J Trauma
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This article is an introduction to brief motivational interventions, which is an effective strategy to address alcohol-use disorders and the public health issues these disorders present. In this article, we summarize core concepts and our clinical experiences. To explore the contrast between these interventions and more traditional approaches to patient-provider interaction, the article describes strategies used in brief motivational interventions, answers common questions about the process, and provides references and resources for those who would like to learn more.
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Most trauma surgeons are unfamiliar with screening, brief intervention, and referral (SBIR) programs for substance use disorders, and few trauma centers provide them. This report describes how an urban private-teaching hospital adapted a protocol from an existing emergency department-based program to include patients treated by the trauma service. ⋯ SBIR services can be effectively integrated into all components of a busy, urban trauma service by adding specially trained health educators to the trauma service staff. This collaboration provides effective SBIR services to both trauma and emergency service patients without interfering with patient flow or medical procedures. The relatively high percentage of patients at risk for alcohol or drug problems supports the inclusion of routine alcohol and drug screening for all eligible trauma patients.
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The use of illicit drugs, specifically heroin and cocaine, complicates trauma patient management and consumes extensive hospital resources. This paper focuses on heroin- and cocaine-related injuries observed by physicians at Detroit Receiving Hospital, a large urban Level I trauma center. The pharmaceutical effects, mode of administration, and the manner in which these drugs affect diagnosis and treatment of injuries are documented and discussed. ⋯ Illicit drug use significantly complicates initial diagnosis and trauma management and is associated with severe adverse pathophysiologic effects. Currently, prevention efforts, such as interventions in trauma centers, should be considered as the most efficient and feasible way to prevent injury recidivism in this patient population. We also conclude that legislative change may be the answer in reducing or preventing the horrendous problems caused by illicit drugs.
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Hypercoagulability is a major source of morbidity and mortality after injury. A resuscitation regimen that modulates this coagulopathy may prove beneficial. We sought to evaluate the effects of lactated Ringer's (LR) solution and Hextend on the resuscitation of uncontrolled hemorrhagic shock. ⋯ Modulation and restoration of normal coagulation is critical in the management of trauma patients. The patient's coagulation profile might determine the type of fluid to be used at various times during their course. Thrombelastography is superior to routine coagulation assays for the detection of a hypercoagulable state. Resuscitation with Hextend results in a decreased fluid requirement and attenuation of hypercoagulability after injury without increased blood loss.
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Historically, arteriography has been used routinely in patients with knee dislocations. Recently, selectivity based on physical examination (PE) has emerged. Critics cite limited clinical evidence. We sought to determine whether PE accurately confirms or excludes surgically significant vascular injuries associated with knee dislocations. ⋯ Routine arteriography is unnecessary in patients with a normal PE after reduction of the knee dislocation.