Articles: trauma.
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Pregnancy and trauma are complex situations with significant implications for maternal and fetal health. Physical and psychological trauma during pregnancy can lead to pre-term labor, abruptio-placenta, and fetal injury or death. Management of trauma is challenging due to physiological and anatomical changes, which can affect fracture management and the risk of radiation exposure. A multidisciplinary approach is beneficial for patient care. This study aimed to determine the impact of orthopaedic trauma on pregnancy and its outcome, and influence of pregnancy on fracture management. ⋯ Orthopaedic trauma during pregnancy can significantly affect pregnancy outcomes and is associated with a notably higher risk of fetal loss. An elective-caesarean-section is recommended for patients with polytrauma, pelvic-injuries, and those who are immobilized for longer-duration. During the third-trimester and in polytraumatized patients, external-fixator-application for lower-limb-injuries is a safe strategy, and definitive fixation could be performed post-delivery.
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Traumatic hemothorax (HTX) is often managed with tube thoracostomy (TT); however, TT carries a high complication rate. In 2017, a guideline was implemented at our Level I trauma center to observe traumatic HTX 300 mL or less in patients who are hemodynamically stable. We hypothesized that this guideline would decrease TT placement without increasing observation failure rates. ⋯ The implementation of the 300-mL guideline led to a decrease in TT placement without increasing observation failure or complication rates.
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Multicenter Study
Risk factors for infection in severe open tibial shaft fractures.
To evaluate risk factors for infection in severe open tibial shaft fractures. ⋯ Surgeons can now counsel patients with these risk factors that they are at a markedly higher risk of infection. The identification of these risk factors may direct future research aimed at mitigating the risk of deep surgical site infection in this patient population.
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The Scottish Highlands face unique prehospital care challenges due to population dispersity, mountainous terrain, seasonal weather, and higher trauma burden compared to the nearest Major Trauma Centres (MTCs) as highlighted by the Scottish Trauma Audit Group (STAG). Primary road/air transfer from scene to nearest designated MTC averages 1-5 hours, making prompt and informed utilisation of prehospital and in-hospital resources within the Highlands critical - comparative to other UK metropolitan regions where the trauma population majority lay within 20-45 minute transfer windows. This paper reviews the Highland pre-hospital immediate care and trauma (PICT) Team's trauma response through a retrospective review of PICT patient report forms (PRFs). ⋯ Results highlight the Scottish Highlands' trauma burden and PICT's added value; with increased trauma response and improving outcomes. Despite the rate and ratio of major trauma not reducing PICT Team utilisation has, potentially led to fewer patients over narrower geography at later stages in emergency calls accessing the enhanced care doctor and advanced physician team than was achieved previously.
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Alcohol is commonly detected in patients presenting to hospital after major trauma and is a key preventable risk factor for injury. While it has been suggested that alcohol intoxication at the time of injury results in worse acute patient outcomes, there is currently limited knowledge on the impact of alcohol on health outcomes following hospital discharge. The aim of this study was to examine the relationship between acute pre-injury alcohol exposure and the self-reported health outcomes of survivors of major trauma 12-months post-injury. ⋯ Acute pre-injury alcohol exposure was not associated with increased reporting of problems on the EQ-5D or with return to work at 12-months post-injury. Further research is needed to understand why patients with alcohol detections were sometimes associated with paradoxically better 12-month post-injury outcomes relative to patients without alcohol detections.