Home About us Contact
|
Home About us Contact | ||
|
|
||
Trauma Response (trauma + response)
Selected AbstractsPaediatric and adolescent horse-related injuries: Does the mechanism of injury justify a trauma response?EMERGENCY MEDICINE AUSTRALASIA, Issue 4 2008John A Craven Objective: To identify the frequency, variety and disposition of horse-related injury presentations to the ED and to use this information to evaluate the existing institutional trauma team activation criteria following horse-related injuries. Methods: A retrospective case analysis was performed of all horse-related injury presentations to the ED of Women's and Children's Hospital, Adelaide, Australia, in the 5 year period between January 1999 and December 2003. Results: A total of 186 children presented with horse-related injuries during the 5 year study period. The median age of injury was 9 years (range 1,17 years), with 81% of presentations female and 60% of patients hospitalized. The mechanism of injury was divided into four groups: 148 falls (79%), 28 kicks (15%), 7 tramples (4%) and 5 bites (3%). There was one death. Seven presentations rated an Injury Severity Score >15, with full trauma team activation occurring for two of these presentations. Conclusion: Although horse-related injury presentations are uncommon, severe injuries do occur. Patients presenting with severe horse-related injuries do not always activate a full trauma team response based on current trauma team activation criteria. These severe injury presentations are supported by a limited trauma team response, which activates on the mechanism of injury. The effectiveness of this as a contingency system needs to be evaluated. [source] Less systemic cytokine response in patients following microendoscopic versus open lumbar discectomyJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 2 2005Tsung-Jen Huang Abstract The magnitude of the tissue damage from surgery impacts the trauma response. This response is proportional to the severity of surgical stress. Systemic cytokines are recognized as markers of postoperative tissue trauma. Microendoscopic discectomy (MED) recently has become popular for treating lumbar disc herniations, and is associated with favorable clinical outcomes compared with open discectomy (OD). This study postulates that MED is a less traumatic procedure, and therefore has a lower surgical stress response compared to OD. In this study, a quantitative comparison of the overall effects of surgical trauma resulting from MED and OD was performed through analyzing patient systemic cytokines response. From April, 2002 to June, 2003, 22 consecutive patients who had symptomatic lumbar disc herniations were prospectively randomized to undergo either intracanalicular MED (N = 10) or OD (N = 12). In this study, the Vertebroscope System (Zeppelin, Pullach, Germany) was used to perform the endoscopic discectomy procedure in all MED patients. Serum levels of tumor necrosis factor-, (TNF-,), Interleukin-1, (IL-1,), Interleukin-6 (IL-6), and Interleukin-8 (IL-8) were measured before surgery and at 1, 2, 4, 8 and 24h after surgery using an enzyme-linked immunosorbent assay. Serum C-reactive protein (CRP) was measured at the same time interval. The results showed the MED patients had shorter postoperative hospital stay (mean, 3.57 ± 0.98 vs. 5.92 ± 2.39 days, p = 0.025) and less intraoperative blood loss (mean. 87.5 ± 69.4 vs. 190 ± 115 ml, p = 0.042). The operating length, including the set-up time, was longer in the MED group (mean, 109 ± 35.9 vs. 72.1 ± 17.8 min, p = 0.01). The mean size of skin incision made for the MED patients was 1.86 ± 0.13cm (range 1.7,2.0cm); and 6.3 ± 0.98 cm for the OD patients (range 5.5,8cm), p = 0.001. The patients' pain severity of the involved limbs on 10-point Visual Analog Scale before operation in MED group was 7.5 ± 0.3 (range 6,9) and 8 ± 0.2 (range 7,9) in OD group, p = 0.17; and after surgery, 1.5 ± 0.2 (range 1,2) in MED group and 1.4 ± 0.1 (range 1,3) in OD group, p = 0.91. CRP levels peaked at 24h in both groups, and OD patients displayed a significantly greater postoperative rise in serum CRP (mean, 27.78 ± 15.02 vs. 13.84 ± 6.25mg/l, p = 0.026). Concentrations of TNF-,, IL-1,, and IL-8 were detected only sporadically. Serum IL-6 increased less significantly following MED than after OD. In the MED group, IL-6 level peaked 8 h after surgery, with the response statistically less than in the open group (mean, 6.27 ± 5.96 vs. 17.18 ± 11.60pg/ml, p = 0.025). A statistically significant correlation was identified between IL-6 and CRP values (r = 0.79). Using the modified MacNab criteria, the clinical outcomes were 90% satisfactory (9/10) in MED patients and 91.6% satisfactory (11/12) in OD patients at a mean 18.9 months (range 10,25) follow-up. Based on the current data, surgical trauma, as reflected by systemic IL-6 and CRP response, was significantly less following MED than following OD. The difference in the systemic cytokine response may support that the MED procedure is less traumatic. Moreover, our MED patients had achieved satisfactory clinical outcomes as the OD patients at a mean 18.9 months follow-up after surgery. © 2004 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved. [source] Community-based trauma response for youthNEW DIRECTIONS FOR YOUTH DEVELOPMENT, Issue 98 2003Robert D. Macy The "golden rule" of youth trauma response is that those most affected by the trauma or threat event must be afforded an ongoing opportunity to play a central role in the resolution of and recovery from the trauma and its aftermath. [source] Posttraumatic Stress Disorder Part III: Health Effects of Interpersonal Violence Among WomenPERSPECTIVES IN PSYCHIATRIC CARE, Issue 3 2006K. M. Hegadoren RN TOPIC.,The aim of this three-part series is to examine the sufficiency of the posttraumatic stress (PTSD) diagnostic construct to capture the full spectrum of human responses to psychological trauma. Part I (Lasiuk & Hegadoren, 2006a) reviewed the conceptual history of PTSD from the nineteenth century to its inclusion in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1980), while Part II (Lasiuk & Hegadoren, 2006b) described subsequent refinements to the original PTSD diagnostic criteria and highlighted subsequent controversies. PURPOSE.,This paper focuses on interpersonal violence (sexual, physical, and emotional abuse/assault) and its sequelae in women. We argue in support of Judith Herman's (1992) conceptualization of the human trauma response as a spectrum, anchored at one end by an acute stress reaction that resolves on its own without treatment, and on the other by "complex" PTSD, with "classic" or "simple" PTSD somewhere between the two. SOURCES OF INFORMATION.,The existing theoretical, clinical and research literatures related to humans responses to trauma. CONCLUSION.,The paper concludes with a call for the need to increase a gendered perspective in all aspects of trauma research and clinical service delivery. [source] | ||||||||||