Articles: trauma.
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Trauma-induced coagulopathy remains a significant contributor to mortality in severely injured patients. Fibrinogen is essential for early hemostasis and is recognized as the first coagulation factor to fall below critical levels, compromising the coagulation cascade. Recent studies suggest that early administration of fibrinogen concentrate is feasible and effective to prevent coagulopathy. We conducted a scoping review to characterize the existing quantity of literature and to explore the usage of prehospital fibrinogen concentrate products in improving clinical outcomes in trauma patients. ⋯ Preliminary research suggests that prehospital fibrinogen concentrate administration in traumatic bleeding patients is both feasible and effective, improving clotting parameters. While implementing a time-saving and proactive approach with fibrinogen holds potential for enhancing trauma care, the current evidence is limited. Further studies in this novel field are warranted.
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Combat casualty care has advanced significantly with the implementation of evidence-based protocols designed to lower combat-related mortality. Over the last decade, two major urban conflicts in southern Israel have challenged the evolving military trauma system. This study aimed to assess differences in prehospital care and compare the outcomes of aeromedically evacuated casualties from the 2014 and 2023 conflicts. ⋯ Over the past decade, there has been a decline in prehospital airway interventions and thoracostomies, coupled with an increase in early blood transfusions. Despite greater injury severity, mortality rates have remained stable. Although not statistically significant, lower mortality rates were recorded among the severely and critically injured. These findings support the "less is more" approach in modern prehospital combat casualty care.
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Case Reports
Delayed diagnosis of pediatric bladder rupture with atypical presentation after a minor fall.
Pediatric bladder injuries, though uncommon, typically result from blunt trauma, often associated with motor vehicle collisions. While most bladder injuries are linked to pelvic fractures, this association may be less common in children due to anatomical differences. Bladder injuries are classified as extraperitoneal, intraperitoneal, or combined, with intraperitoneal injuries being rarer but more prevalent in children due to their higher abdominal bladder position. This case report discusses a rare instance of delayed intraperitoneal bladder rupture in a young child following a relatively minor fall, emphasizing diagnostic challenges. ⋯ A 4-year-old female presented with new onset abdominal pain, vomiting, and subjective fever three days after a minor fall. Initial evaluation revealed diffuse abdominal tenderness, elevated creatinine, and moderate ascites on ultrasound with no gross hematuria. Despite treatment for presumed acute kidney injury, the patient's condition worsened, leading to the identification of a large posterior dome bladder rupture via cystography. Surgical repair was performed, and the patient was discharged with a full recovery after sequential removal of urinary catheters. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Intraperitoneal bladder rupture can occur in healthy children after minor trauma and may not present acutely with the classic signs of gross hematuria and peritonitis. Emergency physicians should consider this diagnosis in young children with unexplained ascites, abdominal pain, hematuria, and renal failure, even with only a remote history of minor abdominal trauma.