The OC reviewed the retrieved papers and selected the most appropriated as related to the three topics. Studies not directly addressing the management of hemodynamically unstable pelvic trauma were excluded (elective procedures, stable patients, reviews studies). Manual cross-reference search of the relevant studies was performed by the OC and the related relevant pa- pers were also retrieved. The selected papers were subse- quently sent to the members of the SC in late December 2012, helping in the review of the literature. The SC and the OC shared the presentation in late February and completed the work in early March 2013. At the confer- ence was also invited a representative of a voluntary as- sociation the Italian Association of Blood Volunteers (Associazione Volontari Italiani del Sangue, AVIS), as a representative of the civil society. During the day of the conference (April 13 th 2013) the SC presented in the morning the whole review of the literature and in the afternoon the statements for each of the three questions. The JP, who was previously aware of the con- tent of presentations and statements, discussed with the
the physiopathologic status of the patients leads the therapeutic decision, more than the anatomy of the splenic lesions. Moreover, there are patients with high-grade splenic lesions without hemodynamic re- percussions that can be managed with NOM thanks to the modern tools in bleeding management. As a counterpart, there exists a cohort of patients with hemodynamic instability requiring urgent surgical intervention due to low-grade splenic injuries. In May 2017, during the World Society of Emergency Surgery (WSES) World Congress in Campinas, Brazil, the final version of the WSES guidelines on spleen trauma was approved (Fig. 1) . The WSES grading system takes into account both the patient’s condition and the anatomy of lesions.
In our study, 37% of participants were specialists, 24% were registrars and 39% were medical officers. Eighty- eight percent of anaesthetists routinely use the ASA-PS grading system. The time period since our respondents last read the ASA-PS Classification is demonstrated in Graph 1 below. A majority (93%) of anaesthetic departments expect their doctors to document the ASA grade in every case. However, only 67% were documenting the grade. Eighty-six percent of anaesthetists find it difficult applying the grading system in the trauma subgroup of patients. Ninety-five percent of participants documented that they had difficulty applying the ASA grading to obstetrics, paediatrics, trauma, vascular and geriatrics. Eighty-two percent believe that there should be modifications made to the ASA-PS Classification.
ABMH: American Board of Medical Hypnosis; ASCH: American Society of Clinical Hypnosis; AUS: Australia; CCBTR: Centre for Children ’ s Burns and Trauma Research; CONSORT: Consolidated Standards of Reporting Trials; CPSS: Child Posttraumatic Stress Disorder Symptom Scale; CPTSD-RI: Child Posttraumatic Stress Disorder Reaction Index; DSM-5: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; FLACC: Face, Legs, Activity, Cry, Consolability pain scale; FPS-R: Faces Pain Scale - Revised; g: gravitational force; GEE: generalized estimating equation; HR: heart rate; HREC: Human Research Ethics Committee; ITT: intention-to-treat; LCCH: Lady Cilento Children ’ s Hospital; LDI: laser Doppler imager; MCID: minimum clinically important difference; NRS: numeric rating scale; PLPBC: Pegg Leditschke Paediatric Burns Centre; PTSD: Posttraumatic stress disorder; rCBF: regional cerebral blood flow; RCT: randomized controlled trial; SD: standard deviation; SHCS-C: Stanford Hypnotic Clinical Scale for Children; SPIRIT: Standard Protocol Items: Recommendations for Interventional Trials; SPSS: Statistical Package for the Social Sciences; TBSA: total body surface area; TIDieR: Template for Intervention Description and Replication; VAS: visual analog scale; VAS-A: visual analog scale for anxiety; YCPC: Young Child Posttraumatic Stress Disorder Checklist.
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Has anyone ever asked you where you were when JFK or MLK was assassinated? Or when the Berlin wall came down? Or on 9/11? Are there particular personal or social milestones that you use to measure your life? It is common for people to divide their lives into periods marked by major events. To understand the women you work with, it is important to understand the historical circumstances in which their lives unfolded. An obvious generational difference between women who grew up in the 1930s-1960s and those who grew up after that is the status of women in society and the accepted norms of behavior for women and children. Earlier generations often believed that one should tolerate whatever your parents did to you, that protecting the family’s reputation was of primary concern, that women belonged in the home, and that children should “be seen and not heard.”
