Gregory W J Hawryluk, Andres M Rubiano, Annette M Totten, Cindy O'Reilly, Jamie S Ullman, Susan L Bratton, Randall Chesnut, Odette A Harris, Niranjan Kissoon, Lori Shutter, Robert C Tasker, Monica S Vavilala, Jack Wilberger, David W Wright, Angela Lumba-Brown, Jamshid Ghajar
When the fourth edition of the Brain Trauma Foundation's Guidelines for the Management of Severe Traumatic Brain Injury were finalized in late 2016, it was known that the results of the RESCUEicp (Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension) randomized controlled trial of decompressive craniectomy would be public after the guidelines were released. The guideline authors decided to proceed with publication but to update the decompressive craniectomy recommendations later in the spirit of "living guidelines," whereby topics are updated more frequently, and between new editions, when important new evidence is published...
August 6, 2020: Neurosurgery
Stefan Huber-Wagner, Rolf Lefering, Mike Qvick, Michael V Kay, Thomas Paffrath, Wolf Mutschler, Karl-Georg Kanz
BACKGROUND: Resuscitation of traumatic cardiorespiratory arrest patients (TCRA) is generally associated with poor outcome, however some authors report survival rates of more than 10% in blunt trauma patients. The purpose of this investigation was to determine predictive factors for mortality in trauma patients having received external chest compressions (ECC). PATIENTS AND METHODS: Twenty thousand eight hundred and fifteen patients from the Trauma Registry of the German Trauma Society were analysed (mean ISS=24...
November 2007: Resuscitation
Michael M Neeki, Fanglong Dong, Jake Toy, Reza Vaezazizi, Joe Powell, David Wong, Michael Mousselli, Massoud Rabiei, Alex Jabourian, Nichole Niknafs, Michelle Burgett-Moreno, Richard Vara, Shanna Kissel, Xian Luo-Owen, Karen R O'Bosky, Daniel Ludi, Karl Sporer, Troy Pennington, Tommy Lee, Rodney Borger, Eugene Kwong
Introduction: Hemorrhage is one of the leading causes of death in trauma victims. Historically, paramedics have not had access to medications that specifically target the reversal of trauma-induced coagulopathies. The California Prehospital Antifibrinolytic Therapy (Cal-PAT) study seeks to evaluate the safety and efficacy of tranexamic acid (TXA) use in the civilian prehospital setting in cases of traumatic hemorrhagic shock. Methods: The Cal-PAT study is a multi-centered, prospective, observational cohort study with a retrospective comparison...
November 2018: Western Journal of Emergency Medicine
Michael M Neeki, Fanglong Dong, Jake Toy, Reza Vaezazizi, Joe Powell, Nina Jabourian, Alex Jabourian, David Wong, Richard Vara, Kathryn Seiler, Troy W Pennington, Joe Powell, Chris Yoshida-McMath, Shanna Kissel, Katharine Schulz-Costello, Jamish Mistry, Matthew S Surrusco, Karen R O'Bosky, Daved Van Stralen, Daniel Ludi, Karl Sporer, Peter Benson, Eugene Kwong, Richard Pitts, John T Culhane, Rodney Borger
INTRODUCTION: The California Prehospital Antifibrinolytic Therapy (Cal-PAT) study seeks to assess the safety and impact on patient mortality of tranexamic acid (TXA) administration in cases of trauma-induced hemorrhagic shock. The current study further aimed to assess the feasibility of prehospital TXA administration by paramedics within the framework of North American emergency medicine standards and protocols. METHODS: This is an ongoing multi-centered, prospective, observational cohort study with a retrospective chart-review comparison...
June 2017: Western Journal of Emergency Medicine
Benjamin D Walrath, Stephen Harper, Ed Barnard, Joshua M Tobin, Brendon Drew, Cord Cunningham, Chetan Kharod, James Spradling, Craig Stone, Matthew Martin
Trauma airway management is a critical skill for medical providers supporting combat casualties since it is an integral component of damage control resuscitation and surgery. This clinical practice guideline presents methods for optimizing the airway management of patients with traumatic injury in the operational medical treatment facility environment. The guidelines represent the knowledge and experience of 10 co-authors from 3 allied countries representing Emergency Medicine, Surgery and Anesthesia.
September 1, 2018: Military Medicine
Chris Evans, David O Quinlan, Paul T Engels, Jonathan Sherbino
Resuscitation of traumatic cardiac arrest is typically considered futile. Recent evidence suggests that traumatic cardiac arrest is survivable. In this article key principles in managing traumatic cardiac arrest are discussed, including the importance of rapidly seeking prognostic information, such as signs of life and point-of-care ultrasonography evidence of cardiac contractility, to inform the decision to proceed with resuscitative efforts. In addition, a rationale for deprioritizing chest compressions, steps to quickly reverse dysfunctional ventilation, techniques for temporary control of hemorrhage, and the importance of blood resuscitation are discussed...
