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Journal of Trauma and Acute Care Surgery

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https://www.readbyqxmd.com/read/28338600/pelvic-fracture-pattern-predicts-the-need-for-hemorrhage-control-intervention-results-of-a-aast-multi-institutional-study
#1
Todd W Costantini, Raul Coimbra, John B Holcomb, Jeanette M Podbielski, Richard Catalano, Allie Blackburn, Thomas M Scalea, Deborah M Stein, Lashonda Williams, Joseph Conflitti, Scott Keeney, Christy Hoey, Tianhua Zhou, Jason Sperry, Dimitra Skiada, Kenji Inaba, Brian H Williams, Joseph P Minei, Alicia Privette, Robert C Mackersie, Brenton R Robinson, Forrest O Moore
BACKGROUND: Early identification of patients with pelvic fractures at risk for severe bleeding requiring intervention is critical. We performed a multi-institutional study to test our hypothesis that pelvic fracture patterns predict the need for a pelvic hemorrhage control intervention. METHODS: This prospective, observational multi-center study enrolled patients with pelvic fracture due to blunt trauma. Inclusion criteria included shock on admission (SBP<90 or HR>120 and base deficit > 5, and the ability to review pelvic imaging...
March 23, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28338599/volumetric-control-of-whole-blood-collection-in-austere-environments
#2
Michael A Meledeo, Andrew D Fisher, Grantham C Peltier, Ethan A Miles, William B Muse, Win B Kerr, Shawn C Nessen, Andrew P Cap
INTRODUCTION: Fresh whole blood transfusions are a powerful tool in prehospital care; however, the lack of equipment such as a scale in field situations frequently leads to collections being under- or overfilled, leading to complications for both patient and donor. This study describes two methods for simple, rapid control of collection bag volume: (1) a length of material to constrict the bag, and (2) folding/clamping the bag. METHOD: Whole blood collection bags were allowed to fill with saline via gravity...
March 23, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28338598/characterization-of-distinct-coagulopathic-phenotypes-in-injury-pathway-specific-drivers-and-implications-for-individualized-treatment
#3
S Ariane Christie, Lucy Z Kornblith, Benjamin M Howard, Amanda S Conroy, Ryan C Kunitake, Mary F Nelson, Carolyn M Hendrickson, Carolyn S Calfee, Rachael A Callcut, Mitchell Jay Cohen
BACKGROUND: International normalized ratio (INR) and partial thromboplastin time (PTT) are used interchangeably to diagnose acute traumatic coagulopathy (ATC) but reflect disparate activation pathways. In this study we identified injury/patient characteristics and coagulation factors that drive contact pathway, tissue factor pathway (TF), and common pathway dysfunction by examining injured patients with discordant coagulopathies. We hypothesized that patients with INR/PTT discordance reflect differing phenotypes representing contact vs...
March 23, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28338597/skill-learning-and-retention
#4
Ivar Austlid, Karl Lukas Arkestaal, Hans Peter Kibsgaard
Skills are hard to learn, and forgotten only months after a course. Initial learning is facilitated by: close individual instruction right from the start, many repetitions, short learning sessions on different days, positive calm athmosphere, learning one skill at the time, and having objective defenitions of mastery. Retention is dependant on frequent training. In the retention fase a major part of the training must be integrated in regular exercise with multiple physical and psycological stressors, to mimic real field situations...
March 23, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28338596/operation-versus-antibiotics-the-appendicitis-conundrum-continues-a-meta-analysis
#5
Joseph V Sakran, Konstantinos S Mylonas, Alexandros Gryparis, Stanislaw P Stawicki, Christopher J Burns, Maher M Matar, Konstantinos P Economopoulos
BACKGROUND: Acute appendicitis continues to constitute a diagnostic and therapeutic challenge. The aim of this study was to synthesize evidence from randomized controlled trials (RCTs) comparing nonoperative versus surgical management of uncomplicated acute appendicitis in adult patients. METHODS: A systematic literature search of the PubMed, Cochrane and Scopus databases was performed with respect to the PRISMA statement (end-of-search date: January 29, 2017). Data on the study design, interventions, participants, and outcomes were extracted by two independent reviewers...
March 23, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28338595/3-0-nacl-adenosine-lidocaine-mg-2-alm-bolus-and-4-hours-drip-infusion-reduces-non-compressible-hemorrhage-by-60-in-a-rat-model
#6
Hayley L Letson, Geoffrey P Dobson
BACKGROUND: Noncompressible torso hemorrhage is the leading cause of potentially survivable trauma in far-forward combat environments. Our aim was to examine the effect of small-volume 3% NaCl adenosine, lidocaine and Mg (ALM) bolus and 0.9% NaCl/ALM 'drip' on survivability and cardiac/gut/kidney function in a rat model of hepatic hemorrhage and shock. METHODS: Male Sprague-Dawley rats (428±4 g) were anesthetized and randomly assigned to one of five groups (n=16): 1) Sham, 2) No Treatment, 3) Saline controls, 4) ALM therapy and 5) Hextend®...
