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Clinical Sequelae and Functional Outcomes
Published in Mark A. Mentzer, Mild Traumatic Brain Injury, 2020
A case of traumatic brain injury (craniocerebral trauma) is either: An occurrence of injury to the head (arising from blunt or penetrating trauma or from acceleration–deceleration forces) with at least one of the following: Observed or self-reported alteration of consciousness or amnesia due to head traumaNeurologic or neuropsychological changes or diagnoses of skull fracture or intracranial lesions that can be attributed to the head traumaOr an occurrence of death resulting from trauma with head injury or traumatic brain injury listed on the death certificate, autopsy report, or medical examiner’s report in the sequence of conditions that resulted in death
Response to Acts of Terrorism
Published in Robert A. Burke, Counter-Terrorism for Emergency Responders, 2017
The following is a list of select interventions that have potential applicability in civilian trauma care systems following an IED and/or active shooter event (Figure 14.29): The use of tourniquets to control extremity hemorrhage.The use of hemostatic gauze to control bleeding from sites not amenable to tourniquet.The use of a nasopharyngeal airway for patients without maxillofacial or neck trauma.Positioning of a casualty in a recovery posture, if feasible for conscious patients with maxillofacial trauma and bleeding into the airway.Spinal precautions, when feasible for patients with blunt but not penetrating trauma.Intravenous (IV) access is not routinely required in the initial phase of treatment but can be performed by those with appropriate training and oversight.
Injury Scoring Systems and Injury Classification
Published in Melanie Franklyn, Peter Vee Sin Lee, Military Injury Biomechanics, 2017
Melanie Franklyn, Christine Read-Allsopp
Since its development, the ISS has been subject to numerous validation studies, both for blunt trauma (which it was designed for) and penetrating trauma (e.g. Baker and O’Neill 1976; Bull 1975; Copes et al. 1988) and as a result, has become the most widely used scoring system in hospital trauma settings. Probably the most well known of these validation studies was a US Major Trauma Outcome Study (MTOS) conducted between 1982 and 1987 (Champion et al. 1990b; Copes et al. 1988). In this research, the authors proposed the ISS intervals in Table 4.4, correlating these ISS intervals with mortality rate for age and injury mechanism (blunt or penetrating), where the graph of ISS versus mortality for penetrating injuries is shown in Figure 4.1. Note that the horizontal axis data points are plotted near the median of each ISS band, except for ISS = 75, which is a discrete value. Of importance is that the mortality rate was shown to be higher for penetrating than for blunt injuries (blunt injuries not shown in Figure 4.1), particularly for lower ISS values. For patients < 50 years of age, the most relevant data for a military population, the mortality rate increased significantly from the ISS = 9–15 category to the ISS = 16–25 category.
Prehospital trauma care evolution, practice and controversies: need for a review
Published in International Journal of Injury Control and Safety Promotion, 2020
Cervical collars are routinely applied in trauma patients with suspected cervical spine injury. However, cervical collar application was reported in penetrating trauma to be associated with unadjusted increased risk of mortality in two concealments of neck injuries in one study and increased scene time in another study, while, in blunt trauma, one study indicated that immobilization might be associated with worsened neurological outcome (Oteir, Smith, Stoelwinder, Middleton, & Jennings, 2015).