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Diagnostic diligence in trauma and injury care through forensic pathology 通过法医病理学对创伤和损伤护理进行诊断
Pub Date : 2019-01-01 DOI: 10.35841/2591-7358.3.1.15-16
Joseph Lewis
This article denotes the severity of necessity attached to diagnostic diligence concerning forensic pathology/death investigation, and thus it is directly pertinent to diagnostic procedural standards and practices in institutions of emergency care regarding more obscure or rare types of injury. A generic scenario is drawn upon from the author’s academic experiences in order to depict this in an accurate and validly weighted manner. The roads less travelled concerning other than average diagnostic procedure in emergency and/or first responder care in situations delineated such as herein, are claimed by the author to be what could be called a weak point in the nature of quality that can be statistically measured in emergency care by precedent of the rarity of certain types of injuries. This is explored in mild depth through scenario depiction and pathological evaluation. The scenario itself can be considered to be a Question of sorts, the answer can be considered to be a type of diagnosis, and the discussion/conclusion demonstrates the overarching point or claim of this article in its relevant concerns regarding scarcely encountered trauma and/or injury types.
这篇文章表明,在法医病理学/死亡调查方面,诊断勤奋的必要性非常严重,因此,它与急诊护理机构对更模糊或罕见类型的伤害的诊断程序标准和做法直接相关。为了以准确和有效的加权方式描述这一点,从作者的学术经验中得出了一个一般的场景。在本文所述的情况下,除了急救和/或急救人员护理的平均诊断程序之外,很少有人走过的道路被提交人称为质量上的一个弱点,可以通过某些类型的伤害罕见的先例在急救护理中进行统计测量。这是通过情景描述和病理评估轻度深入探讨。这个场景本身可以被认为是一个问题,答案可以被认为是一种诊断,讨论/结论表明了本文的主要观点或主张,它涉及到很少遇到的创伤和/或伤害类型。
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引用次数: 0
The use of amniotic membrane in healing excisional debridement of sea urchin stings 羊膜在海胆蜇伤切除清创愈合中的应用
Pub Date : 2019-01-01 DOI: 10.4066/2591-7358-C1-002
C. Peele, S. Foyle, B. Saar
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引用次数: 0
The incidence of chronic pain following tibial diaphyseal fracture. 胫骨骨干骨折后慢性疼痛的发生率。
Pub Date : 2019-01-01 DOI: 10.35841/2591-7358.3.1.6-11
F. Prinsloo, C. Flynn, M. Prime, A. Wickham, S. Hettiaratchy
Introduction: Chronic pain affects up to 40% of patients at 7 years after tibial fracture impacting on their quality of life (QoL) and ability to participate in activities of daily living. Major nerves run in close proximity to the tibia and are prone to injury during tibial fracture. Nerve injury can cause acute neuropathic pain, which responds poorly to commonly prescribed analgesics and predisposes patients to developing chronic pain. This study aims to describe the incidence and impact of pain at 6-12 months after tibial fractures. Methods: Patients admitted to a major trauma centre between 01/01/2016 – 31/12/2016 with isolated tibial fractures were identified using prospectively recorded database eTrauma. Injuries were categorized using the AO classification. Pain and Quality of Life at 6-12 months post injury were assessed using the EuroQol (EQ-5D-5L) questionnaire and the Douleur Neuropathique 4 questionnaire for neuropathic pain. Results: Forty isolated tibial fractures were identified and 20 were followed up. Pain was reported by 18 (90%) of patients. Ten (50%) reported moderate to severe pain, with median pain scores of 2.6/5. Pain scores were significantly greater following high-energy injuries however no significant links were seen between pain and other patient, injury or management factors. Conclusion: Chronic pain is common following tibial fracture and is largely under-reported. Further prospective multi-center investigation is warranted to better identify those with neuropathic pain and other risk factors for chronic pain. This could guide effective management and improve patient outcomes
