How Many PECARN-Negative Kids Have ICH or Fracture on CT?
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This database review of pediatric head trauma patients who had CT identified GCS 3-8 as an exam finding associated with intracranial hemorrhage (ICH); age, gender, and GCS were also associated with facial or skull fracture. It also found significant imaging results may exist in PECARN-negative patients.
Source
Risk Factors Associated with Traumatic Brain Injury and Implementation of Guidelines for Requesting Computed Tomography After Head Trauma Among Children in France. JAMA Netw Open. 2023 May 1;6(5):e2311092. doi: 10.1001/jamanetworkopen.2023.11092.
Siblings of Children with Suspected Physical Abuse – When to Image
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Asymptomatic contact children of patients presenting with physical abuse are a vulnerable population who should be screened for traumatic injuries. This report details guidelines for radiologic screening.
Grandma Broke Her Neck? Prevalence of C-Spine Injuries from Ground Level Fall Over 65 Years
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This systematic review found that the prevalence of cervical spine injuries in patients 65 years or older after a ground level or low-level fall was between 3.8-4.1%.
Source
Cervical spine injuries in adults ≥ 65 years after low-level falls - A systematic review and meta-analysis. Am J Emerg Med. 2023 May;67:144-155. doi: 10.1016/j.ajem.2023.02.008. Epub 2023 Feb 10.
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.
CT C-Spine Negative? Clear The Kid’s Collar
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In this large, single-institution retrospective review of pediatric blunt trauma patients, no clinically significant injuries (requiring operative intervention) were missed when using multi-detector CT scan as the imaging modality of choice.
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.
Should Trauma Patients Be Intubated in the Emergency Department or the OR?
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Patients who required hemorrhage control surgery after major trauma and were intubated in the ED had higher rates of adverse outcomes than those intubated in the OR. Importantly, patients with “clinical indications for intubation” were excluded from analysis.
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.