-Solving Therapy (F-PST) for Adolescent TBI

    ClinicalTrials.gov

    2016-07-25

    Tbi; Intracranial Edema; Brain Edema; Craniocerebral Trauma; Head Injury; Brain Hemorrhage, Traumatic; Subdural Hematoma; Brain Concussion; Head Injuries, Closed; Epidural Hematoma; Cortical Contusion; Wounds and Injuries; Disorders of Environmental Origin; Trauma, Nervous System; Brain Injuries

  2. The Aftermath of Road Trauma: Survivors' Perceptions of Trauma and Growth

    ERIC Educational Resources Information Center

    Harms, Louise; Talbot, Michelle

    2007-01-01

    For many survivors of serious road trauma, the physical and psychological consequences are complex and lifelong. The longer-term psychosocial recovery experience for survivors, however, is rarely documented in the social work literature. This article reports on findings from a study of road trauma recovery experiences. The findings are presented…

  3. Prevalence of interpersonal trauma exposure and trauma-related disorders in severe mental illness

    PubMed Central

    Mauritz, Maria W.; Goossens, Peter J. J.; Draijer, Nel; van Achterberg, Theo

    2013-01-01

    Background Interpersonal trauma exposure and trauma-related disorders in people with severe mental illness (SMI) are often not recognized in clinical practice. Objective To substantiate the prevalence of interpersonal trauma exposure and trauma-related disorders in people with SMI. Methods We conducted a systematic review of four databases (1980–2010) and then described and analysed 33 studies in terms of primary diagnosis and instruments used to measure trauma exposure and trauma-related disorders. Results Population-weighted mean prevalence rates in SMI were physical abuse 47% (range 25–72%), sexual abuse 37% (range 24–49%), and posttraumatic stress disorder (PTSD) 30% (range 20–47%). Compared to men, women showed a higher prevalence of sexual abuse in schizophrenia spectrum disorder, bipolar disorder, and mixed diagnosis groups labelled as having SMI. Conclusions Prevalence rates of interpersonal trauma and trauma-related disorders were significantly higher in SMI than in the general population. Emotional abuse and neglect, physical neglect, complex PTSD, and dissociative disorders have been scarcely examined in SMI. PMID:23577228

  4. The role of trauma scoring in developing trauma clinical governance in the Defence Medical Services

    PubMed Central

    Russell, R. J.; Hodgetts, T. J.; McLeod, J.; Starkey, K.; Mahoney, P.; Harrison, K.; Bell, E.

    2011-01-01

    This paper discusses mathematical models of expressing severity of injury and probability of survival following trauma and their use in establishing clinical governance of a trauma system. There are five sections: (i) Historical overview of scoring systems—anatomical, physiological and combined systems and the advantages and disadvantages of each. (ii) Definitions used in official statistics—definitions of ‘killed in action’ and other categories and the importance of casualty reporting rates and comparison across conflicts and nationalities. (iii) Current scoring systems and clinical governance—clinical governance of the trauma system in the Defence Medical Services (DMS) by using trauma scoring models to analyse injury and clinical patterns. (iv) Unexpected outcomes—unexpected outcomes focus clinical governance tools. Unexpected survivors signify good practice to be promulgated. Unexpected deaths pick up areas of weakness to be addressed. Seventy-five clinically validated unexpected survivors were identified over 2 years during contemporary combat operations. (v) Future developments—can the trauma scoring methods be improved? Trauma scoring systems use linear approaches and have significant weaknesses. Trauma and its treatment is a complex system. Nonlinear methods need to be investigated to determine whether these will produce a better approach to the analysis of the survival from major trauma. PMID:21149354

  5. Potentially perilous pedagogies: teaching trauma is not the same as trauma-informed teaching.

    PubMed

    Carello, Janice; Butler, Lisa D

    2014-01-01

    This article explores why and how trauma theory and research are currently used in higher education in nonclinical courses such as literature, women's studies, film, education, anthropology, cultural studies, composition, and creative writing. In these contexts, traumatic material is presented not only indirectly in the form of texts and films that depict traumatic events but also directly in the form of what is most commonly referred to in nonclinical disciplines as trauma studies, cultural trauma studies, and critical trauma studies. Within these areas of study, some instructors promote potentially risky pedagogical practices involving trauma exposure or disclosure despite indications that these may be having deleterious effects. After examining the published rationales for such methods, we argue that given the high rates of trauma histories (66%-85%), posttraumatic stress disorder (9%-12%), and other past event-related distress among college students, student risk of retraumatization and secondary traumatization should be decreased rather than increased. To this end, we propose that a trauma-informed approach to pedagogy-one that recognizes these risks and prioritizes student emotional safety in learning-is essential, particularly in classes in which trauma theories or traumatic experiences are taught or disclosed.

  6. Trauma Adapted Family Connections: Reducing Developmental and Complex Trauma Symptomatology to Prevent Child Abuse and Neglect

    ERIC Educational Resources Information Center

    Collins, Kathryn S.; Strieder, Frederick H.; DePanfilis, Diane; Tabor, Maureen; Clarkson Freeman, Pamela A.; Linde, Linnea; Greenberg, Patty

    2011-01-01

    Families living in urban poverty, enduring chronic and complex traumatic stress, and having difficulty meeting their children's basic needs have significant child maltreatment risk factors. There is a paucity of family focused, trauma-informed evidence-based interventions aimed to alleviate trauma symptomatology, strengthen family functioning, and…

  7. Trauma Focused CBT for Children with Co-Occurring Trauma and Behavior Problems

    ERIC Educational Resources Information Center

    Cohen, Judith A.; Berliner, Lucy; Mannarino, Anthony

    2010-01-01

    Objective: Childhood trauma impacts multiple domains of functioning including behavior. Traumatized children commonly have behavioral problems that therapists must effectively evaluate and manage in the context of providing trauma-focused treatment. This manuscript describes practical strategies for managing behavior problems in the context of…

  8. The role of trauma scoring in developing trauma clinical governance in the Defence Medical Services.

    PubMed

    Russell, R J; Hodgetts, T J; McLeod, J; Starkey, K; Mahoney, P; Harrison, K; Bell, E

    2011-01-27

    This paper discusses mathematical models of expressing severity of injury and probability of survival following trauma and their use in establishing clinical governance of a trauma system. There are five sections: (i) Historical overview of scoring systems--anatomical, physiological and combined systems and the advantages and disadvantages of each. (ii) Definitions used in official statistics--definitions of 'killed in action' and other categories and the importance of casualty reporting rates and comparison across conflicts and nationalities. (iii) Current scoring systems and clinical governance--clinical governance of the trauma system in the Defence Medical Services (DMS) by using trauma scoring models to analyse injury and clinical patterns. (iv) Unexpected outcomes--unexpected outcomes focus clinical governance tools. Unexpected survivors signify good practice to be promulgated. Unexpected deaths pick up areas of weakness to be addressed. Seventy-five clinically validated unexpected survivors were identified over 2 years during contemporary combat operations. (v) Future developments--can the trauma scoring methods be improved? Trauma scoring systems use linear approaches and have significant weaknesses. Trauma and its treatment is a complex system. Nonlinear methods need to be investigated to determine whether these will produce a better approach to the analysis of the survival from major trauma.

  9. School Based Post Disaster Mental Health Services: Decreased Trauma Symptoms in Youth with Multiple Traumas

    ERIC Educational Resources Information Center

    Graham, Rebecca A.; Osofsky, Joy D.; Osofsky, Howard J.; Hansel, Tonya C.

    2017-01-01

    Children exposed to disasters are at an increased likelihood for multiple trauma exposure. The objective of our study is to understand the efficacy of post disaster school based services for reducing trauma symptoms of youth exposed to multiple traumatic events. Students (N = 112) age 8-17 that were survivors of Hurricane Katrina received…

  10. Negative body experience in women with early childhood trauma: associations with trauma severity and dissociation.

    PubMed

    Scheffers, Mia; Hoek, Maike; Bosscher, Ruud J; van Duijn, Marijtje A J; Schoevers, Robert A; van Busschbach, Jooske T

    2017-01-01

    Background: A crucial but often overlooked impact of early life exposure to trauma is its far-reaching effect on a person's relationship with their body. Several domains of body experience may be negatively influenced or damaged as a result of early childhood trauma. Objective: The aim of this study was to investigate disturbances in three domains of body experience: body attitude, body satisfaction, and body awareness. Furthermore, associations between domains of body experience and severity of trauma symptoms as well as frequency of dissociation were evaluated. Method: Body attitude was measured with the Dresden Body Image Questionnaire, body satisfaction with the Body Cathexis Scale, and body awareness with the Somatic Awareness Questionnaire in 50 female patients with complex trauma and compared with scores in a non-clinical female sample (n = 216). Patients in the clinical sample also filled out the Davidson Trauma Scale and the Dissociation Experience Scale. Results: In all measured domains, body experience was severely affected in patients with early childhood trauma. Compared with scores in the non-clinical group, effect sizes in Cohen's d were 2.7 for body attitude, 1.7 for body satisfaction, and 0.8 for body awareness. Associations between domains of body experience and severity of trauma symptoms were low, as were the associations with frequency of dissociative symptoms. Conclusions: Early childhood trauma in women is associated with impairments in self-reported body experience that warrant careful assessment in the treatment of women with psychiatric disorders.