March 23, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28338594/the-association-of-non-accidental-trauma-with-historical-factors-exam-findings-and-diagnostic-testing-during-the-initial-trauma-evaluation
#7
Mauricio A Escobar, Marc Auerbach, Katherine Flynn-O'Brien, Gunjan Tiyyagura, Matthew A Borgman, Susan J Duffy, Kelly Falcone, Rita Burke, John M Cox, Sabine Maguire
Early identification of non-accidental trauma (NAT) is a critical component of pediatric trauma care. Literature searches were conducted related to the association of NAT with seven key areas: history, exam findings (burns, oral trauma, bruising) and imaging (fractures, abdominal and brain injuries). When available, odds ratios (OR) with 95% confidence intervals (CI) for associations with NAT are presented. Systematic reviews have been published in six of the seven key areas and are described. The operational definition of NAT was widely variable across studies, prohibiting meta-analysis...
March 23, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28338593/clinical-correlates-to-assist-with-cte-diagnosis-insights-from-a-novel-rodent-repeat-concussion-model
#8
Gretchen M Thomsen, Ara Ko, Megan Y Harada, Annie Ma, Livia Wyss, Patricia Haro, Jean-Philippe Vit, Pablo Avalos, Navpreet Dhillon, Noell Cho, Oksana Shelest, Eric J Ley
INTRODUCTION: Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease linked to repetitive head injuries. CTE symptoms include changes in mood, behavior, cognition and motor function, however CTE is only currently diagnosed post-mortem. Using a rat model of recurrent traumatic brain injury (TBI) we demonstrate rodent deficits that predict the severity of CTE-like brain pathology. METHODS: Bilateral, closed skull, mild TBI was administered once per week to 35 WT rats, 8 rats received 2 injuries ('2xTBI'), 27 rats received 5 injuries ('5xTBI') and 13 rats were sham controls...
March 23, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28338592/open-abdomen-with-vacuum-assisted-wound-closure-and-mesh-mediated-fascial-traction-in-patients-with-complicated-diffuse-secondary-peritonitis-a-single-center-8-year-experience
#9
Matti Tolonen, Panu Mentula, Ville Sallinen, Suvi Rasilainen, Minna Bäcklund, Ari Leppäniemi
BACKGROUND: Open abdomen (OA) treatment in patients with peritonitis is increasing worldwide. Various temporary abdominal closure devices are being used. This study included patients with complicated diffuse secondary peritonitis, OA, and vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM). The aim of this study was to describe mortality and major morbidity in terms of delayed primary fascial closure (DPFC) and enteroatmospheric fistula rates. METHODS: This was a single academic center retrospective study of consecutive patients with diffuse peritonitis, OA, and VAWCM between years 2008-2016...
March 23, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28338591/the-course-prediction-and-treatment-of-acute-and-post-traumatic-stress-in-trauma-patients-a-systematic-review
#10
Eva Visser, Taco Gosens, Brenda Leontine Den Oudsten, Jolanda De Vries
BACKGROUND: Trauma patients suffer from Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD). It is unknown how these disorders develop over time and when treatment is effective. Our aim was to systematically review (i) the course and predictors of ASD and PTSD after trauma and (ii) which and when psychological treatments are effective. METHODS: Embase, Medline, Web of Science, Scopus, PsycInfo, Cinahl, Cochrane, Pubmed, and Google Scholar were searched up to September 14, 2015...
March 23, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28338590/small-changes-big-effects-the-hemodynamics-of-partial-and-complete-aortic-occlusion-to-inform-next-generation-resuscitation-techniques-and-technologies
#11
M Austin Johnson, Anders J Davidson, Rachel M Russo, Sarah-Ashley E Ferencz, Oren Gotlib, Todd E Rasmussen, Lucas P Neff, Timothy K Williams
BACKGROUND: The transition from complete aortic occlusion during Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) can be associated with hemodynamic instability. Technique refinements and new technologies have been proposed to minimize this effect. In order to inform new techniques and technology, we examined the relationship between blood pressure and aortic flow during the restoration of systemic circulation following aortic occlusion at progressive levels of hemorrhage...
March 23, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28338589/managing-hip-fracture-and-lower-limb-surgery-in-the-emergency-setting-potential-role-of-non-vitamin-k-antagonist-oral-anticoagulants
#12
William Fisher
Trauma, immobilization, and subsequent surgery of the hip and lower limb are associated with a high risk of developing venous thromboembolism (VTE). Individuals undergoing hip fracture surgery (HFS) have the highest rates of VTE among orthopedic surgery and trauma patients. The risk of VTE depends on the type and location of the lower limb injury. Current international guidelines recommend routine pharmacological thromboprophylaxis based on treatment with heparins, fondaparinux, dose-adjusted vitamin K antagonists and acetylsalicylic acid for patients undergoing emergency HFS; however, not all guidelines recommend pharmacological prophylaxis for patients with lower limb injuries...
