Blunt chest trauma in the elderly: an expert practice review

2019 ◽  
Vol 37 (2) ◽  
pp. 73-78
Author(s):  
Fraser Birse ◽  
Helen Williams ◽  
David Shipway ◽  
Edward Carlton
Keyword(s):  
Chest Trauma ◽  
The Elderly ◽  
Evidence Base ◽  
Spinal Fracture ◽  
Thoracic Injury ◽  
Common Mechanism ◽  
Vulnerable Patient ◽  
Practice Review ◽  
Vulnerable Patient Group ◽  
Expert Practice

Trauma in the elderly (>65 years) is an increasingly common presentation to the ED. A fall from standing height is the most common mechanism after which such patients present, and rib fracture is the most common non-spinal fracture. Thoracic injury in patients aged over 65 is associated with significant morbidity and mortality. There are currently no universally applied guidelines for assessment, investigation and management of such patients. In this expert practice review, we discuss the evidence base and options for clinical management in this vulnerable patient group.

scholarly journals Acetabular fractures in the elderly: modern challenges and the role of conservative management

2021 ◽  
Author(s):  
Kunal Mohan ◽  
James M. Broderick ◽  
Hasnain Raza ◽  
Brendan O’Daly ◽  
Michael Leonard
Keyword(s):  
Conservative Management ◽  
Young Patients ◽  
Treatment Strategies ◽  
The Elderly ◽  
High Energy ◽  
Acetabular Fractures ◽  
Individualized Approach ◽  
Vulnerable Patient ◽  
Vulnerable Patient Group

Abstract Introduction  The incidence of acetabular fractures in the elderly population is ever increasing. While management of acetabular fractures in young patients following high-energy trauma is well described, treatment of the elderly patient subgroup is complex and requires a unique, individualized approach. A variety of treatment strategies including operative and non-operative approaches exists to manage this vulnerable patient group. Conservative management of acetabular fractures in the elderly continues to play an important role in treatment of both stable fracture patterns and those medically unfit for surgery. Aim  This review assessing the current literature was undertaken with the purpose of summarising the challenges of management in this at-risk cohort as well as quantifying the role and outcomes following conservative management in the elderly.  Conclusion Our recommendation is that conservative management of acetabular fractures in the elderly can be considered as a treatment option on a case-by-case basis accounting for patient, injury, and surgical factors. If it is to be pursued, we advise a multidisciplinary approach focused on early mobility, minimisation of risk and regular follow-up to optimise patient outcomes.

scholarly journals Antidiabetic Drugs in Alzheimer’s Disease: Mechanisms of Action and Future Perspectives

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Grazia Daniela Femminella ◽  
Leonardo Bencivenga ◽  
Laura Petraglia ◽  
Lucia Visaggi ◽  
Lucia Gioia ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
The Elderly ◽  
Mechanisms Of Action ◽  
Antidiabetic Drugs ◽  
Common Mechanism ◽  
Public Health Burden ◽  
Preclinical And Clinical Studies ◽  
And Oxidative Stress ◽  
Potential Use

Diabetes mellitus (DM) and Alzheimer’s disease (AD) are two highly prevalent conditions in the elderly population and major public health burden. In the past decades, a pathophysiological link between DM and AD has emerged and central nervous system insulin resistance might play a significant role as a common mechanism; however, other factors such as inflammation and oxidative stress seem to contribute to the shared pathophysiological link. Both preclinical and clinical studies have evaluated the possible neuroprotective mechanisms of different classes of antidiabetic medications in AD, with some promising results. Here, we review the evidence on the mechanisms of action of antidiabetic drugs and their potential use in AD.

scholarly journals Haemothorax and Thoracic Spine Fractures in the Elderly

2012 ◽  
Vol 2012 ◽  
pp. 1-5
Author(s):  
Michael A. Masteller ◽  
Aakash Chauhan ◽  
Harsha Musunuru ◽  
Mark M. Walsh ◽  
Bryan Boyer ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Elderly Patients ◽  
Health Care Professionals ◽  
Osteoporotic Fractures ◽  
The Elderly ◽  
Spinal Fracture ◽  
Thoracic Spinal ◽  
Hemorrhagic Pleural Effusion ◽  
Thoracic Spine Fractures ◽  
Undetermined Etiology

Both osteoporotic fractures and pleural effusions are frequently observed in medicine. However, rarely does one associate a hemorrhagic pleural effusion with a thoracic spinal fracture when the patient has not sustained massive trauma. In this paper, we discuss two cases where seemingly insignificant low-energy trauma precipitated massive haemothoraces in elderly patients with underlying osteoporosis, ultimately resulting in their immediate causes of death. This paper serves to remind health care professionals of the importance of using caution when moving elderly patients as well as to consider thoracic spinal fracture as a potential explanation for a hemorrhagic pleural effusion of undetermined etiology.

