scholarly journals Trauma in the Obstetrical Patient

2009 ◽  
Vol 5 (3) ◽  
pp. 269-283 ◽  
Author(s):  
Christina C Hill
Keyword(s):  
Multidisciplinary Approach ◽  
Healthcare Providers ◽  
Organ System ◽  
Fetal Mortality ◽  
Trauma Patients ◽  
Minor Trauma ◽  
Fetal Exposure ◽  
Trauma Victim ◽  
Assessment And Treatment ◽  
Obstetrical Patient

Trauma complicates approximately 6–7% of all pregnancies and is associated with significant maternal and fetal morbidity and mortality. While the majority of trauma is minor, it is minor trauma that contributes to the majority of fetal mortality. Since virtually every organ system is affected anatomically and physiologically by pregnancy, it is important for healthcare providers who care for trauma victims to be aware of these changes. While assessment and resuscitation considers the existence of two patients, stabilization of the mother takes priority. Diagnostic and radiologic procedures should be used as indicated, with fetal exposure to radiation limited as much as possible. Management of the pregnant trauma victim requires a multidisciplinary approach in order to optimize outcome for mother and fetus. This review discusses the epidemiology, assessment and treatment of pregnant trauma patients and reviews areas where prevention efforts may be focused.

Diabetic Emergencies in Pregnancy

2017 ◽  
Author(s):  
Maribeth Guletz ◽  
Rebecca Minehart
Keyword(s):  
Fetal Mortality ◽  
Diabetes In Pregnancy ◽  
Glucose Levels ◽  
Lower Glucose ◽  
Assessment And Treatment ◽  
Obstetrical Patient ◽  
Precise Diagnosis ◽  
Physiologic Changes Of Pregnancy ◽  
Insulin Replacement ◽  
In Pregnancy

Diabetes in pregnancy is rising in incidence, and with this increase comes additional maternal and fetal risks. Precise diagnosis and timely management of diabetic obstetrical emergencies is critical. In particular, providers must recognize that diabetic ketoacidosis (DKA) may be seen at much lower glucose levels in pregnant patients compared with nonpregnant patients due to physiologic changes of pregnancy. Fluid resuscitation, correction of acidosis and careful electrolyte, glucose, and insulin replacement remain the mainstays of therapy in DKA during pregnancy. Although maternal mortality has decreased over recent decades, fetal mortality remains high, and therefore a multidisciplinary team should guide assessment and treatment of DKA. Decision for early delivery must weigh both the maternal and fetal status and consider adequacy of resuscitative efforts. This chapter provides a brief overview of diabetes in pregnancy with a focus on the diagnosis and management of diabetic emergencies in the obstetrical patient.

Lung ultrasound in blunt chest trauma: A clinical review

Ultrasound ◽  
2021 ◽  
pp. 1742271X2199460
Author(s):  
Serena Rovida ◽  
Daniele Orso ◽  
Salman Naeem ◽  
Luigi Vetrugno ◽  
Giovanni Volpicelli
Keyword(s):  
Blunt Chest Trauma ◽  
Chest Trauma ◽  
Lung Ultrasound ◽  
Lung Parenchyma ◽  
Trauma Patients ◽  
Minor Trauma ◽  
Major Life ◽  
Diagnostic Modality ◽  
Life Threatening ◽  
Sternal Fractures

Introduction Bedside lung sonography is recognized as a reliable diagnostic modality in trauma settings due to its ability to detect alterations both in lung parenchyma and in pleural cavities. In severe blunt chest trauma, lung ultrasound can identify promptly life-threatening conditions which may need direct intervention, whereas in minor trauma, lung ultrasound contributes to detection of acute pathologies which are often initially radio-occult and helps in the selection of those patients that might need further investigation. Topic Description We did a literature search on databases EMBASE, PubMed, SCOPUS and Google Scholar using the terms ‘trauma’, ‘lung contusion’, ‘pneumothorax’, ‘hemothorax’ and ‘lung ultrasound’. The latest articles were reviewed and this article was written using the most current and validated information. Discussion Lung ultrasound is quite accurate in diagnosing pneumothorax by using a combination of four sonographic signs; absence of lung sliding, B-lines, lung pulse and presence of lung point. It provides a rapid diagnosis in hemodynamically unstable patients. Lung contusions and hemothorax can be diagnosed and assessed with lung ultrasound. Ultrasound is also very useful for evaluating rib and sternal fractures and for imaging the pericardium for effusion and tamponade. Conclusion Bedside lung ultrasound can lead to rapid and accurate diagnosis of major life-threatening pathologies in blunt chest trauma patients.

