Reading List • • • • • Boyle EM, Maier RV, Salazar JD, et al: Diagnosis of injuries after stab wounds to the back and flank. J Trauma 42(2):2660, 1997. Velmahos GC, Demetriades D, Foianini E, et al: A selective approach to the management of gunshot wounds to the back. Am J Surg 174(3):342, 1997. Hodgson NF, Stewart TC, Girotti MJ: Open or closed diagnostic peritoneal lavage for abdominal trauma? A meta-analysis. J Trauma 48(6):1091, 2000. Blow O, Bassam D, Butler K, et al: Speed and efficiency in the resuscitation of blunt trauma patients with multiple injuries: the advantage of diagnostic peritoneal lavage over abdominal computed tomography. J Trauma 44(2):287, 1998. Scalfani SJ, Shaftan GW, Scalea TM, et al: Nonoperative salvage of computed tomography-diagnosed splenic injuries: utilization of angiography for triage and embolization for hemostasis. J Trauma 39(5):818, 1995. Myers JG, Dent DL, Stewart RM, et al: Blunt splenic injuries: dedicated trauma surgeons can achieve a high rate of nonoperative success in patients of all ages. J Trauma 48(5):801, 2000. Shatz DV, Schinsky MF, Pais LB, et al: Immune responses of splenectomized trauma patients to the 23-valent pneumococcal polysaccharide vaccine at 1 verses 7 versus 14 days after splenectomy. J Trauma 44(5):760, 1998. Croce MA, Fabian TC, Menke PG, et al: Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients. Ann Surg 221(6):744, 1995. Richardson JD, Franklin GA, Lukan JK, et al: Evolution of hepatic trauma: a 25-year perspective. Ann Surg 232(3):324, 2000. Timaran CH, Martinez O, Ospina JA: Prognostic factors and management of civilian penetrating duodenal trauma. J Trauma 47(2):330, 1999. Takishima T, Sugimoto K, Hirata M, et al: Serum amylase level on admission in the diagnosis of blunt injury to the pancreas: its significance and limitations. Ann Surg 221(1):70, 1997. Allen GS, Moore FA, Cox CS, et al: Delayed diagnosis of blunt duodenal injury: an avoidable complication. J Am Coll Surg 187(4):393, 1998. Stapfer M, Selby RR, Stain SC, et al: Management of duodenal perforation after endoscopic retrograde cholangiopancreatography and sphincterotomy. Ann Surg 232(2):191, 2000. Fang JF, Chen RJ, Lin BC, et al: Small bowel perforation: is urgent surgery necessary? J Trauma 47:515, 1999. Frick EJ, Pasquale MD, Cipolle MD: Small-bowel and mesentery injuries in blunt trauma. J Trauma 46:920, 1999. Bozorgzadeh A, Pizzi WF, Barie PS, et al: The duration of antibiotic administration in penetrating abdominal trauma. Am J Surg 177:125, 1999. Murray JA, Demetriades D, Colson M, et al: Colonic resection in trauma: colostomy verses anastomosis. J Trauma 46:250, 1999. Santucci RA, McAninch JW: Diagnosis and management of renal trauma: past, present, and future. J Am Coll Surg 191(4):443, 2000. Sinnott R, Rhodes M, Brader A: Open pelvic fracture: an injury for trauma centers. Am J Surg 163:283, 1992. Kale IT, Kuzu MA, Berkem H, et al: The presence of hemorrhagic shock increases the rate of bacterial translocation in blunt abdominal trauma. J Trauma 44:171, 1998. Swank GM, Deitch EA: Role of the gut in multiple organ failure: bacterial translocation and permeability changes. World J Surg 20:411, 1996. Kirton OC, Windsor J, Wedderburn R, et al: Failure of splanchnic resuscitation in the acutely injured trauma patient correlates with multiple organ system failure and length of stay in the ICU. Chest 113:1064, 1998. Kshettry VR, Bolmon RMI: Chest trauma: assessment, diagnosis, and management. Clin Chest Med 15:137–146, 1994. Branney SW, Moore EE, Feldhaus KM, et al: Critical analysis of two decades of experience with postinjury emergency department thoracotomy in a regional trauma center. J Trauma 45:87–94; discussion 94–95, 1998. Wall MJ, Granchi T, Liscum K, et al: Penetrating thoracic vascular injuries. Surg Clin North Am 76:749–761, 1996. • Nagy KK, Lohmann C, Kim DO, et al: Role of echocardiography in the diagnosis of occult penetrating cardiac injury. J Trauma 38:859–862, • • • • • • • • • • • • • • • • • • • • 1995.
