F.A.R. in E.M. (Focus Assessed Review in Emergency Medicine ) #3: Trauma

And here we are with the 3th episode of the F.A.R. series. If you accidentally lost the first two episodes you can find them here:

In this episode we’ll explore the best articles of 2014 about:

Trauma

Before approaching specific arguments about trauma here are some fundamental articles to read about new emerging concepts in trauma care. Those are the clinical and physiological bases to understand what is happening in the actual trauma management scene.

And now let’s go to specific area of interest:

Spine immobilization

Spine immobilization in trauma is changing.

After years of dogmatic approach to strict spine immobilization for all trauma patients regardless any other factor, is now pretty clear that not all the trauma patients benefits from this all or nothing way of thinking. MEDEST already faced the argument in previous posts (The Death of the Cervical Collar?) as also did some prehospital consensus guidelines (Faculty of Pre-Hospital Care Consensus Statements).

In 2014 many articles treated this topic in a critical and modern way of re-thinking spinal immobilization, in particular the widespread use of cervical collar. The lessons we learned is that:

Widespread use of cervical collar in neck trauma has to be carefully evaluated (and even avoided) due to the low incidence of unstable spinal lesions.
Routine use of cervical collar is of unclear benefit and supported by weak evidences. A new selective approach has to be implemented based on prehospital clearance protocols.

Cost-utility analysis of prehospital spine immobilization recommendations for penetrating trauma
Learning the lessons from conflict: Pre-hospital cervical spine stabilisation following ballistic neck trauma
Prehospital Use of Cervical Collars in Trauma Patients- A Critical Review
Comparison of Three Prehospital Cervical Spine Protocols for Missed Injuries
Fluids and blood products

What is “revolution” in clinical practice? We don’t have the answer to this dilemma, but what is happening in fluid resuscitation for trauma patients seems likely to be revolutionary. Restrictive strategies and new blood products are the future for the treatment of trauma patients (read also Fluid resuscitation in bleeding trauma patient: are you aware of wich is the right fluid and the right strategy?).

But much more happened in 2014 about trauma….

Resuscitative throacotomy is now a reality not only “in” but even “out” of hospital, so read all about it

Resuscitative thoracotomy an update

An evergreen topic is TBI but new concepts are arousing so read here the latest updates

Critical care management of severe traumatic brain injury in adults

New drugs and new protocols for airway and pain management: a rationale guide to choose the right drug for the right patient.

Choice of General Anesthetics for Trauma Patients

Pain management in trauma patients in (pre)hospital based emergency care: Current practice versus new guideline

DISCLOSURE: MEDEST strongly encourage AWARNESS reading the propoused articles.

Abstracts are often misleading and articles potentially biased. Even this selection is not immune from potential bias (just human factors not commercial interests).

So download the full text and read it carefully to have a clear and complete opinion of the related topics.

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Tag:ACR, advanced airway management, Antiaggregazione, antiplatelets, arresto cardiaco, clinical decision rules, emergency medicine, emergenza sanitaria territoriale, gestione avanzata delle vie aeree, litterature review, medicina d'urgenza, prehospital emergency medicine, sindromi coronariche acute, Stroke

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And here we are with the 3th episode of the F.A.R. series. If you accidentally lost the first two episodes you can find them here:

In this episode we’ll explore the best articles of 2014 about:

Trauma

Development of a simple algorithm to guide the effective management of traumatic cardiac arrest (read also Mind of resuscitation in traumatic cardiac arrest)

Spine immobilization

Fluids and blood products

But much more happened in 2014 about trauma….

DISCLOSURE: MEDEST strongly encourage AWARNESS reading the propoused articles.

Abstracts are often misleading and articles potentially biased. Even this selection is not immune from potential bias (just human factors not commercial interests).

So download the full text and read it carefully to have a clear and complete opinion of the related topics.

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