Emergency medicine clinics of North America
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Blunt and penetrating trauma to the neck can result in life-threatening injuries that demand immediate attention and intervention on the part of the emergency physician and trauma surgeon. This article provides a literature-based update of the evaluation and management of injuries to aerodigestive and vascular organs of the neck. A brief review of cervical spine injuries related to penetrating neck trauma is also included. Airway injuries challenge even the most skilled practitioners; familiarity with multiple approaches to securing a definitive airway is required because success is not guaranteed with any single technique.
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In addition to the large number of patients with isolated limb injuries, many patients with major blunt or penetrating trauma harbor extremity injuries as a component of their overall clinical picture. Extremity injuries range from gross deformities and amputations to more subtle injuries, potentially difficult to diagnose, or may escape detection in unconscious or intoxicated patients. However, many soft tissue and vascular injuries require time sensitive interventions to ensure salvage of the limb and the best outcome for the patient. This article reviews the acute management of vascular and soft tissue injuries in the emergency department.
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Emergency practitioners routinely encounter patients who suffer from abdominal trauma, be it blunt or penetrating. These injuries are often confounded by altered mental status, distracting injuries, or lack of historical information, and may present challenges in management. However, in the last several years new approaches to the diagnosis and management of abdominal trauma, including bedside ultrasound, newer generation computed tomography scans, laparoscopy, and the ability for selected nonoperative management expedite identification of life threatening injury and offer new options in treatment.
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The care of the pregnant trauma patient provides unique challenges and holds profound implications for both fetal and maternal outcomes. The management of these patients is influenced by unique anatomic and physiologic changes, increased concern for deleterious radiation and medication exposures, and the need for multidisciplinary care. This article reviews the critical features necessary in the assessment, diagnosis, treatment, and disposition of pregnant trauma patients with a focus on recent developments reported in the literature as pertinent to emergency management.
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Elderly trauma patients present unique challenges and face more significant obstacles to recovery than younger patients. Despite overall higher mortality, longer length of stay, increased resource use, and higher rates of discharge to rehabilitation, most elderly trauma patients return to independent or preinjury functional status. Critical to improving these outcomes is an understanding that although similar trauma principles apply to the elderly, these patients require more aggressive evaluation and resuscitation. This article reviews the recent developments in the literature regarding care of the elderly trauma patient.