ICU-Admission Hyperphosphataemia Is Related to Shock and Tissue Damage, Indicating Injury Severity and Mortality in Polytrauma Patients
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Measuring Injury Severity
Measuring Injury Severity A brief introduction Thomas Songer, PhD University of Pittsburgh [email protected] Injury severity is an integral component in injury research and injury control. This lecture introduces the concept of injury severity and its use and importance in injury epidemiology. Upon completing the lecture, the reader should be able to: 1. Describe the importance of measuring injury severity for injury control 2. Describe the various measures of injury severity This lecture combines the work of several injury professionals. Much of the material arises from a seminar given by Ellen MacKenzie at the University of Pittsburgh, as well as reference works, such as that by O’Keefe. Further details are available at: “Measuring Injury Severity” by Ellen MacKenzie. Online at: http://www.circl.pitt.edu/home/Multimedia/Seminar2000/Mackenzie/Mackenzie.ht m O’Keefe G, Jurkovich GJ. Measurement of Injury Severity and Co-Morbidity. In Injury Control. Rivara FP, Cummings P, Koepsell TD, Grossman DC, Maier RV (eds). Cambridge University Press, 2001. 1 Degrees of Injury Severity Injury Deaths Hospitalization Emergency Dept. Physician Visit Households Material in the lectures before have spoken of the injury pyramid. It illustrates that injuries of differing levels of severity occur at different numerical frequencies. The most severe injuries occur less frequently. This point raises the issue of how do you compare injury circumstances in populations, particularly when levels of severity may differ between the populations. 2 Police EMS Self-Treat Emergency Dept. doctor Injury Hospital Morgue Trauma Center Rehab Center Robertson, 1992 For this issue, consider that injuries are often identified from several different sources. -
Traumatic Brain Injury
REPORT TO CONGRESS Traumatic Brain Injury In the United States: Epidemiology and Rehabilitation Submitted by the Centers for Disease Control and Prevention National Center for Injury Prevention and Control Division of Unintentional Injury Prevention The Report to Congress on Traumatic Brain Injury in the United States: Epidemiology and Rehabilitation is a publication of the Centers for Disease Control and Prevention (CDC), in collaboration with the National Institutes of Health (NIH). Centers for Disease Control and Prevention National Center for Injury Prevention and Control Thomas R. Frieden, MD, MPH Director, Centers for Disease Control and Prevention Debra Houry, MD, MPH Director, National Center for Injury Prevention and Control Grant Baldwin, PhD, MPH Director, Division of Unintentional Injury Prevention The inclusion of individuals, programs, or organizations in this report does not constitute endorsement by the Federal government of the United States or the Department of Health and Human Services (DHHS). Suggested Citation: Centers for Disease Control and Prevention. (2015). Report to Congress on Traumatic Brain Injury in the United States: Epidemiology and Rehabilitation. National Center for Injury Prevention and Control; Division of Unintentional Injury Prevention. Atlanta, GA. Executive Summary . 1 Introduction. 2 Classification . 2 Public Health Impact . 2 TBI Health Effects . 3 Effectiveness of TBI Outcome Measures . 3 Contents Factors Influencing Outcomes . 4 Effectiveness of TBI Rehabilitation . 4 Cognitive Rehabilitation . 5 Physical Rehabilitation . 5 Recommendations . 6 Conclusion . 9 Background . 11 Introduction . 12 Purpose . 12 Method . 13 Section I: Epidemiology and Consequences of TBI in the United States . 15 Definition of TBI . 15 Characteristics of TBI . 16 Injury Severity Classification of TBI . 17 Health and Other Effects of TBI . -
Sepsis: a Guide for Patients & Relatives