scholarly journals Pneumomediastinum in Blunt Chest Trauma: A Case Report and Review of the Literature

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Gregory Mansella ◽  
Roland Bingisser ◽  
Christian H. Nickel
Keyword(s):  
Case Report ◽  
Physical Examination ◽  
Blunt Chest Trauma ◽  
Chest Trauma ◽  
Common Mechanism ◽  
Cervical Trauma ◽  
X Ray ◽  
Retrosternal Pain ◽  
Chest X Ray ◽  
Bedside Diagnosis

Blunt trauma is the most common mechanism of injury in patients with pneumomediastinum and may occur in up to 10% of patients with severe blunt thoracic and cervical trauma. In this case report we present a 24-year-old man with pneumomediastinum due to blunt chest trauma after jumping from a bridge into a river. He complained of persistent retrosternal pain with exacerbation during deep inspiration. Physical examination showed only a slight tenderness of the sternum and the extended Focused Assessment with Sonography for Trauma (e-FAST) was normal. Pneumomediastinum was suspected by chest X-ray and confirmed by computed tomography, which showed a lung contusion as probable cause of the pneumomediastinum due to the “Mackling effect.” Sonographic findings consistent with pneumomediastinum, like the “air gap” sign, are helpful for quick bedside diagnosis, but the diagnostic criteria are not yet as well established as for pneumothorax. This present case shows that despite minimal findings in physical examination and a normal e-FAST a pneumomediastinum is still possible in a patient with chest pain after blunt chest trauma. Therefore, pneumomediastinum should always be considered to prevent missing major aerodigestive injuries, which can be associated with a high mortality rate.

Cost Effectiveness of Imaging with Nuclear Cardiology

2015 ◽  
Author(s):  
Lawrence M. Phillips ◽  
Leslee J. Shaw
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Nuclear Cardiology ◽  
The Elderly ◽  
Evidence Base ◽  
Negative Evidence ◽  
High Likelihood ◽  
Imaging Data ◽  
Artery Disease

This chapter focuses on the economic data available for cardiovascular (CV) imaging. The total costs of testing are substantively lower than those associated with invasive procedures. There are several ongoing randomized trials, such as the PROMISE trial, that may further add to our evidence base on the cost implications of CV imaging. Data for stress nuclear cardiology supports its utility in terms of a high prognostic accuracy and that this test is economically attractive; notably for patients with a high likelihood of coronary artery disease. Data also supports that this benefit does not only include patients with known coronary artery disease but also the high likelihood subsets of the elderly or functionally impaired where ischemic findings play a fundamental role in ischemia-guided management. Importantly, more recent data support that alternative testing strategies have reduced cost in subsets of patients including lower risk women with stable chest pain and in the acute evaluation of low risk chest pain in the ED. Negative evidence is extremely important for the field of CV imaging and this more recent data should be embraced as defining our limitations in nuclear cardiology.

scholarly journals Missed Diagnoses and Health Problems in Adults With Prader-Willi Syndrome: Recommendations for Screening and Treatment

2020 ◽  
Vol 105 (12) ◽  
pp. e4671-e4687
Author(s):  
Karlijn Pellikaan ◽  
Anna G W Rosenberg ◽  
Anja A Kattentidt-Mouravieva ◽  
Rogier Kersseboom ◽  
Anja G Bos-Roubos ◽  
...  
Keyword(s):  
Medical Center ◽  
Patient Characteristics ◽  
Health Problems ◽  
Pituitary Hormone ◽  
Prader Willi Syndrome ◽  
Living Situation ◽  
Systematic Screening ◽  
Vulnerable Patient ◽  
Physical Examinations ◽  
Vulnerable Patient Group

