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The PTSD survival guide for teens : strategies to overcome trauma, build resilience & take back your life
In this guide, you'll find skills based in cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and acceptance and commitment therapy (ACT) to help you tackle anxiety and harmful avoidance behaviors, manage negative emotions, cope with flashbacks and nightmares, and develop trusting, healthy relationships--even if your trust in others has been shaken to the core.
Book
Trauma to the bladder and ureter: a review of diagnosis, management, and prognosis
Background
Injuries to the ureter or bladder are relatively rare. Therefore, a high level of clinical suspicion and knowledge of operative anatomy is of utmost importance for their management. Herein, a review of the literature related to the modern diagnosis, management, and prognosis for bladder and ureteral injuries is presented.
Methods
A literature search was conducted through PubMed. A thorough search of the world’s literature published in English was completed. Search terms included “injury, diagnosis, prognosis, and management for ureter and bladder”. All years, both genders, as well as penetrating, blunt, and iatrogenic mechanisms were evaluated for inclusion. Following PRISMA guidelines, studies were selected based on relevance and then categorized.
Results
172 potentially relevant studies were identified. Given our focus on modern diagnosis and treatment, we then narrowed the studies in each category to those published within the last 30 years, resulting in a total of 26 studies largely consisting of Level IV retrospective case series. Our review found that bladder ruptures occur from penetrating, blunt, or iatrogenic mechanisms, and most are extraperitoneal (63%). Ureteral injuries are incurred from penetrating mechanisms in 77% of cases. The overall mortality rates for bladder rupture and ureteral injury were 8 and 7%, respectively.
Limitations
Limitations of this article are similar to all PRISMA-guided review articles: the dependence on previously published research and availability of references.
Conclusion
The bladder is injured far more often than the ureter but ureteral injuries have higher injury severity. Both of these organs can be damaged by penetrating, blunt, or iatrogenic mechanisms and surgical intervention is often required for severe ureter or bladder injuries. Since symptoms of these injuries may not always be apparent, a high level of suspicion is required for appropriate diagnosis and treatment.
Journal Article
Operative and nonoperative management for renal trauma: comparison of outcomes. A systematic review and meta-analysis
Preservation of kidney and renal function is the goal of nonoperative management (NOM) of renal trauma (RT). The advantages of NOM for minor blunt RT have already been clearly described, but its value for major blunt and penetrating RT is still under debate. We present a systematic review and meta-analysis on NOM for RT, which was compared with the operative management (OM) with respect to mortality, morbidity, and length of hospital stay (LOS).
The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed for this study. A systematic search was performed on Embase, Medline, Cochrane, and PubMed for studies published up to December 2015, without language restrictions, which compared NOM versus OM for renal injuries.
Twenty nonrandomized retrospective cohort studies comprising 13,824 patients with blunt (2,998) or penetrating (10,826) RT were identified. When all RT were considered (American Association for the Surgery of Trauma grades 1-5), NOM was associated with lower mortality and morbidity rates compared to OM (8.3% vs 17.1%, odds ratio [OR] 0.471; 95% confidence interval [CI] 0.404-0.548;
<0.001 and 2% vs 53.3%, OR 0.0484; 95% CI 0.0279-0.0839,
<0.001). Likewise, NOM represented the gold standard treatment resulting in a lower mortality rate compared to OM even when only high-grade RT was considered (9.1% vs 17.9%, OR 0.332; 95% CI 0.155-0.708;
=0.004), be they blunt (4.1% vs 8.1%, OR 0.275; 95% CI 0.0957-0.788;
=0.016) or penetrating (9.1% vs 18.1%, OR 0.468; 95% CI 0.398-0.0552;
<0.001).
Our meta-analysis demonstrated that NOM for RT is the treatment of choice not only for AAST grades 1 and 2, but also for higher grade blunt and penetrating RT.
Journal Article
Accuracy of prehospital focused abdominal sonography for trauma after a 1-day hands-on training course
ObjectivesTo establish a training course for Prehospital Focused Abdominal Sonography for Trauma (P-FAST) and to evaluate the accuracy of the participants after the course and at the trauma scene.MethodsA training programme was developed to provide medical staff with the skills needed to perform P-FAST. In order to evaluate the accuracy of P-FAST performed by the students, nine participants (five emergency doctors and four paramedics) were followed during their course and in practice after the course. An assessment was made of 200 ultrasound procedures performed during the course in healthy volunteers and in patients with peritoneal dialysis or ascites. Regular P-FAST performed on-scene by the participants commenced immediately following the course. The results for the nine participants (C-group, course group) were compared with those members of medical staff with more than 3 years of experience in FAST (P-group, professional group). A group of physicians untrained in P-FAST served as a control (I-group, indifferent group). P-FAST findings were further verified by subsequent FAST and CT scans in the emergency department.ResultsAfter the training programme the C-group performed 39 P-FAST procedures without any false negative or false positive findings (100% accuracy). In the P-group, 112 procedures were performed with one false positive case. In the I-group there were 2 false negative cases among the 46 procedures performed.ConclusionFollowing completion of a 1-day P-FAST course, participants were able to perform ultrasound procedures at the scene of an accident with a high level of accuracy.