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EL ÁRBOL DEL TRAUMA adult o adolescen te niñez bebé o niño pequeño nacimie nto prenata l
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Reading List • • • • • • • • • • • • • • • • • • • • • • • • • • Zipnick RI, Scalea TM, Trooskin SZ, et al: Hemodynamic responses to penetrating spinal cord injuries. J Trauma 35:578–582, 1993. Chang MC, Meredith JW: Cardiac preload, splanchnic perfusion, and their relationship during resuscitation in trauma patients. J Trauma 42:577–584, 1997. Chang MC, Blinman TA, Rutherford EJ, et al: Preload assessment in trauma patients during large-volume shock resuscitation. Arch Surg 131:728–731, 1996. Miller PR, Meredith JW, Chang MC: Randomized, prospective comparison of increased preload versus inotropes in the resuscitation of trauma patients: effects on cardiopulmonary function and visceral perfusion. J Trauma 44:107–113, 1998. Cheatham ML: Right ventricular end-diastolic volume measurements in the resuscitation of trauma victims. Int J Crit Care 1–6, 2000. Abramson D, Scalea TM, Hitchcock R, et al: Lactate clearance and survival following injury. J Trauma 35:584–589, 1993. Choi PTL, Yip G, Quinonez LG, et al: Crystalloids vs. colloids in fluid resuscitation: a systematic review. Crit Care Med 27:200–210, 1999. Kellum JA, Decker J: Use of dopamine in acute renal failure: a meta-analysis. Crit Care Med 29:1526–1531, 2001. Goodnough LT, Brecher ME, Kanter MH, et al: Transfusion medicine: first of two parts—blood transfusion. N Engl J Med 340:438, 1999. Matsuoka T, Wisner DH: Resuscitation of uncontrolled liver hemorrhage: effects on bleeding, oxygen delivery, and oxygen consumption. J Trauma 41:439, 1996. Mann CN, Mullins RJ, MacKenzie EJ, et al: Systematic review of published evidence regarding trauma system effectiveness. J Trauma 47:S25, 1999. Bullock R, Chestnut RM, Clifton G, et al: Guidelines for the Management of Severe Head Injury. New York, Brain Trauma Foundation, 1995. Chesnut RM, Marshall LF, Klauber MR, et al: The role of secondary brain injury in determining outcome from severe head injury. J Trauma 34:216, 1993. Muizelaar JP, Marmarou A, Ward JD, et al: Adverse effects of prolonged hyperventilation in patients with severe head injury. J Neurosurg 75:731, 1991. Temkin NR, Dikman SS, Wilensky AJ, et al: A randomized, double-blind study of phenytoin for the prevention of post-traumatic seizures. N Engl J Med 323:497, 1990. Hsiang JK, Chesnut RM, Crisp CB, et al: Early, routine paralysis for intracranial pressure control in severe head injury: is it necessary? Crit Care Med 22:1471, 1994. Robertson CS, Gopinath SP, Goodman JC, et al: SjVO2 monitoring in head-injured patients. J Neurotrauma 12:891, 1995. Amar A, Levy M: Pathogenesis and pharmacological strategies for mitigating secondary damage in acute spinal injury. Neurosurgery 44:1027–1040, 1999. Lu J, Ashwell K, Waite P: Advances in secondary spinal cord injury. Spine 25:1859–1866, 2000. Harrop J, Sharan A, Vaccaro A, et al: The cause of neurologic deterioration after acute cervical spinal cord injury. Spine 26:340–346, 2001. Marino R, Ditunno J, Donovan W, et al: Neurologic recovery after traumatic spinal cord injury: data from the Model Spinal Cord Injury Systems. Arch Phys Med Rehab 80:1391–1396, 1999. Maynard F, Bracken M, Creasey G, et al: International standards for neurological and functional classification of spinal cord injury. Spinal Cord 35:266–274, 1997. Bracken M: Methylprednisolone and spinal cord injury. J Neurosurg 96:140–141, 2002. Deep K, Jigajinni M, McLean A, et al: Prophylaxis of thromboembolism in spinal injuries—results of enoxaparin used in 276 patients. Spinal Cord 39:88–91, 2001. Velmahos G, Kern J, Chan L, et al: Prevention of venous thromboembolism after injury: an evidence-based report—Part II: analysis of risk factors and evaluation of the role of vena caval filters. J Trauma 49:140–144, 2000. Nagy KK, Krosner SM, Joseph KT, et al: A method of determining peritoneal penetration in gunshot wounds to the abdomen. J Trauma 43(2):242, 1997. Zantut LF, Ivatury RR, Smith RS, et al: Diagnostic and therapeutic laparoscopy for penetrating abdominal trauma—a multicenter experience. J Trauma 42(5):825, 1997.