scholarly journals 291 Pre-Operative Venepuncture: An Audit of The Trauma and Orthopaedic Department at The Royal Sussex County Hospital, Brighton

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
H Harris ◽  
T Antonio ◽  
A Hagiga ◽  
D Crone
Keyword(s):  
Major Trauma ◽  
Elective Surgery ◽  
Financial Burden ◽  
Trauma Patients ◽  
Minor Trauma ◽  
Inclusion Criteria ◽  
Blood Testing ◽  
Orthopaedic Department ◽  
Minor Surgery ◽  
Routine Coagulation

Abstract Background NICE recommends that patients undergoing intermediate or minor elective surgery do not need routine coagulation or transfusion blood testing unless they are ASA 3+ or taking anticoagulation mediation, where testing may be considered. Currently there is no guidance for trauma patients. Method We identified all patients that underwent intermediate or minor trauma and orthopaedic surgery within a three-month period from December 2019- February 2020 at the RSCH. We excluded major trauma patients, patients taking anticoagulants and patients with complex admission or past medical history. Computer records were used to identify pre-operative investigations and admission history. Results 843 patients met our inclusion criteria. In total, 92 clotting studies and 200 transfusion samples were taken preoperatively. The majority of tests were for patients undergoing ankle 130/292 (45%) or Tibia/Fibula 54/292 (18%) procedures. This equates to approximately 1168 blood tests per year. Based on the lab cost of £15.97 for a transfusion sample and £18 for a coagulation sample, this is a cost of approximately £19,616 each year on blood testing that is not indicated. Discussion We hope that by presenting these results we will help reduce the unnecessary time and financial burden of routine venipuncture in departments undertaking intermediate and minor surgery.

Performance of Advanced Nurse Practitioners in Minor Trauma Patients

2021 ◽  
Author(s):  
Nameer Choudhry ◽  
Caroline Charlton ◽  
David Bodansky ◽  
Saif Ul Islam ◽  
Jenna Doherty ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Trauma Patients ◽  
Minor Trauma

scholarly journals Pain experience, pain management strategies and satisfaction of hospitalized trauma patients in Indonesia

2017 ◽  
Vol 8 (1) ◽  
pp. 79
Author(s):  
Deya Prastika ◽  
Luppana Kitrungrote ◽  
Jintana Damkliang
Keyword(s):  
Pain Management ◽  
Pain Intensity ◽  
Management Strategies ◽  
Healthcare Providers ◽  
Pain Interference ◽  
Trauma Patients ◽  
Pain Experience ◽  
Analgesic Drugs ◽  
Effective Strategies ◽  
Experience Pain

Although trauma is a common cause of greater pain and interference on daily activities, little is known about pain experience, pain management strategies and pain management outcomes in hospitalized trauma patients in Indonesia. This descriptive study aimed (1) to assess the pain experience, (2) to describe pain management strategies, and (3) to describe satisfaction with pain management conducted by healthcare providers as perceived by trauma patients. A total of 154 hospitalized trauma patients from a teaching hospital in Indonesia were recruited from January to March 2016. Data were analyzed using descriptive and inferential statistics. The study found that most of the hospitalized trauma patients had single extremity fractures (56.49%) and mild head injury (20.13%). They have experienced a mild to moderate level of pain intensity and pain interference during the first three days of admission. These pain intensity and pain interference levels were found to be significantly decreased from the first to the third day. The pain management strategies often used by the healthcare providers were showing interest and asking about pain, assessing the outcomes after receiving analgesic drugs, and giving information about pain. The pain management strategies often used by patients were praying (86.36%), slow and deep breathing (77.27%), and reciting Dzikir (meditation) (68.18%). Patients reported that performing Dzikir and praying were the effective strategies to reduce their pain. The patients rated moderate to high levels of satisfaction with pain management conducted by healthcare providers. Therefore, combinations analgesic drugs with praying and performing Dzikir related to cultural contexts are crucial to alleviate pain among hospitalized trauma patients in Indonesia.