  11. The Aftermath of Road Trauma: Survivors' Perceptions of Trauma and Growth

    ERIC Educational Resources Information Center

    Harms, Louise; Talbot, Michelle

    2007-01-01

    For many survivors of serious road trauma, the physical and psychological consequences are complex and lifelong. The longer-term psychosocial recovery experience for survivors, however, is rarely documented in the social work literature. This article reports on findings from a study of road trauma recovery experiences. The findings are presented…

  12. Trauma Focused CBT for Children with Co-Occurring Trauma and Behavior Problems

    ERIC Educational Resources Information Center

    Cohen, Judith A.; Berliner, Lucy; Mannarino, Anthony

    2010-01-01

    Objective: Childhood trauma impacts multiple domains of functioning including behavior. Traumatized children commonly have behavioral problems that therapists must effectively evaluate and manage in the context of providing trauma-focused treatment. This manuscript describes practical strategies for managing behavior problems in the context of…

  13. Exploring trauma recidivism in an elderly cohort.

    PubMed

    Allan, Bassan J; Davis, James S; Pandya, Reeni K; Jouria, Jassin; Habib, Fahim; Namias, Nicholas; Schulman, Carl I

    2013-09-01

    As the population ages, trauma in the elderly is an increasingly recognized source of elderly morbidity. However, previous reviews on the topic provide only broad recommendations. The purpose of this study was to examine the elderly recidivist cohort at an urban trauma center for mechanisms of repeat injury. The trauma registry at a major urban trauma center was queried to identify all patients aged 65 and older admitted from 1991-2010. Recidivist admissions were compared to nonrecidivist admissions. Demographics, mechanism of injury, injury location, length of stay, and mortality data were collected. Recidivists' mechanism of injury was compared with their initial mechanism of injury. Descriptive statistics, Student t-test, and a z-rank test of proportions were applied with significance set to P ≤ 0.05. Between 1991 and 2010, 6476 patients aged 65+ were admitted, of which 79 (1.22%) were recidivists. Of these, 64 patients were aged 65 and older for both admissions. Most often, recidivists were male (70% versus 60%) and injured in penetrating trauma (17% versus 7.5%, P = 0.045). Recidivists trended towards more frequent injuries in bicycle collisions (3% versus 1.9%) and all-terrain vehicle (ATV)/motorcycle crashes (6.3% versus 1.7%), but were less likely to be hit by cars (49% versus 36%, P = 0.034). At least two thirds of recidivist patients injured in falls, ATV/motorcycle accidents, and stabbings had previously been injured by the same mechanism. The overall recidivism rate in the elderly population is low. Nevertheless, recidivists were more susceptible to penetrating trauma, ATV/motorcycle collisions, and possibly bicycle accidents. These findings can help design counseling initiatives and injury prevention programs that target specific elderly trauma patients. Copyright © 2013 Elsevier Inc. All rights reserved.

  14. Resuscitation of trauma-induced coagulopathy.

    PubMed

    Hess, John R

    2013-01-01

    For 30 years, the Advanced Trauma Life Support course of the American College of Surgeons taught that coagulopathy was a late consequence of resuscitation of injury. The recognition of trauma-induced coagulopathy overturns that medical myth and creates a rationale for procoagulant resuscitation. Analysis of the composition of currently available blood components allows prediction of the upper limits of achievable coagulation activity, keeping in mind that oxygen transport must be maintained simultaneously. RBCs, plasma, and platelets given in a 1:1:1 unit ratio results in a hematocrit of 29%, plasma concentration of 62%, and platelet count of 90,000 in the administered resuscitation fluid. Additional amounts of any 1 component dilute the other 2 and any other fluids given dilute all 3. In vivo recovery of stored RBCs is ∼90% and that of platelets ∼60% at the mean age at which such products are given to trauma patients. This means that useful concentrations of the administered products are a hematocrit of 26%, a plasma coagulation factor activity of 62% equivalent to an international normalized ratio of ∼1.2, and a platelet count of 54,000. This means there is essentially no good way to give blood products for resuscitation of trauma-induced coagulopathy other than 1:1:1. Because 50% of trauma patients admitted alive to an academic-level 1 trauma center who will die of uncontrolled hemorrhage will be dead in 2 hours, the trauma system must be prepared to deliver plasma- and platelet-based resuscitation at all times.

  15. Pain management in trauma: A review study

    PubMed Central

    Ahmadi, Alireza; Bazargan-Hejazi, Shahrzad; Heidari Zadie, Zahra; Euasobhon, Pramote; Ketumarn, Penkae; Karbasfrushan, Ali; Amini-Saman, Javad; Mohammadi, Reza

    2016-01-01

    Abstract: Background: Pain in trauma has a role similar to the double-edged sword. On the one hand, pain is a good indicator to determine the severity and type of injury. On the other hand, pain can induce sever complications and it may lead to further deterioration of the patient. Therefore, knowing how to manage pain in trauma patients is an important part of systemic approach in trauma. The aim of this manuscript is to provide information about pain management in trauma in the Emergency Room settings. Methods: In this review we searched among electronic and manual documents covering a 15-yr period between 2000 and 2016. Our electronic search included Pub Med, Google scholar, Web of Science, and Cochrane databases. We looked for articles in English and in peer-reviewed journals using the following keywords: acute pain management, trauma, emergency room and injury. Results: More than 3200 documents were identified. After screening based on the study inclusion criteria, 560 studies that had direct linkage to the study aim were considered for evaluation based World Health Organization (WHO) pain ladder chart. Conclusions: To provide adequate pain management in trauma patients require: adequate assessment of age-specific pharmacologic pain management; identification of adequate analgesic to relieve moderate to severe pain; cognizance of serious adverse effects of pain medications and weighting medications against their benefits, and regularly reassessing patients and reevaluating their pain management regimen. Patient-centered trauma care will also require having knowledge of barriers to pain management and discussing them with the patient and his/her family to identify solutions. PMID:27414816

  16. Frequency and causes of bilateral occular trauma.

    PubMed

    Babar, Tariq Farooq; Khan, Mohammad Naeem; Jan, Sana Ullah; Shah, Shafqat Ali; Zaman, Mir; Khan, Mohammad Daud

    2007-11-01

    To determine the frequency and causes of bilateral ocular trauma. A descriptive case series. Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar from October 1999 to September 2006. All patients coming to the hospital with bilateral eye trauma and requiring admission were recruited into the study. The details of patients' demographics, risk factors, ocular examination, treatment offered and final visual acuity were noted and described as frequency and percentages. Out of a total of 1551 patients of hospitalized ocular trauma, 46 (2.9%, 92 eyes) had bilateral ocular trauma. The majority (54.3%) were due to landmine blast injuries followed by dynamite blast in 10.8%, coalmine blast and firearm injury in 6.5% each. Pressure cooker explosion and road traffic accident was the cause in 4.3% each. Gas cylinder and automobile battery explosion, alkali and acid burn, assault and incidental trauma occurred in 2.1%. Sixty three percent were between 16 and 40 years of age. Males were affected in 93.4%. Corneal and / or scleral repair was done in 58.6%, conjunctival and or corneal foreign body removal in 26% and extracapular cataract extraction with intraocular lens implantation in 16.3%. The visual acuity was in the range of 6/60 and perception of light in 54.3%, while in 21.7%, there was no perception of light at the time of admission. Due to severity of injury, the final visual acuity was poor and only 28.2% regained vision between 6/18 and 6/60. In this series, landmine, dynamite and coalmine blasts were the major causes of bilateral ocular trauma. Victims were usually young males. Due to severity of ocular trauma, majority had poor visual outcome.

  17. The Effect of Trauma Center Designation and Trauma Volume on Outcome in Specific Severe Injuries

    PubMed Central

    Demetriades, Demetrios; Martin, Mathew; Salim, Ali; Rhee, Peter; Brown, Carlos; Chan, Linda

    2005-01-01

    Objective: The objective of this study was to investigate the effect of American College of Surgeons (ACS) trauma center designation and trauma volume on outcome in patients with specific severe injuries. Background: Trauma centers are designated by the ACS into different levels on the basis of resources, trauma volume, and educational and research commitment. The criteria for trauma center designation are arbitrary and have never been validated. Methods: The National Trauma Data Bank study, which included patients >14 years of age and had injury severity score (ISS) >15, were alive on admission and had at least one of the following severe injuries: aortic, vena cava, iliac vessels, cardiac, grade IV/V liver injuries, quadriplegia, or complex pelvic fractures. Outcomes (mortality, intensive care unit stay, and severe disability at discharge) were compared among level I and II trauma centers and between centers within the same level designation but different volumes of severe trauma (<240 vs ≥240 trauma admissions with ISS >15 per year). The outcomes were adjusted for age (<65 ≥65), gender, mechanism of injury, hypotension on admission, and ISS (≤25 and >25). Results: A total of 12,254 patients met the inclusion criteria. Overall, level I centers had significantly lower mortality (25.3% vs 29.3%; adjusted odds ratio [OR], 0.81; 95% confidence interval [CI], 0.71–0.94; P = 0.004) and significantly lower severe disability at discharge (20.3% vs 33.8%, adjusted OR, 0.55; 95% CI, 0.44–0.69; P < 0.001) than level II centers. Subgroup analysis showed that cardiovascular injuries (N = 2004) and grades IV–V liver injuries (N = 1415) had a significantly better survival in level I than level II trauma centers (adjusted P = 0.017 and 0.023, respectively). Overall, there was a significantly better functional outcome in level I centers (adjusted P < 0.001). Subgroup analysis showed level I centers had significantly better functional outcomes in complex pelvic