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Traumatic cardiac injuries are rare and are usually asso- ciated with a high mortality rate. To save a patient with a blunt or penetrating cardiac injury, rapid diagnosis, decisions, and treatment by an experienced surgeon is mandatory . The Advanced Trauma Operative Management (ATOM) course, which is a program of the American College of Surgeons and administered in Japan through the Japan Surgical Society, is a 1-day trauma course that includes a series of lectures and live- animal surgery simulation training with pigs to teach the surgical management of penetrating traumatic injuries
The Trauma Registry of the German Trauma Society (DGU) was initiated in 1993 by the society’s working Group on Polytrauma to collect data on patients with polytrauma within German-speaking countries (Ger- many, austria, and Switzerland). This trauma registry is a prospective, multicenter, standardized, and anonymized, documentation of severely injured pa- tients. Basic facts about the patient (P), prehospital (a), and treatment in the trauma room (B), and the subsequent course in the IcU (c), and scoring and outcome data (D) are entered continuously to a web- based data server. Every injured patient admitted to one of the participating trauma hospitals*** with an injury severity score (ISS) of 16 or more, or IcU treat- ment is documented. Data are submitted to a central database at the Institute for Research in operative Medicine (IfoM) at the University of witten/ Herdecke in cologne. Irreversible anonymity of data is guaranteed both for the individual patient and the participating hospital, so the registry comprises epi- demiologic, physiologic, laboratory, diagnostic, opera- tive, interventional, and intensive care medical data as well as scoring and outcome data .
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Temporary abdominal closure technique (TACT) or open abdomen (OA) techniques were firstly described more than 120 years ago . OA procedure is defined as intentionally leaving the fascial edges of the abdomen un-approximated (laparostomy). Since that moment, this technique has been utilized decade by decade more frequently. The “old” paradigm of closing the abdomen at “any cost” has been definitely overcome by the literature evidence. However, no definitive data about OA epidemiology and outcomes exist even if in many cases such as trauma, abdominal sepsis, se- vere acute pancreatitis, and more in general all those situa- tions in which an intra-abdominal hypertension condition is present and/or when is necessary to prevent the develop- ment of abdominal compartment syndrome (ACS), the OA is applied. Moreover, patients treated with OA procedures are absolutely heterogeneous even within the same study and large cohorts of patients treated with the same proce- dures are rare [2–7]. To overcome this lack of high level of evidence data about the OA indications, management, de- finitive closure, and follow-up, the World Society of Emer- gency Surgery (WSES) and the Panamerican Trauma Society (PTS) promoted the International Register of Open Abdomen (IROA) .
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Trauma is the principal public health problem in every country regardless of the level of socio- economic development and modern trauma care. However despite its huge importance, trauma has been called the neglected disease of modern society. Incidence of trauma is increasing with the increasing incidence of road traffic accidents, industrial accidents, violence and assault. Anesthesiologists are prepared to immediate care of patients with any form and severity of injury, which may require any kind of operations regardless of the day time of night. Therefore anesthesiologists offer a unique expertise and skill set that are significantly different from those offered by other medical specialists.
Since the study groups (HEMS vs. GEMS) were not directly comparable, we used prognostic scores to adjust the observed mortality rates. The prognosis of trauma patients was estimated using the Trauma and Injury Severity Score (TRISS) and the Revised Injury Severity Classification (RISC) [19,20]. TRISS is a logistic regres- sion model that compares outcomes to a large cohort of patients in the Major Trauma Outcomes Study (MTOS), including physiological parameters, trauma mechanism and age . The RISC score is based upon the Trau- maRegister DGU ® of the German Society for Trauma Surgery (TR-DGU), which analyzes the injury severity and distribution, physiological parameters, and reanima- tion in order to generate the risk of mortality . While the TRISS was based on pre-hospital data only (blood pressure, consciousness, respiratory rate), the RISC score also considered initial laboratory findings in the emergency department. The prognosis calculated with the TRISS and the RISC method was compared to the actually observed in-hospital mortality rate by calcu- lating the observed vs. expected ratio (Standardized Mortality Ratio, SMR). SMR values were given with 95% confidence intervals (CI) based on the respective CIs of the observed mortality rates. Differences of SMRs were evaluated with the t-test. Since the database on which both scores are based are more or less outdated, the SMR itself might be of limited use but interpretation should focus on the relative effects of HEMS vs. GEMS .
