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https://www.readbyqxmd.com/read/29465274/intubation-success-in-critical-care-transport-a-multicenter-study
#1
Ryan J Reichert, Megan Gothard, M David Gothard, Hamilton P Schwartz, Michael T Bigham
INTRODUCTION: Tracheal intubation (TI) is a lifesaving critical care skill. Failed TI attempts, however, can harm patients. Critical care transport (CCT) teams function as the first point of critical care contact for patients being transported to tertiary medical centers for specialized surgical, medical, and trauma care. The Ground and Air Medical qUality in Transport (GAMUT) Quality Improvement Collaborative uses a quality metric database to track CCT quality metric performance, including TI...
February 21, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29441123/circulation-first-the-time-has-come-to-question-the-sequencing-of-care-in-the-abcs-of-trauma-an-american-association-for-the-surgery-of-trauma-multicenter-trial
#2
Paula Ferrada, Rachael A Callcut, David J Skarupa, Therese M Duane, Alberto Garcia, Kenji Inaba, Desmond Khor, Vincent Anto, Jason Sperry, David Turay, Rachel M Nygaard, Martin A Schreiber, Toby Enniss, Michelle McNutt, Herb Phelan, Kira Smith, Forrest O Moore, Irene Tabas, Joseph Dubose
Background: The traditional sequence of trauma care: Airway, Breathing, Circulation (ABC) has been practiced for many years. It became the standard of care despite the lack of scientific evidence. We hypothesized that patients in hypovolemic shock would have comparable outcomes with initiation of bleeding treatment (transfusion) prior to intubation (CAB), compared to those patients treated with the traditional ABC sequence. Methods: This study was sponsored by the American Association for the Surgery of Trauma multicenter trials committee...
2018: World Journal of Emergency Surgery: WJES
https://www.readbyqxmd.com/read/29430408/using-bronchoscopy-to-detect-acquired-tracheoesophageal-fistula-in-mechanically-ventilated-patients
#3
Michael S Green, Johann J Mathew, Lia J Michos, Parmis Green, Mansoor M Aman
Introduction: An acquired Tracheoesophageal fistula (TEF) is commonly caused by a malignancy or trauma, with pulmonary infection or aspiration being the presenting symptom. However, in the critical care setting the presentation can be subtle and may present with difficult ventilation. High endotracheal tube cuff pressures can lead to tracheal erosions and thus increasing the chances for developing a TEF. Prolonged intubation in the presence of other risk factors like poor general state of health, episodic hypotension, nasogastric tubes, and repeated intubations can increase the likelihood of developing an acquired TEF...
August 2017: Anesthesiology and Pain Medicine
https://www.readbyqxmd.com/read/29422726/audit-of-postoperative-surgical-intensive-care-unit-admissions
#4
Shaili K Patel, Samir M Kacheriwala, Dipesh D Duttaroy
Objective: The objective of this study was to conduct an audit of Surgical Intensive Care Unit (SICU) for identifying the admission risk factors and evaluating the outcomes of postoperative surgical patients. Design: This was a prospective, observational study. Setting: This study was conducted at SICU of a 1500-bedded tertiary care university hospital in Western India. Subject and Methods: Two hundred and forty patients admitted to the SICU postoperatively over a period of 15 months...
January 2018: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29421694/resuscitative-endovascular-balloon-occlusion-of-the-aorta-and-resuscitative-thoracotomy-in-select-patients-with-hemorrhagic-shock-early-results-from-the-american-association-for-the-surgery-of-trauma-aortic-occlusion-in-resuscitation-for-trauma-and-acute-care
#5
Megan Brenner, Kenji Inaba, Alberto Aiolfi, Joseph DuBose, Timothy Fabian, Tiffany Bee, John B Holcomb, Laura Moore, David Skarupa, Thomas M Scalea
BACKGROUND: Aortic occlusion (AO) is a potentially valuable tool for early resuscitation in patients nearing extremis or in arrest from severe hemorrhage. STUDY DESIGN: AAST AORTA registry identified trauma patients without penetrating thoracic injury undergoing AO at the level of the descending thoracic aorta (RT or Zone 1 REBOA) in the Emergency Department (ED). Survival outcomes relative to the timing of CPR need and admission hemodynamic status were examined...
