Abdominal trauma in dogs 2. management

Trauma represents a big challenge for emergency doctors both in human and veterinary medicine. There have been great advancements in trauma medicine in people and these often provide an inspiration for veterinary surgeons. However, the vast differences in the facilities and finances available in human and veterinary medicine make the approach to trauma in both fields quite different. This article, the second in a two-part series, describes how to manage canine trauma patients. The first part focused on the initial investigation of canine abdominal trauma. Although this article will mention guidelines in people, these should not be automatically applied to dogs, especially when more relevant evidence for this species exists

Treating Trauma Among Veterans Using Complementary and Alternative Medicine: A Systematic Review

In this systematic review, literature and empirical intervention studies pertaining to the treatment of trauma among veterans using a Complementary and Alternative Medicine was analyzed. Using two databases, PsycINFO and PILOTS, 10 studies were located and key data was identified on theoretical foundations, therapy components, populations being served, as well as outcomes of interventions treating trauma among veterans via Complementary and Alternative Medicine. Each study was analyzed in full, to determine types of Complementary and Alternative Medicine interventions as well as results of the interventions utilized. The findings produced two major themes of Complementary and Alternative Medicine research treating trauma among veterans; Mindfulness-based and non-mindfulness based practices. The findings suggested that all interventions studied showed promising results in Complementary and Alternative Medicine interventions treating trauma among veterans, and implications for future research should focus on additional research and inquiry into the use of Complementary and Alternative Medicine treating trauma among veterans

Adverse Childhood Experiences in the New Mexico Juvenile Justice Population

Faculty from the University of New Mexico (UNM) School of Law and the UNM School of Medicine, and New Mexico’s Children, Youth and Families Department (CYFD) initiated a joint project to look at the prevalence of Adverse Childhood Experiences (ACEs) nationally and in New Mexico. The study was intended to better establish the association between early childhood trauma and delinquency, as well as to explore the role that law and medicine can play in ensuring better health and juvenile justice outcomes for children who have experienced ACEs

A holistic aboriginal framework for individual healing

This paper offers up an holistic Indigenous model of individual healing that utilizes medicine wheel teachings to break down the four aspects (spiritual, emotional, physical, and mental) of individual wellness. Teachings about each direction are presented followed by practice techniques for each aspect of the individual self. It is bookended by an introduction to the historical trauma faced by Indigenous peoples in Canada, and a conclusion that draws implications for healing

Characteristics of Mortalities related to Pulmonary Embolism following Multiple Trauma; a Brief Report

Introduction: Pulmonary embolism (PE) is introduced as the third major cause of death after trauma in those who survive more than 24 hours. This study aimed to describe the characteristics of mortalities due to trauma related PE in cases referred to the forensic medicine department.Methods: The present cross sectional study was conducted on medical profiles of cadavers that were registered as trauma related mortality in the dissection department of the Forensic Medicine Organization, Tehran, Iran, during 2011 to 2016.Results: The cause of death for 92 of the 10800 (0.85%) evaluated cadavers was diagnosed as trauma related PE. The mean age of these patients was 58.37 ± 19.39 years (66.3% male). Only 14 (15.2%) hospitalized patients had received anticoagulant agents. The most frequent trauma related PE mortality cases were male (p = 0.003) and aged > 55 years (p = 0.005), with trauma to death time of < 3 weeks (p = 0.004), lower limb injury (p = 0.003), car crash trauma mechanism (p = 0.003), and no anticoagulant prescribed (p = 0.001).Conclusion: According to the results of the present study, the prevalence of trauma related PE mortality was 0.85%. It seems that, having a clear anticoagulation therapy protocol in trauma centers could be helpful in decreasing the prevalence of traumatic thromboembolism and its’ related mortality

