Current Issue : October - December Volume : 2014 Issue Number : 4 Articles : 5 Articles
Background: Concern has been raised that cervical collars may increase intracranial pressure in traumatic brain\ninjury. The purpose of this study was to compare four types of cervical collars regarding efficacy of immobilizing\nthe neck, effect on jugular venous pressure (JVP), as a surrogate for possible effect on intracranial pressure, and\npatient comfort in healthy volunteers.\nMethods: The characteristics of four widely used cervical collars (Laerdal StifneckÃ?® (SN), VistaÃ?® (VI), Miami J\nAdvancedÃ?® (MJ), PhiladelphiaÃ?® (PH)) were studied in ten volunteers. Neck movement was measured with\ngoniometry, JVP was measured directly through an endovascular catheter and participants graded the collars\naccording to comfort on a scale 1ââ?¬â??5.\nResults: The mean age of participants was 27 Ã?± 5 yr and BMI 26 Ã?± 5. The mean neck movement (53 Ã?± 9Ã?°) decreased\nsignificantly with all the collars (p < 0.001) from 18 Ã?± 7Ã?° to 25 Ã?± 9Ã?° (SN < MJ < PH < VI). There was a significant increase in\nmean JVP (9.4 Ã?± 1.4 mmHg) with three of the collars, but not with SN, from 10.5 Ã?± 2.1 mmHg to 16.3 Ã?± 3.3 mmHg\n(SN < MJ < VI < PH). The grade of comfort between collars varied from 4.2 Ã?± 0.8 to 2.2 Ã?± 0.8 (VI >MJ > SN > PH).\nConclusion: Stifneck and Miami J collars offered the most efficient immobilization of the neck with the least effect on\nJVP. Vista and Miami J were the most comfortable ones. The methodology used in this study may offer a new\napproach to evaluate clinical efficacy and safety of neck collars and aid their continued development....
Introduction: Horse riding, with almost 200,000 participants, is the eighth most popular sport in Sweden. Severe\ninjuries can occur with horse riding accidents which is well documented. This study was undertaken to investigate\nif injuries associated with horse riding are common, which type of injuries occur, what mechanisms are involved\nand to estimate the costs to the society.\nMaterial and methods: All patients attending the emergency department at Link�¶ping University Hospital, during\nthe years 2003-2004, due to horse related trauma were prospectively recorded. The patients were divided into two\ngroups according to age, 147 children and 141 adults. The medical records were retrospectively scrutinized.\nResults: The most common mechanism of injury was falling from the horse. Most commonly, minor sprains and\nsoft tissue injuries were seen, but also minor head injuries and fractures, mainly located in the upper limb. In total\n26 adults and 37 children were admitted. Of these 63 patients 19 were considered having a serious injury. In total,\nfour patients needed treatment in intensive care units.\nThe total cost in each group was 200,000 Euro/year.\nConclusion: Horse riding is a sport with well known risks. Our results corresponds to the literature, however we\nhave not observed the same incidence of serious injuries. In contrast we find these to be fairly uncommon. The\ninjuries are mainly minor, with a small risk of long term morbidity. Over time regulations and safety equipment\nseem to have decreased the number of serious accidents....