在胫骨骨折后7年,慢性疼痛影响高达40%的患者,影响他们的生活质量(QoL)和参与日常生活活动的能力。主要神经靠近胫骨,在胫骨骨折时容易受到损伤。神经损伤可引起急性神经性疼痛,这种疼痛对常用的镇痛药物反应不佳,容易使患者发展为慢性疼痛。本研究旨在描述胫骨骨折后6-12个月疼痛的发生率和影响。方法:使用前瞻性记录数据库eTrauma对2016年1月1日至2016年12月31日在一家大型创伤中心收治的孤立性胫骨骨折患者进行识别。采用AO分类对损伤进行分类。采用EuroQol (EQ-5D-5L)问卷和Douleur神经性疼痛4问卷对损伤后6-12个月的疼痛和生活质量进行评估。结果:发现孤立性胫骨骨折40例,随访20例。18例(90%)患者报告疼痛。10例(50%)报告中度至重度疼痛,中位疼痛评分为2.6/5。高能量损伤后的疼痛评分明显更高,但疼痛与其他患者、损伤或管理因素之间没有明显联系。结论:胫骨骨折后慢性疼痛是常见的,但在很大程度上被低估了。进一步的前瞻性多中心研究是必要的,以更好地识别神经性疼痛和其他慢性疼痛的危险因素。这可以指导有效的管理并改善患者的预后
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引用次数: 1
Future of ultrasound wound therapy: Technologies, devices, science and clinical outcomes 超声伤口治疗的未来:技术、设备、科学和临床结果
Pub Date : 2019-01-01 DOI: 10.4066/2591-7358-C1-001
E. Babaev
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引用次数: 0
Acute compartment syndrome in patients on long-term anticoagulation therapy 急性筋膜室综合征患者长期抗凝治疗
Pub Date : 2019-01-01 DOI: 10.35841/2591-7358.3.1.1-5
M. M. Mazur, Nour Jabaly, N. Ebraheim
Development of acute compartment syndrome (ACS) poses problems for patients on long-term anticoagulation, who are at higher risk for hemorrhagic insult. The populations predisposed to ACS and long-term anticoagulation individually are quite different, making this a particularly unique population that has been rarely studied. Eight patients at our institution were included in this study based on development of ACS while being on long-term anticoagulation. Causes of ACS were almost evenly split between idiopathic, fracture, and blunt trauma without fracture. The most commonly involved compartment was the lower leg. ACS was appropriately diagnosed based on clinical assessment alone in all patients, based on heightened level of suspicion. All patients were treated with single- or double-incision fasciotomy, as is the standard of treatment in the general population. All patients experienced good outcomes post-fasciotomy with prompt bridging to anticoagulant regimen, with minimal complications and no cases of mortality. These patients were not revealed to have any identifiably unique risk factors for developing ACS, and they can be treated similarly to patients not on anticoagulation and adequately bridged to therapeutic anticoagulation levels.
急性间室综合征(ACS)的发展给长期抗凝治疗的患者带来了问题,他们有较高的出血性损伤风险。易患ACS和长期抗凝治疗的人群是完全不同的,这使得这是一个特别独特的人群,很少被研究。本研究纳入我院8例长期抗凝治疗期间发生ACS的患者。ACS的病因几乎平均分为特发性、骨折和无骨折的钝性创伤。最常见的受累腔室是小腿。在所有患者中,基于高度的怀疑,仅根据临床评估就可适当诊断ACS。所有患者均行单切口或双切口筋膜切开术,这是一般人群的标准治疗方法。所有患者在筋膜切开术后均获得良好的预后,并及时转入抗凝治疗方案,并发症最少,无死亡病例。这些患者没有发现任何可识别的发展为ACS的独特危险因素,他们可以与未使用抗凝治疗的患者类似,并充分桥接到治疗性抗凝水平。
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引用次数: 2
Frontal placement of subdural drain for subdural hemorrhage: A single center experience 硬脑膜下引流术治疗硬脑膜下出血:单中心经验
Pub Date : 2019-01-01 DOI: 10.35841/2591-7358.3.1.12-14
M. Yunus, Mohd Asrol Hafizi Ab Majid, Arman Muhammad Nor, Nujaimin Udin
Placing a drain following evacuation of Chronic Subdural Hemorrhage (CSDH) has beneficial outcome for patients. The placement of the drain’s tip however is debatable as it has different rationale among neurosurgeons. Objective: The objective is to see whether the outcome is satisfactory by putting the tip of the drain at the frontal region of the sub dural space. Methodology: We retrospectively studied all patients who had CSDH underwent surgery in our center between January 2013 to December 2016. A total of 34 patients with CSDH underwent drilling of one burr hole and irrigation of CSDH. Silicone catheter placed in the sub dural space and the tip of the drain in the frontal region. We measured the SDH volume reduction and volume of pneumocranium post operatively as our outcomes of the study. Results: The mean reduction of SDH volume after surgery is 8.11 cc (73%), while the mean volume of pneumocranium post SDH drainage is 1.58 cc with a range of 0 cc to 9 cc. The mean Global Outcome Score is 2.85 and the recurrence, which need re-operation are 2 cases (6%). Conclusion: The retrospective case series shows a good potential outcome based on the reduction of SDH volume after surgery. A proper randomized trial is needed to determine the efficacy of the frontal placement of the subdural catheter for a comparable outcome.
