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Trauma in the Elderly
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Management should be targeted at avoiding delays in definitive treatment. Assessment of abdominal trauma on clinical grounds alone may miss significant pathology. Abdominal ultrasound may detect free fluid in the abdomen, but CT will better image abdominal injuries and will demonstrate retroperitoneal bleeding. CT may, however, miss early bowel perforation, and observation with repeated examination is needed if this is a possibility. Options for management of solid organ injury include observation, interventional radiology and operative intervention. The specific management plan will depend on the patient’s haemodynamic status, the level of organ disruption and other injuries sustained. The mortality for trauma laparotomy increases with age, and other comorbidities.51
Miscellaneous procedures
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Potential triggers for WBCT (although not exhaustive) include [5–7]: Road traffic accidents at speeds >65 kph (>40 mph).Falls >6 m (>20 ft).Ejection from a motor vehicle.Pedestrian thrown 3 m (10 ft) or run over.Stabbing through the peritoneum.Penetrating injuries to head, neck, chest, abdomen and groin.Traumatic spinal injuries.Intra-abdominal trauma.Flail chest.Major industrial accident.Significant assault.
The Abdomen
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
Most patients with penetrating abdominal trauma managed non-operatively may be discharged after 24 hours of observation in the presence of a reliable abdominal examination and minimal to no tenderness. In addition, diagnostic laparoscopy may be considered as a tool to evaluate diaphragmatic lacerations and peritoneal penetration to avoid unnecessary laparotomy (see also Section 15.1.7). If the laparoscopy is positive, one should convert to a full trauma laparotomy to explore the abdominal cavity fully for other injuries.
Early start of thromboprophylaxis does not increase risk of intracranial hematoma progression in multiply injured patients with traumatic brain injury
Published in Brain Injury, 2022
Philipp Störmann, William Osinloye, René D. Verboket, Cora R. Schindler, Mathias Woschek, Ingo Marzi, Thomas Lustenberger
Severe blunt abdominal trauma and especially the paradigm shift to a more conservative, wait-and-see therapy of these injuries during the last decade is another complicating factor that needs to be considered in the decision process of VTEp administration. Usually, in these cases, the initiation of anticoagulation is delayed for at least 2–5 days, even though no guidelines exist here either (23,30,31). In our collective, 13 patients with serious abdominal injuries, including liver and kidney lacerations, were recorded. Of these, 11 patients received pharmacological prophylaxis and did not show any clinically relevant complications with regards to their abdominal injury; in particular, no increasing bleeding signs were registered after the start of VTEp. However, since it was not the primary goal of this study to evaluate the safety of early pharmacological VTEp in severe abdominal trauma, this aspect should be further analyzed in future studies.
The long-term urinary dysfunction after type C2 radical hysterectomy in patients with cervical cancer
Published in Journal of Obstetrics and Gynaecology, 2022
Linjuan Huang, Yingdi He, Yao Gong
Laparoscopic surgery is associated with less abdominal trauma and shorter recovery period when compared with an open approach (Turnbull et al. 2012). A retrospective study by Corrado et al. (2018) confirmed that minimally invasive surgery (laparoscopy or robotics) was as adequate and effective as abdominal surgery in terms of surgical and oncological outcomes in the treatment of early-stage cervical cancer. Laterza et al. reported that laparoscopic approach could reduce the occurrence of postoperative urinary incontinence and increase bladder sensation with the time of 6 months after surgery when compared with ARH (Laterza, Salvatore, et al. 2015). More and more LRH were done globally until the findings by Ramirez et al. (2018) that LRH was associated with lower rates of disease-free survival and overall survival than ARH among women with early-stage cervical cancer. Our findings indicate that patients after type C2 RH by laparoscopy had more urinary dysfunction than those after ARH. The reason is unclear. Laparoscopy utilises more electric manipulations, which could lead to more injury to autonomic nerve around lower urinary tract (Laterza, Sievert, et al. 2015). This might explain the high incidence of recatheterisation and LUTS after LRH.
Ultrasound Use in the Prehospital Setting for Trauma: A Systematic Review
Published in Prehospital Emergency Care, 2021
Christopher B. Mercer, Matthew Ball, Rebecca E. Cash, Madison K. Rivard, Kirsten Chrzan, Ashish R. Panchal
PHUS by physicians was conducted in many settings with different outcome variables. McNeil at al. (19) performed a prospective observational study utilizing PHUS at a battalion aid station in an austere combat zone. In 2013, Ketelaars et al. (27) performed a retrospective analysis of a HEMS database linked to hospital outcomes to evaluate the use of PHUS for chest trauma. The authors reported changes in treatment and transport decisions made using PHUS. PHUS was reported to impact transport decisions and choice of destination hospital in 1.6% and 4% of this population, respectively. Ketelaars et al. (26) also published a 2019 retrospective study for abdominal trauma in a HEMS system. Positive PHUS findings of hemoperitoneum were compared to CT or laparotomy results. Impacts on treatment decisions were reported as 12.6% and additional information to the hospital at 7.6%. PHUS impact on mode of transportation changes was 3.9% and choice of hospital destination 2.2% in this study. Finally, Büttner, et al. (29) provided a randomized control approach to utilizing peripheral nerve blocks with PHUS in the reduction of traumatic dislocations in the prehospital environment. Furthermore, the follow-up provider analysis of pain scores in this study was blinded to PHUS guided nerve blockage versus analgosedation (midazolam combined with either ketamine or fentanyl) for analgesia for initial dislocation reduction. This study stands out as the lone example of a randomized control trial implementing the use of PHUS in the management of trauma patients.