Background: The goal of this study was to examine PHTLS Provider courses in Germany and to proof the\nassumption that formation of physicians and paramedics in prehospital trauma care can be optimized.\nMethods: PHTLS participants were asked to fill out standardized questionnaires during their course preparation and\ndirectly after the course. There were some open questions regarding their professional background and closed\nquestions concerning PHTLS itself. Further questions were to be answered on an analog scale in order to quantify\nsubjective impressions of confidence, knowledge and also to describe individual levels of education and training.\nResults: 247 questionnaires could be analyzed. Physicians noted significant (p < 0.001) more deficits in their\nprofessional training than paramedics. 80% of the paramedics affirmed to have had adequate training with respect\nto prehospital trauma care, all physicians claimed not to have had sufficient training for prehospital trauma care\nsituations at Medical School. Physicians were statistically most significant dissatisfied then paramedics (p < 0.001).\nWhile most participants gave positive feedback, anesthetists were less convinced of PHTLS (p = 0.005), didn�t\nbenefit as much as the rest (p = 0.004) and stated more often, that the course was of less value for their daily work\n(p = 0.03). After the course confidence increased remarkably and reached higher rates than before the course\n(p < 0.001). After PHTLS both groups showed similar ratings concerning the course concept indicating that PHTLS\ncould equalize some training deficits and help to gain confidence and assurance in prehospital trauma situations. 90%\nof the paramedics and 100% of the physicians would recommend PHTLS. Physicians and especially anesthetists revised\ntheir opinions with regard to providing PHTLS at Medical School after having taken part in a PHTLS course.\nConclusion: The evaluation of PHTLS courses in Germany indicates the necessity for special prehospital trauma care\ntraining. Paramedics and physicians criticize deficits in their professional training, which can be compensated by PHTLS.\nWith respect to relevant items like confidence and knowledge PHTLS leads to a statistically significant increase in\nratings on a visual analogue scale. PHTLS should be integrated into the curriculum at Medical School....
Background: Screening for acute stress is not part of routine trauma care owing in part to high variability of acute\nstress symptoms in identifying later onset of posttraumatic stress disorder (PTSD). The objective of this pilot study\nwas to assess the sensitivity, specificity, and power to predict onset of PTSD symptoms at 1 and 4 months using a\nroutine screening program in comparison to current ad hoc referral practice.\nMethods: Prospective cross-sectional observational study of a sample of hospitalized trauma patients over a\nfour-month period from a level-I hospital in Canada. Baseline assessments of acute stress (ASD) and subsyndromal\nASD (SASD) were measured using the Stanford Acute Stress Reaction Questionnaire (SASRQ). In-hospital psychiatric\nconsultations were identified from patient discharge summaries. PTSD symptoms were measured using the PTSD\nChecklist-Specific (PCL-S). Post-discharge health status and health services utilization surveys were also collected.\nResults: Routine screening using the ASD (0.43) and SASD (0.64) diagnoses were more sensitive to PTSD symptoms at\none month in comparison to ad hoc referral (0.14) and also at four months (0.17, 0.33 versus 0.17). Ad hoc referral had\ngreater positive predictive power in identifying PTSD caseness at 1 month (0.50) in comparison to the ASD (0.46) and\nSASD (0.43) diagnoses and also at 4 months (0.67 versus 0.25 and 0.29).\nConclusions: Ad hoc psychiatric referral process for acute stress is a more conservative approach than employing\nroutine screening for identifying persons who are at risk of psychological morbidity following injury. Despite known\nlimitations of available measures, routine patient screening would increase identification of trauma survivors at risk of\nmental health sequelae and better position trauma centers to respond to the circumstances that affect mental health\nduring recovery....
Major trauma remains a significant cause of mortality and morbidity in young people and adolescents throughout\nthe western world. Both the physical and psychological consequences of trauma are well documented and it is\nshown that peri-traumatic factors play a large part in the emotional recovery of children involved in trauma. Indeed,\nparental anxiety levels may play one of the biggest roles. There are no publically available guidelines on pre-hospital\naccompaniment, and where research has been done on parental presence it often focuses primarily on the parents or\nstaff, rather than the child themselves. Whilst acknowledging the impact on parents and staff, the importance of the\nemotional wellbeing of the child should be reinforced, to reduce the likelihood of developing symptoms in keeping\nwith post-traumatic stress disorder. This non-systematic literature review, aims to examine the impact of parental\naccompaniment to hospital, following paediatric trauma, and to help pre-hospital clinicians decide whether\naccompaniment would be of benefit to their patient population. The lack of published data does not enable a\nformal recommendation of parental accompaniment in the helicopter to be mandated, though it should be the\npreference in land based conveyance. Future research is needed into the emotional recovery of children after\ntrauma, as well as the experiences of patient, parent and staff during conveyance....
Loading....