SEPSIS: A GUIDE FOR PATIENTS & RELATIVES CONTENTS ABOUT SEPSIS ABOUT SEPSIS: INTRODUCTION P3 What is sepsis? In the UK, at least 150,000* people each year suffer from serious P4 Why does sepsis happen? sepsis. Worldwide it is thought that 3 in a 1000 people get sepsis P4 Different types of sepsis P4 Who is at risk of getting sepsis? each year, which means that 18 million people are affected. P5 What sepsis does to your body Sepsis can move from a mild illness to a serious one very quickly, TREATMENT OF SEPSIS which is very frightening for patients and their relatives. P7 Why did I need to go to the Critical Care Unit? This booklet is for patients and relatives and it explains sepsis P8 What treatment might I have had? and its causes, the treatment needed and what might help after P9 What other help might I have received in the Critical Care Unit? having sepsis. It has been written by the UK Sepsis Trust, a charity P10 How might I have felt in the Critical Care Unit? which supports people who have had sepsis and campaigns to P11 How long might I stay in the Critical Care Unit and hospital? raise awareness of the illness, in collaboration with ICU steps. P11 Moving to a general ward and The Outreach Team/Patient at Risk Team If a patient cannot read this booklet for him or herself, it may be helpful for AFTER SEPSIS relatives to read it. This will help them to understand what the patient is going through and they will be more able to support them as they recover. -
Pre-Review Questionnaire Frequently Asked Questions
Pre-Review Questionnaire (PRQ) Frequently Asked Questions 1. Can abbreviations be used on the Pre-Review Questionnaire? Do not use abbreviations on the Pre-Review Questionnaire because abbreviations may not be the same from trauma care facility to trauma care facility. Write out all words and examples. 2. For the type of visit (question # 1 on the Pre-Review Questionnaire and Application Checklist form, DPH 7484), do I mark first visit or renewal visit? Mark the first visit this time. This is the first site visit made by the State of Wisconsin to your trauma care facility. The site visit means the actual physical site visit to your hospital. Filling out the assessment criteria document does not count as a site visit. The renewal box will be marked on your second site visit which will not start until at least 2010. This document is made so that the state does not have to create another Pre- Review Questionnaire document for future site visits. The renewal box can be checked and new information added or updated. 3. What are injury prevention initiatives and/or programs? Injuries cause death and disability. Strategies that decrease or prevent injury can improve the health of the community. Injury prevention initiatives and/or strategies focus primarily on environmental design, product design, human behavior, education, and legislative and regulatory requirements that support environmental and behavioral change (Center for Disease Control). Examples can include, but are not limited to: car seat clinics, bike helmet clinics, burn safety camp, farm safety, teen alcohol prevention programs (ENCARE, PARTY, Every 15 Minutes, etc…), ATV safety, hunting safety, snowmobiling safety, boating safety, poison control prevention, seat belt safety, etc… There are so many great national, state, and/or local programs to utilize or you can develop your own. -
Evaluation and Management of the Polytraumatized Patient in Various Centers
World J. Surg. 7, 143-148, 1983 Wor Journal of Stirgery Evaluation and Management of the Polytraumatized Patient in Various Centers S. Olerud, M.D., and M. Allg6wer, M.D. The Akademiska Sjukhuset Uppsala, Sweden, and the Department of Surgery, Kantonsspital, Basel, Switzerland A questionnaire was sent to the following 6 trauma centers: Paris: Two or more peripheral, visceral, or com- University Hospital for Accident Surgery, Hannover, Fed- plex injuries with respiratory and circulatory fail- eral Republic of Germany (Prof. H. Tscherne); University ure. (This excludes patients who only have sus- of Munich, Department of Surgery, Klinikum Grossha- tained fractures.) dern, Munich, Federal Republic of Germany (Prof. G. Dallas: Multiply injured patient presenting le- Heberer); Akademiska Sjukhuset Uppsala, Sweden (Prof. sions to 2 cavities, associated with 2 or more long S. Olerud); University Hospital, Department of Surgery, bone failures; lesions to 1 cavity associated with 2 Basel, Switzerland (Prof. M. Allgiiwer); H6pital de la Piti~, or more long bone failures; or lesions to multiple Paris, France (Prof. R. Roy-Camille); and University of extremities (at minimum, 3 long bone failures). Texas Southwestern Medical School, Dallas, Texas, U.S.A. (Prof. B. Claudi). Their answers have been summarized in a few short paragraphs where tabulation was not possible, Do You Grade Polytrauma, and If So, How? and then mainly in tabular form for convenient comparison among the various centers. There seems to be considerable international agreement on the main points of early aggres- Hannover: Yes, with our own grading system along sive cardiopulmonary management to prevent multiple with ISS and AIS. -