  18. Leading in times of trauma.

    PubMed

    Dutton, Jane E; Frost, Peter J; Worline, Monica C; Lilius, Jacoba M; Kanov, Jason M

    2002-01-01

    An employee is diagnosed with cancer or loses a family member unexpectedly. An earthquake destroys an entire section of a city, leaving hundreds dead, injured, or homeless. At time like these, managerial handbooks fail us. After all, leaders can't eliminate personal suffering, nor can they ask employees who are dealing with these crises to check their emotions at the door. But compassionate leadership can facilitate personal as well as organizational healing. Based on research the authors have conducted at the University of Michigan and the University of British Columbia's CompassionLab, this article describes what leaders can do to foster organizational compassion in times of trauma. They recount real-world examples, including a story of personal tragedy at Newsweek, natural disasters that affected Macy's and Malden Mills, and the events of September 11, 2001. During times of collective pain and confusion, compassionate leaders take some form of public action, however small, that is intended to ease people's pain and inspire others to act. By openly demonstrating their own humanity, executives can unleash a compassionate response throughout the whole company, increasing bonds among employees and attachments to the organization. The authors say compassionate leaders uniformly provide two things: a "context for meaning"--creating an environment in which people can freely express and discuss how they feel--and a "context for action"--creating an environment in which those who experience or witness pain can find ways to alleviate their own and others' suffering. A leader's competence in demonstrating and fostering compassion is vital, the authors conclude, to nourishing the very humanity that can make people--and organizations--great.

  19. Are Australian and New Zealand trauma service resources reflective of the Australasian Trauma Verification Model Resource Criteria?

    PubMed

    Leonard, Elizabeth; Curtis, Kate

    2014-01-01

    The Australasian Trauma Verification Program was developed in 2000 to improve the quality of care provided at services in Australia and New Zealand. The programme outlines resources required for differing levels of trauma services. This study compares the human resources in Australia and New Zealand trauma services with those recommended by the Australasian College of Surgeons Trauma Verification Program. In September 2011, all trauma nurse coordinators in Australia and New Zealand were invited to participate in an electronic survey endorsed by the Australasian Trauma Society. This study expands on previous bi-national research and aimed to identify demographic and trauma service human resource levels. Fifty-three surveys (78%) were completed and all 27 Level 1 trauma centres represented. Of the Level 1 trauma centres, a trauma director and fellow were available at 16 (51.8%) and 14 (40.7%) centres, respectively. The majority (93%) had a full-time trauma coordinator although a trauma case manager was only available at 14 (48.1%) of Level 1 trauma centres. Despite the large amount of data collection and extraction required, trauma services had limited access to a data manager (50.9%) or clerical staff (36.9%). Human resources in Australian and NZ trauma services are not reflective of those recommended by the Australasian Trauma Verification Program. This impacts on the ability to coordinate trauma monitoring and performance improvement. Review of the Australasian Trauma Verification Model Resource Criteria is required. Injury surveillance in Australia and NZ is hampered by insufficient trauma registry resources. © 2014 Royal Australasian College of Surgeons.

  20. Trauma adapted family connections: reducing developmental and complex trauma symptomatology to prevent child abuse and neglect.

    PubMed

    Collins, Kathryn S; Strieder, Frederick H; DePanfilis, Diane; Tabor, Maureen; Freeman, Pamela A Clarkson; Linde, Linnea; Greenberg, Patty

    2011-01-01

    Families living in urban poverty, enduring chronic and complex traumatic stress, and having difficulty meeting their children's basic needs have significant child maltreatment risk factors. There is a paucity of family focused, trauma-informed evidence-based interventions aimed to alleviate trauma symptomatology, strengthen family functioning, and prevent child abuse and neglect. Trauma Adapted Family Connections (TA-FC) is a manualized trauma-focused practice rooted in the principles of Family Connections (FC), an evidence supported preventive intervention developed to address the glaring gap in services for this specific, growing, and underserved population. This paper describes the science based development of TA-FC, its phases and essential components, which are based on theories of attachment, neglect, trauma, and family interaction within a comprehensive community-based family focused intervention framework.

  1. [Trauma-Informed Peer Counselling in the Care of Refugees with Trauma-Related Disorders].

    PubMed

    Wöller, Wolfgang

    2016-09-01

    Providing adequate culture-sensitive care for a large number of refugees with trauma-related disorders constitutes a major challenge. In this context, peer support and trauma-informed peer counselling can be regarded as a valuable means to complement the psychosocial care systems. In recent years, peer support and peer education have been successfully implemented e. g. in health care education, in psychiatric care, and in the treatment of traumatized individuals. Only little research data is available for traumatized refugees. However, results are encouraging. A program is presented which integrates trauma-informed peer educators (TIP) with migration background in the care of traumatized refugees. Peers' responsibility includes emotional support and understanding the refugees' needs, sensitizing for trauma-related disorders, providing psychoeducation, and teaching trauma-specific stabilization techniques under supervision of professional psychotherapists. © Georg Thieme Verlag KG Stuttgart · New York.

  2. Trauma registrar training: integrating registry functions into the trauma program--Part 2.

    PubMed

    Auerbach, S

    1999-01-01

    Effective health-information management is heavily reliant upon the data-collection process of the health care program. This is also true in trauma-care systems, where healthcare providers have come to rely on timely access to complete and accurate information to support many critical functions of a trauma program. The process by which data are collected and analyzed deserves constant attention and reassessment. Data obtained in reports and analyses are only as accurate as the data abstraction and validation processes allow. The University of Pennsylvania Health System Trauma Network recognizes this, and as a result, developed this training and orientation guideline. This guideline supports the importance of the registry role in the overall trauma program, but most importantly, it fosters and supports a team approach to data collection, which in our experience has allowed us to develop and maintain trauma registry databases which provides valid, useful and current information for all.

  3. Air bag-mediated fatal craniocervical trauma: a case report.

    PubMed

    Büyük, Yalçin; Uzün, Ibrahim; Erkol, Zerrin; Ağritmiş, Hasan; Ustündağ, Kasim T

    2010-07-01

    This case report describes a four-year-old girl (102 cm, 17 kg) who sustained fatal craniocerebral injuries as a result of an inflating automobile air bag. The car struck the lid of the sewer system, which was 15 cm above the ground level, at a low speed, and both the driver and passenger air bags inflated. Despite the fact that air bag usage has lessened both the possibility and severity of occupant injuries in frontal collisions, case reports of serious injuries and even deaths especially in children due to air bag deployment, particularly during low speed impacts, highlight the need for changes in both system design and possibly the threshold speed of air bag deployment.

  4. Time for a change in injury and trauma care delivery: a trauma death review analysis.

    PubMed

    Sugrue, Michael; Caldwell, Erica; D'Amours, Scott; Crozier, John; Wyllie, Peter; Flabouris, Arthas; Sheridan, Mark; Jalaludin, Bin

    2008-11-01

    Safety and error reduction in medical care is crucial to the future of medicine. This study evaluates trauma patients dying at a level 1 trauma centre to determine the adequacy of care. All trauma deaths at a level 1 trauma centre between 1996 and 2003 were reviewed by an eight-member multidisciplinary death review panel. Errors in care were classified according to their location, nature, impact, outcome and whether the deaths were avoidable or non-avoidable. Avoidable deaths were categorized as potentially, probably and definitely avoidable. Between 1996 and 2003, there were 17 157 trauma admissions, including 307 trauma deaths. The mean patient age was 47.7 years +/- 24.8 years, mean injury severity score 38.1 +/- 19.6. Of all deaths, 69 (22.5%) were deemed avoidable. Of the avoidable deaths, 61 (88%) were potentially avoidable, 7 (10%) probably avoidable and 1 (1.4%) definitely avoidable. Avoidable deaths were associated with patients with increased age, lower injury severity score, admissions to intensive care unit, longer hospital stay and treatment by a non-trauma surgeon (P < 0.05). Of the 307 trauma deaths, 271 (89.3%) patients experienced a total of 1063 errors, an overall error rate of 3.5 per patient. The error rate in the non-avoidable group was 2.9 per patient and 5.3 per patient in the avoidable group (P < 0.0001). Most errors occurred in the resuscitation area. Age, severity of injury, hospital length of stay and care by a non-trauma surgeon are factors associated with avoidable deaths. A new approach to trauma and injury care is required.