scholarly journals World trauma education: hemorrhage control training for healthcare providers in India

2019 ◽  
Vol 4 (1) ◽  
pp. e000263 ◽  
Author(s):  
Lindsay Andrea Smith ◽  
Sarah Caughey ◽  
Susan Liu ◽  
Cassandra Villegas ◽  
Mohan Kilaru ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Trauma Patients ◽  
Bleeding Control ◽  
Cross Sectional Survey ◽  
Hemorrhage Control ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Life Saving ◽  
Poor Outcomes ◽  
Trauma Education

BackgroundHemorrhage remains a major cause of death around the world. Eighty percent of trauma patients in India do not receive medical care within the first hour. The etiology of these poor outcomes is multifactorial. We describe findings from the first Stop the Bleed (StB) course recently offered to a group of medical providers in southern India.MethodsA cross-sectional survey of 101 participants who attended StB trainings in India was performed. Pre-training and post-training questionnaires were collected from each participant. In total, 88 healthcare providers’ responses were analyzed. Three bleeding control skills were presented: wound compression, wound packing, and tourniquet application.ResultsAmong participants, only 23.9% had received prior bleeding control training. Participants who reported feeling ‘extremely confident’ responding to an emergency medical situation rose from 68.2% prior to StB training to 94.3% post-training. Regarding hemorrhage control abilities, 37.5% felt extremely confident before the training, compared with 95.5% after the training. For wound packing and tourniquet application, 44.3% and 53.4%, respectively, felt extremely confident pre-training, followed by 97.7% for both skills post-training. Importantly, 90.9% of StB trainees felt comfortable teaching newly acquired hemorrhage control skills. A significant majority of participants said that confidence in their wound packing and tourniquet skills would improve with more realistic mannequins.ConclusionTo our knowledge, this is the first StB training in India. Disparities in access to care, long transport times, and insufficient numbers of prehospital personnel contribute to its significant trauma burden. Dissemination of these critical life-saving skills into this region and the resulting civilian interventions will increase the number of trauma patients who survive long enough to reach a trauma center. Additionally, considerations should be given to translating the course into local languages to increase program reach.Level of EvidenceLevel IV.

scholarly journals Timing of Repair or Reconstruction after Knee Dislocation

2019 ◽  
Vol 33 (04) ◽  
pp. 335-338
Author(s):  
Gregory C. Fanelli
Keyword(s):  
Ligament Reconstruction ◽  
Head Injuries ◽  
Knee Dislocation ◽  
Organ System ◽  
Initial Assessment ◽  
Surgical Timing ◽  
Knee Ligament ◽  
Knee Ligament Reconstruction ◽  
Assessment And Treatment ◽  
Injured Knee

AbstractThe multiple ligament injured knee (knee dislocation) is, often times, part of a multisystem injury complex that can include not only injuries to knee ligaments but also to blood vessels, skin, nerves, bones (fractures), head injuries, and other organ system trauma. These additional injuries can affect surgical timing for knee ligament reconstruction and also affect the results of the treatment. This article will present the author's approach and experience in the initial assessment and treatment of the acute multiple ligament injured (dislocated) knee, and also present considerations in the treatment of chronic multiple ligament injured knee.

scholarly journals Deficiencies in healthcare prior to suicide and actions to deal with them: a retrospective study of investigations after suicide in Swedish healthcare

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e032290 ◽  
Author(s):  
Elin Roos af Hjelmsäter ◽  
Axel Ros ◽  
Boel Andersson Gäre ◽  
Åsa Westrin
Keyword(s):  
Retrospective Study ◽  
Suicide Prevention ◽  
Suicide Risk ◽  
Healthcare Providers ◽  
Educational Interventions ◽  
Future Research ◽  
Suicide Risk Assessment ◽  
Prevention Strategies ◽  
Supervisory Authority ◽  
Assessment And Treatment