Regional Anesthesia in Trauma Medicine

Regional anesthesia is an established method to provide analgesia for patients in the operating room and during the postoperative phase. While regional anesthesia offers unique advantages, as shown by the recent military experience, it is not commonly utilized in the prehospital or emergency department setting. Most often, regional anesthesia techniques for traumatized patients are first utilized in the operating room for procedural anesthesia or for postoperative pain control. While infiltration or single nerve block procedures are often used by surgeons or emergency medicine physicians in the preoperative phase, more advanced techniques such as plexus block procedures or regional catheter placements are more commonly performed by anesthesiologists for surgery or postoperative pain control. These regional techniques offer advantages over intravenous anesthesia, not just in the perioperative phase but also in the acute phase of traumatized patients and during the initial transport of injured patients. Anesthesiologists have extensive experience with regional techniques and are able to introduce regional anesthesia into settings outside the operating room and in the early treatment phases of trauma patients

Adherence to Guidelines for Acute Rehabilitation in the Norwegian Trauma Plan.

Objective: To evaluate adherence to 3 central operational recommendations for acute rehabilitation in the Norwegian trauma plan. Methods: A prospective multi-centre study of 538 adults with moderate and severe trauma with New Injury Severity Score >9. Results: Adherence to the first recommendation, assessment by a physical medicine and rehabilitation physician within 72 h following admission to the intensive care unit (ICU) at the trauma centre, was documented for 18% of patients. Adherence to the second recommendation, early rehabilitation in the intensive care unit, was documented for 72% of those with severe trauma and ≥2 days ICU stay. Predictors for early rehabilitation were ICU length of stay and spinal cord injury. Adherence to the third recommendation, direct transfer of patients from acute ward to a specialized rehabilitation unit, was documented in 22% of patients, and occurred more often in those with severe trauma (26%), spinal cord injury (54%) and traumatic brain injury (39%). Being employed, having head or spinal chord injury and longer ICU stay were predictors for direct transfer to a specialized rehabilitation unit. Conclusion: Adherence to acute rehabilitation guidelines after trauma is poor. This applies to documented early assessment by a physical medicine and rehabilitation physician, and direct transfer from acute care to rehabilitation after head and extremity injuries. These findings indicate a need for more systematic integration of rehabilitation in the acute treatment phase after trauma

Trauma Ultrasound in Civilian Tactical Medicine

The term “tactical medicine” can be defined in more than one way, but in the nonmilitary setting the term tactical emergency medical services (TEMS) is often used to denote medical support operations for law enforcement. In supporting operations involving groups such as special weapons and tactics (SWAT) teams, TEMS entail executing triage, diagnosis, stabilization, and evacuation decision-making in challenging settings. Ultrasound, now well entrenched as a part of trauma evaluation in the hospital setting, has been investigated in the prehospital arena and may have utility in TEMS. This paper addresses potential use of US in the tactical environment, with emphasis on the lessons of recent years’ literature. Possible uses of US are discussed, in terms of both specific clinical applications and also with respect to informing triage and related decision making

Arbitrium

Part of learning hospital based medicine is coming to grips with the grief and trauma of illness, aging and disease

Surgeons’ and Emergency Physicians’ Perceptions of Trauma Management and Training

Objective: The study objective was to determine whether surgeons and emergency medicine physicians (EMPs) have differing opinions on trauma residency training and trauma management in clinical practice.Methods: A survey was mailed to 250 EMPs and 250 surgeons randomly selected.Results: Fifty percent of surgeons perceived that surgery exclusively managed trauma compared to 27% of EMPs. Surgeons were more likely to feel that only surgeons should manage trauma on presentation to the ED. However, only 60% of surgeons currently felt comfortable with caring for the trauma patient, compared to 84% of EMPs. Compared to EMPs, surgeons are less likely to feel that EMPs can initially manage the trauma patient (71% of surgeons vs. 92% of EMPs).Conclusion: EMPs are comfortable managing trauma while many surgeons do not feel comfortable with the complex trauma patient although the majority of surgeons responded that surgeons should manage the trauma.[WestJEM. 2009;10:144-149.