  5. Disaster preparedness of Canadian trauma centres: the perspective of medical directors of trauma

    PubMed Central

    Gomez, David; Haas, Barbara; Ahmed, Najma; Tien, Homer; Nathens, Avery

    2011-01-01

    Background Owing to their constant readiness to treat injured patients, trauma centres are essential to regional responses to mass casualty incidents (MCIs). Reviews of recent MCIs suggest that trauma centre preparedness has frequently been limited. We set out to evaluate Canadian trauma centre preparedness and the extent of their integration into a regional response to MCIs. Methods We conducted a survey of Canadian level-1 trauma centres (n = 29) to characterize their existing disaster-response plans and to identify areas where pre-paredness could be improved. The survey was directed to the medical director of trauma at each centre. Descriptive statistics were used to analyze responses. Results Twenty-three (79%) trauma centres in 5 provinces responded. Whereas most (83%) reported the presence of a committee dedicated to disaster preparedness, only half of the medical directors of trauma were members of these committees. Almost half (43%) the institutions had not run any disaster drill in the previous 2 years. Only 70% of trauma centres used communications assets designed to function during MCIs. Additionally, more than half of the trauma directors (59%) did not know if their institutions had the ability to sustain operations for at least 72 hours during MCIs. Conclusion The results of this study suggest important opportunities to better prepare Canadian trauma centers to respond to an MCI. The main areas identified for potential improvement include the need for the standardization of MCI planning and response at a regional level and the implementation of strategies such as stockpiling of resources and novel communication strategies to avoid functional collapse during an MCI. PMID:21251427

  6. Disaster preparedness of Canadian trauma centres: the perspective of medical directors of trauma.

    PubMed

    Gomez, David; Haas, Barbara; Ahmed, Najma; Tien, Homer; Nathens, Avery

    2011-02-01

    Owing to their constant readiness to treat injured patients, trauma centres are essential to regional responses to mass casualty incidents (MCIs). Reviews of recent MCIs suggest that trauma centre preparedness has frequently been limited. We set out to evaluate Canadian trauma centre preparedness and the extent of their integration into a regional response to MCIs. We conducted a survey of Canadian level-1 trauma centres (n = 29) to characterize their existing disaster-response plans and to identify areas where preparedness could be improved. The survey was directed to the medical director of trauma at each centre. Descriptive statistics were used to analyze responses. Twenty-three (79%) trauma centres in 5 provinces responded. Whereas most (83%) reported the presence of a committee dedicated to disaster preparedness, only half of the medical directors of trauma were members of these committees. Almost half (43%) the institutions had not run any disaster drill in the previous 2 years. Only 70% of trauma centres used communications assets designed to function during MCIs. Additionally, more than half of the trauma directors (59%) did not know if their institutions had the ability to sustain operations for at least 72 hours during MCIs. The results of this study suggest important opportunities to better prepare Canadian trauma centers to respond to an MCI. The main areas identified for potential improvement include the need for the standardization of MCI planning and response at a regional level and the implementation of strategies such as stockpiling of resources and novel communication strategies to avoid functional collapse during an MCI.

  7. Evaluating trauma center process performance in an integrated trauma system with registry data.

    PubMed

    Moore, Lynne; Lavoie, André; Sirois, Marie-Josée; Amini, Rachid; Belcaïd, Amina; Sampalis, John S

    2013-04-01

    The evaluation of trauma center performance implies the use of indicators that evaluate clinical processes. Despite the availability of routinely collected clinical data in most trauma systems, quality improvement efforts are often limited to hospital-based audit of adverse patient outcomes. To identify and evaluate a series of process performance indicators (PPI) that can be calculated using routinely collected trauma registry data. PPI were identified using a review of published literature, trauma system documentation, and expert consensus. Data from the 59 trauma centers of the Quebec trauma system (1999, 2006; N = 99,444) were used to calculate estimates of conformity to each PPI for each trauma center. Outliers were identified by comparing each center to the global mean. PPI were evaluated in terms of discrimination (between-center variance), construct validity (correlation with designation level and patient volume), and forecasting (correlation over time). Fifteen PPI were retained. Global proportions of conformity ranged between 6% for reduction of a major dislocation within 1 h and 97% for therapeutic laparotomy. Between-center variance was statistically significant for 13 PPI. Five PPI were significantly associated with designation level, 7 were associated with volume, and 11 were correlated over time. In our trauma system, results suggest that a series of 15 PPI supported by literature review or expert opinion can be calculated using routinely collected trauma registry data. We have provided evidence of their discrimination, construct validity, and forecasting properties. The between-center variance observed in this study highlights the importance of evaluating process performance in integrated trauma systems.

  8. Trauma teams and time to early management during in situ trauma team training

    PubMed Central

    Härgestam, Maria; Lindkvist, Marie; Jacobsson, Maritha; Brulin, Christine

    2016-01-01

    Objectives To investigate the association between the time taken to make a decision to go to surgery and gender, ethnicity, years in profession, experience of trauma team training, experience of structured trauma courses and trauma in the trauma team, as well as use of closed-loop communication and leadership styles during trauma team training. Design In situ trauma team training. The patient simulator was preprogrammed to represent a severely injured patient (injury severity score: 25) suffering from hypovolemia due to external trauma. Setting An emergency room in an urban Scandinavian level one trauma centre. Participants A total of 96 participants were divided into 16 trauma teams. Each team consisted of six team members: one surgeon/emergency physician (designated team leader), one anaesthesiologist, one registered nurse anaesthetist, one registered nurse from the emergency department, one enrolled nurse from the emergency department and one enrolled nurse from the operating theatre. Primary outcome HRs with CIs (95% CI) for the time taken to make a decision to go to surgery was computed from a Cox proportional hazards model. Results Three variables remained significant in the final model. Closed-loop communication initiated by the team leader increased the chance of a decision to go to surgery (HR: 3.88; CI 1.02 to 14.69). Only 8 of the 16 teams made the decision to go to surgery within the timeframe of the trauma team training. Conversely, call-outs and closed-loop communication initiated by the team members significantly decreased the chance of a decision to go to surgery, (HR: 0.82; CI 0.71 to 0.96, and HR: 0.23; CI 0.08 to 0.71, respectively). Conclusions Closed-loop communication initiated by the leader appears to be beneficial for teamwork. In contrast, a high number of call-outs and closed-loop communication initiated by team members might lead to a communication overload. PMID:26826152

  9. Evaluating trauma center process performance in an integrated trauma system with registry data

    PubMed Central

    Moore, Lynne; Lavoie, André; Sirois, Marie-Josée; Amini, Rachid; Belcaïd, Amina; Sampalis, John S

    2013-01-01

    Background: The evaluation of trauma center performance implies the use of indicators that evaluate clinical processes. Despite the availability of routinely collected clinical data in most trauma systems, quality improvement efforts are often limited to hospital-based audit of adverse patient outcomes. Objective: To identify and evaluate a series of process performance indicators (PPI) that can be calculated using routinely collected trauma registry data. Materials and Methods: PPI were identified using a review of published literature, trauma system documentation, and expert consensus. Data from the 59 trauma centers of the Quebec trauma system (1999, 2006; N = 99,444) were used to calculate estimates of conformity to each PPI for each trauma center. Outliers were identified by comparing each center to the global mean. PPI were evaluated in terms of discrimination (between-center variance), construct validity (correlation with designation level and patient volume), and forecasting (correlation over time). Results: Fifteen PPI were retained. Global proportions of conformity ranged between 6% for reduction of a major dislocation within 1 h and 97% for therapeutic laparotomy. Between-center variance was statistically significant for 13 PPI. Five PPI were significantly associated with designation level, 7 were associated with volume, and 11 were correlated over time. Conclusion: In our trauma system, results suggest that a series of 15 PPI supported by literature review or expert opinion can be calculated using routinely collected trauma registry data. We have provided evidence of their discrimination, construct validity, and forecasting properties. The between-center variance observed in this study highlights the importance of evaluating process performance in integrated trauma systems. PMID:23723617

  10. Major genitourinary-related bicycle trauma: Results from 20 years at a level-1 trauma center.

    PubMed

    Osterberg, E Charles; Awad, Mohannad A; Gaither, Thomas W; Sanford, Thomas; Alwaal, Amjad; Hampson, Lindsay A; Yoo, Jennie; McAninch, Jack W; Breyer, Benjamin N

    2017-01-01

    Epidemiological studies have shown that bicycle trauma is associated with genitourinary (GU) injuries. Our objective is to characterize GU-related bicycle trauma admitted to a level I trauma center. We queried a prospective trauma registry for bicycle injuries over a 20-year period. Patient demographics, triage data, operative interventions and hospital details were collected. In total, 1659 patients were admitted with major bicycle trauma. Of these, 48 cases involved a GU organ, specifically the bladder (n=7), testis (n=6), urethra (n=3), adrenal (n=4) and/or kidneys (n=36). The median age of cyclists with GU injuries was 29 (range 5-70). More men were injured versus women (35 versus 13). GU-related bicycle trauma involved a motor vehicle in 52% (25/48) of injuries. The median injury severity score for GU-related bicycle trauma was 17 (range 1-50). The median number of concomitant organ injuries was 2 (range 0-6), the most common of which was the lungs (13/48, 27%) and ribs (13/48, 27%). The majority of GU injured cyclists were admitted to an ICU (15/48, 31%) or hospital floor (12/48, 25%). Operative intervention for a GU-related trauma was low (12/48, 25%). The most common GU organ injured was the kidney (36/48, 75%) however most were managed nonoperatively (33/36, 92%). Bladder injuries most often required operative intervention (6/7, 86%). Mortality following GU-related bicycle trauma was low (2/48, 4%). In a large series of bicycle trauma, GU organs were injured in 3% of cases. The majority of cases were managed non-operatively and mortality was low. Published by Elsevier Ltd.