Journal Article
Implementation of tranexamic acid for bleeding trauma patients: a longitudinal and cross-sectional study
ObjectiveTo describe the use of tranexamic acid (TXA) in trauma care in England and Wales since the Clinical Randomization of an Antifibrinolytic in Significant Hemorrhage (CRASH-2) trial results were published in 2010.MethodsA national longitudinal and cross-sectional study using data collected through the Trauma Audit and Research Network (TARN), the clinical audit of major trauma care for England and Wales. All patients in the TARN database injured in England and Wales were included apart from those with an isolated traumatic brain injury, with a primary outcome of the proportion of patients given TXA and the secondary outcome of time to treatment.ResultsAmong 228 250 patients, the proportion of trauma patients treated with TXA increased from near zero in 2010 to 10% (4593) in 2016. In 2016, most patients (82%) who received TXA did so within 3 hours of injury, however, only 30% of patients received TXA within an hour of injury. Most (80%) of the patients who had an early blood transfusion were given TXA. Patients treated with TXA by an ambulance paramedic received treatment at a median of 49 min (IQR 33–72) compared with 111 min (IQR 77–162) for patients treated in hospital.ConclusionsThere is a low proportion of patients treated with TXA across the range of injury severity and the range of physiological indicators of severity of bleeding. Most patients receive treatment within the existing target of 3 hours from injury, however there remains the potential to further improve major trauma outcomes by the earlier treatment of a wider patient group.
Journal Article
Martial arts technique for control of severe external bleeding
ObjectivesHaemorrhage control is a critical component of preventing traumatic death. Other than the battlefield, haemostatic devices, such as tourniquets or bandages, may not be available, allowing for significant avoidable blood loss. We hypothesised that compression of vascular pressure points using a position adapted from the martial art of Brazilian Jiu-Jitsu could be adapted to decrease blood flow velocity in major extremity arteries.MethodsKnee mount compression was applied to the shoulder, groin and abdomen of healthy adult volunteer research subjects from Seattle, Washington, USA, from March through May 2018. Mean arterial blood flow velocity (MAV) was measured using ultrasound in the brachial and femoral arteries before and after compression. A MAV decrease greater than 20% with compression was deemed clinically relevant.ResultsFor 11 subjects, median (IQR) MAV combining all anatomical locations tested was 29.2 (34.1, 24.1) cm/s at baseline and decreased to 3.3 (0, 19.1) cm/s during compression (Wilcoxon p<0.001). MAV was significantly decreased during compression for each individual anatomical position tested (Wilcoxon p≤0.004). Per cent (95% CI) MAV reduction was significantly greater than 20% for shoulder compression at 97.5%(94% to 100%) and groin compression at 78%(56% to 100%), but was not statistically greater for abdominal compression at 35%(12% to 57%). Complete vessel occlusion was most common with compression at the shoulder (73%), followed by groin (55%) and abdomen (9%) (χ² LR, p=0.018).ConclusionThe Brazilian Jiu-Jitsu knee mount position can significantly decrease blood flow in major arteries of the extremities. This technique may be useful for bleeding control after injury.
Journal Article
Cranial burr holes in the emergency department: to drill or not to drill?
Due to a number of factors, it was a challenging airway but I was able to successfully secure the patients airway with an Endotrachael tube v. CT scan showed an isolated large right sided epidural haematoma with mass effect. Earliest evidence of cranial trephination on live subjects dates back to as early as 8000 BC.1 Fortunately tribalism has largely faded as we now see well-trained non-surgeon physicians routinely performing traditional surgical procedures (lateral canthotomy, thoracotomy, surgical airway, REBOA and even resuscitative hysterotomy) in emergency situations with excellent outcomes.
