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Purpose: Penetrating neck injuries (PNIs), defined as deep to the platysma, can result in significant morbidity and mortality. Management has evolved from a zone‐based approach to a 'no zone' algorithm, resulting in reduced non‐therapeutic neck exploration rates. The aim of this study was to examine PNIs and its management trends in an Australian tertiary trauma centre, to determine if a 'no zone' approach could be safely implemented in this population, as has been demonstrated internationally. Methodology: This was a retrospective observational study at a level 1 adult Australian tertiary trauma centre using prospectively collated data from January 2008 to December 2018. Observed data included age, gender, mechanism of injury, computed tomography angiography (CT‐A) use and operative intervention. Patients were examined based on zone of injury and presenting signs – 'hard', 'soft' or 'asymptomatic'. Major outcomes were CT‐A usage, positive CT‐A correlation with therapeutic neck explorations and negative neck exploration rates. Results: This study identified 238 PNI patients, with 204 selected for review. Most injuries occurred in zone 2 (71.6%), with soft signs accounting for 53.4% of cases. Over 10 years, CT‐A utilization increased from 55% to 94.1%, with positive CT‐As being more likely to yield therapeutic neck explorations. There was a general decreased trend in operative intervention but without a clear reduction in non‐therapeutic neck explorations. Conclusion: Our data suggests similarities with results from around the world, demonstrating that the 'no zone' approach should be considered when managing PNIs, but with clinician discretion in individual cases. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Guidelines for the management of major trauma are used terrestrially to guide and subsequently evaluate complex trauma situations. Prior research exists on the altered human physiology encountered in microgravity and how this would influence a trauma patient in the environment of the Moon, Mars or within a space vehicle. NASA's Integrated Medical Model confirms that trauma situations are a significant component of the medical risks in space exploration. METHODS: The aim of this study was to develop trauma guidelines for space exploration - integrating current knowledge of human physiology, specifically related to trauma in microgravity, with current trauma guidelines from major Australian surgical trauma services. A review of the major medical databases (Pubmed, Medline, Ovid, Google Scholar) was undertaken using keywords of ("TRAUMA" OR "ACCIDENT") and ("MICROGRAVITY" OR "SPACE" OR "MOON" OR "MARS"). Expert Trauma Surgeon review was then performed of the results with application of the currently used Hospital (The Royal Melbourne Hospital, Melbourne and Westmead Hospital, Sydney) trauma guidelines to space exploration. RESULTS: Understanding of human physiology in microgravity is critical in the management of trauma with long duration missions to the Moon and Mars. A trauma guideline specifically for microgravity was developed based on current major trauma centres guidelines. Specific considerations within the guideline included: the use of diagnostic peritoneal lavage in the absence of cross-sectional imaging; Focused Assessment with Sonography for Trauma (FAST) scan training for Astronauts; considerations for chest drain use in the altered pressure environment and specifically re-entry; and development of stabilisation of fractures through minimal weight or 3D printed devices. DISCUSSION: Current trauma guidelines can be modified to develop tailored guidelines for space exploration. Trauma guidelines from major trauma centres were reviewed and compared to known physiological responses in microgravity and an applicable guideline developed. Learning Objectives 1. The audience will learn about physiology in microgravity as it relates specifically to trauma. 2. The audience will learn of a trauma guideline for space exploration developed in conjunction with currently used major center trauma guidelines. [ABSTRACT FROM AUTHOR]

The article presents the discussion on trauma patients being most at risk of poor outcome. Topics include frailty being a loss of physiological reserve leaving an individual vulnerable to a significant decline from a seemingly minor insult; and multiple studies in orthogeriatric trauma showing multidisciplinary care with surgeons and geriatricians.

Background: Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), is a major cause of potentially preventable morbidity and mortality amongst trauma patients. Venous thromboembolism prevalence varies from 1 to 58%, and traditionally, compliance with prophylaxis protocols is low in major trauma cohorts. This study aimed to describe VTE prevalence, prophylaxis practices and outcomes amongst VTE cases at an Australian level-one trauma centre. Methods: A retrospective review of all VTE cases occurring in acute, major trauma admissions between 1 January 2010 and 30 June 2019 was conducted using prospectively collected registry data. Data regarding demographics, time to diagnosis, VTE prophylaxis, VTE risk assessment tool (RAT) usage and all-cause mortality were collected. Chemoprophylaxis was considered adequate if administered for 48 h prior to diagnosis. VTE cases diagnosed within 48 h of admission were excluded from prophylaxis compliance analysis. A subgroup analysis of patients with intracranial haemorrhage (ICH) was also completed. Results: During the study period, 238 VTE events occurred in 237 patients from 7482 major trauma admissions, giving a VTE prevalence of 3.18%. The all-cause mortality rate was 8.0%. VTE chemoprophylaxis was administered for 109 of 211 eligible patients (51.7%). Of the remaining 102 VTE cases, 75 (73.5%) did not receive prophylaxis due to a documented contraindication, while 27 (26.5%) did not receive prophylaxis with no contraindication recorded. The VTE RAT was completed in 49.0% of cases. Conclusion: Venous thromboembolism prevalence at our institution was consistent with published figures for comparable institutions. A review of compliance with prophylaxis protocols showed several potential areas for improvement. [ABSTRACT FROM AUTHOR]

Background: The acute surgical unit (ASU) is a recently established model of care in Australasia and worldwide. Limited data are available regarding its effect on the management of small bowel obstruction. We compared the management of small bowel obstruction before and after introduction of ASU at a major tertiary referral centre. We hypothesized that introduction of ASU would correlate with improved patient outcomes., Methods: A retrospective review of prospectively maintained databases was performed over two separate 2-year periods, before and after the introduction of ASU. Data collected included demographics, co-morbidity status, use of water-soluble contrast agent and computed tomography. Outcome measures included surgical intervention, time to surgery, hospital length of stay, complications, 30-day readmissions, use of total parenteral nutrition, intensive care unit admissions and overall mortality., Results: Total emergency admissions to the ASU increased from 2640 to 4575 between the two time periods. A total of 481 cases were identified (225 prior and 256 after introduction of ASU). Mortality decreased from 5.8% to 2.0% (P = 0.03), which remained significant after controlling for confounders with multivariate analysis (odds ratio = 0.24, 95% confidence interval 0.08-0.73, P = 0.012). The proportion of surgically managed patients increased (20.9% versus 32.0%, P = 0.003) and more operations were performed within 5 days from presentation (76.6% versus 91.5%, P = 0.02). Fewer patients received water-soluble contrast agent (27.1% versus 18.4%, P = 0.02), but more patients were investigated with a computed tomography (70.7% versus 79.7%, P = 0.02)., Conclusion: The ASU model of care resulted in decreased mortality, shorter time to intervention and increased surgical management. Overall complications rate and length of stay did not change., (© 2015 Royal Australasian College of Surgeons.)