scholarly journals Initial Assessment of Whiplash Patients

2003 ◽  
Vol 8 (1) ◽  
pp. 24-27 ◽  
Author(s):  
R Gunzburg ◽  
M Szpalski ◽  
J. Van Goethem
Keyword(s):  
Emergency Room ◽  
Initial Treatment ◽  
Severe Trauma ◽  
Initial Assessment ◽  
Early Mobilisation ◽  
Major Injury ◽  
Key Points ◽  
Inflammatory Drugs ◽  
Whiplash Associated Disorders ◽  
Whiplash Associated Disorder

The article looks at how for severe trauma, the outcome of treatment depends on the initial medical care. This has now also been accepted for whiplash associated disorders, underlining the importance of a proper initial assessment. Once major injury has been excluded and the diagnosis of whiplash associated disorder has been established, the initial treatment of whiplash in the emergency room can be started. The four key points to remember are described, including reassuring the patient about evolution, no soft collar, nonsteroidal anti-inflammatory drugs and early mobilisation.

scholarly journals Cost-effectiveness of a hybrid emergency room system for severe trauma: a health technology assessment from the perspective of the third-party payer in Japan

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Takahiro Kinoshita ◽  
Kensuke Moriwaki ◽  
Nao Hanaki ◽  
Tetsuhisa Kitamura ◽  
Kazuma Yamakawa ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Emergency Room ◽  
Healthcare Costs ◽  
Cost Effective ◽  
Severe Trauma ◽  
Third Party ◽  
Trauma Patients ◽  
Short Term ◽  
The Third

Abstract Background Hybrid emergency room (ER) systems, consisting of an angiography-computed tomography (CT) machine in a trauma resuscitation room, are reported to be effective for reducing death from exsanguination in trauma patients. We aimed to investigate the cost-effectiveness of a hybrid ER system in severe trauma patients without severe traumatic brain injury (TBI). Methods We conducted a cost-utility analysis comparing the hybrid ER system to the conventional ER system from the perspective of the third-party healthcare payer in Japan. A short-term decision tree and a long-term Markov model using a lifetime time horizon were constructed to estimate quality-adjusted life years (QALYs) and associated lifetime healthcare costs. Short-term mortality and healthcare costs were derived from medical records and claims data in a tertiary care hospital with a hybrid ER. Long-term mortality and utilities were extrapolated from the literature. The willingness-to-pay threshold was set at $47,619 per QALY gained and the discount rate was 2%. Deterministic and probabilistic sensitivity analyses were conducted. Results The hybrid ER system was associated with a gain of 1.03 QALYs and an increment of $33,591 lifetime costs compared to the conventional ER system, resulting in an ICER of $32,522 per QALY gained. The ICER was lower than the willingness-to-pay threshold if the odds ratio of 28-day mortality was < 0.66. Probabilistic sensitivity analysis indicated that the hybrid ER system was cost-effective with a 79.3% probability. Conclusion The present study suggested that the hybrid ER system is a likely cost-effective strategy for treating severe trauma patients without severe TBI.

scholarly journals Penetrating Neck Injuries Treated at a U.S. Role 3 Medical Treatment Facility in Afghanistan During Operation Resolute Support

2020 ◽  
Author(s):  
John Breeze ◽  
William G Gensheimer ◽  
Joseph J DuBose
Keyword(s):  
Medical Treatment ◽  
Emergency Room ◽  
Neck Region ◽  
Neck Injuries ◽  
Treatment Facility ◽  
Medical Treatment Facility ◽  
Trauma Registries ◽  
Neck Wound ◽  
Major Injury ◽  
High Negative Predictive Value