  11. [Quality of initial trauma care in paediatrics].

    PubMed

    Ibáñez Pradas, Vicente; Pérez Montejano, Rut

    2017-04-18

    Trauma care in Spain is not provided in specific centres, which means that health professionals have limited contact to trauma patients. After the setting up of a training program in paediatric trauma, the aim of this study was to evaluate the quality of the initial care provided to these patients before they were admitted to the paediatric intensive care unit (PICU) of a third level hospital (trauma centre), as an indirect measurement of the increase in the number of health professionals trained in trauma. Two cohorts of PICU admissions were reviewed, the first one during the four years immediately before the training courses started (Group 1, period 2001-2004), and the second one during the 4 years (Group 2, period 2012-2015) after nearly 500 professionals were trained. A record was made of the injury mechanism, attending professional, Glasgow coma score (GCS), and paediatric trauma score (PTS). Initial care quality was assessed using five indicators: use of cervical collar, vascular access, orotracheal intubation if GCS ≤ 8, gastric decompression if PTS≤8, and number of actions carried out from the initial four recommended (neck control, provide oxygen, get vascular access, provide IV fluids). Compliance was compared between the 2 periods. A P<.05 was considered statistically significant. A total of 218 patient records were analysed, 105 in Group 1, and 113 in Group 2. The groups showed differences both in injury mechanism and in initial care team. A shift in injury mechanism pattern was observed, with a decrease in car accidents (28% vs 6%; P<.0001). Patients attended to in low complexity hospitals increased from 29.4% to 51.9% (P=.008), and their severity decreased when assessed using the GCS ≤ 8 (29.8% vs 13.5%; P=.004), or PTS≤8 (48.5% vs 29.7%; P=.005). As regards quality indicators, only the use of neck collar improved its compliance (17.3% to 32.7%; P=.01). Patients who received no action in the initial care remained unchanged (19% vs 11%%; P=.15

  12. The invisible trauma patient: emergency department discharges.

    PubMed

    Reilly, Patrick M; Schwab, C William; Kauder, Donald R; Dabrowski, G Paul; Gracias, Vicente; Gupta, Rajan; Pryor, John P; Braslow, Benjamin M; Kim, Patrick; Wiebe, Douglas J

    2005-04-01

    As the malpractice and financial environment has changed, injured patients evaluated by the trauma team and discharged from the emergency department (ED) are now commonplace. The evaluation, care, and disposition of this population has become a significant workload component but is not reported to accrediting organizations and is relatively invisible to hospital administrators. Our objective was to quantify and begin to qualify the evolving picture of the trauma ED discharge population as a work component of trauma service function in an urban, Level I trauma center with an aeromedical program. Trauma registry (contacts, mechanism, transport, injuries, and disposition) and hospital databases (ED closure, occupancy rates) were queried for a 5-year period (1999-2003). Trend analysis provided statistical comparisons for questions of interest. During the 5-year study period, the total number of trauma contacts rose by 18.1% (2,220 in 1999 vs. 2,622 in 2003; trend p < 0.05). This increase in total contacts was not a manifestation of an increase in admissions (1,672 in 1999 vs. 1,544 in 2003) but rather a reflection of a marked increase in patients seen primarily by the trauma team and discharged from the ED (473 in 1999 vs. 1,000 in 2003; trend p < 0.05). These ED discharge patients were increasingly transported by helicopter (12.3% in 1999 vs. 29.2% in 2003; trend p < 0.05) and less frequently from urban areas (57.1% in 1999 vs. 48.1% in 2003; trend p < 0.05) over the course of the study period. Average injury severity of this group increased over the study period (Injury Severity Score of 2.7 +/- 0.1 in 1999 vs. 3.3 +/- 0.1 in 2003; trend p < 0.05). ED length of stay for this group increased 19.8% over the study period (trend p < 0.05), averaging nearly 5 hours in 2003. The total number, relative percentage, and injury severity of patients evaluated by the trauma team and discharged from the ED has significantly increased over the last 5 years, representing nearly 5

  13. A civilian perspective on ballistic trauma and gunshot injuries

    PubMed Central

    2010-01-01

    Background Gun violence is on the rise in some European countries, however most of the literature on gunshot injuries pertains to military weaponry and is difficult to apply to civilians, due to dissimilarities in wound contamination and wounding potential of firearms and ammunition. Gunshot injuries in civilians have more focal injury patterns and should be considered distinct entities. Methods A search of the National Library of Medicine and the National Institutes of Health MEDLINE database was performed using PubMed. Results Craniocerebral gunshot injuries are often lethal, especially after suicide attempts. The treatment of non space consuming haematomas and the indications for invasive pressure measurement are controversial. Civilian gunshot injuries to the torso mostly intend to kill; however for those patients who do not die at the scene and are hemodynamically stable, insertion of a chest tube is usually the only required procedure for the majority of penetrating chest injuries. In penetrating abdominal injuries there is a trend towards non-operative care, provided that the patient is hemodynamically stable. Spinal gunshots can also often be treated without operation. Gunshot injuries of the extremities are rarely life-threatening but can be associated with severe morbidity. With the exception of craniocerebral, bowel, articular, or severe soft tissue injury, the use of antibiotics is controversial and may depend on the surgeon's preference. Conclusion The treatment strategy for patients with gunshot injuries to the torso mostly depends on the hemodynamic status of the patient. Whereas hemodynamically unstable patients require immediate operative measures like thoracotomy or laparotomy, hemodynamically stable patients might be treated with minor surgical procedures (e.g. chest tube) or even conservatively. PMID:20565804

  14. A civilian perspective on ballistic trauma and gunshot injuries.

    PubMed

    Lichte, Philipp; Oberbeck, Reiner; Binnebösel, Marcel; Wildenauer, Rene; Pape, Hans-Christoph; Kobbe, Philipp

    2010-06-17

    Gun violence is on the rise in some European countries, however most of the literature on gunshot injuries pertains to military weaponry and is difficult to apply to civilians, due to dissimilarities in wound contamination and wounding potential of firearms and ammunition. Gunshot injuries in civilians have more focal injury patterns and should be considered distinct entities. A search of the National Library of Medicine and the National Institutes of Health MEDLINE database was performed using PubMed. Craniocerebral gunshot injuries are often lethal, especially after suicide attempts. The treatment of non space consuming haematomas and the indications for invasive pressure measurement are controversial. Civilian gunshot injuries to the torso mostly intend to kill; however for those patients who do not die at the scene and are hemodynamically stable, insertion of a chest tube is usually the only required procedure for the majority of penetrating chest injuries. In penetrating abdominal injuries there is a trend towards non-operative care, provided that the patient is hemodynamically stable. Spinal gunshots can also often be treated without operation. Gunshot injuries of the extremities are rarely life-threatening but can be associated with severe morbidity.With the exception of craniocerebral, bowel, articular, or severe soft tissue injury, the use of antibiotics is controversial and may depend on the surgeon's preference. The treatment strategy for patients with gunshot injuries to the torso mostly depends on the hemodynamic status of the patient. Whereas hemodynamically unstable patients require immediate operative measures like thoracotomy or laparotomy, hemodynamically stable patients might be treated with minor surgical procedures (e.g. chest tube) or even conservatively.

  15. A Pilot Study of Deaf Trauma Survivors' Experiences: Early Traumas Unique to Being Deaf in a Hearing World.

    PubMed

    Anderson, Melissa L; Wolf Craig, Kelly S; Hall, Wyatte C; Ziedonis, Douglas M

    2016-12-01

    Conducting semi-structured American Sign Language interviews with 17 Deaf trauma survivors, this pilot study explored Deaf individuals' trauma experiences and whether these experiences generally align with trauma in the hearing population. Most commonly reported traumas were physical assault, sudden unexpected deaths, and "other" very stressful events. Although some "other" events overlap with traumas in the general population, many are unique to Deaf people (e.g., corporal punishment at oral/aural school if caught using sign language, utter lack of communication with hearing parents). These findings suggest that Deaf individuals may experience developmental traumas distinct to being raised in a hearing world. Such traumas are not captured by available trauma assessments, nor are they considered in evidence-based trauma treatments.

  16. Trauma networks: present and future challenges.

    PubMed

    Kanakaris, Nikolaos K; Giannoudis, Peter V

    2011-11-11

    In England, trauma is the leading cause of death across all age groups, with over 16,000 deaths per year. Major trauma implies the presence of multiple, serious injuries that could result in death or serious disability. Successive reports have documented the fact that the current ad hoc unstructured management of this patient group is associated with considerable avoidable death and disability. The reform of trauma care in England, especially of the severely injured patient, has already begun. Strong clinical leadership is embraced as the way forward. The present article summarises the steps that have been made over the last decade that led to the recent decision to move towards a long anticipated restructure of the National Health Service (NHS) trauma services with the introduction of Regional Trauma Networks (RTNs). While, for the first time, a genuine political will and support exists, the changes required to maintain the momentum for the implementation of the RTNs needs to be marshalled against arguments, myths and perceptions from the past. Such an approach may reverse the disinterest attitude of many, and will gradually evolve into a cultural shift of the public, clinicians and policymakers in the fullness of time.