慢性硬膜下出血(CSDH)术后引流对患者有益。然而,引流管尖端的位置是有争议的,因为神经外科医生有不同的理由。目的:目的是通过将引流管尖端置于硬脑膜下间隙额部,观察其效果是否满意。方法:我们回顾性研究了2013年1月至2016年12月在我中心接受手术的所有CSDH患者。34例CSDH患者行1个毛刺钻孔和CSDH冲洗。硅胶导管放置在硬脑膜下间隙和额部引流管尖端。我们测量了SDH体积减少和术后肺颅骨体积作为我们研究的结果。结果:术后SDH体积平均减少8.11 cc (73%), SDH引流后肺容积平均减少1.58 cc (0 ~ 9 cc), Global Outcome Score平均2.85,复发需再手术2例(6%)。结论:回顾性病例系列显示手术后SDH体积减少的良好潜在结果。需要一项适当的随机试验来确定硬膜下导管正面放置的有效性,以获得可比的结果。
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引用次数: 0
TRAUMATIC BRAIN INJURY 创伤性脑损伤
Pub Date : 2016-11-14 DOI: 10.4172/2329-9096.1000E120
ion The Oxford English Dictionary notes that the term “abstraction” came into the English language in 1647� It is defined as the act of processing separately in thought, or considering a thing independently of its associations, or acknowledging a substance independent of its attributes, or separating an attribute or quality independent of the substance to which it belongs (Simpson and Weiner 1989)� In other words, the ability to abstract is the mental act of interpreting observations and associations beyond their apparent or literal meaning� The lack of ability of abstract thought is termed “concrete thinking�” Persons with executive function impairment, particularly frontal lobe disease, often lose the ability to think abstractly� The common test taught to all psychiatric residents is that of interpretation of proverbs or being able to draw a similarity between terms or words (similarities)� The classic forms of asking the patient to interpret “A rolling stone gathers no moss,” is known to all psychiatric residents� Obviously, the clinician can increase the complexity of proverb interpretation by ultimately asking the patient to interpret “He who chooses to eat with the tiger must remember that the tiger eats last�” The FAB asks the patient to determine in what way a banana and an orange are alike� If the patient fails the question, she is asked “What makes a table and a chair alike?” In the alternative, she is asked “What makes a tulip, a rose, and a daisy alike?” (Dubois et al� 2000)� Clearly, one must take into account the culture, language, educational level, and socioeconomic background of the person when interpreting their ability to abstract correctly� Table 4�14 lists common signs and symptoms of dysexecutive disorders� SENSORY DOMAIN-SPECIFIC RECOGNITION This domain of mental status testing is used to determine the presence of agnosia (a lack of knowing)� Agnosia may present as impairment in any of the five senses and may occur in myriad diseases� Therefore, for proper assessment, elementary sensory function has to be present in the patient, and the clinician must ensure that there is no presence of blindness, deafness, inability to smell, a dense hemisensory loss, or peripheral neuropathy� Agnosia is sensory domain-specific, and, therefore, the stimulus used must be specific to the sense in which agnosia is identified� If visual agnosia is considered in the patient, a simple test can be performed to have the individual sit across from the clinician, place