ABSTRACT Introduction Military trauma registries can identify broad epidemiological trends from neck wounds but cannot reliably demonstrate temporal casualty from clinical interventions or differentiate penetrating neck injuries (PNI) from those that do not breach platysma. Materials and Methods All casualties presenting with a neck wound to a Role 3 Medical Treatment Facility in Afghanistan between January 1, 2016 and September 15, 2019 were retrospectively identified using the Emergency Room database. These were matched to records from the Operating Room database, and computed tomography (CT) scans reviewed to determine damage to the neck region. Results During this period, 78 casualties presented to the Emergency Room with a neck wound. Forty-one casualties underwent surgery for a neck wound, all of whom had a CT scan. Of these, 35/41 (85%) were deep to platysma (PNI). Casualties with PNI underwent neck exploration in 71% of casualties (25/35), with 8/25 (32%) having surgical exploration at Role 2 where CT is not present. Exploration was more likely in Zones 1 and 2 (8/10, 80% and 18/22, 82%, respectively) compared to Zone 3 (2/8, 25%). Conclusion Hemodynamically unstable patients in Zones 1 and 2 generally underwent surgery before CT, confirming that the low threshold for exploration in such patients remains. Only 25% (2/8) of Zone 3 PNI were explored, with the high negative predictive value of CT angiography providing confidence that it was capable of excluding major injury in the majority of cases. No deaths from PNI that survived to treatment at Role 3 were identified, lending evidence to the current management protocols being utilized in Afghanistan.

scholarly journals French recommendations for the management of Behçet’s disease

2021 ◽  
Vol 16 (S1) ◽  
Author(s):  
Isabelle Kone-Paut ◽  
◽  
Stéphane Barete ◽  
Bahram Bodaghi ◽  
Kumaran Deiva ◽  
...  
Keyword(s):  
Behçet’S Disease ◽  
Behcet’S Disease ◽  
Behçet's Disease ◽  
Initial Assessment ◽  
Diagnostic Process ◽  
Behcet's Disease ◽  
Therapeutic Modalities ◽  
Clinical Presentations ◽  
Key Points

AbstractBehçet’s disease (BD) is a systemic variable vessel vasculitis that involves the skin, mucosa, joints, eyes, arteries, veins, nervous system and gastrointestinal system, presenting with remissions and exacerbations. It is a multifactorial disease, and several triggering factors including oral cavity infections and viruses may induce inflammatory attacks in genetically susceptible individuals. BD vasculitis involves different vessel types and sizes of the vascular tree with mixed-cellular perivascular infiltrates and is often complicated by recurrent thrombosis, particularly in the venous compartment. Several new therapeutic modalities with different mechanisms of action have been studied in patients with BD. A substantial amount of new data have been published on the management of BD, especially with biologics, over the last years. These important therapeutic advances in BD have led us to propose French recommendations for the management of Behçet’s disease [Protocole National de Diagnostic et de Soins de la maladie de Behçet (PNDS)]. These recommendations are divided into two parts: (1) the diagnostic process and initial assessment; (2) the therapeutic management. Thirty key points summarize the essence of the recommendations. We highlighted the main differential diagnosis of BD according to the type of clinical involvement; the role of genetics is also discussed, and we indicate the clinical presentations that must lead to the search for a genetic cause.

scholarly journals Obinutuzumab plus fludarabine/cyclophosphamide or bendamustine in the initial therapy of CLL patients: the phase 1b GALTON trial

Blood ◽  
2015 ◽  
Vol 125 (18) ◽  
pp. 2779-2785 ◽  
Author(s):  
Jennifer R. Brown ◽  
Susan O’Brien ◽  
C. Daniel Kingsley ◽  
Herbert Eradat ◽  
John M. Pagel ◽  
...  
Keyword(s):  
Adverse Event ◽  
Initial Treatment ◽  
Initial Therapy ◽  
Common Adverse Event ◽  
Clinical Activity ◽  
Key Points ◽  
Infusion Reactions ◽  
Phase 1B

Key Points In this phase 1b study, obinutuzumab plus FC or B had acceptable safety, with infusion reactions the most common adverse event. Obinutuzumab plus FC or B showed promising clinical activity in the initial treatment of CLL, with no relapses to date.

Headache

2020 ◽  
Keyword(s):  
Initial Treatment ◽  
Abrupt Change ◽  
Healthy Lifestyle ◽  
Symptomatic Relief ◽  
Lifestyle Habits ◽  
Key Points ◽  
Chronic Daily Headaches ◽  
Systemic Symptoms

Key Points Most headaches in children, in the absence of neurologic or systemic findings, require only symptomatic relief with ibuprofen or acetaminophen. Neuroimaging is indicated only with abnormal neurologic features, systemic symptoms, an abrupt change in pattern, or with chronic daily headaches. With recurrent headaches the 1st step in management is promoting healthy lifestyle habits—nutrition, sleep, exercise, hydration, etc. With migraine, DON’T WAIT—medication works best the earlier it is given. Ibuprofen is the initial treatment of choice. If needed, triptans are safe and can be effective.

