Injury
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An abnormal shock index (SI) is associated with greater injury severity among children with trauma. We sought to empirically-derive age-adjusted SI cutpoints associated with major trauma in children, and to compare the accuracy of these cutpoints to existing criteria for pediatric SI. ⋯ Age-adjusted SI cutpoints demonstrated a mild gain in sensitivity compared to existing measures. However, our findings suggest that the SI alone has a limited role in the identification of major trauma in children.
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Recurrent pneumothorax (rPTX) is a common complication following thoracostomy tube (TT) removal in chest trauma patients. While chest X-ray (CXR) is most commonly used to detect a rPTX, bedside ultraportable ultrasound (UPUS) is a feasible, low cost, and radiation free alternative. No consensus exists with regards to the optimal timing of diagnostic imaging to assess for rPTX post-TT removal. Accordingly, we sought to identify an ideal UPUS timing to detect a rPTX METHODS: We conducted a single center prospective study of adult (≥18years) patients admitted with a chest trauma. UPUS examinations were performed using the Butterfly iQ+™ ultrasound. Three intercostal spaces (ICS) were evaluated (2nd through 4th). Post-TT UPUS examinations were performed at different timepoints following tube removal (1-6 h). A rPTX on UPUS was defined as the absence of lung-sliding in one or more intercostal spaces, and was considered a clinically concerning rPTX if lung-sliding was absent in ≥2 ICS. UPUS findings were compared to CXR. ⋯ Level II, Diagnostic Tests or Criteria.
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The Advanced Trauma Life Support guidelines (ATLS; 2018, 10th ed.) recommend an early and liberal supplemental oxygen for all severely injured trauma patients to prevent hypoxaemia. As of 2024, these guidelines remain the most current. This may lead to hyperoxaemia, which has been associated with increased mortality and respiratory complications. We aimed to investigate the attitudes among clinicians, defined as physicians and prehospital personnel, towards the use of supplemental oxygen in trauma cases. ⋯ Almost three out of four clinicians did not support the administration of supplemental oxygen to all severely injured trauma patients, regardless of SpO2. This corresponds to a more restrictive approach than recommended in the current ATLS (2018, 10th ed.) guidelines.
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There is a global surge in blast injuries, which are associated with high morbidity and mortality. To our knowledge, there are no guidelines for the management of blast injuries in the trauma bay. ⋯ Blast injuries present unique challenges in management and demand a multidisciplinary approach and specialized resources. We present an algorithm for terror- and combat-related blast injuries treated in our trauma bay. The step-by-step procedures may be applicable to any blast injury sustained under variable conditions.
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Vascular injuries are associated with high morbidity and mortality. The management is exceedingly demanding and requires involvement of senior clinician. There are known complications associated with vascular injury ranging from limb loss, stroke, and death. There are limited studies examining other injuries that are associated with vascular trauma. This study aimed to review the pattern, management and outcomes of the other injuries associated with vascular injuries. ⋯ Out of 2805 patients that were admitted in trauma ICU from 2013 to 2022, 153 (5 %) patients had vascular injuries. There were 154 documented vascular injuries and 212 associated injuries. This study found that fractures are the most common injuries to be associated with vascular injury CONCLUSION: The nature of vascular injury and delay to intervention determines outcome of patients, however associated injuries also play an important role in affecting outcomes. The presence of associated injury encourages the multi-disciplinary approach to optimise outcomes.