Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · Feb 2023
ReviewTrauma in the Aging Population: Geriatric Trauma Pearls.
The relative proportion of trauma patients who are older adults continues to rise as the population ages. Older adults who experience trauma have unique needs compared with their younger counterparts. ⋯ This article reviews the most important aspects of geriatric trauma care. We focus on presentation and initial resuscitation, triage guidelines and the issue of undertriage, the importance of multidisciplinary and specialized geriatric care, and common injuries and their management.
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Procedures such as central access and tube thoracostomy are integral in the care of the injured patient. However, both increasing life span and patient complexity of comorbidities can hinder procedural success. ⋯ From anatomy to pain control to postprocedural management, this article will be the building block for technical success. Understanding what you are doing and careful planning ahead are now more than ever crucial to patient care.
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Emerg. Med. Clin. North Am. · Feb 2023
ReviewResuscitative Endovascular Balloon Occlusion of the Aorta: A Practical Review.
Hemorrhage, in particular, noncompressible torso hemorrhage, remains a significant contributor to mortality in trauma cases. Despite many advances in resuscitation, noncompressible sites of bleeding have presented a particular challenge. ⋯ Although the technique is relatively straight-forward, it carries significant risk, in particular, from ischemia due to aortic occlusion. This article describes the role and considerations for the use of REBOA in the critically injured patient.
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Polytrauma patients often require medications to treat pain, treat agitation, and facilitate painful procedures. Though analgesia will be deferred in obtunded patients in profound shock, reduced-dose opioids or ketamine should be administered to unstable patients with severe pain with good mental status. ⋯ Severe agitation can be effectively managed with dissociative-dose ketamine, which facilitates ongoing resuscitation, including CT. Severely painful procedures can be effectively facilitated by propofol or dissociative-dose ketamine, with continuous attention to ventilation and application of a step-by-step response to hypoventilation.