February 5, 2018: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/29405803/prehospital-rapid-sequence-intubation-by-intensive-care-flight-paramedics
#6
Ashleigh Delorenzo, Toby St Clair, Emily Andrew, Stephen Bernard, Karen Smith
OBJECTIVE: Rapid sequence intubation (RSI) is an advanced airway procedure for critically ill or injured patients. Paramedic-performed RSI in the prehospital setting remains controversial, as unsuccessful or poorly conducted RSI is known to result in significant complications. In Victoria, intensive care flight paramedics (ICFPs) have a broad scope of practice including RSI in both the adult and pediatric population. We sought to describe the success rates and characteristics of patients undergoing RSI by ICFPs in Victoria, Australia...
February 6, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29389838/too-little-too-late-hypotension-and-blood-transfusion-in-the-trauma-bay-are-independent-predictors-of-death-in-injured-children
#7
Christine M Leeper, Christine McKenna, Barbara A Gaines
BACKGROUND: Hypotension is a late finding in pediatric shock despite significant blood loss; consequently, recognition of hemodynamic compromise can be delayed. We sought to describe the impact of late stage shock in children, indicated by hypotension or trauma bay blood transfusion, and quantify the association with poor outcome. METHODS: Children age<18 from the Pennsylvania Trauma Outcome Study registry (2000-2013) were included. Primary outcome was mortality...
January 31, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29387960/nonoperative-management-of-blunt-splenic-trauma-in-patients-with-traumatic-brain-injury-feasibility-and-outcomes
#8
Navpreet K Dhillon, Galinos Barmparas, Gretchen M Thomsen, Kavita A Patel, Nikhil T Linaval, Emma Gillette, Daniel R Margulies, Eric J Ley
INTRODUCTION: Preventing secondary insult to the brain is imperative following traumatic brain injury (TBI). Although TBI does not preclude nonoperative management (NOM) of splenic injuries, development of hypotension in this setting may be detrimental and could therefore lead trauma surgeons to a lower threshold for operative intervention and a potentially higher risk of failure of NOM (FNOM). We hypothesized that the presence of a TBI in patients with blunt splenic injury would lead to a higher risk of FNOM...
January 31, 2018: World Journal of Surgery
https://www.readbyqxmd.com/read/29379406/management-of-destructive-colon-injuries-after-damage-control-surgery
#9
REVIEW
Jad Chamieh, Priya Prakash, William J Symons
After the World War II, fecal diversion became the standard of care for colon injuries, although medical, logistic, and technical advancements have challenged this approach. Damage control surgery serves to temporize immediately life-threatening conditions, and definitive management of destructive colon injuries is delayed until after appropriate resuscitation. The bowel can be left in discontinuity for up to 3 days before edema ensues, but the optimal repair window remains within 12 to 48 hours. Delayed anastomosis performed at the take-back operation or stoma formation has been reported with variable results...
January 2018: Clinics in Colon and Rectal Surgery
https://www.readbyqxmd.com/read/29373044/interactive-effect-between-on-scene-hypoxia-and-hypotension-on-hospital-mortality-and-disability-in-severe-trauma
#10
Min Woo Kim, Sang Do Shin, Kyoung Jun Song, Young Sun Ro, Yu Jin Kim, Ki Jeong Hong, Joo Jeong, Tae Han Kim, Jeong Ho Park, So Yeon Kong
BACKGROUND: It is unclear whether effect size of the hypoxia is different on in-hospital mortality and disability according to hypotension status in the field. METHODS: Adult severe trauma (ST) patients during 2012-13 who were treated by emergency medical services (EMS) and had abnormal revised trauma scores in the field or who had positive trauma triage criteria were analyzed. Exposure was hypoxia (<94%) measured by EMS. End points were hospital mortality and disability defined as a Glasgow Outcome Scale that decreased by 2 points or more...