ObjectivesThe overall aim of this study was to aggregate the conclusions of all investigations conducted after suicides reported to the supervisory authority in Sweden in 2015, and to identify deficiencies in healthcare found in these investigations; the actions proposed to deal with the deficiencies; the level of the organisational hierarchy (micro–meso–macro) in which the deficiencies and actions were situated; and outcomes of the supervisory authority’s decisions.Design and settingThis is a retrospective study of all reports from Swedish primary and secondary healthcare after suicide to the regulatory authority in Sweden in 2015.ResultsIn 55% (n=240) of cases, healthcare providers reported healthcare deficiencies that contributed to suicide; these deficiencies were primarily in ‘suicide risk assessment’ and ‘treatment’. Actions aimed at preventing new suicides were proposed in 80% of cases (n=347). By far, the most frequent actions were ‘education and competence’, present in 52% of cases (n=227) and did not much correspond with identified deficiencies. Sixty-five per cent of the deficiencies and actions were at microlevel, while the remainders were at mesolevel. In 65% (n=284) of cases, the supervisory authority approved the investigation without further requirements.ConclusionsThe most common identified deficiencies were related to care in the immediate interface between patient and staff. Actions proposed to prevent new suicides were centred on single educational interventions without distinctive sustainable effects in the organisations and usually did not correspond with the identified deficiencies. Future research should examine if application of a framework based on knowledge of the suicide process, suicide prevention strategies and patient safety would enable more sophisticated investigations that could facilitate progress on suicide prevention.

Endovascular Therapy for Acute Trauma: A Pictorial Review

2014 ◽  
Vol 65 (2) ◽  
pp. 158-167 ◽  
Author(s):  
Anirudh Mirakhur ◽  
Richard Cormack ◽  
Muneer Eesa ◽  
Jason K. Wong
Keyword(s):  
Critically Ill ◽  
Multidisciplinary Approach ◽  
Trauma Patients ◽  
Solid Organ ◽  
Traditional Role ◽  
Acute Trauma ◽  
Endovascular Interventions ◽  
Pictorial Review ◽  
The Common

The traditional role of radiology in the multidisciplinary approach to modern trauma care has been primarily diagnostic and noninvasive. With the advent of more sophisticated and faster imaging equipment, computed tomography has further entrenched its role as the workhorse of trauma imaging. However, the specialty has evolved over the years with various therapeutic techniques now part of the interventional radiology armamentarium. Several of these techniques have become essential for the management of critically ill trauma patients. This article provides an overview of the common imaging findings of vascular and solid organ trauma from head to toe and subsequent endovascular interventions in these critically ill trauma patients.

scholarly journals (P2-91) EMS Trauma Triage: Does the Red-Blue Criteria Enable Overtriage?

2011 ◽  
Vol 26 (S1) ◽  
pp. s166-s166
Author(s):  
D.M. Higgins ◽  
R.E. Thaxton
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Initial Assessment ◽  
Trauma Patients ◽  
Minor Trauma ◽  
Trauma Severity ◽  
Physician Assessment ◽  
Assessment Skills ◽  
Trauma Triage ◽  
Level 1

IntroductionWith the current need for effective trauma center utilization, understanding how current trauma triage criteria may promote overtriage will enable both field and hospital teams to provide the most appropriate patient care. It is hypothesized that current Southwest Texas trauma criteria promote overtriage by prehospital emergency medical services (EMS) of patients in favor of a Level 1 trauma facility when compared to physician assessment and Injury Severity Score (ISS).MethodsThis prospective, observational study at a Southwest Texas military Level 1 trauma center compared adult trauma patients' prehospital status noted by EMS personnel with the triage criteria documented by the treating emergency physician. The patients were divided into four groups: Prehospital Criteria Met or Not Met; Arrival Criteria Met or Not Met. Each patient's ISS and mechanism of injury were also collected and compared to initial assessment for predictive value. Descriptive statistics were used.ResultsThe study enrolled 278 adult trauma patients. EMS reported Level 1 trauma status similar to physician assessment (60.1% vs. 59.7%, respectively). The rates patients met Level 1 trauma status corresponded with trauma severity when compared to the ISS. Assessment between EMS and physicians for ISSs were similar among the four groups. Comparisons using multivariate analysis of the four groups found similar ISSs, except for the Prehospital Criteria Met/Arrival Criteria Not Met group. Seventy-five percent of these patients were assigned an ISS in the Minor (ISS < 9) category (p = 0.013).ConclusionTrauma triage criteria assessment skills were similar between EMS personnel and emergency physicians except for identifying minor trauma patients. While the criteria generally led to overtriage, EMS crews appear to overtriage minor trauma patients at a much higher rate.

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