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Organ Injury Scaling 2020 update: Bowel and mesentery

Tominaga, Gail T; Crandall, Marie; Cribari, Chris; Zarzaur, Ben L; Bernstein, Mark; Kozar, Rosemary A
PMID: 34137742
ISSN: 2163-0763
CID: 5010542

A multiple casualty incident clinical tracking form for civilian hospitals

Frangos, Spiros G; Bukur, Marko; Berry, Cherisse; Tandon, Manish; Krowsoski, Leandra; Bernstein, Mark; DiMaggio, Charles; Gulati, Rajneesh; Klein, Michael J
BACKGROUND:While mass-casualty incidents (MCIs) may have competing absolute definitions, a universally ac-cepted criterion is one that strains locally available resources. In the fall of 2017, a MCI occurred in New York and Bellevue Hospital received multiple injured patients within minutes; lessons learned included the need for a formal-ized, efficient patient and injury tracking system. Our objective was to create an organized MCI clinical tracking form for civilian trauma centers. METHODS:After the MCI, the notes of the surgeon responsible for directing patient triage were analyzed. A suc-cinct, organized template was created that allows MCI directors to track demographics, injuries, interventions, and other important information for multiple patients in a real-time fashion. This tool was piloted during a subsequent MCI. RESULTS:In late 2018, the hospital received six patients following another MCI. They arrived within a 4-minute window, with 5 patients being critically injured. Two emergent surgeries and angioembolizations were performed. The tool was used by the MCI director to prioritize and expedite care. All physicians agreed that the tool assisted in orga-nizing diagnostic and therapeutic triage. CONCLUSIONS:During MCIs, a streamlined patient tracking template assists with information recall and communica-tion between providers and may allow for expedited care.
PMID: 32441042
ISSN: 1543-5865
CID: 4444722

A multiple casualty incident clinical tracking form for civilian hospitals

Frangos, Spiros G; Bukur, Marko; Berry, Cherisse; Tandon, Manish; Krowsoski, Leandra; Bernstein, Mark; DiMaggio, Charles; Gulati, Rajneesh; Klein, Michael J
BACKGROUND:While mass-casualty incidents (MCIs) may have competing absolute definitions, a universally accepted criterion is one that strains locally available resources. In the fall of 2017, a MCI occurred in New York and Bellevue Hospi-tal received multiple injured patients within minutes; lessons learned included the need for a formalized, efficient patient and injury tracking system. Our objective was to create an organized MCI clinical tracking form for civilian trauma centers. METHODS:After the MCI, the notes of the surgeon responsible for directing patient triage were analyzed. A suc-cinct, organized template was created that allows MCI directors to track demographics, injuries, interventions, and other important information for hmultiple patients in a real-time fashion. This tool was piloted during a subsequent MCI. RESULTS:In late 2018, the hospital received six patients following another MCI. They arrived within a 4-minute window, with 5 patients being critically injured. Two emergent surgeries and angioembolizations were performed. The tool was used by the MCI director to prioritize and expedite care. All physicians agreed that the tool assisted in organizing diagnostic and therapeutic triage. CONCLUSIONS:During MCIs, a streamlined patient tracking template assists with information recall and communica-tion between providers and may allow for expedited care.
PMID: 32804385
ISSN: 1932-149x
CID: 4566582

Multidetector CT in Vascular Injuries Resulting from Pelvic Fractures: A Primer for Diagnostic Radiologists

Raniga, Sameer B; Mittal, Alok K; Bernstein, Mark; Skalski, Matthew R; Al-Hadidi, Aymen M
Pelvic vascular injuries are typically caused by high-energy trauma. The majority of these injuries are caused by motor vehicle collisions, and the rest are caused by falls and industrial or crush injuries. Pelvic vascular injuries are frequently associated with pelvic ring disruption and have a high mortality rate due to shock as a result of pelvic bleeding. Morbidity and mortality resulting from pelvic vascular injury are due to pelvic hemorrhage and resultant exsanguination, which is potentially treatable and reversible if it is diagnosed early with multidetector CT and treated promptly. The pelvic bleeding source can be arterial, venous, or osseous, and differentiating an arterial (high-pressure) bleed from a venous-osseous (low-pressure) bleed is of paramount importance in stratification for treatment. Low-pressure venous and osseous bleeds are initially treated with a pelvic binder or external fixation, while high-pressure arterial bleeds require angioembolization or surgical pelvic packing. Definitive treatment of the pelvic ring disruption includes open or closed reduction and internal fixation. Multidetector CT is important in the trauma setting to assess and characterize pelvic vascular injuries with multiphasic acquisition in the arterial and venous phases, which allows differentiation of the common vascular injury patterns. This article reviews the anatomy of the pelvic vessels and the pelvic vascular territory; discusses the multidetector CT protocols used in diagnosis and characterization of pelvic vascular injury; and describes the spectrum of pelvic vascular injuries, the differentiation of common injury patterns, mimics, and imaging pitfalls. Online supplemental material is available for this article.©RSNA, 2019 See discussion on this article by Dreizin.
PMID: 31697619
ISSN: 1527-1323
CID: 4175822