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Reading List • • • • • • • • • • • • • • • • , Moore EE, Ilke DN, et al: Thoracic aortic injury: how predictive is mechanism and is chest computed tomography a reliable screening tool? A prospective study of 1,561 patients. J Trauma 48:673–682; discussion 682–683, 2000. Smith MD, Cassidy JM, Souther S, et al: Transesophageal echocardiography in the diagnosis of traumatic rupture of the aorta. N Engl J Med 332:356–362, 1995. Minard G, Schurr MJ, Croce MA, et al: A prospective analysis of transesophageal echocardiography in the diagnosis of traumatic disruption of the aorta. J Trauma 40:225–230, 1996. Ziegler DW, Agarwal NN: The morbidity and mortality of rib fractures. J Trauma 37:975–979, 1994. Freedland M, Wilson RF, Bender JS, et al: The management of flail chest injury: factors affecting outcome. J Trauma 30:1460–1468, 1990. Ahmed Z, Mohyuddin Z: Management of flail chest injury: internal fixation versus endotracheal intubation and ventilation. J Thorac Cardiovasc Surg 110:1676–1680, 1995. Allen GS, Coates NE: Pulmonary contusion: a collective review. Am Surg 62:895–900, 1996. Sharma S, Mullins RJ, Trunkey DD: Ventilatory management of pulmonary contusion patients. Am J Surg 172:529–532, 1996. Bertinchant JP, Polge A, Mohty D, et al: Evaluation of incidence, clinical significance, and prognostic value of circulating cardiac troponin I and T elevation in hemodynamically stable patients with suspected myocardial contusion after blunt chest trauma. J Trauma 48:924–931, 2000. Fabian TC, Richardson JD, Croce MA, et al: Prospective study of blunt aortic injury: multicenter trial of the American Association for the Surgery of Trauma. J Trauma 42:374–383, 1997. Luchette FA, Barrie PS, Oswanski MF, et al: Practice management guidelines for prophylactic antibiotic use in tube thoracostomy for traumatic hemopneumothorax: the EAST practice management guidelines work group. J Trauma 48:758–759, 2000. Reed WJ, Doyle SE, Aprahamian C: Tracheoesophageal fistula after blunt chest trauma. Ann Thorac Surg 59:1251–1256, 1995. Hargens AR, Mubarak SJ: Current concepts in the pathophysiology, evaluation, and diagnosis of compartment syndrome. Hand Clin 14:371, 1998. Whitesides TE, Heckman MM: Acute compartment syndrome: update on diagnosis and treatment. J Am Acad Orthop Surg 4:209, 1996. Andermahr J, Helling HJ, Tsironis K, et al: Compartment syndrome of the foot. Clin Anat 14:184, 2001. Block EF, Dobo S, Kirton OC: Compartment syndrome in the critically injured following massive resuscitation: case reports. J Trauma 39:787, 1995.
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Understanding Provider Role in Treating Trauma – Trauma Informed Care • To begin with, it is important to understand what trauma is for purposes of “Trauma Informed Care.” It can be thought of as an event or series of events that involve a direct or perceived threat of death, severe bodily harm, and/or psychological injury that a person at the time of the event finds deeply distressing. Trauma can be experienced by being a witness to trauma, such as when a child sees domestic violence. Trauma can occur at any point in the lifespan (Huckshorn & Lebel, 2013; Trauma Informed Care Resource Guide, 2017). • Purkey et al. (2018) support having all who work in healthcare, from the receptionist and the nurse to allied health professionals as well as physicians, understand and apply the principles of Trauma Informed Care (TIC), principles which have been recommended as “universal precautions” (Bruce et al., 2018). • Epidemiologic studies estimate between 36% to 81% of the general population have experienced trauma (Huckshorn & Lebel, 2013). It is challenging to accurately determine the extent of trauma within the population if it is unassessed and allowed to remain invisible. Not all who experienced trauma will have the same manifestations – thus the idea of “universal precautions”- that is, approaching each individual using TIC principles.