Abbreviated Injury Scale 1985 Revision
ABBREVIATED INJURY SCALE 1985 REVISION DICTIONARY EXTERNAL ABBREVIATED INJURY SCALE HEAD&FACE 1985 REVISION COMMITTEE ON INJURY SCALING NECK Thomas A.Gennarelli. Philadelphia PA (Chairman) Susan P. Baker. Baltimore MD THORAX Robert W. Bryant. Bloomfield Hills MI H.A. Fenner. Hobbs NM Robert N. Green. London ONT CONTENTS A.C. Hering. Chicago IL ABDOMEN & PELVIC Donald F. Huelke. Ann Arbor MI Ellen J. Mackenzie. Baltimore MD Elaine Petrucelli. Arlington Heights IL John E. Pless. Indianapolis IN John D. States. Rochester NY SPINE Donald D. Trunkey. San Francisco CA EXTREMITIES & BONY ACKNOWLEDGEMENT Members of the American College of Surgeons’ Committee on Trauma were consulted to assist in reviewing the sections on the thorax and abdomen and in developing the new injury descriptions for the vascular system. The American Association for Automotive Medicine is grateful to present and former members of the COT’s ad hoc committee on injury scaling for their contributions to this edition of the AIS, especially to the following physicians: William F. Blaisdell. M.D.: Charles F. Frey M.D.: Frank R. Lewis. Jr. M.D. and Donald F. Trunkey. M.D. Copyright 1985 American Association for Automotive Medicine Arlington Heights II 60005, USA TABLE OF CONTENTS Page INTRODUCTION The Abbreviated Injury Scale: A Historical Note 1 Assessment of Multiple Injuries 1 Fundamental Improvements to AIS 85 3 Future Directions 4 References 5 INJURY SCALING DICTIONARY Format 7 Changes in AIS Code Numbers 8 Terminology 8 Other Clarifications 8 Condensed AIS 85 9 Dictionary Index 10 AIS Severity Code 17 INJURY DESCRIPTIONS External 18 Skin 18 Burns 19 Head 21 Cranium and Brain 24 Face including ear and eye 28 (Continued on reverse) TABLE OF CONTENTS Page Neck 31 Thorax 35 Abdomen and Pelvic Contents 44 Spine Cervical spine 55 Thoracic Spine 57 Lumbar spine 59 Extremities and Bony Pelvis Upper Extremity 61 Lower Extremity 66 TABLE OF CONTENTS THE ABBREVIATED INJURY SCALE A HISTORICAL NOTE Classification of road transport injuries by types and severity is fundamental to the study of their etiology. -
Characteristics and Risk Factors for Intensive Care Unit Cardiac Arrest in Critically Ill Patients with COVID-19—A Retrospective Study
Journal of Clinical Medicine Article Characteristics and Risk Factors for Intensive Care Unit Cardiac Arrest in Critically Ill Patients with COVID-19—A Retrospective Study Kevin Roedl 1,* , Gerold Söffker 1, Dominic Wichmann 1 , Olaf Boenisch 1, Geraldine de Heer 1 , Christoph Burdelski 1, Daniel Frings 1, Barbara Sensen 1, Axel Nierhaus 1 , Dirk Westermann 2, Stefan Kluge 1 and Dominik Jarczak 1 1 Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany; [email protected] (G.S.); [email protected] (D.W.); [email protected] (O.B.); [email protected] (G.d.H.); [email protected] (C.B.); [email protected] (D.F.); [email protected] (B.S.); [email protected] (A.N.); [email protected] (S.K.); [email protected] (D.J.) 2 Department of Interventional and General Cardiology, University Heart Centre Hamburg, 20246 Hamburg, Germany; [email protected] * Correspondence: [email protected]; Tel.: +49-40-7410-57020 Abstract: The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causing the coron- avirus disease 2019 (COVID-19) led to an ongoing pandemic with a surge of critically ill patients. Very little is known about the occurrence and characteristic of cardiac arrest in critically ill patients Citation: Roedl, K.; Söffker, G.; with COVID-19 treated at the intensive care unit (ICU). The aim was to investigate the incidence Wichmann, D.; Boenisch, O.; de Heer, and outcome of intensive care unit cardiac arrest (ICU-CA) in critically ill patients with COVID-19. G.; Burdelski, C.; Frings, D.; Sensen, This was a retrospective analysis of prospectively recorded data of all consecutive adult patients B.; Nierhaus, A.; Westermann, D.; with COVID-19 admitted (27 February 2020–14 January 2021) at the University Medical Centre et al. -
Development of a Large Animal Model of Lethal Polytrauma and Intra