  17. Reconstruction after pancreatic trauma by pancreaticogastrostomy

    PubMed Central

    Martín, Gonzalo Martín; Morillas, Patricia Jiménez; Pino, José C. Rodríguez; Canis, José M. Morón; Argenté, Francesc X. González

    2015-01-01

    Introduction Pancreatic lesions are very infrequent after closed abdominal trauma (5% of cases) with a complication rate that affects 30–40% of patients, and a mortality rate that can reach 39%. In our experience, closed abdominal traumatisms occurring at typical popular horse-riding festivals in our region constitute a high risk of pancreatic trauma. The purpose of the present paper is to raise awareness about our experience in the diagnosis and treatment of pancreatic lesions secondary to closed abdominal traumatism. Presentation of case We present the clinical cases of two young patients who, after suffering blunt abdominal trauma secondary to the impact of a horse during the celebration of typical horse-riding festival, were diagnosed with pancreatic trauma type III. The treatment was surgical in both cases and consisted in performing a pancreaticogastric anastomosis with preservation of the distal pancreas and spleen. The postoperative period was uneventful and, at present, both patients are asymptomatic. Discussion Signs and symptoms caused by pancreatic lesion are unspecific and difficult to objectify. With some limitations CT is the imaging test of choice for diagnosis and staging in the acute phase. The Wirsung section is indication for surgical treatment. The most extended surgical procedure in these cases is the resection of pancreatic body, tail, and spleen. Conclusion The identification of a pancreatic injury after closed abdominal trauma requires a high suspicion based on the injury mechanism. A safer option may be the distal pancreatic preservation with pancreaticogastric anastomosis in grade III lesions with healthy pancreatic tissue. PMID:25744560

  18. Trauma networks: present and future challenges

    PubMed Central

    2011-01-01

    In England, trauma is the leading cause of death across all age groups, with over 16,000 deaths per year. Major trauma implies the presence of multiple, serious injuries that could result in death or serious disability. Successive reports have documented the fact that the current ad hoc unstructured management of this patient group is associated with considerable avoidable death and disability. The reform of trauma care in England, especially of the severely injured patient, has already begun. Strong clinical leadership is embraced as the way forward. The present article summarises the steps that have been made over the last decade that led to the recent decision to move towards a long anticipated restructure of the National Health Service (NHS) trauma services with the introduction of Regional Trauma Networks (RTNs). While, for the first time, a genuine political will and support exists, the changes required to maintain the momentum for the implementation of the RTNs needs to be marshalled against arguments, myths and perceptions from the past. Such an approach may reverse the disinterest attitude of many, and will gradually evolve into a cultural shift of the public, clinicians and policymakers in the fullness of time. PMID:22078223

  19. Coagulopathy and blood component transfusion in trauma.

    PubMed

    Spahn, D R; Rossaint, R

    2005-08-01

    Trauma is a serious global health problem, accounting for approximately one in 10 deaths worldwide. Uncontrollable bleeding accounts for 39% of trauma-related deaths and is the leading cause of potentially preventable death in patients with major trauma. While bleeding from vascular injury can usually be repaired surgically, coagulopathy-related bleeding is often more difficult to manage and may also mask the site of vascular injury. The causes of coagulopathy in patients with severe trauma are multifactorial, including consumption and dilution of platelets and coagulation factors, as well as dysfunction of platelets and the coagulation system. The interplay between hypothermia, acidosis and progressive coagulopathy, referred to as the 'lethal triad', often results in exsanguination. Current management of coagulopathy-related bleeding is based on blood component replacement therapy. However, there is a limit on the level of haemostasis that can be restored by replacement therapy. In addition, there is evidence that transfusion of red blood cells immediately after injury increases the incidence of post-injury infection and multiple organ failure. Strategies to prevent significant coagulopathy and to control critical bleeding effectively in the presence of coagulopathy may decrease the requirement for blood transfusion, thereby improving clinical outcome of patients with major trauma.

  20. Blunt laryngeal trauma secondary to sporting injuries.

    PubMed

    Mendis, D; Anderson, J A

    2017-08-01

    Laryngeal injury after blunt trauma is uncommon, but can cause catastrophic airway obstruction and significant morbidity in voice and airway function. This paper aims to discuss a case series of sports-related blunt laryngeal trauma patients and describe the results of a thorough literature review. Retrospective case-based analysis of laryngeal trauma referrals over six years to a tertiary laryngology centre. Twenty-eight patients were identified; 13 (46 per cent) sustained sports-related trauma. Most were young males, presenting with dysphonia, some with airway compromise (62 per cent). Nine patients were diagnosed with a laryngeal fracture. Four patients were managed conservatively and nine underwent surgery. Post-treatment, the majority of patients achieved good voice outcomes (83 per cent) and all had normal airway function. Sports-related neck trauma can cause significant injury to the laryngeal framework and endolaryngeal soft tissues, and most cases require surgical intervention. Clinical presentation may be subtle; a systematic approach along with a high index of suspicion is essential, as early diagnosis and treatment have been reported to improve airway and voice outcome.

  1. Does childhood trauma influence offspring's birth characteristics?

    PubMed

    Vågerö, Denny; Rajaleid, Kristiina

    2017-02-01

    : A recent epigenetic hypothesis postulates that 'a sex-specific male-line transgenerational effect exists in humans', which can be triggered by childhood trauma during 'the slow growth period' just before puberty. The evidence is based on a few rather small epidemiological studies. We examine what response childhood trauma predicts, if any, in the birth size and prematurity risk of almost 800 000 offspring. Children of parity 1, 2 or 3, born 1976-2002 in Sweden, for whom we could trace both parents and all four grandparents, constituted generation 3 (G3, n = 764 569). Around 5% of their parents, G2, suffered parental (G1) death during their own childhood. The association of such trauma in G2 with G3 prematurity and birthweight was analysed, while controlling for confounders in G1 and G2. We examined whether the slow growth period was extra sensitive to parental loss. Parental (G1) death during (G2) childhood predicts premature birth and lower birthweight in the offspring generation (G3). This response is dependent on G2 gender, G2 age at exposure and G3 parity, but not G3 gender. The results are compatible with the Pembrey-Bygren hypothesis that trauma exposure during boys' slow growth period may trigger a transgenerational response; age at trauma exposure among girls seems less important, suggesting a different set of pathways for any transgenerational response. Finally, parental death during childhood was not important for the reproduction of social inequalities in birthweight and premature birth.

  2. [Utility of digital thoracotomy in chest trauma].

    PubMed

    Vélez, Sebastián E; Sarquis, Guillermo

    2006-01-01

    toracostomy in thoracic trauma is a good opportunity for the digital exploration of pleural cavity. To evaluate the utility of digital exploration during chest tube insertion in thoracic trauma. Hospital de Urgencias. Córdoba. patients with blunt and penetrating chest trauma by stab wound, who need chest tube insertion and treated by only one surgeon, were evaluated from July 10 to December 31st 2000. Previously to the thoracostomy with 24 french tube in 5th intercostal space, at the affected side, a digital exploration of pleural cavity was done, attempting to find intrathoracic injuries. in a six months period, 36 thoracostomy tubes were placed, due thoracic trauma (11 blunt trauma and 25 penetrating, by stab wound). Three patients had positive findings in the digital exploration, which forced to do another diagnostic or therapeutic procedures. digital thoracotomy is not considered a formal procedure, but as a part of a technique, in which, the previous exploration with the finger before chest tube insertion, allows to reach a diagnosis of the pleural space situation, to confirm suspicions, to modify a conduct, and to avoid greater morbidity to patients.

  3. Trauma systems--state of the art.

    PubMed

    Gwinnutt, C L; Driscoll, P A; Whittaker, J

    2001-01-01

    Trauma is an inevitable consequence of the lives we lead. There are many approaches to dealing with it but an ideal system, universally applicable, probably does not exist because of the national variations in social, economic, cultural and geographical characteristics. Many countries are beginning to recognise that the 'systems' they have in place for dealing with the burden of trauma are seriously deficient and that this situation cannot be allowed to continue into the new millennium. However, it is highly unlikely that in the near future. governments will suddenly find substantial extra finance for trauma care or the implementation of new systems. Throughout many countries, the individual components of trauma care systems are in place but, for whatever reasons, there is a lack of integration, which results in suboptimal care. The system we all should be aiming for is one of closer communication and greater cooperation. By taking into account community and national needs, available resources, and adapting what is currently in place it should then be possible to create 'a set of things working together as parts of a trauma mechanism'.

  4. Missed injuries. The trauma surgeon's nemesis.

    PubMed

    Enderson, B L; Maull, K I

    1991-04-01

    The multiply injured trauma patient presents a diagnostic and therapeutic challenge: that of discovering all injuries while simultaneously proceeding with resuscitation and maintaining life. Many factors involved in the initial resuscitation of the multiply injured patient, such as altered level of consciousness, hemodynamic instability, or inexperience and diagnostic oversight, may lead to missed injuries. Injuries may be missed at any stage of the management of the trauma patient, including intraoperatively, and may involve all regions of the body. Established protocols in the initial management of the multiply injured patient, such as the primary and secondary surveys of the Advanced Trauma Life Support Course, will minimize the chance of missing immediately life-threatening injuries in the emergency department. A careful intraoperative approach must be used in all patients, but especially in those with hemodynamic instability, so that all areas are examined for possible injury, rather than concentrating simply on what is known to be injured. Use of the tertiary survey, a careful re-examination of the multiply injured trauma patient, especially when he or she awakes, will help detect injuries missed during the initial evaluation. Injuries will be missed. Rather than dismissing these as occurrences that happen only to the inexperienced or incompetent, one should approach the multiply injured trauma patient with both special alertness and the humility necessary to search for diagnostic oversights. This approach will lead to early discovery of missed injuries and will minimize the consequences.