Clinical and Laboratory Management of the Prothrombin G20210A Mutation

2002 ◽  
Vol 126 (11) ◽  
pp. 1319-1325 ◽  
Author(s):  
Ronald C. McGlennen ◽  
Nigel S. Key
Keyword(s):  
Significant Risk ◽  
Factor V Leiden ◽  
Initial Assessment ◽  
Prothrombin G20210a ◽  
Factor V Leiden Mutation ◽  
Published Evidence ◽  
G20210a Mutation ◽  
Key Points ◽  
Prothrombin Mutation ◽  
History Of

Abstract Objective.—To make recommendations regarding the appropriate evaluation for the prothrombin G20210A mutation, as reflected by published evidence and the consensus opinion of recognized experts in the field. Data Sources.—Review of the medical literature, primarily since 1996. Data Extraction and Synthesis.—After an initial assessment of the literature, key points defining the condition, and review of the clinical study design, a draft manuscript was prepared and circulated to every participant in the College of American Pathologists Conference on Diagnostic Issues in Thrombophilia before the meeting. Each of the key points and associated recommendations were then presented for discussion at the conference. Recommendations were accepted if a consensus of 70% of experts attending the conference was reached. The results of the discussion were used to revise the manuscript into its final form. Conclusions.—Consensus was reached on several recommendations concerning the criteria for testing for the prothrombin G20210A mutation and for the method of testing. First, a major point of consensus was that the prothrombin G20210A mutation is a significant risk factor for venous thromboembolism (VTE) and that testing should be considered in the initial evaluation of suspected inherited thrombophilia. Second, although several analytic methods are commonly used for genetic testing for the prothrombin mutation, all are generally robust and reliable. The recommendations for testing for the prothrombin mutation parallel those for the factor V Leiden mutation and include patients with a history of recurrent VTE, a first episode of VTE before the age of 50 years, a history of an unprovoked VTE at any age, thromboses in unusual anatomic sites, or an affected first-degree relative with VTE. A history of VTE related to pregnancy or estrogen use and unexplained pregnancy loss during the second or third trimesters were also considered to be indications for testing. Other scenarios remain controversial or not recommended, including general population screening.

Abdominal assessment

2019 ◽  
pp. 169-176
Author(s):  
Justin Kirk-Bayley ◽  
James Doyle
Keyword(s):  
Lung Ultrasound ◽  
Severe Trauma ◽  
Initial Assessment ◽  
Abdominal Organs

The role of focused abdominal scanning includes its use during the initial assessment of severe trauma and to guide safe drainage of ascites. Knowledge of the normal abdominal appearance is essential for the safe interpretation of focused abdominal scanning. Assessment of the sub-diaphragmatic structures is also integral to undertaking lung ultrasound. This chapter describes the technique of abdominal scanning, the ultrasonographic features of the major intra-abdominal organs, and the appearances of some common pathology.

Hand Injuries in the Textile Industry

1985 ◽  
Vol 10 (3) ◽  
pp. 293-296
Author(s):  
S. M. MYLES ◽  
A. H. N. ROBERTS
Keyword(s):  
Plastic Surgery ◽  
Initial Treatment ◽  
Textile Industry ◽  
Acute Treatment ◽  
Hand Injuries ◽  
Early Mobilisation ◽  
Early Referral ◽  
Skin Replacement ◽  
Wool Industry

This paper is a review of the hand injuries occurring in the Yorkshire Wool Industry and referred to the Regional Plastic Surgery Unit for skin replacement, or other treatment, during the years 1965–1984. A total of forty-one cases has been seen, and although the number employed in the industry has fallen about fivefold, the injuries referred yearly have remained approximately constant. An analysis of the types of injury has been made and the improvement in the results is shown with changes in the method of acute treatment. The case for early referral, active initial treatment and early mobilisation is very obvious from the results.

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