Articles: trauma.
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Pediatric emergency care · Dec 2024
The Use of POCUS to Identify Subgaleal Fluid Collections and Intracranial Infections.
Point-of-care ultrasound (POCUS) has been useful in describing soft tissue infections, such as cellulitis and abscesses. There has been limited use of ultrasound to describe findings of intracranial infections, such as Pott's puffy tumor, in cases of forehead prominence and signs of infection. ⋯ Ultrasound findings revealed subgaleal fluid collections with associated periosteal lifting of the frontal bone in cases of Pott's Puffy tumor and intracranial infection, but no bony disruption or periosteal lifting in the patient with traumatic soft tissue edema. As pediatric intracranial infections may continue to have uncharacteristic seasonal peaks, POCUS may be considered as a first-line imaging technique for patients presenting with forehead swelling for differentiating infectious and traumatic etiologies as well as judging the need for further imaging techniques such as computed tomography and magnetic resonance imaging.
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Early administration of supplemental oxygen for all severely injured trauma patients is recommended, but liberal oxygen treatment has been associated with increased risk of death and respiratory complications. ⋯ In adult trauma patients, an early restrictive oxygen strategy compared with a liberal oxygen strategy initiated in the prehospital setting or on trauma center admission for 8 hours did not significantly reduce death and/or major respiratory complications within 30 days.
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Fluid resuscitation choices in prehospital trauma care are limited, with most Emergency Medical Services (EMS) agencies only having access to crystalloids. Which solution to use, how much to administer, and judging the individual risks and benefits of giving or withholding fluids remains an area of uncertainty. To address the role of crystalloid fluids in prehospital trauma care, we reviewed the available relevant literature and developed recommendations to guide clinical care. ⋯ Risks of IV fluid use, or restriction, in trauma resuscitation should be weighed against possible benefits. Strategies to reduce the need for IV fluids should be considered. A standard trauma resuscitation curriculum for prehospital providers should be developed to improve evidence-based delivery of IV fluids in trauma.
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Monitoring of electrocorticography for the purpose of detecting spreading depolarization (SD) events is becoming increasingly used both for research and clinical applications. Although such monitoring bears many similarities to standard long-term epilepsy monitoring, there are a number of differences that neurosurgeons need to be aware of when initiating such a program. In addition, most of the focus in SD monitoring has been on traumatic and vascular conditions, where invasive monitoring is used commonly, but electrocorticography is not commonly used. ⋯ It is also recognized that this is a rapidly evolving field and that new advances may disrupt these approaches and that there is a diversity of opinion on these topics, even among SD experts. Nonetheless, the general approach to SD monitoring has now been in use for >15 years and is the basis for several active and proposed clinical trials (NCT05337618, NCT04966546), so an understanding from a neurosurgical perspective of the rationale and approach to monitoring is warranted. In this review, we will consider the potential indications for SD monitoring in clinical trials or clinical care, the methodology for recording and interpreting, and finally some potential therapeutic approaches that are being considered in patients with clinically detected SD.
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Military sexual trauma (MST) has been associated with long-term negative outcomes such as increased rates of cardiovascular disease, post-traumatic stress disorder (PTSD), and suicidal thoughts and behaviors. While evidence supports the effectiveness of psychotherapeutic approaches as treatments for MST and related PTSD symptoms, these interventions have limited impact, attributed to perceived stigma with high dropout rates in female Veterans. Complementary and integrative health (CIH) interventions provide an alternative that may be more acceptable and can help transition Veterans into mental health treatments. Although evidence supports the utility of individual CIH interventions to be both effective and acceptable treatments for MST-related PTSD amongst female Veterans, there are limited evaluations of interventions that combine multiple CIH modalities, specifically in populations of at-risk female Veterans with histories of suicidal ideation or behavior. Thus, this quality improvement (QI) project aimed to assess the impact of a multimodal CIH intervention on mental and physical health symptoms specifically in female at-risk Veterans with MST. ⋯ The results of this QI evaluation add to the growing body of evidence demonstrating that CIH interventions can be effective in attenuating mental health symptom-related MST and particularly within female Veteran populations at-risk for suicide, underscoring the potential importance of investigating integration of multiple CIH interventions for treatment of at-risk populations in future clinical research studies.