  5. Blunt Force Trauma in Veterinary Forensic Pathology.

    PubMed

    Ressel, L; Hetzel, U; Ricci, E

    2016-09-01

    Veterinary pathologists commonly encounter lesions of blunt trauma. The development of lesions is affected by the object's mass, velocity, size, shape, and angle of impact and by the plasticity and mobility of the impacted organ. Scrape, impact, and pattern abrasions cause localized epidermal loss and sometimes broken hairs and implanted foreign material. Contusions are best identified after reflecting the skin, and must be differentiated from coagulopathies and livor mortis. Lacerations-traumatic tissue tears-may have irregular margins, bridging by more resilient tissue, deviation of the wound tail, crushed hairs, and unilateral abrasion. Hanging or choking can cause circumferential cervical abrasions, contusions and rupture of hairs, hyoid bone fractures, and congestion of the head. Other special forms of blunt trauma include fractured nails, pressure sores, and dog bites. Ocular blunt trauma causes extraocular and intraocular hemorrhages, proptosis, or retinal detachment. The thoracic viscera are relatively protected from blunt trauma but may develop hemorrhages in intercostal muscles, rib fractures, pulmonary or cardiac contusions or lacerations with subsequent hemothorax, pneumothorax, or cardiac arrhythmia. The abdominal wall is resilient and moveable, yet the liver and spleen are susceptible to traumatic laceration or rupture. Whereas extravasation of blood can occur after death, evidence of vital injury includes leukocyte infiltration, erythrophagocytosis, hemosiderin, reparative lesions of fibroblast proliferation, myocyte regeneration in muscle, and callus formation in bone. Understanding these processes aids in the diagnosis of blunt force trauma including estimation of the age of resulting injuries. © The Author(s) 2016.

  6. Analysis of the Revised Trauma Score (RTS) in 200 victims of different trauma mechanisms.

    PubMed

    Alvarez, Bruno Durante; Razente, Danilo Mardegam; Lacerda, Daniel Augusto Mauad; Lother, Nicole Silveira; VON-Bahten, Luiz Carlos; Stahlschmidt, Carla Martinez Menini

    2016-01-01

    to analyze the epidemiological profile and mortality associated with the Revised Trauma Score (RTS) in trauma victims treated at a university hospital. we conducted a descriptive, cross-sectional study of trauma protocols (prospectively collected) from December 2013 to February 2014, including trauma victims admitted in the emergency room of the Cajuru University Hospital. We set up three groups: (G1) penetrating trauma to the abdomen and chest, (G2) blunt trauma to the abdomen and chest, and (G3) traumatic brain injury. The variables we analyzed were: gender, age, day of week, mechanism of injury, type of transportation, RTS, hospitalization time and mortality. we analyzed 200 patients, with a mean age of 36.42 ± 17.63 years, and 73.5% were male. The mean age was significantly lower in G1 than in the other groups (p <0.001). Most (40%) of the visits occurred on weekends and the most common pre-hospital transport service (58%) was the SIATE (Emergency Trauma Care Integrated Service). The hospital stay was significantly higher in G1 compared with the other groups (p <0.01). Regarding mortality, there were 12%, 1.35% and 3.95% of deaths in G1, G2 and G3, respectively. The median RTS among the deaths was 5.49, 7.84 and 1.16, respectively, for the three groups. the majority of patients were young men. RTS was effective in predicting mortality in traumatic brain injury, however failing to predict it in patients suffering from blunt and penetrating trauma. analisar o perfil epidemiológico e a mortalidade associada ao escore de trauma revisado (RTS) em vítimas de trauma atendidas em um hospital universitário. estudo transversal descritivo de protocolos de trauma (coletados prospectivamente) de dezembro de 2013 a fevereiro de 2014, incluindo vítimas de trauma admitidas na sala de emergência do Hospital Universitário Cajuru. Três grupos foram criados: (G1) trauma penetrante em abdome e tórax, (G2) trauma contuso em abdome e tórax, e (G3) trauma cranioencef

  7. Advanced Trauma Life Support certified physicians in a non trauma system setting: is it enough?

    PubMed

    Drimousis, Panagiotis G; Theodorou, Dimitrios; Toutouzas, Konstantinos; Stergiopoulos, Spiros; Delicha, Eumorfia M; Giannopoulos, Panagiotis; Larentzakis, Antreas; Katsaragakis, Stylianos

    2011-02-01

    The purpose of this study was to evaluate the impact of ATLS(®) on trauma mortality in a non-trauma system setting. ATLS represents a fundamental element of trauma training in every trauma curriculum. Nevertheless, there are limited studies in the literature as for the impact of ATLS training in trauma mortality, especially outside the US. This is a prospective observational study. The primary end point was to investigate factors that affect mortality of trauma patients in our health care system. We performed a multivariate analysis for this purpose and we identified ATLS certification as a predictor of overall mortality. Following this finding we stratified patients according to the severity of injury as expressed by the ISS score and we compared outcome between those treated by an ATLS certified physician and those treated by non-certified ones. Trauma volume and demographics of trauma patients, factors that affect mortality of traumatized patients and mortality between patients treated by ATLS(®) certified and non-certified physicians. In total, 8862 trauma patients were included in the analysis. The majority of trauma patients (5988, 67.6%) were treated by a general surgeon, followed by those treated by an orthopedic surgeon (2194, 24.8%). There were 446 deaths in the registry but, 260 arrived dead in the Emergency Department and were excluded from the analysis. Multivariate analysis of the 186 deaths that occurred in the hospital revealed age, high ISS score, low GCS score, urban location of injury, neck injury and ATLS(®) certification as factors predisposing to mortality. Cross tabulation of ATLS(®) certification and ISS of the trauma patients shows that those treated by certified physicians died more often in all subcategories of ISS score (p<0.05). In Greece, with no formal trauma system implementation, ATLS(®) certified physicians achieve worse outcomes than their non-certified colleagues when managing trauma patients. We believe that these findings

  8. Taking the trauma out of trauma: an easy to follow guide for the management of trauma to the permanent dentition.

    PubMed

    White, Ian; Spiers, Gareth

    2013-10-01

    Treatment of dental trauma can be an infrequent, unpredictable and stressful experience for a dental practitioner. Correct diagnosis and management of such cases is of primary importance in the prognosis of the affected dentition. We have therefore constructed a number of easy to follow algorithms in management, both short and long term, for the range of traumatic injuries that can affect the permanent dentition. Immediate as well as longer term management of dental trauma cases can be difficult, therefore a clear treatment plan is of great importance in successful results.

  9. A Survey on Trauma Systems and Education in Europe.

    PubMed

    Leppäniemi, Ari

    2008-12-01

    To assess the current stage of trauma system development and trauma surgery training in Europe. Email-based survey from 53 physicians representing 25 European countries. On a scale of 0-10, the mean (SD) score for trauma system development was 5.4 (2.4) and for trauma surgery specialization 4.1 (2.9). There was a significant positive correlation between trauma system development and trauma surgery specialization (p = 0.018). Countries with ties to the Austro-German surgical tradition had higher scores both in trauma system development (p = 0.003) and in trauma surgery specialization (p = 0.000), whereas the size, economic performance or geographical location were not associated with either. Despite the great variation from country to country, three trends in developing trauma care and education can be identified: trauma system development based exclusively on major (life-threatening) trauma care (the old United States model), combining trauma and emergency surgery into a single regionalized system (the acute care surgery model), or maintaining the orthopedic surgery-orientated all-inclusive trauma care model as practiced in most central European countries today. Although each country and region might proceed along their own line depending on local circumstances, some kind of general guidelines and recommendations at least at the European Union level would be urgently needed.

  10. Imaging of sequelae of head trauma.

    PubMed

    Zee, Chi-Shing; Hovanessian, Armen; Go, John L; Kim, Paul E

    2002-05-01

    The imaging of head trauma has been one of the fundamental cornerstones of neuroradiology. As the practice of neuroimaging has matured, great strides have been made in the diagnostic as well as prognostic armamentarium available to physicians. Given the vast diversity of trauma mechanisms and clinical pathways, new advanced imaging technologies have had a lasting impact on the detection, description, and depiction of head trauma. Furthermore, these new tools are allowing the imaging specialist to function not only as an interpreter of what is seen but as a 21st century radiographic oracle. We present a comprehensive review of the imaging findings of sequlae of traumatic brain injury and the growing correlation of new neuroimaging techniques and neurotraumatic outcomes.

