Tag: trauma

Which Injured Patients with Moderate Fibrinogen Deficit Need Fibrinogen Supplementation?

We have shown in this study an association between shock parameters and fibrinogen administration. Further studies are needed to determine how these parameters may be used to guide fibrinogen administration in trauma patients... read more

Foley Catheter Tamponade Usage for Bleeding Control in Penetrating Injuries

We recently used a Foley catheter to manage a stab wound to the left anterior neck (zone 1) in a 26 year-old male. Police arrived shortly after the incident but couldn’t stop the bleeding with external compression with... read more

To Bronch or Not to Bronch – That Is the Question

Percutaneous tracheostomy was safely and effectively performed by an experienced surgical team both with and without bronchoscopic guidance with no difference in the complication rates. This study suggests that the use... read more

Intravenous Push Levetiracetam Safety in a Neuro-Spine ICU

Administration of levetiracetam doses up to 2000 mg via IVP is a safe method of administration that results in a reduction of time to medication administration and a reduction of benzodiazepine use. Of the 2,055 hospital-wide... read more

Prehospital FAST Reduces Admission Time and Treatment

The focused assessment with sonography in trauma (FAST) exam is an established trauma care diagnostic procedure. Ultrasound performed during prehospital care can improve early treatment and management of the patients. According... read more

Approach to the Critically Ill Poisoned Patient

Toxicology histories are notoriously unreliable. Any available medical records, especially medication lists. Timing & amount of ingestions. Immediate vs. sustained-release formulations. Consider inquiring specifically... read more

Continuous Pneumatic Regulation of Tracheal Cuff Pressure to Decrease VAP in Mechanically Ventilated Patients

Continuous regulation of cuff pressure of the tracheal tube using a pneumatic device was not superior to routine care in preventing Ventilator-associated pneumonia (VAP) in patients with severe trauma. A total of 434 patients... read more

Imputation Strategies for Missing Baseline Neurological Assessment Covariates After TBI

Statistical models for outcome prediction are central to traumatic brain injury (TBI) research and critical to baseline risk adjustment. Glasgow coma score (GCS) and pupil reactivity are crucial covariates in all such models... read more

Managing Rising COVID-19 Cases in ICU

I have been working in intensive care for over 20 years, including a decade as a consultant, and facing winter pressures has always been the norm. However, the past 18 months have been something else. During the winter... read more

Transcatheter arterial embolization for severe blunt liver injury in hemodynamically unstable patients

Transcatheter arterial embolization (TAE) in hemodynamically unstable patients who responded to initial infusion therapy to some extent has acceptable in-hospital mortality and clinical failure rates. Hemodynamic instability... read more

Preoperative vena cava filter placement in recurrent cerebral fat embolism following traumatic multiple fractures

Despite scarce evidence, we reckon that Inferior Vena Cava Filter (IVCF) could improve prognosis in selected patients with fat embolism syndrome (FES), especially those presenting high risk factors, after accurately weighing... read more

Point-of-Care Transcranial Doppler by Intensivists

In the unconscious patient, there is a diagnostic void between the neurologic physical exam, and more invasive, costly and potentially harmful investigations. Transcranial color-coded sonography and two-dimensional transcranial... read more

What is the Ideal Approach for Emergent Pericardiocentesis Using POCUS Guidance?

A total of 166 pericardial effusions were identified during the study period. The mean skin-to-pericardial fluid distance was 5.6 cm for the subxiphoid views, which was significantly greater than that for the parasternal... read more

Lactate = LactHATE

Like many others who attended SMACC earlier this year I returned home dazed and confused about the significance of lactate in the septic patient. So like any good (aspiring to be) evidence-based medicine practitioner,... read more

Diagnostic accuracy of prehospital serum S100B and GFAP in patients with mild TBI

Early prehospital and in-hospital S100B levels  0.10 μg/L was 100% (95%CI: 89.1;100.0) in prehospital samples and 100% (95% CI 89.1;100.0) in in-hospital samples. The specificity was 15.4% (95%CI: 12.4;18.7) in prehospital... read more

Impact of Marijuana on Venous Thromboembolic Events

Tetrahydrocannabinoids (THC) exposure increases the risk of TEC in patients with trauma. Early identification and treatment for TEC is required to improve outcomes in this high-risk subset of trauma patients. We performed... read more

Major Trauma Definition Using Different Revisions of the Abbreviated Injury Scale

Injury Severity Score (ISS) 08 ≥ 11 and ISS 15 ≥ 12 perform similarly to a threshold ISS 98 ≥ 16 for in-hospital mortality and ICU admission. This confirms studies evaluating mapped datasets, and is the... read more

Randomised controlled trials in pre-hospital trauma

This mapping review has highlighted that evidence from trials in prehospital trauma is sparse and where trials have been completed, the reporting is generally poor and study designs sub-optimal. There is a continued need,... read more

Defining Major Trauma: a Delphi Study

Based upon the output of this Delphi study, major trauma may be defined as: "Significant injury or injuries that have potential to be life-threatening or life-changing sustained from either high energy mechanisms or low energy... read more

Safety of Arterial Catheterization Using the Distal Radial Approach in ICU Management

Distal radial approach (DRA) may be a safe option for insertion of a new A-line in the ICU. The study included 20 patients with a median age of 70 (interquartile range (IQR): 58.5–77) years: 10 patients with traumas,... read more

Optimal Needle Position for Decompression of Tension Pneumothorax

Tension Pneumothorax (TP) can occur as a potentially life-threatening complication of chest trauma. With the risk of respiratory and cardiac arrest, an immediate temporizing intervention for this condition is required by... read more

Prehospital Management of Trauma Patients with Rib Fractures

Rib fractures are associated with a direct, blunt force trauma to the thorax. It is estimated that 10% of all patients who were admitted to the hospital after blunt chest trauma have at least one rib fracture. In the prehospital... read more