Imaging of Spine Trauma

Bernstein, Mark P; Young, Matthew G; Baxter, Alexander B
Every year in North America, approximately 3 million patients are evaluated for spinal injury. Of blunt trauma patients presenting to the emergency department, 3% to 4% will have a cervical spine injury, and up to 18% will suffer a thoracolumbar spine injury. Failure to identify an unstable spine injury can lead to devastating outcomes.
PMID: 31076031
ISSN: 1557-8275
CID: 3864752

New and emerging patient-centered CT imaging and image-guided treatment paradigms for maxillofacial trauma

Dreizin, David; Nam, Arthur J; Hirsch, Jeffrey; Bernstein, Mark P
This article reviews the conceptual framework, available evidence, and practical considerations pertaining to nascent and emerging advances in patient-centered CT-imaging and CT-guided surgery for maxillofacial trauma. These include cinematic rendering-a novel method for advanced 3D visualization, incorporation of quantitative CT imaging into the assessment of orbital fractures, low-dose CT imaging protocols made possible with contemporary scanners and reconstruction techniques, the rapidly growing use of cone-beam CT, virtual fracture reduction with design software for surgical pre-planning, the use of 3D printing for fabricating models and implants, and new avenues in CT-guided computer-aided surgery.
PMID: 29922866
ISSN: 1438-1435
CID: 3158172

The Imaging of Maxillofacial Trauma 2017

Bernstein, Mark P
Maxillofacial injuries account for a large portion of emergency department visits and often result in surgical consultation. Although many of the principles of fracture detection and repair are basic, the evolution of technology and therapeutic strategies has led to improved patient outcomes. This article aims to provide a clinical review of imaging aspects involved in maxillofacial trauma and to delineate its relevance to patient management.
PMID: 30007759
ISSN: 1557-9867
CID: 3201802

Multidetector CT of Midfacial Fractures: Classification Systems, Principles of Reduction, and Common Complications

Dreizin, David; Nam, Arthur J; Diaconu, Silviu C; Bernstein, Mark P; Bodanapally, Uttam K; Munera, Felipe
The advent of titanium hardware, which provides firm three-dimensional positional control, and the exquisite bone detail afforded by multidetector computed tomography (CT) have spurred the evolution of subunit-specific midfacial fracture management principles. The structural, diagnostic, and therapeutic complexity of the individual midfacial subunits, including the nose, the naso-orbito-ethmoidal region, the internal orbits, the zygomaticomaxillary complex, and the maxillary occlusion-bearing segment, are not adequately reflected in the Le Fort classification system, which provides only a general framework and has become less relevant in contemporary practice. The purpose of this article is to facilitate the involvement of radiologists in the delivery of individualized multidisciplinary care to adults who have sustained blunt trauma and have midfacial fractures by providing a clinically relevant review of the role of multidetector CT in the management of each midfacial subunit. Surgically relevant anatomic structures, search patterns, critical CT findings and their management implications, contemporary classification systems, and common posttraumatic and postoperative complications are emphasized. ©RSNA, 2018.
PMID: 29320322
ISSN: 1527-1323
CID: 3052542

Imaging Genitourinary Trauma

Dane, Bari; Baxter, Alexander B; Bernstein, Mark P
Contrast-enhanced multidetector computed tomography (MDCT) has become a critical tool in the evaluation of the trauma patient. MDCT can quickly and accurately assess trauma patients for renal, ureteral, and bladder injuries. Moreover, CT guides clinical management triaging patients to those requiring discharge, observation, angioembolization, and surgery. Recognition of urinary tract trauma on initial scan acquisition should prompt delayed excretory phase imaging to identify urine leaks. Urethral and testicular trauma are imaged with retrograde urethrography and sonography, respectively.
PMID: 28126218
ISSN: 1557-8275
CID: 2418682

Imaging of Spine Trauma

Dane, Bari; Bernstein, Mark P
PMID: 27287950
ISSN: 1558-4658
CID: 2136672