  11. Combined tracheoesophageal transection after blunt neck trauma.

    PubMed

    Hamid, Umar Imran; Jones, James Mark

    2013-04-01

    Survival following tracheoesophageal transection is uncommon. Establishing a secure airway has the highest priority in trauma management. Understanding the mechanism of the incident can be a useful adjunct in predicting the likelihood and severity of specific anatomical patterns of injuries. We discuss published literature on combined tracheoesophageal injuries after blunt neck trauma and their outcome. A search of MEDLINE for papers published regarding tracheoesophageal injury was made. The literature search identified 14 such articles referring to a total of 27 patients. Age ranged from 3-73 years. The mechanism of injury was secondary to a rope/wire in 33%, metal bar in 4% of cases and unspecified in 63%. All of the patients were managed surgically. A number of tissues were used to protect the anastomosis including pleural and sternocleidomastoid muscle flaps. There were no reported mortalities. Patients with combined tracheoesophageal injury after blunt neck trauma require acute management of airway along with concomitant occult injuries.

  12. Mechanisms of trauma-induced coagulopathy.

    PubMed

    White, Nathan J

    2013-01-01

    The identification and management of coagulopathy is a critical component of caring for the severely injured patient. Notions of the mechanisms of coagulopathy in trauma patients have been supplanted by new insights resulting from close examination of the biochemical and cellular changes associated with acute tissue injury and hemorrhagic shock. Acute intrinsic coagulopathy arising in severely injured trauma patients is now termed trauma-induced coagulopathy (TIC) and is an emergent property of tissue injury combined with hypoperfusion. Mechanisms contributing to TIC include anticoagulation, consumption, platelet dysfunction, and hyperfibrinolysis. This review discusses current understanding of TIC mechanisms and their relative contributions to coagulopathy in the face of increasingly severe injury and highlights how they interact to produce coagulation system dysfunction.

  13. Emotional intelligence--essential for trauma nursing.

    PubMed

    Holbery, Natalie

    2015-01-01

    Patients and their relatives are increasingly considered partners in health and social care decision-making. Numerous political drivers in the UK reflect a commitment to this partnership and to improving the experience of patients and relatives in emergency care environments. As a Lecturer/Practitioner in Emergency Care I recently experienced the London Trauma System as a relative. My dual perspective, as nurse and relative, allowed me to identify a gap in the quality of care akin to emotional intelligence. This paper aims to raise awareness of emotional intelligence (EI), highlight its importance in trauma care and contribute to the development of this concept in trauma nursing and education across the globe. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. Retroperitoneal hematoma following trauma: its clinical importance.

    PubMed

    Grieco, J G; Perry, J F

    1980-09-01

    Records of 100 consecutive patients treated in 1973 through 1977 with post-traumatic retroperitoneal hematomas (RH) were studied. Eighty RH followed blunt injury and 20 were due to penetrating trauma. Overall mortality was 26%. The worst prognosis was associated with RH from automobile accidents and pedestrian injuries. Pelvic RH were almost uniformly associated with pelvic fracture and were the primary cause of 39% of deaths. Blunt perinephric RH required renal exploration in 47% of patients. Blunt RH in other locations were associated with major visceral or vascular injury in half the patients and were the cause of death in five. Sixty-five per cent of RH due to penetrating trauma had visceral or vascular injury requiring operative correction. Contained rupture of descending choracic aorta presented as retrogastric RH in two patients. RH from penetrating trauma should be explored routinely, since 65% are associated with visceral or vascular injury.

  15. Trauma symptomatology: implications for return to work.

    PubMed

    Strauser, David R

    2008-01-01

    Research has suggested that individuals who experience work related injuries may be at an increased risk for developing trauma symptoms or Posttraumatic Stress Disorder (PTSD). The purpose of this article is to provide a brief overview of PTSD from both a categorical and dimensional perspective and discuss implications for rehabilitation planning with workers with industrial injuries. The negative impact of trauma symptoms and PTSD is profiled according the following four areas that are important for effective career and vocational behavior: (a) making occupational adjustments, (b) adjusting performance to meet specific work demands, (c) utilizing appropriate social and interpersonal skills in the work setting, and (d) meeting the production and time requirements associated with the specific job. Recommendations are then offered to increase the effectiveness of rehabilitation professionals working with industrial injured workers who may be experiencing trauma symptoms or PTSD.

  16. Early management of ballistic hand trauma.

    PubMed

    Eardley, W G P; Stewart, M P M

    2010-02-01

    Complex hand wounds are an unfortunate consequence of conflict. Increased battlefield survival rates have resulted in an evolving range of ballistic hand trauma encountered by deployed surgical teams, requiring increased knowledge and understanding of these injuries. In the civilian setting, the combined threats of gun crime and acts of terrorism warrant appreciation for such injury among all surgeons. Surgeons often have to relearn the management of ballistic hand trauma and other aspects of war surgery under difficult circumstances because the experiences of their predecessors may be forgotten. Current evidence regarding these injuries is scarce. Ballistic hand trauma is rarely isolated. The demand on surgical resources from combat injury is significant, and it is imperative that a phased strategy be followed in this setting. Minimal, accurate débridement and decompression with early stability are crucial. Delayed primary closure and an awareness of future reconstructive options are fundamental.

  17. Sensitive and Motor Neuroanastomosis After Facial Trauma.

    PubMed

    Ribeiro-Junior, Paulo Domingos; Senko, Ricardo Alexandre Galdioli; Mendes, Gabriel Cury Batista; Peres, Fernando Gianzanti

    2016-10-01

    Facial nerve has great functional and aesthetic importance to the face, and damage to its structure can lead to major complications. This article reports a clinical case of neuroanastomosis of the facial nerve after facial trauma, describing surgical procedure and postoperative follow-up. A trauma patient with extensive injury cut in right mandibular body causing neurotmesis of the VIIth cranial nerve and mandibular angle fracture right side was treated. During surgical exploration, the nerve segments were identified and a neuroanastomosis was performed using nylon 10-0, after reduction and internal fixation of the mandibular fracture. Postoperatively, an 8-month follow-up showed good evolution and preservation of motor function of the muscles of facial mime, highlighting the success of the surgical treatment. Nerve damage because of facial trauma can be a surgical treatment challenge, but when properly conducted can functionally restore the damaged nerve.

  18. Trauma-related papular granuloma annular.

    PubMed

    Hu, Stephanie W; Kaplan, Jennifer; Patel, Rishi R; Kamino, Hideko

    2013-12-16

    Granuloma annulare (GA) is a benign, granulomatous disease with several clinical manifestations, which include localized, generalized, perforating, subcutaneous, patch, papular, and linear forms. We report a case of papular GA of the dorsal aspects of the hands that arose after repeated, direct trauma to the site of subsequent involvement. Although multiple etiologies for GA have been proposed, which include ultraviolet light, arthropod bites, trauma, tuberculin skin tests, viral infections, and PUVA photochemotherapy, the underlying pathogenesis of the disorder remains unclear. However, owing to the key histopathologic findings of focal collagen and elastic fiber degeneration and mucin deosition in GA, it is not surprising that cutaneous trauma may have played a role in connective tissue injury, subsequent degeneration, and the production of a granulomatous response with increased mucin deposition.

  19. Maxillofacial trauma resulting from terror in Israel.

    PubMed

    Ringler, Doron; Einy, Shmuel; Giveon, Adi; Goldstein, Liab; Peleg, Kobi

    2007-01-01

    During a 33 month period, maxillofacial injuries resulting from terrorist attacks in Israel were compared with non-terror trauma maxillofacial injuries. Files of patients hospitalized from October 1, 2000 to June 30, 2003 were obtained from the Israel National Trauma Registry. Data were evaluated and compared with a hospitalized non-terror related trauma population within the same period. A literature survey was also conducted. Terror casualties totaled 1,811. In 493 patients with facial injuries, 322 had soft facial tissue injuries (excluding eyes and ears), and 104 had hard tissue injuries of the maxillofacial complex. A significantly higher prevalence was found in terror casualties (explosions and gunshots) compared with non-terror related casualties. Most suffered multiple injuries. Maxillofacial terror casualties experience a unique epidemiology, with more severe injuries and higher prevalence of soft and hard tissue injuries. Preparedness and awareness to the unique pattern of injuries are needed when terrorists strike.

  20. Optimizing trauma system design: the GEOS (Geospatial Evaluation of Systems of Trauma Care) approach.

    PubMed

    Jansen, Jan O; Morrison, Jonathan J; Wang, Handing; Lawrenson, Robin; Egan, Gerry; He, Shan; Campbell, Marion K

    2014-04-01

    Trauma systems have been shown to reduce death and disability from injury but must be appropriately configured. A systematic approach to trauma system design can help maximize geospatial effectiveness and reassure stakeholders that the best configuration has been chosen. This article describes the GEOS [Geospatial Evaluation of Systems of Trauma Care] methodology, a mathematical modeling of a population-based data set, which aims to derive geospatially optimized trauma system configurations for a geographically defined setting. GEOS considers a region's spatial injury profile and the available resources and uses a combination of travel time analysis and multiobjective optimization. The methodology is described in general and with regard to its application to our case study of Scotland. The primary outcome will be trauma system configuration. GEOS will contribute to the design of a trauma system for Scotland. The methodology is flexible and inherently transferable to other settings and could also be used to provide assurance that the configuration of existing trauma systems is fit for purpose.