her palms face up on her TABLE 4.14 Signs and Symptoms of Executive Dysfunction • Outrageous and disinhibited behavior • Impulsiveness or perseveration of oral or written information • Reduced ability to express words • Poor visual or auditory attention • Reduction in motivation or drive • Inability to switch sets or inhibit responses • Inability to plan for the future • Inability to organize 150 Traumatic Brain Injury: Methods for Clinical and Forensic Neuropsychiatric Assessment kne
《牛津英语词典》指出,“抽象”一词于1647年进入英语,它被定义为在思想中单独处理的行为,或独立于其联想来考虑一件事物,或承认一种独立于其属性的物质,或分离一种独立于其所属物质的属性或品质(Simpson and Weiner 1989)。抽象能力是一种超越表面或字面意义来解释观察和联想的心理行为。缺乏抽象思维能力被称为"具体思维"。通常会失去抽象思考的能力——对所有精神科住院医生的常见测试是对谚语的解读,或者是在术语或单词之间找出相似之处的能力(相似之处)——让病人解释“滚石不生苔”的经典形式,显然,临床医生可以增加谚语解释的复杂性,最终要求患者解释“选择与虎共食的人必须记住老虎最后才吃”,FAB要求患者确定香蕉和橙子在哪些方面是相似的如果患者没有回答这个问题,她会被问到“是什么让桌子和椅子相似?”在另一种情况下,她被问到“是什么让郁金香、玫瑰和雏菊相似?”(Dubois et al . 2000)显然,人们必须考虑到文化、语言、教育水平、表4 - 14列出了执行障碍的常见体征和症状感觉领域特异性识别这一领域的精神状态测试用于确定失认症(缺乏认知)的存在失认症可能表现为五种感官中的任何一种受损,并可能发生在无数疾病中因此,为了进行适当的评估,患者必须具备基本的感觉功能临床医生必须确保患者没有失明、耳聋、嗅觉丧失、密集的半感觉丧失或周围神经病变。失认症是一种特定的感觉领域,因此,所使用的刺激必须针对识别失认症的感觉。如果患者被认为是视觉失认症,可以进行一个简单的测试,让患者坐在临床医生对面。表4.14执行功能障碍的体征和症状•令人发指和失控的行为•口头或书面信息的冲动或坚持性•表达能力下降•视觉或听觉注意力差•动机或驱动力下降•无法切换场景或抑制反应•无法计划未来•无法组织150创伤性脑损伤:临床和法医神经精神评估方法:膝盖,闭上眼睛,然后临床医生把一个常见的物体,比如一把钥匙,放在病人的手掌上,然后指导病人闭着眼睛去感受这个物体,并说出它的名字,如果她不能这样做,临床医生要求她睁开眼睛,看着物体并演示它是如何使用的,这将测试对物体的识别和适当使用,应该记住,一个人可能患有视觉失认症,但当物体在触觉或听觉上呈现时,他仍然能够说出物体的名字,如果她不能通过主动触摸来识别物体,尽管她无法在视觉上识别它,她被描述为患有体感失认症——如果病人不能说出物体的名字,不管它是在哪个感官领域出现的,这一发现与失范症是一致的,应该寻找语言功能受损的其他因素——正如我们将在第6章进一步讨论的那样,霍尔斯特德-雷坦电池的感觉运动元素可以用来检查体感失认症、失认症(无法识别指尖或手部的字母和数字)。或者其他的触觉识别失败——作为听觉领域的另一个例子,纯粹的文字失聪是指尽管病人有阅读能力,但在说话时却无法识别单词。同时失认症是指无法识别图像或图片的格式塔或完整性,尽管能够识别图像或图片的一部分;手指失认症是无法识别手上的手指,通常表现为格斯特曼综合征的一个组成部分;嗅觉失认症(嗅觉失认症)是无法识别气味,即使神经I完好无损
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引用次数: 4
Geriatric Trauma and Critical Care 老年创伤和危重症护理
Pub Date : 2015-06-01 DOI: 10.1097/ta.0000000000000664
S. Shackford
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引用次数: 0
Management of Musculoskeletal Injuries in the Trauma Patient 创伤患者肌肉骨骼损伤的处理
Pub Date : 2014-11-01 DOI: 10.1097/TA.0000000000000456
A. Starr
Now welcome, the most inspiring book today from a very professional writer in the world, management of musculoskeletal injuries in the trauma patient. This is the book that many people in the world waiting for to publish. After the announced of this book, the book lovers are really curious to see how this book is actually. Are you one of them? That's very proper. You may not be regret now to seek for this book to read.
现在欢迎,当今世界上最鼓舞人心的书来自一位非常专业的作家,创伤患者肌肉骨骼损伤的管理。这是世界上许多人等待出版的书。在这本书公布之后,爱书的人真的很好奇这本书到底是怎么回事。你是他们中的一员吗?这很合适。你现在也许不会后悔找这本书来读了。
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引用次数: 2
Surgery of Complex Abdominal Wall Defects 复杂腹壁缺损的外科治疗
Pub Date : 2014-08-01 DOI: 10.1097/TA.0000000000000258
C. Burlew
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引用次数: 0
期刊
Journal of Trauma-Injury Infection and Critical Care
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