Open access Original research Trauma Surg Acute Care Open: first published as 10.1136/tsaco-2020-000636 on 1 February 2021. Downloaded from Development of a large animal model of lethal polytrauma and intra- abdominal sepsis with bacteremia Rachel L O’Connell, Glenn K Wakam , Ali Siddiqui, Aaron M Williams, Nathan Graham, Michael T Kemp, Kiril Chtraklin, Umar F Bhatti, Alizeh Shamshad, Yongqing Li, Hasan B Alam, Ben E Biesterveld ► Additional material is ABSTRACT abdomen and pelvic contents. The same review published online only. To view, Background Trauma and sepsis are individually two of showed that of patients with whole body injuries, please visit the journal online 1 (http:// dx. doi. org/ 10. 1136/ the leading causes of death worldwide. When combined, 37.9% had penetrating injuries. The abdomen is tsaco- 2020- 000636). the mortality is greater than 50%. Thus, it is imperative one area of the body which is particularly suscep- to have a reproducible and reliable animal model to tible to penetrating injuries.2 In a review of patients Surgery, Michigan Medicine, study the effects of polytrauma and sepsis and test novel in Afghanistan with penetrating abdominal wounds, University of Michigan, Ann treatment options. Porcine models are more translatable the majority of injuries were to the gastrointes- Arbor, Michigan, USA to humans than rodent models due to the similarities tinal tract with the most common injury being to 3 Correspondence to in anatomy and physiological response. We embarked the small bowel. While this severe constellation Dr Glenn K Wakam; gw akam@ on a study to develop a reproducible model of lethal of injuries is uncommon in the civilian setting, med. -
Underestimated Traumatic Brain Injury in Multiple Injured Patients; Is the Glasgow Coma Scale a Reliable Tool?
Research Artice iMedPub Journals Trauma & Acute Care 2017 http://www.imedpub.com/ Vol.2 No.2:42 Underestimated Traumatic Brain Injury in Multiple Injured Patients; Is the Glasgow Coma Scale a Reliable Tool? Ladislav Mica1*, Kai Oliver Jensen1, Catharina Keller2, Stefan H. Wirth3, Hanspeter Simmen1 and Kai Sprengel1 1Division of Trauma Surgery, University Hospital of Zürich, 8091 Zürich, Switzerland 2LVR-Klinik, 51109 Köln, Germany 3Orthopädische Universitätsklink Balgrist, 8008 Zürich, Switzerland *Corresponding author: Ladislav Mica, Division of Trauma Surgery, University Hospital of Zürich, 8091 Zürich, Switzerland, Tel: +41 44 255 41 98; E- mail: [email protected] Received date: March 16, 2017; Accepted date: April 12, 2017; Published date: April 20, 2017 Citation: Mica L, Jensen KO, Keller C, Wirth SH, Simmen H, et al. (2017) Underestimated Traumatic Brain Injury in Multiple Injured Patients, is the Glasgow Coma Scale a Reliable Tool? Trauma Acute Care 2: 42. Copyright: © 2017 Mica L, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abbreviations: Abstract AIS: Abbreviated Injury Severity Score; ANOVA: Analysis of Variance; APACHE II: Acute Physiology and Chronic Health Background: Traumatic brain injuries are common in Evaluation; ATLS: Advanced Trauma Life Support; AUC: Area multiple injured patients. Here, the impact of traumatic under the Curve; CT: Computed Tomography; GCS: Glasgow brain injuries according age and mortality and predictive Coma Scale; IBM: International Business Machines Corporation; value was investigated. ISS: Injury Severity Score; NISS: New Injury Severity Score; ROC: Methods: Totally 2952 patients were included into this Receiver Operating Curve; SAPS: Simplified Acute Physiology sample. -
Essentials of Sepsis Management
Essentials of Sepsis Management John M. Green, MD KEYWORDS Sepsis Sepsis syndrome Surgical infection Septic shock Goal-directed therapy KEY POINTS Successful treatment of perioperative sepsis relies on the early recognition, diagnosis, and aggressive treatment of the underlying infection; delay in resuscitation, source control, or antimicrobial therapy can lead to increased morbidity and mortality. When sepsis is suspected, appropriate cultures should be obtained immediately so that antimicrobial therapy is not delayed; initiation of diagnostic tests, resuscitative measures, and therapeutic interventions should otherwise occur concomitantly to ensure the best outcome. Early, aggressive, invasive monitoring is appropriate to ensure adequate resuscitation and to observe the response to therapy. Any patient suspected of having sepsis should be in a location where adequate resources can be provided. INTRODUCTION Sepsis is among the most common conditions encountered in critical care, and septic shock is one of the