The Hip

References: XARELTO (rivaroxaban)

NICE recommends rivaroxaban (XARELTO®) to prevent blood clots in people who have had a heart attack – NICE 3/25/15 Bayer discloses encouraging data on anticoagulant XARELTO® Bayer happy with rivaroxaban (XARELTO®) trial results Efficacy and safety of rivaroxaban versus low-molecular-weight heparin therapy in patients with lower limb fractures. A non-interventional comparison of rivaroxaban with standard … Read more

Work Up for Pelvic Fracture

– Trauma Management:     – damage control resusitation             – ref:  Damage-Control Orthopedics Versus Early Total Care in the Treatment of Borderline High-Energy Pelvic Fractures     – fluid management             – hypotension is associated with an increased risk of mortality, ARDS, and multiple organ failure;             – IV access is secured with at least … Read more

Work Up and Treatment of Acetabular Frx

– See: Trauma Menu – Discussion:     – note that with acetabular fracture associated with major trauma that there will be 50% chance of            at least one other major injury;            – neuro and head injury (see Glasgow)            – abdominal and chest injury (pulmonary … Read more

Deep Venous Thrombosis (DVT) – Ultrasound

Discussion allows assessment of DVT from the external iliac vein down to the popliteal veins visualization distal to the popliteal veins is usually not possible may be able to detect patency of major vessels, but it is not effective for smaller vessels will not diagnose pelvic thrombi note that clots seen on ultrasound comprise a … Read more

Treatment of DVT and PE

Clinical Cardiology: Diagnosis, Treatment, and Prevention of Pulmonary Embolism: Report of the WHO/International Society and Federation of Cardiology Task Force. Subcutaneous low-molecular-weight heparin compared with continuous intravenous heparin in the treatment of proximal-vein thrombosis. Heparin for 5 days as compared with 10 days in the initial treatment of proximal venous thrombosis. Is anticoagulation indicated for asymptomatic postoperative … Read more

Deep Venous Thrombosis (DVT) – Treatment

Indications for treatment proximal DVT proximal propagation of a distal DVT some authors advocate that isolated asymptomatic distal DVT can be followed on serial Duplex Ultra-sound, and does not require treatment distal DVT will propagate proximally in less than 10-20% of cases, and has a low risk of PE serial ultrasound can be performed on … Read more

DVT Risk Reduction – Trauma, Pelvic Fractures, and Extremity Fractures

Prevention:      – coumadin, low molecular weight dextran, adjusted dose heparin, or low molecular weight heparin are proven effective for patients undergoing elective surgery Low Risk Trauma Patients w/ Lower Extremity Fracture:       – prophylaxis may be considered for patients with risk factors (female, obese, birth control, smoking ect).       – references:    … Read more

Trauma Management:

– Advanced Cardiac Life Support (ACLS)     – ACLS     – Iowa Family Practice Handbook     – AHCPR Guidelines     – eMedicine Online Text – Advanced Trauma Life Support (ATLS)       – Assessment of Perfusion/Shock: damage control orthopaedics               – blood pressure (systolic), heart rate, urine output (30 mL/hr) body temperature;               – labs: … Read more