Articles: trauma.
-
Wien. Klin. Wochenschr. · Oct 2024
Case ReportsEsophageal perforation with near fatal mediastinitis secondary to Th3 fracture.
A 74-year-old male patient was referred with signs of sepsis 5 days after having been diagnosed with a rib fracture following a fall out of bed. Novel hypodensities were visible on thoracic X‑rays and laboratory tests revealed elevated inflammatory parameters. Subsequently performed thoracic computed tomography (CT) scan showed burst fracture of the 3rd thoracic vertebra, posttraumatic esophageal rupture at the same level and mediastinitis. ⋯ Up to the latest follow-up 41 months following injury, several endoscopic dilations with a bougie due to constrictions at the anastomosis have been performed. Similar to previous cases in the literature, esophageal injury was diagnosed delayed, with the patient already having developed severe complications. This extremely seldom injury should be suspected in young patients following high-energy trauma, but also in older patients after low-energy trauma but known degenerative changes of the vertebral column.
-
Eur J Trauma Emerg Surg · Oct 2024
Observational StudyCarbon dioxide angiography during angioembolization for trauma patients increases the detection of active bleeding and leads to reliable hemostasis: a retrospective, observational study.
Angiography with carbon dioxide (CO2) has long been used as an alternative when iodine contrast media (ICM) cannot be used due to allergy to iodine or renal dysfunction. Conversely, CO2 angiography is also known as a provocation method for active bleeding. In this study, we examined the efficacy of CO2 angiography in angioembolization (AE) for trauma patients. ⋯ CO2 angiography of trauma patients may have a better detection rate of active bleeding compared with ICM, leading to reliable hemostasis.
-
Complex fractures are severe injuries that cause considerable disability, particularly in the working population. Effective rehabilitation is essential to achieve good outcomes, however, it is unclear what the best rehabilitation strategy is for adults with complex fractures, after their discharge from hospital. The aim of this scoping review was to identify and map the breadth of evidence available on this topic. ⋯ There is a broad and varied approach to the rehabilitation of complex fractures. The studies differed in population and approach, with a wide range of injuries, interventions and modes of delivery reported. Fidelity was poorly described, with only a third of studies reporting adherence or acceptability. There was inconclusive evidence to inform clinical practice and further research is advised. Qualitative, expert consensus, and coproduction approaches are recommended methods to develop complex interventions and best practice guidance.
-
Critical care clinics · Oct 2024
ReviewDisparities in Access, Management and Outcomes of Critically Ill Adult Patients with Trauma.
Despite legal protections guaranteeing care for patients with trauma, disparities exist in patient outcomes. We review disparities in patient management and outcomes related to insurance status, race and ethnicity, and gender for patients with trauma in the preadmission, in-hospital, and postdischarge settings. We highlight groups understudied and either underrepresented or unrepresented in national trauma databases-including American Indians/Alaska Natives, non-English preferred patients, and patients with disabilities. We call for more study of these groups and of upstream factors affecting the reviewed demographics to measure and improve outcomes for these vulnerable populations.
-
Growing evidence from pharmacovigilance data and postmortem toxicology reports highlights the misuse potential of gabapentinoids. This study aimed to investigate the risk of serious adverse outcomes (drug misuse, overdose, major trauma), and their risk factors, in primary care patients who are prescribed gabapentinoids. Using the UK Clinical Practice Research Datalink, a matched cohort study calculated adverse event rates separately for gabapentinoid-exposed and unexposed cohorts. ⋯ The association with overdose was stronger for pregabalin than gabapentin. All adverse outcomes were significantly associated with smoking, history of substance misuse, overdose, or a mental health condition and prescription of opioids, benzodiazepines, antidepressants, and Z-drug hypnotics (eg, gabapentin hazard ratios for association of concurrent opioid use: misuse 1.49 [1.47-1.51]; overdose 1.87 [1.78-1.96]; major trauma 1.28 [1.26-1.30]). Our findings highlight the importance of careful patient selection when prescribing gabapentinoids and the need to educate prescribers about the risks of these drugs, particularly in combination with other central nervous system depressants.