leading causes of morbidity and mortality in the intensive care unit (ICU). Indeed, sepsis is among the 10 most common causes of death in the United States.1 Martin and colleagues2 showed that surgical patients account for nearly one-third of sepsis cases in the United States. Despite advanced knowledge in the field, sepsis remains a common threat to life in the perioperative period. Survival relies on early recognition and timely targeted correction of the syndrome’s root cause as well as ongoing organ support. The objective of this article is to review strategies for detection and timely management of sepsis in the perioperative surgical patient. A comprehensive review of the molecular and cellular mechanisms of organ dysfunc- tion and sepsis management is beyond the scope of this article. -
Health Care Facilities Hospitals Report on Training Visit
SLOVAK UNIVERSITY OF TECHNOLOGY IN BRATISLAVA FACULTY OF ARCHITECTURE INSTITUTE OF HOUSING AND CIVIC STRUCTURES HEALTH CARE FACILITIES HOSPITALS REPORT ON TRAINING VISIT In the frame work of the project No. SAMRS 2010/12/10 “Development of human resource capacity of Kabul polytechnic university” Funded by UÜtà|áÄtät ECDC cÜÉA Wtâw f{t{ YtÜâÖ December, 14, 2010 Prof. Daud Shah Faruq Health Care Facilities, Hospitals 2010/12/14 Acknowledgement: I Daud Shah Faruq professor of Kabul Poly Technic University The author of this article would like to express my appreciation for the Scientific Training Program to the Faculty of Architecture of the Slovak University of Technology and Slovak Aid program for financial support of this project. I would like to say my hearth thanks to Professor Arch. Mrs. Veronika Katradyova PhD, and professor Arch. Mr. stanislav majcher for their guidance and assistance during the all time of my training visit. My thank belongs also to Ing. Juma Haydary, PhD. the coordinator of the project SMARS/2010/10/01 in the frame work of which my visit was realized. Besides of this I would like to appreciate all professors and personnel of the faculty of Architecture for their good behaves and hospitality. Best regards cÜÉyA Wtâw ft{t{ YtÜâÖ December, 14, 2010 2 Prof. Daud Shah Faruq Health Care Facilities, Hospitals 2010/12/14 VISITING REPORT FROM FACULTY OF ARCHITECTURE OF SLOVAK UNIVERSITY OF TECHNOLOGY IN BRATISLAVA This visit was organized for exchanging knowledge views and advices between us (professor of Kabul Poly Technic University and professors of this faculty). My visit was especially organized to the departments of Public Buildings and Interior design. -
Renal Endocrine Manifestations During Polytrauma: a Cause of Concern for the Anesthesiologist
Review Article Renal endocrine manifestations during polytrauma: A cause of concern for the anesthesiologist Sukhminder Jit Singh Bajwa, Ashish Kulshrestha Department of Anesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India ABSTRACT Nowadays, an increasing number of patients get admitted with polytrauma, mainly due to road traffic accidents. These polytrauma victims may exhibit associated renal injuries, in addition to bone injuries and injuries to other visceral organs. Nevertheless, even in cases of polytrauma, renal tissue is hyperfunctional as part of the normal protective responses of the body to external insults. Both polytrauma and renal injuries exhibit widespread renal, endocrine, and metabolic responses. The situation is very challenging for the attending anesthesiologist, as he is expected to contribute immensely, not only in the resuscitation of such patients, but if required, to allow the operative procedures in case of life-threatening injuries. During administration of anesthesia, care has to be taken, not only to maintain hemodynamic stability, but equal attention has to be paid to various renal protection strategies. At the same time, various renoendocrine manifestations have to be taken into account, so that a judicious use of anesthesia drugs can be made, to minimize the renal insults. Key words: Anesthesia, polytrauma, renal injuries, renal protection, renoendocrine manifestations INTRODUCTION trauma are also one of the major protective responses exerted by the body to maintain a normal metabolic and Major trauma is a pathophysiological state that threatens endocrine milieu. The caloric substitutes are mobilized so [2] the integrity of the internal environment, causing alteration that supply of glucose to the vital organs is maintained.