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emergency management of craniocerebral trauma

René Verboket, Christina Verboket, Oliver Schöffski, Johanna Tlatlik, Ingo Marzi, Christoph Nau
The introduction of the diagnosis-related groups (DRG) in 2003 radically changed the billing of the treatment costs. From the very beginning, trauma surgeons questioned whether the introduction of the DRG could have a negative impact on the care of the severely injured. "Trauma centers in need" was the big catchword warning against shortfalls at trauma centers due to the billing via DRG. This situation was confirmed in the first publications after introduction of the DRG, showing a clearly deficient level of care of polytrauma cases...
October 10, 2018: Der Unfallchirurg
Catherine T Mccann, Richard R Welbury
This article aims to provide a practical clinician's guide to assessing and diagnosing dental trauma involving permanent teeth in children and young people, and for carrying out appropriate, guideline supported acute management. Timely referral to specialist paediatric dental services is crucial in more complex trauma presentations and will lead to improved outcomes for the dentition. Appropriate acute management by the primary clinician optimises the prognosis of any traumatised tooth and this article will focus on the emergency treatment of the traumatised permanent tooth...
May 1, 2017: Primary Dental Journal
Matthew Brown, Navid Pourtaheri, Kristopher Katira, Sunil Manjila, Ali S Totonchi
A 4-year-old-boy required emergent craniectomy and drainage of a large right-sided acute subdural hematoma after head trauma, during which massive sinus hemorrhage with brain swelling occurred. Acute intraoperative management entailed dural cover using synthetic dural membrane substitute and scalp coverage over the herniated brain using acellular dermal matrix. After intensive monitoring and control of raised intracranial pressure over the next few days, the exposed brain was then covered by scalp and forehead flaps with cadaveric skin grafting to the donor site...
January 2017: Journal of Craniofacial Surgery
Sattha Riyapan, Jeffrey Lubin
OBJECTIVE: This study sought to determine the effectiveness of apneic oxygenation in preventing hypoxemia during prehospital rapid sequence intubation (RSI). METHODS: We performed a case-cohort study using a pre-existing database looking at intubation management by a single helicopter emergency medical service between July 2013 and June 2015. Apneic oxygenation using high-flow nasal cannula (15 L/min) was introduced to the standard RSI protocol in July 2014. Severe hypoxemia was defined as an incidence of oxygen saturation less than 90%...
November 2016: Air Medical Journal
Bernd A Leidel, Christian Peiser, Stefan Wolf, Karl-Georg Kanz
No abstract text is available yet for this article.
April 28, 2016: MMW Fortschritte der Medizin
Peter Biberthaler, Karl-Georg Kanz, Bernd A Leidel
No abstract text is available yet for this article.
April 28, 2016: MMW Fortschritte der Medizin
Edward R Melnick, Katherine Shafer, Nayeli Rodulfo, Joyce Shi, Erik P Hess, Robert L Wears, Rija A Qureshi, Lori A Post
BACKGROUND: Overuse of computed tomography (CT) for minor head injury continues despite developed and rigorously validated clinical decision rules like the Canadian CT Head Rule (CCHR). Adherence to this sensitive and specific rule could decrease the number of CT scans performed in minor head injury by 35%. But in practice, the CCHR has failed to reduce testing, despite its accurate performance. OBJECTIVES: The objective was to identify nonclinical, human factors that promote or inhibit the appropriate use of CT in patients presenting to the emergency department (ED) with minor head injury...
December 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Martin Holzmann, Per O Bylund, Lisa Degerfält, Axel C Carlsson, Per Wändell, Toralph Ruge
The main purpose was to study the prehospital and early intrahospital treatment of patients with traumatic brain injury (TBI) in the county of Västerbotten 2011-2012. In total, 162 patients were included. The main finding was that a large proportion of TBI patients were older men who fell in the same or from a different level. Older patients had higher mortality and had to wait longer for diagnostic imaging compared to younger patients. Furthermore, most patients were initially relatively unaffected by the injury and around 1/5 of the patients were transported to hospital by private transport...