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References • Bruce, M.M., Kassam-Adams, N., Rogers, M., Anderson, K., Sluys, K.P., & Richmond, T.S. (2018). Trauma provider’s knowledge, views, and practice of trauma-informed care. Journal of Trauma Nursing, 25(2), 131 – 138. • Huckshorn, K., & Lebel, J. (2013). Trauma-informed care In Yeager, et al. (Eds) Modern community mental health: An interdisciplinary approach (pp. 62-83). Oxford, UK:Oxford University Press. • Isobel, S., & Delgado, C. (2017). Safe and collaborative communication skills: A step towards mental health nurses implementing trauma informed care. Archives of Psychiatric Nursing, 32, 291-296. • National Center Trauma Informed Care (2015). Trauma-informed approach and trauma-specific interventions. Accessed: https://www.samhsa.gov/nctic/trauma-interventions • Purkey, E., Patel, R., & Phillips, S.P. (2018). Trauma-informed care: Better for everyone. Canadian Family Physician, 64, 170-173. • Stevens, J. E. (2012). ACE study, child abuse, child trauma, chronic disease, neurobiology comments. Daily Archives: October 3,2012, Accessed: https://acestoohigh.com/2012/10/03/
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St.Barnabas Hospital Trauma ICU • The ACGME requirement for Trauma/Critical Care management training of fellows is met in this 16 bed ICU that is an integral part of the ACGME CCM accredited fellowship program of Mount Sinai Medical Center Program (ACGME # 0453521020). Medical Director is Daryll Adler, MD, & The Departmentb of Surgery is Dr. DiRossi, with the head of Trauma & Critical Care being Dr. Davis. There are 900 major Trauma cases per year admitted to Elmhurst Hospital, and 250-300 is admitted to the Trauma ICU each year. At least 50% of patients in this ICU has suffered from critical injury due to penetrating or blunt trauma. Some 50% of the trauma patients have significant neurosurgical critical illness. This service is fully integrated with the program of Department of Surgery under Dr. DiRossi. The Critical Care fellow calls alternates Monday through Fridayplus Friday night, with Monday through Saturday plus Saturday night. In addition to excellent surgical critical care training, the focused programs in this unit allows fellows to gain experience in being part of the trauma team. Also, they participate in Anesthesia operating room procedures, perform procedures not routinely done in Montefiore such as percutaneous tracheotomy, and are responsible for CRRT techniques such as CVVH and SLED. The CCM fellows will participate in the trauma case conferences, grand rounds and core curriculum lectures including the trauma journal club and M&M conferences as required by ACGME. • Goals: The educational purpose of this rotation is to develop full competence in evaluation, diagnosis and treatment of patients with severe traumatic injury requiring medical and surgical correction and critical care support. The principle teaching method is thorough case management of all patients including history, physical exam, and interpretation of laboratory tests and cardiorespiratory physiology data. Teaching rounds, unit based conferences for both clinical and administrative management, increased involvement in house staff instruction, and mastery of technical aspects of major required procedures are mandatory. Fellows are required to prepare for teaching rounds by supplementing case based understanding with review of major textbooks and current peer reviewed literature. Fellows are required to attend all curriculum conferences, and competently prepare their presentations under faculty supervision while on this rotation. Faculty will provide supervision to fellows on site from 7am to 7pm every day.
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Trauma Informed Schools/Systems vs. Trauma Informed Therapy TRAUMA INFORMED • Takes into account knowledge about trauma into all aspects of service delivery (education, discipline, socialization) • Integrates sensitivity approaches into the school culture for the student body as a whole • Does not diagnose or treat symptoms or syndromes related to trauma TRAUMA SPECIFIC • Utilize evidence-based, best practices treatment models that have been proven to facilitate trauma recovery • Directly assesses the individual for trauma • Directly address the impact of trauma on the individual’s life and facilitate recovery based on a relational
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Controversy: Who is Poor? Adult A has 24 hours of leisure since he does not work. He has zero income, and so cannot afford any housing. Adult B has 16 hours of leisure since he works 8 hours per day. He has income $80, and so can afford 800 square feet of housing. Can Adult A afford the consumption of Adult B? Adult A spends $0.11 x 0 + $12 x 24 = $288 per day. And to consume like Adult B would cost Adult A $0.11 x 800 + $12 x 16 = $280 per day. So, yes, Adult A can afford the consumption of Adult B. The fact that Adult A rejects the consumption of B means Adult A is happier. BA 210 Lesson I.1 Introduction 36
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