Emergency medicine clinics of North America
-
Old age is a risk factor for poor outcome in trauma patients, as a result of undertriage and the presence of occult life-threatening injuries. The mechanisms of injury for geriatric trauma differ from those in younger patients, with a much higher incidence of low-impact trauma, especially falls from a low height. Frailty is a risk factor for severe injury after minor trauma, and caring for these patients require a multidisciplinary team with both trauma and geriatric expertise. With early recognition and aggressive management, severe injuries can still be associated with good outcomes, even in very elderly patients.
-
Emerg. Med. Clin. North Am. · Feb 2018
ReviewReanimating Patients After Traumatic Cardiac Arrest: A Practical Approach Informed by Best Evidence.
Resuscitation of traumatic cardiac arrest is typically considered futile. Recent evidence suggests that traumatic cardiac arrest is survivable. ⋯ In addition, a rationale for deprioritizing chest compressions, steps to quickly reverse dysfunctional ventilation, techniques for temporary control of hemorrhage, and the importance of blood resuscitation are discussed. The best available evidence and the authors' collective experience inform this article.
-
Emerg. Med. Clin. North Am. · Feb 2018
ReviewThe Human Factor: Optimizing Trauma Team Performance in Dynamic Clinical Environments.
Resilience is built, not born, and there is no single strategy that reliably manufactures resilient performance in all circumstances. Optimizing team performance in dynamic environments involves the complex interplay of strategies that target individual preparation, team interaction, environmental optimization, and systems-level resilience engineering. To accomplish this, health care can draw influence from human factors research to inform tangible, practical, and measurable improvements in performance and outcomes, modified to suit local and domain-specific needs.
-
Airway management in the trauma patient presents numerous unique challenges beyond placement of an endotracheal tube and outcomes are dependent on the provider's ability to anticipate difficulty. Airway management strategies for the care of the polytrauma patient are reviewed, with specific considerations for those presenting with traumatic brain injury, suspected c-spine injury, the contaminated airway, the agitated trauma patient, maxillofacial trauma, and the traumatized airway. An approach to airway management that considers the potential anatomic and physiologic challenges in caring for these complicated trauma patients is presented.
-
Emerg. Med. Clin. North Am. · Feb 2018
ReviewCritical Decisions in the Management of Thoracic Trauma.
Traumatic injuries to the thorax are common after both blunt and penetrating trauma. Emergency medicine physicians must be able to manage the initial resuscitation and diagnostic workup of these patients. ⋯ This knowledge is critical to allow for rapid decision making when life-threatening injuries are encountered. This article explores the initial resuscitation and assessment of patients after thoracic trauma, discusses available imaging modalities, reviews frequently performed procedures, and provides an overview of the indications for operative intervention, while emphasizing the critical decision making throughout.