Trauma

Autopsy by CT – What Can Post-Mortem CT Teach Us About Trauma Care?

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Information gathered from post-mortem CT shows that fatal injury patterns in blunt trauma are similar for those who die prior to ED arrival vs. after arrival. The frequent identification of unevacuated pneumothorax and endotracheal tube misplacement suggests that mandatory surgical chest decompression and tube placement confirmation should always be performed on blunt trauma arrest patients.

PROCOAG RCT – Early PCC for Trauma Patients at Risk of Massive Transfusion

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This well-designed RCT finds early administration of 4-factor prothrombin complex concentrate (PCC) to patients at risk of receiving massive transfusion protocol (MTP) did not reduce 24-hour blood product consumption or mortality but did increase thrombotic events.

Source
Efficacy and Safety of Early Administration of 4-Factor Prothrombin Complex Concentrate in Patients With Trauma at Risk of Massive Transfusion: The PROCOAG Randomized Clinical Trial. JAMA. 2023 Mar 21. doi: 10.1001/jama.2023.4080. Online ahead of print.

Does Ketamine Raise ICP in Children with TBI?

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This retrospective study of thirty-three pediatric patients with severe traumatic brain injury (sTBI) demonstrated no increase in intracranial pressure (ICP) after administration of ketamine.

Source
Acute Effects of Ketamine on Intracranial Pressure in Children with Severe Traumatic Brain Injury. Crit Care Med. 2023 Feb 24; e005806 DOI: 10.1097

Can We Observe Liver Lacs with Active Extravasation?

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Observation is highly effective in select hemodynamically stable patients with liver laceration and active extravasation and leads to few additional interventions in these patients, while angioembolization is associated with higher rates of drain placement for abscess or biloma and increased length of stay (LOS).

Source
An observation-first strategy for liver injuries with “blush” on computed tomography is safe and effective. J Trauma Acute Care Surg. 2023 Feb 1;94(2):281-287. doi: 10.1097/TA.0000000000003786. Epub 2022 Sep 23.

A New TASER Model is Out There – What You Need to Know

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Conducting energy devices (CEDs, i.e., TASER) are used to bridge the gap between interpersonal (punching, batons, spray) and firearm techniques when deescalating violent or serious situations by law enforcement. This article covers general considerations of CEDs and specific need to know info on the newest TASER model to hit the streets.

Does E-FAST Add Value Before CT Traumagram?

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An initial diagnostic workup that includes an E-FAST exam and targeted chest and pelvis x-rays allows clinicians an opportunity to assess and intervene appropriately on the majority of patients prior to WBCT in the setting of blunt trauma.

Source
Appropriateness of Initial Course of Action in the Management of Blunt Trauma Based on a Diagnostic Workup Including an Extended Ultrasonography Scan. JAMA Netw Open. 2022 Dec 1;5(12):e2245432. doi: 10.1001/jamanetworkopen.2022.45432.

Stop the Bleeding…of Unnecessary Care – Another Strike Against Delayed Head CT

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No significant difference in delayed intracranial hemorrhage (dICH) was seen in patients on antithrombotic (AT) medication vs. no AT among patients with repeat CT.

Source
Findings on Repeat Posttraumatic Brain Computed Tomography Scans in Older Patients With Minimal Head Trauma and the Impact of Existing Antithrombotic Use. Ann Emerg Med. 2022 Oct 31;S0196-0644(22)00580-7. doi: 10.1016/j.annemergmed.2022.08.006. Online ahead of print.

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