January 26, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29370058/permissive-hypotension-vs-conventional-resuscitation-strategies-in-adult-trauma-patients-with-hemorrhagic-shock-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#11
Alexandre Tran, Jeffrey Yates, Aaron Lau, Jacinthe Lampron, Maher Matar
BACKGROUND: Aggressive fluid resuscitation in trauma promotes deleterious effects such as clot disruption, dilutional coagulopathy and hypothermia. Animal studies suggest that permissive hypotension maintains appropriate organ perfusion, reduces bleeding and improves mortality. This review assesses the efficacy and safety of permissive hypotension in adult trauma patients with hemorrhagic shock. METHODS: We searched the MEDLINE and EMBASE databases from inception to May 2017 for randomized controlled trials comparing permissive hypotension vs...
January 24, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29369057/clinical-epidemiology-of-adults-with-moderate-traumatic-brain-injury
#12
Arraya Watanitanon, Vivian H Lyons, Abhijit V Lele, Vijay Krishnamoorthy, Nophanan Chaikittisilpa, Theerada Chandee, Monica S Vavilala
OBJECTIVES: To characterize admission patterns, treatments, and outcomes among patients with moderate traumatic brain injury. DESIGN: Retrospective cohort study. SETTING: National Trauma Data Bank. PATIENTS: Adults (age > 18 yr) with moderate traumatic brain injury (International Classification of Diseases, Ninth revision codes and admission Glasgow Coma Scale score of 9-13) in the National Trauma Data Bank between 2007 and 2014...
January 23, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29368085/selective-nonoperative-management-of-liver-gunshot-injuries
#13
Pradeep Navsaria, Andrew Nicol, Jake Krige, Sorin Edu, Sharfuddin Chowdhury
PURPOSE: Nonoperative management (NOM) of gunshot liver injuries (GLI) is infrequently practiced. The aim of this study was to assess the safety of selective NOM of GLI. METHODS: A prospective, protocol-driven study, which included patients with GLI admitted to a level 1 trauma center, was conducted over a 52-month period. Stable patients without peritonism or sustained hypotension with right-sided thoracoabdominal (RTA) and right upper quadrant (RUQ), penetrating wounds with or without localized RUQ tenderness, underwent contrasted abdominal CT scan to determine the trajectory and organ injury...
January 24, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29362272/what-fluids-are-given-during-air-ambulance-treatment-of-patients-with-trauma-in-the-uk-and-what-might-this-mean-for-the-future-results-from-the-rescuer-observational-cohort-study
#14
David N Naumann, James M Hancox, James Raitt, Iain M Smith, Nicholas Crombie, Heidi Doughty, Gavin D Perkins, Mark J Midwinter
OBJECTIVES: We investigated how often intravenous fluids have been delivered during physician-led prehospital treatment of patients with hypotensive trauma in the UK and which fluids were given. These data were used to estimate the potential national requirement for prehospital blood products (PHBP) if evidence from ongoing trials were to report clinical superiority. SETTING: The Regional Exploration of Standard Care during Evacuation Resuscitation (RESCUER) retrospective observational study was a collaboration between 11 UK air ambulance services...
January 23, 2018: BMJ Open
https://www.readbyqxmd.com/read/29355141/an-observational-study-of-incidence-risk-factors-outcome-of-systemic-inflammatory-response-organ-dysfunction-following-major-trauma
#15
Satish Balkrishna Dharap, Sanket Vishnu Ekhande
BACKGROUND & OBJECTIVES: Trauma is known to lead to systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS), which is often a cause of late deaths after injury. SIRS and MODS have been objectively measured using scoring systems. This prospective observational study was carried out in a tertiary care hospital in India to evaluate SIRS and MODS following trauma in terms of their incidence, the associated risk factors and the effect on the outcome. METHODS: All adult patients with major life- and limb-threatening trauma were included...