2015: Läkartidningen
James R Miner, John Rubin, Jacob Clark, Robert F Reardon
BACKGROUND: The intubating laryngeal mask airway (ILMA) is an extraglottic device with a high rate of successful ventilation and oxygenation. Most modern airway algorithms suggest using an extraglottic device as the first-line rescue technique for a failed airway in emergency airway management. Eventually, a more secure airway is needed if the extraglottic temporizing device is working well. Retrograde intubation is a surgical airway management technique that is effective but relatively slow, making it most useful when ventilation can be maintained during the procedure...
December 2015: Journal of Emergency Medicine
Georg Reith, Rolf Lefering, Arasch Wafaisade, Kai O Hensel, Thomas Paffrath, Bertil Bouillon, Christian Probst
BACKGROUND: Pedestrians who are involved in motor vehicle collisions present with a unique trauma situation. The aim of this study was to demonstrate the specific clinical characteristics of this patient population in comparison to injured motor vehicle occupants in the medical emergency setting. METHODS: A total of 4435 pedestrian traffic collision victims admitted to hospitals participating at TraumaRegister DGU® between 2002 and 2012 (primary admission, Injury Severity Score, ISS ≥ 9; age ≥ 2 years) was assessed and compared to 16,042 severely injured motor vehicle occupants...
August 5, 2015: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Jeanne Simon-Pimmel, Fleur Lorton, Nicolas Guiziou, Karine Levieux, Bénédicte Vrignaud, Damien Masson, Benoit Dupas, Christèle Gras-Leguen
Minor head trauma is a common reason for consultation in pediatric emergency departments. In 2009, the Pediatric Emergency Care Applied Research Network (PECARN) published a clinical decision rule for its management. It aimed to help clinicians identify children with a very low risk of developing intracranial lesions, so that unnecessary cranial computed tomography (CCT) scan radiation could be avoided, as such exposure is associated with a rising risk of cancer in this young population. In the meantime, the serum S100β neuroprotein showed encouraging results, with a 30% potential decrease in CCTs for the management of minor head traumas in adults and children...
November 2015: Shock
Abdurrahman Aycan, Ulaş Yener, Nur Aycan, Edip Gönüllü, Recep Dursun, Hayriye Gönüllü
BACKGROUND: On October 23, 2011, a devastating earthquake, magnitude 7.2 on the Richter Scale, jolted the province of Van in the east of Turkey and led to hundreds of casualties. OBJECTIVES: In this study, we aimed to present our clinical experience in the management of patients with cranial and spinal injuries who were admitted to the Van Regional Training and Research Hospital. METHODS: The retrospective study included 44 (77.2%) patients who were referred to the neurosurgery department after being diagnosed with spinal and cranial injuries due to earthquake at the emergency department between October 23 and 27, 2011...
October 2015: Journal of Emergency Medicine
Huchen Lu, Lian Wang, Wuzhao Zhong, Rongfeng Qi, Ning Li, Wanchun You, Xingfeng Su, Zong Zhuang, Huilin Cheng, Jixin Shi
BACKGROUND: Bullet-induced brain wounds are common among military personnel in war zones and among civilians with gun accidents or crime-related gun injuries. The goal of this study was to develop a nonfatal porcine model of penetrating craniocerebral gunshot wound (PCGW) by firing a projectile in live swine to induce PCGW in such a realistic manner as to reconstruct their physical characteristics. MATERIALS AND METHODS: We established a nonfatal porcine model of PCGW based on a custom-designed experimental gun that emulates the shooting of a 5...
December 2015: Journal of Surgical Research
Ahmed Alterkait, Roaa Jamjoom, Savithiri Ratnapalan
BACKGROUND: The current guidelines for management of idiopathic thrombocytopenic purpura (ITP) does not address head trauma and the current emergency pediatric head trauma management guidelines do not address children with ITP. The characteristics of patients who develop intracranial hemorrhage (ICH) as a result of head trauma or the management of head trauma in patients with ITP are not clear. OBJECTIVES: Review the literature to identify and describe the characteristics and outcomes of intracranial haemorrhage as a result of head trauma in children with ITP...
