Archive for April 2014

Brazilian Neurosurgery — Vol 33, No 1

Neurocirugía Abril 2014 (Vol 23)

Neurocirugía Hoy, Vol. 5, Numero 17

Journal Club No. 1, 2014

 

The University of Chicago Journal Club. Feb-March 2014.

“Management of brain trauma”

Participating faculty; Awad I; Frim D, Ramos E, Hekmat-Panah J, Roitberg B.

Residents: Dey M, Ralston A, Stamates M, Hobbs J, Wong R, Polster S,  Bhansali A, Sun Mar M.

1) Polytrauma: Pathophysiology, Priorities and Management. Otmar Trentz. In H-J Oestern et al (eds.) General Trauma Care and Related Aspects. European Manual of Medicine. Springer-Verlag 2014.

Stamates: Otmar Trentz is a Swiss Professor of trauma surgery. This book chapter deals with patients who have polytrauma.  Although not a neurosurgical problem in the narrow sense, the presence of polytrauma can dramatically change our management.

The most important objective in properly managing trauma patients is to ensure their proper resuscitation, according to ATLS protocol. If a patient is unable to be resuscitated, Trentz discusses the idea of “bail-out” surgery to decompress body cavities or control life threatening hemorrhage.  After these immediate risks are controlled, new problems arise. Patients often respond to trauma with a systemic inflammatory response, noted in literature as SIRS, reacting to pain and stress. Therefore Trentz recommends to proceed with staged, definitive surgery in the “window of opportunity” 5 to 10 days post-trauma.  This window is defined as a period of immunosuppression with new cell recruitment that follows the acute phase of hyperinflammation.

In managing polytrauma patients with fractures, the article captures the most common fracture management concepts: control hemorrhage & contamination, debride dead & ischemic tissue, limit ischemia-reperfusion injury, manage stress & pain & lower the hindrance to ICU care. In long-bone fractures, the options of early intramedullary pinning v. external fixation are debated, each with unique advantages.

The article describes three common trauma examples: massive hemorrhage from pelvic injury, planning fracture surgery in the setting of TBI and early fracture fixation in patients with concomitant chest injury. In all trauma scenarios however, Trentz advocates utilizing algorithms to optimize all trauma patients, whether or not they require surgical treatment. Early fixation has proven a critical piece of the “stabilization” objective of all trauma centers & the surgeons who care for this population. Continue reading ‘Journal Club No. 1, 2014’ »

Russian Neurosurgical Journal; Vol 6, No 1