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Importance of the trauma aftermath Counselors working in the immediate after math of trauma—whether individual, group, or community in nature—face many challenges. For example, survivors may be forced to adjust without access to other health services, em ployment, support, or insurance. In these in stances, counselors must often work with individuals and communities coping with the trauma while struggling daily to meet basic needs. Research suggests that reestablishing ties to family, community, culture, and spiritual systems can not only be vital to the individual, but can also influence the impact of the trau ma upon future generations. For example, Baker and Gippenreiter (1998) studied the descendants of people victimized by Joseph Stalin’s purge. They found that families who were able to maintain a sense of connection and continuity with grandparents affected by the purge experienced fewer negative effects than did those who were emotionally or physi cally severed from their grandparents. The researchers also found that whether the grandparents survived was less important than the connection the grandchildren managed to keep to their past. Ties to family and commu nity can also have an adverse effect, especially if the family or community downplays the trauma or blames the victim. Counselors need to have a full understanding of available sup port before advocating a particular approach. Treatment strategies
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Prisons are challenging settings for trauma- informed care. Prisons are designed to house perpetrators, not victims. Inmates arrive shack led and are crammed into overcrowded hous ing units; lights are on all night, loud speakers blare without warning and privacy is severely limited. Security staff is focused on maintain ing order and must assume each inmate is po tentially violent. The correctional environment is full of unavoidable triggers, such as pat downs and strip searches, frequent discipline from authority figures, and restricted move- ment….This is likely to increase trauma- related behaviors and symptoms that can be difficult for prison staff to manage….Yet, if trauma-informed principles are introduced, all staff can play a major role in minimizing trig gers, stabilizing offenders, reducing critical in cidents, deescalating situations, and avoiding restraint, seclusion or other measures that may repeat aspects of past abuse.
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Results: The developed curriculum covers basic ultrasound of the abdomen and the throat, eFAST (Extended Focused Assessment with Sonography for Trauma), lung-ultrasound, FEEL (Focused Echocardiography in Emergency Life Support) and compression duplex sonography of the thigh deep vein system. All 5th year medical students receive a 90 min lecture on ultrasound basics by a faculty member and then a 12.5 h hands-on course divided into three sessions with one student tutor for every 4 students. The students are provided with a script (PDF-File) that covers all the learning goals, including example images of pathologies. The student tutors are trained during a 1 week ultrasound course and a 21-day rotation through seven different ultrasound laboratories. In addition, they undergo a standardized 1.5 day didactical training. Prior to the implementation for all students, the overall course was tested on 27 volunteer students. These students rated (on a 6-point Likert scale from 1 = excellent to 6 = very poor) the satisfaction with the student tutors and the faculty members as 1.4 ± .9 (mean ± stddev) and 1.3 ± .5 respectively.
What has become known as the memory wars revolved around the issue of whether traumatic memories can be repressed and then many years later be recovered in, for example, a therapeutic environment (Lindsay & Read, 1994; Loftus, 1994). Many mental health profes- sionals asserted that they saw patients in their clinical practice who, after extensive treatment, remembered a traumatic childhood incident (e.g., sexual abuse). In response to these clinical observations, many memory researchers argued that psychotherapeutic interventions often involve inherently suggestive prompts, ones that might have led patients to falsely remember entire epi- sodes of trauma. In support of this notion, some patients who initially remembered having been abused, later retracted their claims, arguing that their memories were contaminated because of the suggestive treatment that they had received (e.g., Maran, 2012; Ost, Costall, & Bull, 2002). In many of these cases, people were in therapy because they suffered from some form of psy- chopathology. The question then arises as to whether their psychopathology might have affected their suscep- tibility to false memories. Scoboria and colleagues (2017) recently argued that “people struggling with psy- chopathology who seek help for their symptoms may be particularly vulnerable to suggestions” (p. 160). How- ever, a meta-analytic review looking into the evidence for or against this position has so far been lacking.
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officers can assist youth in developing strategies for managing stress by offering referrals to services that teach positive coping skills and increase youth access to healthy and supportive relationships. Regulating affect. Trauma-related disorders among youth result in a range of behavioral symptoms that may interfere with probation and system-desired outcomes. For some youth, the symptoms may appear as anxiety or depression (e.g., appearing sad or withdrawn). For others, the behavioral manifestations may appear in unpleasant and disrespectful behavior. Emotional outbursts, defiance, temper tantrums, aggressive confrontations, and similar behaviors can create provocative and tense interactions between youth and probation personnel. When these reactions are symptoms of trauma, overly authoritative or punitive reactions may inadvertently reinforce those behaviors and exacerbate the trauma disorders. Whether they are dealing with depressive symptoms or aggressive outbursts, trauma-informed systems of care will need to address affect regulation. Again, while clinical treatment may be necessary to address affect disorders, training in how to help youth slow down and reorient themselves to a situation can be important to reinforcing healing and recovery. Training that includes interactive practice can help probation personnel respond to affect problems displayed by youth and provide skills that will help staff refrain from overreacting to confrontation and use it instead as an opportunity to model calmer responses that ultimately could lead to more productive interactions.