February 2018: Emergency Medicine Clinics of North America
Junichi Izawa, Taku Iwami, Koichiro Gibo, Masashi Okubo, Kentaro Kajino, Kousuke Kiyohara, Chika Nishiyama, Tatsuya Nishiuchi, Yasuyuki Hayashi, Takeyuki Kiguchi, Daisuke Kobayashi, Sho Komukai, Takashi Kawamura, Clifton W Callaway, Tetsuhisa Kitamura
BACKGROUND: Early prehospital advanced airway management (AAM) by emergency medical services (EMS) personnel has been intended to improve patient outcomes from out-of-hospital cardiac arrest (OHCA). However, few studies examine the effectiveness of early prehospital AAM. We investigated whether early prehospital AAM was associated with functionally favourable survival after adult OHCA. METHODS: We conducted a population-based cohort study of OHCA in Osaka, Japan, between 2005 and 2012...
July 2018: Resuscitation
Judith S Palfrey, Sean Palfrey
As practicing pediatricians who have lost patients to gun violence, we join our colleagues in mourning the 20 children and their teachers who were killed in Newtown, Connecticut, on December 14, 2012. Our sadness is deepened by our knowledge that the deaths, terror, and post-traumatic stress of the..
January 31, 2013: New England Journal of Medicine
J E Smith, S Le Clerc, P A F Hunt
Attempts to resuscitate patients in traumatic cardiac arrest (TCA) have, in the past, been viewed as futile. However, reported outcomes from TCA in the past five years, particularly from military series, are improving. The pathophysiology of TCA is different to medical causes of cardiac arrest, and therefore, treatment priorities may also need to be different. This article reviews recent literature describing the pathophysiology of TCA and describes how the military has challenged the assumption that outcome is universally poor in these patients...
December 2015: Emergency Medicine Journal: EMJ
Gil Z Shlamovitz, William R Mower, Jonathan Bergman, Jonathan Crisp, Heather K DeVore, David Hardy, Martine Sargent, Sunil D Shroff, Eric Snyder, Marshall T Morgan
STUDY OBJECTIVE: Current advanced trauma life support guidelines recommend that a digital rectal examination be performed as part of the initial evaluation of all trauma patients. Our goal is to estimate the test characteristics of the digital rectal examination in trauma patients. METHODS: We conducted a retrospective medical record review study of consecutive trauma patients treated in our emergency department from January 2003 to February 2005 for whom the trauma team was activated and who had a documented digital rectal examination...
July 2007: Annals of Emergency Medicine
Randall M Chesnut, Nancy Temkin, Nancy Carney, Sureyya Dikmen, Carlos Rondina, Walter Videtta, Gustavo Petroni, Silvia Lujan, Jim Pridgeon, Jason Barber, Joan Machamer, Kelley Chaddock, Juanita M Celix, Marianna Cherner, Terence Hendrix
BACKGROUND: Intracranial-pressure monitoring is considered the standard of care for severe traumatic brain injury and is used frequently, but the efficacy of treatment based on monitoring in improving the outcome has not been rigorously assessed. METHODS: We conducted a multicenter, controlled trial in which 324 patients 13 years of age or older who had severe traumatic brain injury and were being treated in intensive care units (ICUs) in Bolivia or Ecuador were randomly assigned to one of two specific protocols: guidelines-based management in which a protocol for monitoring intraparenchymal intracranial pressure was used (pressure-monitoring group) or a protocol in which treatment was based on imaging and clinical examination (imaging-clinical examination group)...
December 27, 2012: New England Journal of Medicine
H R Guly, O Bouamra, M Spiers, P Dark, T Coats, F E Lecky
AIM: The Advanced Trauma Life Support (ATLS) system classifies the severity of shock. The aim of this study is to test the validity of this classification. METHODS: Admission physiology, injury and outcome variables from adult injured patients presenting to hospitals in England and Wales between 1989 and 2007 and stored on the Trauma Audit and Research Network (TARN) database, were studied. For each patient, the blood loss was estimated and patients were divided into four groups based on the estimated blood loss corresponding to the ATLS classes of shock...
May 2011: Resuscitation
Amani D Politano, Lin M Riccio, Douglas E Lake, Craig G Rusin, Lauren E Guin, Christopher S Josef, Matthew T Clark, Robert G Sawyer, J Randall Moorman, James F Calland
BACKGROUND: Analysis and modeling of data monitoring vital signs and waveforms in patients in a surgical/trauma intensive care unit (STICU) may allow for early identification and treatment of patients with evolving respiratory failure. METHODS: Between February 2011 and March 2012, data of vital signs and waveforms for STICU patients were collected. Every-15-minute calculations (n = 172,326) of means and standard deviations of heart rate (HR), respiratory rate (RR), pulse-oxygen saturation (SpO2), cross-correlation coefficients, and cross-sample entropy for HR-RR, RR-SpO2, and HR-SpO2, and cardiorespiratory coupling were calculated...