June 2015: Pediatric Emergency Care
Rowena Johnson, Maxine Kuczawski, Suzanne Mason
INTRODUCTION: In February 2014, all 23 National Institute for Health Research medical research specialities were failing to meet recruitment targets, with 'Injuries and Emergencies' research performing particularly poorly. In this paper, the multicentre AHEAD study was used to explore issues surrounding recruitment in UK emergency departments. METHOD: The AHEAD study investigated management and outcomes in over 3000 anticoagulated patients who suffered a head injury...
January 2016: Emergency Medicine Journal: EMJ
Ashkon Shaahinfar, Kevin D Whitelaw, Karim M Mansour
PURPOSES OF REVIEW: This article provides an update on abusive head trauma (AHT), focusing on new developments most salient to the emergency medicine clinician, including epidemiology, clinical recognition, diagnostic work-up, management of neurologic injury, and public health implications. RECENT FINDINGS: The recent literature has focused on honing the clinician's ability to recognize AHT and its immediate sequelae, to more accurately distinguish between abusive and accidental head injuries by patterns of neuroimaging and retinal hemorrhages, and to appreciate the long-term impacts...
June 2015: Current Opinion in Pediatrics
Gerd Schueller, Mariano Scaglione, Ulrich Linsenmaier, Claudia Schueller-Weidekamm, Chiara Andreoli, Marina De Vargas Macciucca, Gianfranco Gualdi
Trauma causes greater losses of life years and it is the most common cause of death for people under the age of 45. Time is one of the most relevant factors for the survival of injured patients, particularly the time elapsed from trauma until the resuscitation procedures. As a member of the trauma team, the radiologist contributes to the rapid diagnosis of traumatic disorders, with appropriate imaging modalities. Based on the evidence, the most appropriate diagnostic tool for severe/multiple trauma is computed tomography (CT)...
July 2015: La Radiologia Medica
Opeyemi O Daramola, Samuel S Becker
PURPOSE OF REVIEW: To review the current evidence in diagnosing olfactory disorders and suggest an algorithmic approach to patients with relevant complaints. RECENT FINDINGS: New literature suggests that the incidence of olfactory loss increases with age. Age-associated olfactory loss is often multifactorial and requires careful history and physical exam. Psychophysical tests have a role in screening patients at risk for Parkinson's and Alzheimer's disease, but there is lack of evidence regarding timing and patient selection...
February 2015: Current Opinion in Otolaryngology & Head and Neck Surgery
Kuang-Yu Hsiao, Leng-Chieh Lin, Wen-Cheng Li, Martin Hisu-Chu Lin, Cheng-Hsien Wang, Kai-Hua Chen
BACKGROUND: Control of blood pressure is considered essential in the management of trauma patients. In patients with head injuries, both hypotension and hypertension are associated with poor outcomes. The present study was undertaken to ascertain whether hypertension at emergency triage is associated with traumatic intracranial haemorrhage. METHODS: From September 2012 to August 2013, data were collected prospectively for patients who presented with head injury and who received a brain CT examination at a university hospital...
May 2015: Injury
Chun Sung Byun, Il Hwan Park, Joong Hwan Oh, Keum Seok Bae, Kang Hyun Lee, Eunbi Lee
PURPOSE: There is an increasing incidence of mortality among trauma patients; therefore, it is important to analyze the trauma epidemiology in order to prevent trauma death. The authors reviewed the trauma epidemiology retrospectively at a regional emergency center of Korea and evaluated the main factors that led to trauma-related deaths. MATERIALS AND METHODS: A total of 17007 trauma patients were registered to the trauma registry of the regional emergency center at Wonju Severance Christian Hospital in Korea from January 2010 to December 2012...
January 2015: Yonsei Medical Journal
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