Trends in nonoperative management of traumatic injuries – A synopsis

Stawicki, Stanislaw P.

doi:10.4103/ijciis.ijciis_7_17

Cited by 71 publications

(58 citation statements)

References 98 publications

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“…The benefits of non-operative management of blunt liver injuries should be weighed against possible risks of delayed operation [18]. Also the key for success is the frequent clinical examination and patient monitoring as stated by Bhavinder K. et al; 2016 [19].…”

Section: Discussionmentioning

confidence: 99%

Selective Non Operative Management of Blunt Liver Trauma: Is It Still a Challenge?

Hablus¹

2017

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Abstract:The non-therapeutic laparotomy in managing cases with blunt liver injuries is not without risks, so selective nonoperative treatment in stable patients was tried in many centers and has become the standard of care of these patients The aim of this study was to assess the feasibility and safety of selective non-operative management of blunt liver injury in our institution Patients and Methods: This prospective study was conducted on 40 patients with blunt liver injury who met our inclusion criteria admitted to Tanta University Hospital during the period from January 2012 to January 2014. All patients were treated by selective non-operative treatment (repeated clinical examination, serial U/S and CT study and follow up) Results: The age of our patients ranged from 26 to 40 years with a mean (±SD) of 31.3 ± 3.77 years. 36 patients were males (90%), while 4 patients (10%), were female. Total length of stay was ranged from 2 days to 15 days with a mean (±SD) of 5.8 ± 3.27 days as regards all cases. Intensive care unit stay was in 2 cases (5%) which FNOM with mean (±SD) of 1.5 ± 0.7 days. CT study was done in all cases (100%), 2 cases (5%) was operated after 6 hours of conservatism in ICU due to hemodynamic instability after initial assessment of stability. Conclusions: Selective non operative management of blunt liver injury in bunt abdominal trauma is safe, efficient, and cost-effective in the appropriate clinical setting and can lead to fewer unnecessary laparotomies in patients with liver injury. Proper patient selection, resources that permit close observation, and frequent abdominal examinations are paramount in obtaining the best results.

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Section: Discussionmentioning

confidence: 99%

Selective Non Operative Management of Blunt Liver Trauma: Is It Still a Challenge?

Hablus¹

2017

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“…[8] The optimal approach to the multiply injured patient involves the involvement of anesthesiologists, trauma-trained surgeons, intensivists, orthopedic specialists, diagnostic and interventional radiologists, urologists, neurosurgeons, rehabilitation specialists, otolaryngologists, among many others. [79] Fine-tuned team management, leadership, and communication skills are of critical importance. Excellent communication between physicians and teams, including awareness of important clinical pitfalls and constant vigilance on the part of all participating team members (i.e., presence of multiple cross-checks), as well as the need for centralized care planning (including multi-disciplinary patient care conferences) are crucial.…”

Section: Multi-disciplinary Teamsmentioning

confidence: 99%

“…Despite its seemingly chaotic nature, such an approach requires excellent coordination of care and actively engages a multitude of medical and surgical specialists including anesthesiologists, trauma surgeons, radiologists (both diagnostic and interventional), orthopedic surgeons, oral maxillofacial surgeons, vascular, and neurosurgeons, among many others. [79]…”

Section: Trauma Centers and Systemsmentioning

confidence: 99%

The right team at the right time – Multidisciplinary approach to multi-trauma patient with orthopedic injuries

Bach

Leskovan

Scharschmidt

et al. 2017

Int J Crit Illn Inj Sci

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Integrated, multidisciplinary team approach to the multiply injured patient can help optimize care, minimize morbidity, and reduce mortality. It also provides a framework for accelerated postinjury rehabilitation course. The characteristics and potential benefits of this approach, including team dynamics and interactions, are discussed in this brief review. Emphasis is placed on synergies provided by specialty teams working together in the framework of care coordination, timing of surgical and nonsurgical interventions, and injury/physiologic considerations.Republished with permission from:Bach JA, Leskovan JJ, Scharschmidt T, Boulger C, Papadimos TJ, Russell S, Bahner DP, Stawicki SPA. Multidisciplinary approach to multi-trauma patient with orthopedic injuries: the right team at the right time. OPUS 12 Scientist 2012;6(1):6-10.

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“…Ultrasound operators from different backgrounds and medical disciplines can be trained to obtain adequate images [9,24,55,56,[66][67][68][69][70], in some cases following a focused, 1-day training course [71]. Positive FAST images (i.e., the presence of intraperitoneal or pericardial blood/fluid) can be recognized very quickly, whereas a negative FAST can be comfortably completed in an average of 2.5 min [71][72][73].…”

Section: Bioterrorismmentioning

confidence: 99%

“…Prior research demonstrates that FAST is most sensitive and specific as a diagnostic tool in hemodynamically unstable patients with blunt abdominal trauma, or those with penetrating chest wounds [118,119]. A clear advantage of ultrasound (FAST) in the MCI setting is its ability to be performed repeatedly, without requiring significant additional resources in an already resource-constrained environment [17,73]. To further strengthen the case for ultrasound use in disaster and mass casualty triage, some have suggested scoring systems to quantify hemoperitoneum in clinically translatable ways, including possible prediction of the need for surgical intervention [120].…”

Section: Caveat: the Proposed Sonographic Triage Examinationmentioning

confidence: 99%

Portable ultrasound in disaster triage: a focused review

Wydo

Seamon

Melanson

et al. 2015

Eur J Trauma Emerg Surg

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Ultrasound technology has become ubiquitous in modern medicine. Its applications span the assessment of life-threatening trauma or hemodynamic conditions, to elective procedures such as image-guided peripheral nerve blocks. Sonographers have utilized ultrasound techniques in the pre-hospital setting, emergency departments, operating rooms, intensive care units, outpatient clinics, as well as during mass casualty and disaster management. Currently available ultrasound devices are more affordable, portable, and feature user-friendly interfaces, making them well suited for use in the demanding situation of a mass casualty incident (MCI) or disaster triage. We have reviewed the existing literature regarding the application of sonology in MCI and disaster scenarios, focusing on the most promising and practical ultrasound-based paradigms applicable in these settings.

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Trends in nonoperative management of traumatic injuries – A synopsis

Cited by 71 publications

References 98 publications

Selective Non Operative Management of Blunt Liver Trauma: Is It Still a Challenge?

Selective Non Operative Management of Blunt Liver Trauma: Is It Still a Challenge?

The right team at the right time – Multidisciplinary approach to multi-trauma patient with orthopedic injuries

Portable ultrasound in disaster triage: a focused review

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