November 2013: Surgery
Jessica L Mckee, Derek J Roberts, Mary H van Wijngaarden-Stephens, Christine Vis, He Gao, Kathy L Belton, Don Voaklander, Chad G Ball, Ioana Bratu, Geoffrey C Ibbotson, Kevin Martin, Paul Engels, Damian Paton-Gay, Paul Parks, Lyle Thomas, Jonathan Guilfoyle, John B Kortbeek, Andrew W Kirkpatrick
OBJECTIVE: To evaluate the implementation of an all-inclusive philosophy of trauma care in a large Canadian province. BACKGROUND: Challenges to regionalized trauma care may occur where transport distances to level I trauma centers are substantial and few level I centers exist. In 2008, we modified our predominantly regionalized model to an all-inclusive one with the hopes of increasing the role of level III trauma centers. METHODS: We conducted a population-based, before-and-after study of patient admission and transfer practices and outcomes associated with implementation of an all-inclusive provincial trauma system using multivariable Poisson and linear regression and Cox proportional hazard models...
March 2015: Annals of Surgery
Raphael Sun, Dionne Skeete, Kristel Wetjen, Michele Lilienthal, Junlin Liao, Mark Madsen, Gabriel Lancaster, Joel Shilyansky, Kent Choi
BACKGROUND: To minimize radiation exposure in children and reduce resource use, we implemented an age-specific algorithm to evaluate cervical spine injuries at a Level 1 trauma center. The effects of protocol implementation on computed tomography (CT) use in children (≤ 10 y) were determined. METHODS: With institutional review board approval, we conducted a retrospective review using the institutional trauma registry. All pediatric patients (≤ 10 y) (n = 324) between January 2007 and present were reviewed...
July 2013: Journal of Surgical Research
Naomi T Hughes, Randall S Burd, Stephen J Teach
Evidence for changes in adult trauma management often precedes evidence for changes in pediatric trauma management. Many adult trauma centers have adopted damage-control resuscitation management strategies, which target the metabolic syndrome of acidosis, coagulopathy, and hypothermia often found in severe uncontrolled hemorrhage. Two key components of damage-control resuscitation are permissive hypotension, which is a fluid management strategy that targets a subnormal blood pressure, and hemostatic resuscitation, which is a transfusion strategy that targets coagulopathy with early blood product administration...
September 2014: Pediatric Emergency Care
Michal Radomski, Ritesh Agnihothri, Stephanie Knapp, Daniel Scher, Nadia Khati, Kathleen Brindle, Richard Amdur, Jonathan Messing, James Dunne, Babak Sarani
BACKGROUND: The inferior vena cava (IVC) collapses with shock but may also be collapsed in volume-depleted patients in the absence of shock. The speed and availability of computed tomography (CT) make IVC measurement an attractive diagnostic modality for shock. The purpose of this study was to determine if IVC size following injury is associated with shock. METHODS: Retrospective data were collected on 272 trauma patients admitted to an adult trauma center from January 1 to December 31, 2012...
July 2014: Journal of Trauma and Acute Care Surgery
Joseph P Minei, Timothy C Fabian, Danielle M Guffey, Craig D Newgard, Eileen M Bulger, Karen J Brasel, Jason L Sperry, Russell D MacDonald
OBJECTIVE: To investigate the relationship between trauma center volume and outcome. BACKGROUND: The Resuscitation Outcomes Consortium is a network of 11 centers and 60 hospitals conducting emergency care research. For many procedures, high-volume centers demonstrate superior outcomes versus low-volume centers. This remains controversial for trauma center outcomes. METHODS: This study was a secondary analysis of prospectively collected data from the Resuscitation Outcomes Consortium multicenter out-of-hospital Hypertonic Saline Trial in patients with Glasgow Coma Scale score of 8 or less (traumatic brain injury) or systolic blood pressure of 90 or less and pulse of 110 or more (shock)...
September 2014: Annals of Surgery
J W Tuckett, A Lynham, G A Lee, M Perry, U Harrington
OBJECTIVES: In 1978 the Advanced Trauma Life Support guidelines were first implemented and are viewed by many as the gold standard of care in the emergency setting. It may not be immediately obvious where assessment and management of maxillofacial injuries fits within these trauma guidelines. This article aims to provide a concise, contemporary guide for the treatment of maxillofacial trauma in the emergency setting. METHODS: An electronic database search was conducted in PubMed and Science Direct on articles from 1970 to the present day...
April 2014: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
Emma Sydenham, Ian Roberts, Phil Alderson
BACKGROUND: Hypothermia has been used in the treatment of head injury for many years. Encouraging results from small trials and laboratory studies led to renewed interest in the area and some larger trials. OBJECTIVES: To estimate the effect of mild hypothermia for traumatic head injury on mortality and long-term functional outcome complications. SEARCH STRATEGY: We searched the Injuries Group Specialised Register, Current Controlled Trials MetaRegister of trials, Zetoc, ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED) and Conference Proceedings Citation Index-Science (CPCI-S), CENTRAL (The Cochrane Library), MEDLINE and EMBASE...
April 15, 2009: Cochrane Database of Systematic Reviews
2014-06-27 17:46:47
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