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populations (Golding et al. 2002; Gibson and Hartshorne 1996). Golding, Wilsnack, and Cooper (2002) found, using data from six non-incarcerated samples, that individuals with sexual trauma reported lower current emotional sup- port, and Gibson and Hartshorne (1996) found that victims of sexual abuse experienced more loneliness in their mixed sample of female university students and female clients at treatment centers. Though we were unable to explore the reasons for the association between trauma and loneliness/ social support among incarcerated populations found in the current study, the wider literature on sexual trauma provides possible explanations. For example, several studies examining coping in adults with histories of childhood sex- ual abuse have found that survivors engage in strategies such as social withdrawal and self-isolation (Griffing et al. 2006; Futa et al. 2003) and are less likely to seek out so- cial support. Victims of sexual trauma may also engage in behaviors that indirectly impact their social support and levels of loneliness such as acting out sexually and aggressively (Filipas and Ullman 2006), emotional sup- pression (Brand and Alexander 2003), self-blame (DiLillo et al. 1994; Futa et al. 2003; Oaksford and Frude 2004), addictive behaviors or substance use (Brand et al. 1997; Filipas and Ullman 2006), and decreased self- esteem and life satisfaction (Fergusson et al. 2008).
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1. GCS is a widely used measure of level of consciousness in the trauma populations. Its components include eye opening, verbal response, and motor response. Although the overall scale ranges from 3 to 15, it is recommended that individual items be reported separately in addition to the total score (Teasdale & Jennett, 1974). The scale is often used to classify severity of injury, such as severe TBI for scores of 8 or less, moderate TBI for scores of 9–12, and mild TBI for scores of 13–15. GCS as a measure of severity of concussion has been used to assist with the clinical decision to perform CT scans or not. Specifically, GCS 15 with no clinically significant findings was deemed a “low risk” category in a large prospective study. This group was able to be discharged from the ED without a CT scan with a favor- able outcome (Fabbri et al., 2004).
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Fig 2. FLAIR scan, FA map, and fiber tracking in a 49-year-old patient with TBI who was imaged 16 months after the initial trauma. The FLAIR image shows no abnormalities (top left image). After analysis of the color-coded FA map (top middle image), a region with reduced FA was identified in the white matter of the left frontal lobe. This ROI, illustrated in the top right T2-weighted image, included forceps minor and fronto- temporo-occipital fibers (bottom left image, superior oblique view; the ROI is red and located centrally; the fibers are superimposed on an axial T2-weighted scan). At the level of the ROI, the respective fibers are discontinuous (arrow, bot- tom right image; the ROI is left out in this image).
Because people who have experienced multiple traumas do not relate to the world in the same way as those who have not had these experiences, they require services and responses that are tailored to their needs. In response to the impact of trauma on people experiencing homelessness, the homelessness field is moving toward a new way of providing care. People can and do recover from trauma, and it is imperative to design services and service environments that best support healing. Meeting the needs of trauma survivors requires that organizations become “trauma-informed” (Harris & Fallot, 2001). Providing “trauma-informed” care involves using what we know about trauma and its impact to respond differently. Maxine Harris (2004) describes a trauma- informed service system as “a human services or health care system whose primary mission is altered by virtue of knowledge about trauma and the impact it has on the lives of consumers receiving services.” This means looking at all aspects of programming through a trauma lens, constantly keeping in mind how traumatic experiences impact consumers. Organizations that are informed by an understanding of trauma respond best to consumer needs and avoid engaging in practices that may cause additional harm. This type of change requires providers at all levels and in all roles and organizations as a whole to modify what they do based on an understanding of the impact of trauma and the specific needs of trauma survivors.
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PNT represents approximately 5%–10% of all trauma cases that present to the emergency department. Approximately 30% of these cases are accompanied by injury outside of the neck zones as well (McConnell, 1994; Thal, 1992). The current mortality rate in civilians with PNI is 3%–6% (McConnell, 1994; Thal, 1992). During World War II, the mortality rate was 7%, and in World War I, it was 11% (McConnell, 1994; Thal, 1992). Higher mortality rates occur with injuries to large vessels, such as the carotid or subclavian arteries and veins.PNI involves a missile or sharp object penetrating the skin and violating the platysma layer of the neck. This includes gunshot wounds, stab or puncture wounds, and impalement injuries (Brennan et al., 2011; Dubois-Marshall, 2011; Gupta et al., 2011). Experience in the treatment of casualties from the Iraq War reported the common carotid artery as the most frequently injured cervical vessel (Woo et al., 2005). PNI in Iraq War was estimated in 10% of all trauma patients, overall mortality rates were estimated at 3%– 6%, most commonly because of injury to vascular structures and hemorrhage (Brennan, 2013; Burgess et al., 2012; Mahmoodie et al., 2012). Anatomically, the neck can be divided into three major zones according to Monson et al. (1969). These three zones allow for easy initial assessment and management, including surgical exploration and hemorrhage control.Successful management of PNT depends on a clear understanding of the anatomy of the neck (Thompson et al., 2002).