New-onset delirium among elderly acute care orthopedic trauma patients

Abstract Background It is rare that drains cannot be removed after surgery, however, this situation cannot be completely avoided, and is also hard to deal with. The main reason for a tethered drain is inadvertent suture fixation. At present, no effective way was published or widely accepted to locate the tethered drain. Methods Three cases of orthopedic trauma patients experienced unsuccessful removal of the drain after surgery. The ultrasound was used to locate the sutured site of the drain. Based on the sliding sign and vanishing point which can be detected by the ultrasound, the sutured site of the drain can be clearly identified. Finally, the suture was loosened through a small incision, and the drain was completely removed. Results The surgical procedure was very successful in all patients. The tethered drain was quickly and completely removed through a small incision with locating by ultrasound. Intravenous antibiotics were administered within 24 h after surgery, and no wound or deep infections occurred. Conclusions Ultrasound can be used to locate a tethered drain based on the sliding sign. This method can simplify the release procedure and achieve fast removal of the drain. Furthermore, it will help lower the risk of a retained drain and soft tissue complications.

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Clinical Study on the Screening of Lower Extremity Deep Venous Thrombosis by D-Dimer Combined with RAPT Score Among Orthopedic Trauma Patients

Indian Journal of Orthopaedics ◽

10.1007/s43465-020-00268-3 ◽

2020 ◽

Vol 54 (S2) ◽

pp. 316-321

Author(s):

Xin Zhao ◽

Salma Juma Ali ◽

Xiguang Sang

Keyword(s):

Clinical Study ◽

Lower Extremity ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Trauma Patients ◽

Orthopedic Trauma ◽

D Dimer

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Implementation of a Perioperative Cardiac Risk Stratification Protocol Is Associated with Improved Adherence with American Heart Association Guidelines in Geriatric Orthopedic Trauma Patients

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2019.08.1363 ◽

2019 ◽

Vol 229 (4) ◽

pp. e231

Author(s):

Bryce E. Haac ◽

Ugo Udogwu ◽

Marckenley Isaac ◽

Jake Johnson ◽

Marcus F. Sciadini ◽

...

Keyword(s):

Risk Stratification ◽

American Heart Association ◽

American Heart ◽

Heart Association ◽

Cardiac Risk ◽

Trauma Patients ◽

Orthopedic Trauma

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Hospital Surge Capacity during Expo 2015 in Milano, Italy

Prehospital and Disaster Medicine ◽

10.1017/s1049023x18000742 ◽

2018 ◽

Vol 33 (5) ◽

pp. 459-465 ◽

Cited By ~ 1

Author(s):

Roberto Faccincani ◽

Francesco Della Corte ◽

Giovanni Sesana ◽

Riccardo Stucchi ◽

Eric Weinstein ◽

...

Keyword(s):

Acute Care ◽

Trauma Patients ◽

Publication Type ◽

Surge Capacity ◽

Preparedness Plan ◽

Hospital Capacity ◽

Adequate Care ◽

Method Of Measurement ◽

Critical Resources ◽

Command Center

AbstractIntroductionHospital Acute Care Surge Capacity (HACSC), Hospital Acute Care Surge Threshold (HACST), and Total Hospital Capacity (THC) are scales that were developed to quantify surge capacity in the event of a multiple-casualty incident (MCI). These scales take into consideration the need for adequate care for both critical (T1) and moderate (T2) trauma patients. The objective of this study was to verify the validity of these scales in nine hospitals of the Milano (Italy) metropolitan area that prepared for a possible MCI during EXPO 2015.MethodsBoth HACSC and HACST were computed for individual hospitals. These were compared to surge capacities declared by individual hospitals during EXPO 2015, and also to surge capacity evaluated during a simulation organized on August 23, 2016.ResultsBoth HACSC and HACST were smaller compared to capacities measured and reported by the hospitals, as well as those found during the simulation. This resulted in significant differences in THC when this was computed from the different methods of calculation.Conclusions:Surge capacity is dependent on the method of measurement. Each method has its inherent deficiencies. Until more reliable methodologies are developed, there is a benefit to analyze surge capacity using several methods rather than just one. Emergency committee members should be aware of the importance of critical resources when looking to the hospital capacity to respond to an MCI, and to the possibility to effectively increase it with a good preparedness plan. Since hospital capacity during real events is not static but dynamic, largely depending on occupation of the available resources, it is important that the regional command center and the hospitals receiving casualties constantly communicate on specific agreed upon critical resources, in order for the regional command center to timely evaluate the overall regional capacity and guarantee the appropriate distribution of the patients.FaccincaniR,Della CorteF,SesanaG,StucchiR,WeinsteinE,AshkenaziI,IngrassiaP.Hospital surge capacity during Expo 2015 in Milano, Italy.Prehosp Disaster Med.2018;33(5):459–465.

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Admitting paediatric trauma patients to rehabilitation following acute care: Decision making practices in the USA and Australia

Pediatric Rehabilitation ◽

10.3109/17518429709167361 ◽

1997 ◽

Vol 1 (4) ◽

pp. 207-218 ◽

Cited By ~ 7

Author(s):

Carolyn A. Unsworth ◽

J. Scott Osberg ◽

Annette Graham

Keyword(s):

Decision Making ◽

Acute Care ◽

Trauma Patients ◽

Paediatric Trauma ◽

The Usa ◽

Care Decision

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The Associations Between OPRM1 and COMT Genotypes and Postoperative Pain, Opioid Use, and Opioid-Induced Sedation

Biological Research For Nursing ◽

10.1177/1099800411436171 ◽

2012 ◽

Vol 15 (3) ◽

pp. 309-317 ◽

Cited By ~ 31

Author(s):

Richard A. Henker ◽

Allison Lewis ◽

Feng Dai ◽

William R. Lariviere ◽

Li Meng ◽

...

Keyword(s):

Postoperative Pain ◽

Postanesthesia Care Unit ◽

Trauma Patients ◽

Orthopedic Trauma ◽

Nucleotide Polymorphisms ◽

Opioid Use ◽

Acute Postoperative Pain ◽

Comt Genotype ◽

Sedation Scores ◽

Physiologic Responses

Previous studies have associated mu-opioid receptor ( OPRM1) genotype with pain and analgesia responses in postoperative and patient populations. This study investigates the role of catechol-O-methyltransferase ( COMT) and OPRM1 genotypes in acute postoperative pain scores, opioid use, and opioid-induced sedation after surgical procedures for orthopedic trauma in an otherwise healthy patient population. Verbal pain/sedation scores, opioid use, and physiologic responses in the immediate postoperative period were examined for association with genetic variants in Caucasians genotyped for OPRM1 single nucleotide polymorphisms (SNPs) A118G and C17T and COMT SNPs. The OPRM1 A118G genotype was associated with patients’ postoperative Numerical Pain scale (NPS) ratings at 15 min in the postanesthesia care unit (PACU) ( p = .01) and patients' sedation scores at 15 min in the PACU ( p = .02). COMT genotype (rs4818) was associated with opioid consumption in the first 45 min in the PACU ( p = .04). NPS ratings at 45 min were also higher in the group of patients with A/A genotype of rs4680 than in patients with the other two genotypes at this SNP ( p = .03). Our haplotype trend analysis identified a COMT haplotype “GCGG” significantly associated with NPS at 15 min ( p = .0013), amount of opioids consumed in the first 45 min ( p = .0024), and heart rate at 45 min in the PACU ( p = .017). The results indicate that genetic variations in COMT contribute to the acute postoperative pain and analgesia responses and physiologic responses in this group of otherwise healthy postoperative orthopedic trauma patients.

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