Emergency medicine clinics of North America
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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.
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Emergency department response to the pediatric trauma patient starts with the basics-ABCDE. Certain important differences in pediatric patients, such as airway physiology and drug dosing, must be considered but standardized resources are available. Pediatric blunt and penetrating trauma treatment also have mechanisms and nuances that distinguish them from adult cases. Pediatric literature is slowly growing which can shape evidence-based practice for care including blood transfusions, medications, and procedures.
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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
ReviewProtect That Neck! Management of Blunt and Penetrating Neck Trauma.
Blunt and penetrating vascular injuries to the neck represent a significant burden of mortality and disability among trauma patients. Blunt cerebrovascular injury can present with signs of stroke either immediately or in a delayed fashion. ⋯ In contrast, for patients presenting with penetrating neck injuries, assessment for hard signs of vascular and aerodigestive injury should be done and prompt emergent surgical consultation if present. Overall management priorities for penetrating neck injuries focus on airway management, hemorrhage control, and damage control resuscitation before definitive surgical repair.