Abstract Context Prader-Willi syndrome (PWS) is a complex hypothalamic disorder, combining hyperphagia, hypotonia, intellectual disability, and pituitary hormone deficiencies. Annual mortality of patients with PWS is high (3%). In half of the patients, the cause of death is obesity related and/or of cardiopulmonary origin. Health problems leading to this increased mortality often remain undetected due to the complexity and rareness of the syndrome. Objective To assess the prevalence of health problems in adults with PWS retrospectively. Patients, Design, and Setting We systematically screened 115 PWS adults for undiagnosed health problems. All patients visited the multidisciplinary outpatient clinic for rare endocrine syndromes at the Erasmus University Medical Center, Rotterdam, Netherlands. We collected the results of medical questionnaires, interviews, physical examinations, biochemical measurements, polygraphy, polysomnography, and radiology. Main outcome measures Presence or absence of endocrine and nonendocrine comorbidities in relation to living situation, body mass index, genotype, and demographic factors. Results Seventy patients (61%) had undiagnosed health problems, while 1 in every 4 patients had multiple undiagnosed health problems simultaneously. All males and 93% of females had hypogonadism, 74% had scoliosis, 18% had hypertension, 19% had hypercholesterolemia, 17% had type 2 diabetes mellitus, and 17% had hypothyroidism. Unfavorable lifestyles were common: 22% exercised too little (according to PWS criteria) and 37% did not see a dietitian. Conclusions Systematic screening revealed many undiagnosed health problems in PWS adults. Based on patient characteristics, we provide an algorithm for diagnostics and treatment, with the aim to prevent early complications and reduce mortality in this vulnerable patient group.

scholarly journals Treatment of type II odontoid fracture in the elderly

2020 ◽  
Vol 2020 (8) ◽  
Author(s):  
Preci Hamilton ◽  
Peyton Lawrence ◽  
Christian Valentin Eisenring
Keyword(s):  
Screw Fixation ◽  
Holistic Approach ◽  
The Elderly ◽  
Spinal Fracture ◽  
Cannulated Screw ◽  
Odontoid Fracture ◽  
Zenker’S Diverticulum ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Zenker's Diverticulum

Abstract Odontoid fractures constitute the commonest cervical spinal fracture in the elderly. There are varied management approaches with paucity of robust evidence to guide decision-making. We review the case of a 92-years-old man with traumatic Grauer type II B odontoid fracture treated with anterior cannulated screw fixation. Postoperatively, he was noted to have dysphagia due to a zenker’s diverticulum. Further history revealed repair of a zenker’s diverticulum ~40 years prior. Cervical spine images and video fluoroscopy demonstrated a recurrent zenker’s diverticulum. After re-excision of the recurrent zenker’s diverticulum his dysphagia resolved. This unique case describes dysphagia due to recurrent zenker’s diverticulum presenting after anterior cannulated screw fixation for type II B odontoid fracture. The dysphagia was diagnosed and treated in close collaboration with speech and language therapists and otorhinolaryngologist. This underscores the importance of holistic approach to the elderly patient with odontoid fractures.

The metabolic implications of long term cannabis use in patients with psychosis

2008 ◽  
Vol 17 (3) ◽  
pp. 221-226 ◽  
Author(s):  
Farrah Mushtaq ◽  
Valeria Mondelli ◽  
Carmine M. Pariante
Keyword(s):  
Body Weight ◽  
General Population ◽  
Endocannabinoid System ◽  
Cannabis Use ◽  
Long Term Effects ◽  
Glucose Levels ◽  
High Prevalence ◽  
Vulnerable Patient ◽  
Vulnerable Patient Group

SummaryAimsThe aim of this paper is to summarise the effects of cannabis use on appetite and energy balance, and to subsequently investigate the possible implications this may have in patients with psychosis, in whom a high prevalence of cannabis use has been reported.Methods– A narrative review based on the recent literature regarding cannabis use in the gen-eral population and patients with psychosis.Results– The short-term abilities of cannabis to increase appetite and body weight, through actions on the endogenous endocannabinoid system, have been well characterised throughout the literature. The long term effects of cannabis use are however unclear and only a minority of studies have been conducted in the general population with overall conflicting results. In terms of the effects of cannabis in patients with psychosis, there has only been one study to date that has investigated this and interestingly found cannabis use to be associated with increased body weight and blood glucose levels, thus providing evidence that cannabis use may be an important contributing factor to the reduced life expectancy, as is currently observed in this vulnerable patient group.Conclusions– It is clear from the literature that patients with psychosis are at a high risk of metabolic and cardiovascular disease in comparison to the general population. However the contribution of cannabis use to this risk is as of yet undetermined and further long term studies are need to confirm current findings and evaluate hypothesised mechanisms.Declaration of Interest: None.

Blunt Chest Trauma in the Elderly

1989 ◽  
Vol 29 (2) ◽  
pp. 234-237 ◽  
Author(s):  
ROBERT M. SHORR ◽  
AURELIO RODRIGUEZ ◽  
MATTHEW C. INDECK ◽  
MICHAEL D. CRITTENDEN ◽  
SUSAN HARTUNIAN ◽  
...  
Keyword(s):  
Blunt Chest Trauma ◽  
Chest Trauma ◽  
The Elderly
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