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Intensive care medicine
Published in Ian Greaves, Military Medicine in Iraq and Afghanistan, 2018
Ethical dilemmas arise when children present with very severe injuries that may radically limit quality of life or injuries known to have a poor outcome in the deployed environment. Examples include penetrating head trauma, severe burns, renal failure or multiple injuries. In the deployed operations in Afghanistan, there was evidence from survival figures in major burns for the need for early palliation.12
Chronic Posttraumatic Stress
Published in Rolland S. Parker, Concussive Brain Trauma, 2016
This endocrine disorder is characterized by inability to excrete water so that the urine is hypertonic (highly concentrated) with potential fatigue, headache, nausea, and anorexia, which can progress to altered mental status, seizures, coma, and death. It results from the disruption of hypothalamic pituitary pathways caused by closed or penetrating head trauma, surgery, tumors, or numerous CNS disorders. This can trigger the unregulated increase of vasopressin (ADH), resulting in water retention. SIADH has been reported in 0.6% of patients with mild head injury, 10.6% of those with moderate head injury, and 4.7% of those with severe head injury (Kirby et al., 2007; Kokko, 1996). The clinical picture may be a marker for trauma (Kokko, 2004). Plasma levels of ADH (AVP) are elevated when secretion would ordinarily be suppressed (Robinson, 2007; Robinson & Verbalis, 2003). Water retention results in the production of decreased volumes of highly concentrated urine. There is a decrease in the osmotic pressure of body fluids (i.e., hypoosmolality). If the condition eventually results in the death of the last vasopressin neurons to reduce the vasopressin level, there might be a great increase in urine volume (Robinson & Verbalis, 2003). The cause is impairment of inhibitory control over the neurohypophysis (i.e., excessive secretion of AVP). Clinically it appears as water retention with dilution of body fluids, such as hyponatremia or deficiency of blood sodium (reduced sodium ions in the blood, high urine sodium, with potential increase of body water content by 10% without edema), or water intoxication that may include mild headache, confusion, anorexia, nausea, vomiting, coma, and convulsions (Robertson, 2005).
Cefotaxime
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Baek-Nam Kim, David L. Paterson
The third-generation cephalosporins (especially cefotaxime and ceftriaxone) have revolutionized treatment of bacterial meningitis. Cefotaxime or ceftriaxone are recommended for empiric therapy of bacterial meningitis in children older than 1 month and in adults (Tunkel et al., 2004; van de Beek et al., 2012; Le Saux and Canadian Paediatric Society Infectious Diseases Immunization Committee, 2014). Cefotaxime is specifically recommended as empiric therapy for neonatal meningitis in combination with ampicillin (Tunkel et al., 2004; van de Beek et al., 2012). Ceftriaxone use is generally not recommended for neonates because cases of fatal reactions have been observed when ceftriaxone–calcium precipitates developed in the lungs and kidneys in both term and premature neonates (Runel Belliard and Sibille, 2007). In addition, bilirubin is “displaced” from albumin by ceftriaxone, thereby increasing the risk of neonatal jaundice (Gulian et al., 1987; Wadsworth and Suh, 1988; Martin et al., 1993). A third-generation cephalosporin (cefotaxime or ceftriaxone) plus vancomycin should be considered for empiric therapy in patients with nosocomial bacterial meningitis that occurs after basilar skull fracture or early after otorhinologic surgery (van de Beek et al., 2010). Neither cefotaxime or ceftriaxone is regarded as appropriate empiric therapy for bacterial meningitis occurring after penetrating head trauma, postneurosurgery, or in patients with CSF shunt infections (Tunkel et al., 2004; van de Beek et al., 2010). Recommended dosing regimens for cefotaxime for the treatment of bacterial meningitis for infants and children are 225–300 mg/kg/day given in three to four divided doses and 8–12 g/day in four to six divided doses for adults (Tunkel et al., 2004; van de Beek et al., 2012).
Cognitive function and participation in children and youth with mild traumatic brain injury two years after injury
Published in Brain Injury, 2018
S.A.M Lambregts, J.E.M Smetsers, I.M.A.J Verhoeven, A.J de Kloet, I.G.L van de Port, G.M Ribbers, C.E Catsman-Berrevoets
Traumatic brain injury (TBI) is a major cause of death and disability as it may cause a variety of long-term disorders across motor (1), communication (2), cognitive (3) and behavioural (4) domains resulting in decreased quality of life and high societal costs (5–8). Worldwide each year, almost 10 million people are affected by TBI (8, 9). Based on clinical variables such as duration of unconsciousness, amnesia and neurological symptoms, TBI can be categorised into mild, moderate and severe (10). Mild TBI (mTBI) represents 80–90% of all cases and is typically caused by blunt non-penetrating head trauma. Individuals who sustain mTBI are likely to experience a full recovery within months to one year. However, 10–15% of patients may experience a complicated recovery with lowered satisfaction with life, and impaired cognitive functions.
How Well Do EMS Providers Predict Intracranial Hemorrhage in Head-Injured Older Adults?
Published in Prehospital Emergency Care, 2020
Simson Hon, Samuel D. Gaona, Mark Faul, James F. Holmes, Daniel K. Nishijima
Inclusion and exclusion criteria regarding participants for this study has been outlined previously (19, 20). Briefly, our participants were patients 55 years and older who experienced head trauma and were transported by EMS between August 1, 2015 and September 30, 2016. Participants were excluded if they experienced penetrating head trauma, inter-facility transport, or did not undergo cranial CT imaging at their index ED visit. In addition, patients who did not consent to a follow-up telephone call or those who did not have a reliable means for follow-up were also excluded. EMS providers were given standardized data collection forms that included information pertaining to demographics, anticoagulant usage, and other clinical variables.
Effects of platelet dysfunction and platelet transfusion on outcomes in traumatic brain injury patients
Published in Brain Injury, 2018
Andrew R. Guillotte, Joseph P. Herbert, Richard Madsen, Richard D. Hammer, N. Scott Litofsky
Patients admitted to the University of Missouri Hospital with TBI between August 2016 and May 2017 were enrolled in this study. The study included adults with evidence of traumatic injury on computed tomography (CT) following blunt head trauma. Patients presenting with multisystem trauma were included in the study as long as they met the criteria for TBI. Types of lesions and injuries included subdural hematoma (SDH), traumatic subarachnoid hemorrhage (SAH), intraparenchymal hemorrhage (IPH), intraventricular hemorrhage, and skull fracture. Exclusions from the study included age younger than 18 and penetrating head trauma. Patients taking anticoagulant and antiplatelet medications were included in the study.