Journal Article
Evaluation of the provision of helicopter emergency medical services in Europe
BackgroundHelicopter emergency medical services (HEMS) are a useful means of reducing inequity of access to specialist emergency care. The aim of this study was to evaluate the variations in HEMS provision across Europe, in order to inform the further development of emergency care systems.MethodsThis is a survey of primary HEMS in the 32 countries of the European Economic Area and Switzerland. Information was gathered through internet searches (May to September 2016), and by emailing service providers, requesting verification and completion of data (September 2016 to July 2017). HEMS provision was calculated as helicopters per million population and per 1000 km2 land area, by day and by night, and per US$10 billion of gross domestic product (GDP), for each country.ResultsIn 2016, the smallest and least prosperous countries had no dedicated HEMS provision. Luxembourg had the highest number of helicopters by area and population, day and night. Alpine countries had high daytime HEMS coverage and Scandinavia had good night-time coverage. Most helicopters carried a doctor. Funding of services varied from public to charitable and private. Most services performed both primary (from the scene) and secondary (interfacility) missions.ConclusionsWithin Europe, there is a large variation in the number of helicopters available for emergency care, regardless of whether assessed with reference to population, land area or GDP. Funding of services varied, and did not seem to be clearly related to the availability of HEMS.
Journal Article
Educational and Clinical Impact of Advanced Trauma Life Support (ATLS) Courses: A Systematic Review
Background
We aimed to systematically review the literature on the educational impact of Advanced Trauma Life Support (ATLS) courses and their effects on death rates of multiple trauma patients.
Methods
All Medline, Pubmed, and the Cochrane Library English articles on the educational impact of ATLS courses and their effects on trauma mortality for the period 1966–2012 were studied. All original articles written in English were included. Surveys, reviews, editorials/letters, and other trauma courses or models different from the ATLS course were excluded. Articles were critically evaluated regarding study research design, statistical analysis, outcome, and quality and level of evidence.
Results
A total of 384 articles were found in the search. Of these, 104 relevant articles were read; 23 met the selection criteria and were critically analyzed. Ten original articles reported studies on the impact of ATLS on cognitive and clinical skills, six articles addressed the attrition of skills gained through ATLS training, and seven articles addressed the effects of ATLS on trauma mortality. There is level I evidence that ATLS significantly improves the knowledge of participants managing multiple trauma patients, their clinical skills, and their organization and priority approaches. There is level II–1 evidence that knowledge and skills gained through ATLS participation decline after 6 months, with a maximum decline after 2 years. Organization and priority skills, however, are kept for up to 8 years following ATLS. Strong evidence showing that ATLS training reduces morbidity and mortality in trauma patients is still lacking.
Conclusions
It is highly recommended that ATLS courses should be taught for all doctors who are involved in the management of multiple trauma patients. Future studies are required to properly evaluate the impact of ATLS training on trauma death rates and disability.
Journal Article
What is the purpose of log roll examination in the unconscious adult trauma patient during trauma reception?
BackgroundDuring assessment after injury, the log roll examination, in particular palpation of the thoracolumbar spine, has low sensitivity for detecting spinal injury. The manoeuvre itself requires a pause during trauma resuscitation. The aim of this study was to assess the utility of the log roll examination in unconscious trauma patients for the diagnosis of soft tissue and thoracolumbar spine injuries.MethodsA retrospective cohort study was undertaken, reviewing the cases of unconscious (Glasgow Coma Scale (GCS) <9) and/or intubated major trauma (Injury Severity Scale (ISS) >12, abbreviated injury scale 2008) patients from the Alfred Trauma Registry, over a 2-year period from January 2011 to December 2012. Log roll examination findings, as documented in the medical record, were compared with CT reports. Out of the 624 screened records, 222 (35.6%) were excluded as the log roll or CT/MRI had not been performed.ResultsThere were a total of 2028 major trauma presentations to the Alfred Hospital Emergency and Trauma Centre during the study period. Excluded cases comprised 147 patients who did not have a documented log roll, and 75 patients who did not have a CT or MRI. Of the 402 cases that met inclusion criteria, 35.3% had a thoracolumbar fracture, and the sensitivity of log roll examination was found to be 27.5%, with a specificity of 91%. The negative likelihood ratio for abnormalities on log roll was low (0.8).ConclusionsExamination of the back in unconscious trauma patients could be limited to visual inspection only to allow identification of penetrating wounds and other soft tissue injuries (including of the posterior scalp) and removal of foreign bodies, in patients planned for CT scans. The low sensitivity and poor negative likelihood ratio suggest that a normal log roll examination does not accurately predict the absence of bony injury to the thoracolumbar spine.
Journal Article