March 23, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28333837/leadership-lessons-learned-in-tactical-combat-casualty-care
#13
Frank K Butler
The US Military has achieved remarkable success in improving survival for our nation's combat wounded throughout the 14 years of conflict in Iraq and Afghanistan. For the prehospital phase of care, where most combat fatalities occur, these advances have been embodied in Tactical Combat Casualty Care (TCCC.) TCCC is a set of evidence-based, best-practice, prehospital trauma care guidelines that are customized for use on the battlefield. The TCCC Guidelines have been updated on an ongoing basis over the last 15 years through the work of the Committee on TCCC and the TCCC Working Group...
March 22, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28333836/the-need-for-optimized-crystalloid-based-resuscitation
#14
Avi Yitzhak, Yuval Glick, Avi Benov, Roy Nadler, Joseph F Rappold, Elon Glassberg
No abstract text is available yet for this article.
March 22, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28333835/zero-preventable-deaths-after-traumatic-injury-an-achievable-goal
#15
Philip C Spinella
Preventable deaths after injury must be reduced to improve outcomes for trauma patients. The elimination of preventable deaths after injury has been documented by the 75th US Army Ranger Regiment. Therefore, zero preventable deaths after injury is an achievable goal. Trauma is the most common cause of death between the ages of 1-46 and is the most common cause of life-years lost, before 75 years of age, compared to all other etiologies. Traumatic Hemorrhagic Shock (THS) is the leading cause of death that is preventable after injury, accounting for potentially 17,000 preventable deaths per year in the US...
March 22, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28333834/measuring-the-compensatory-reserve-to-identify-shock
#16
Victor A Convertino, Alicia M Schiller
Successful management of shock heavily relies on the ability to identify early stages of hemorrhage. During blood loss and reduced blood volume, multiple physiological mechanisms are able to compensate in order to preserve tissue oxygenation and blood flow. Unfortunately, this compensation makes the crucial early stage identification of hemorrhage complicated as traditionally monitored vital signs reflect this compensation, and do not change until significant amounts of blood have been lost. New insights and a recent body of literature utilizing a human model of hemorrhage provide evidence that it is possible to measure the body's reserve to continue to compensate for a reduced circulating blood volume...
March 22, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28333833/leadership-and-a-casualty-response-system-for-eliminating-preventable-death
#17
Russ S Kotwal, Harold R Montgomery, Ethan A Miles, Curtis C Conklin, Michael T Hall, Stanley A McChrystal
Combat casualties who die from their injuries do so primarily in the prehospital setting. Although most of these deaths result from injuries that are non-survivable, some are potentially survivable. Of injuries that are potentially survivable, most are from hemorrhage. Thus, military organizations should direct efforts toward prehospital care, particularly through early hemorrhage control and remote damage control resuscitation, in order to eliminate preventable death on the battlefield. A systems-based approach and priority of effort for institutionalizing such care was developed and maintained by medical personnel and command-directed by non-medical combatant leaders within the 75th Ranger Regiment, U...
March 22, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28333832/immunologic-effects-of-trauma-and-transfusion
#18
Sanjna Shah, Philip C Spinella, Jennifer A Muszynski
The immunologic response to severe traumatic injury is complex - such that individual patients may face exceptionally different immunologic challenges at different points in time. It is in this context that one must consider potentially additive immunomodulatory effects of blood product transfusion. This review will consider first the immunologic response to traumatic injury, followed by the epidemiology and outcomes related to blood product transfusion in trauma patients, and lastly immunologic effects of transfusion in the context of trauma...
March 22, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28333831/deployed-skills-training-for-whole-blood-collection-by-a-special-operations-expeditionary-surgical-team
#19
Linda C Benavides, Iain M Smith, Jerome M Benavides, Douglas M Bowley, Heidi A Doughty, Jonathan B Lundy
BACKGROUND: Non-compressible hemorrhage is the leading cause of potentially preventable battlefield death. Combining casualty retrieval from the battlefield and damage control resuscitation (DCR) within the "golden hour" increases survival. However, transfusion requirements may exceed the current blood component stocks held by forward surgical teams. Warm fresh whole blood (WFWB) is an alternative. We report WFWB transfusion training developed by and delivered to a US Golden Hour Offset Surgical Treatment Team (GHOST-T) and the resulting improvement in confidence with WFWB transfusion...
March 22, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28333830/minimal-variation-in-anti-a-and-b-titers-among-healthy-volunteers-over-time-implications-for-the-use-of-out-of-group-blood-components
#20
Ulrik Sprogøe, Mark Yazer, Mads Hvidkjær Rasmussen, Berit Antonsen, Claus Bistrup, Kristian Assing
BACKGROUND: Using potentially out-of-group blood components, like low titer A plasma and O whole blood, in the resuscitation of trauma patients is becoming increasingly popular. However, very little is known whether the donors' anti-A and/or -B titers change over time and whether repeated titer measurements on the same donor are required to ensure that each donation produces a low titer product. METHODS: The anti-A and/or -B titers were measured on 56 healthy adult volunteers (47 blood donors; 9 blood center personnel) every three months for 12 consecutive months using an automated solid phase analyzer...
March 22, 2017: Journal of Trauma and Acute Care Surgery
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