September 2017: Indian Journal of Medical Research
https://www.readbyqxmd.com/read/29329171/nonhuman-primate-rhesus-macaque-models-of-severe-pressure-targeted-hemorrhagic-and-polytraumatic-hemorrhagic-shock
#16
Forest R Sheppard, Antoni R Macko, Jacob J Glaser, Philip J Vernon, Alexander J Burdette, Ruth Madelaine Paredes, Craig A Koeller, Anthony E Pusateri, Douglas K Tadaki, Sylvain Cardin
BACKGROUND: We endeavored to develop clinically translatable nonhuman primate (NHP) models of severe polytraumatic hemorrhagic shock. METHODS: NHPs were randomized into five severe pressure-targeted hemorrhagic shock (PTHS) ± additional injuries scenarios: 30-min PTHS (PTHS-30), 60-min PTHS (PTHS-60), PTHS-60 + soft tissue injury (PTHS-60+ST), PTHS-60+ST + femur fracture (PTHS-60+ST+FF), and decompensated PTHS+ST+FF (PTHS-D). Physiologic parameters were recorded and blood samples collected at five time points with animal observation through T = 24 h...
February 2018: Shock
https://www.readbyqxmd.com/read/29319774/renal-artery-pseudoaneurysm
#17
Luiz Inácio Roman, Cauana Fabrício Efel, Victória Teles França, Carolina Meert Merten, Claus Dieter Dummer
The renal artery pseudoaneurysm embody a rare vascular complication coming of percutaneous procedures, renal biopsy, nephrectomy, penetrating traumas and more rarely blunt traumas. The clinical can be vary according the patient, the haematuria is the symptom more commom. Is necessary a high level of clinical suspicion for your diagnosis, this can be elucidated by through complementary exams as the eco-color Doppler and the computed tomography scan (CT). This report is a case of a patient submitted a right percutaneous renal biopsy and that, after the procedure started with macroscopic haematuria, urinary tenesmus and hypogastric pain...
October 2017: Jornal Brasileiro de Nefrologia: ʹorgão Oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
https://www.readbyqxmd.com/read/29315456/pre-hospital-emergency-anaesthesia-in-awake-hypotensive-trauma-patients-beneficial-or-detrimental
#18
K Crewdson, M Rehn, K Brohi, D J Lockey
BACKGROUND: The benefits of pre-hospital emergency anaesthesia (PHEA) are controversial. Patients who are hypovolaemic prior to induction of anaesthesia are at risk of severe cardiovascular instability post-induction. This study compared mortality for hypovolaemic trauma patients (without major neurological injury) undergoing PHEA with a patient cohort with similar physiology transported to hospital without PHEA. METHODS: A retrospective database review was performed to identify patients who were hypotensive on scene [systolic blood pressure (SBP) < 90 mmHg], and GCS 13-15...
January 7, 2018: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29305023/early-vs-late-fracture-fixation-in-severe-head-and-orthopedic-injuries
#19
Yuan Zhang, Kai Sun, Yuling Wang, Yafei Qin, Hui Li
BACKGROUND: Patients suffered from craniocerebral trauma with extermities fracture is one of the most common multiple injuries.Actually there is no comparative study demonstrating advantages of early or delayed treatment of skeletal injuries. PURPOSES: To conduct a meta-analysis with studies published in full text to demonstrate database to show the associations of perioperative, postoperative outcomes of early fracture fixation(EFF) and late fracture fixation(LFF) for patients with severe head and orthopedic injuries to provide the predictive diagnosis for clinic...
December 29, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29297718/evaluation-of-physiologic-alterations-during-prehospital-paramedic-performed-rapid-sequence-intubation
#20
Robert G Walker, Lynn J White, Geneva N Whitmore, Alexander Esibov, Michael K Levy, Gregory C Cover, Joel D Edminster, James M Nania
OBJECTIVE: Physiologic alterations during rapid sequence intubation (RSI) have been studied in several emergency airway management settings, but few data exist to describe physiologic alterations during prehospital RSI performed by ground-based paramedics. To address this evidence gap and provide guidance for future quality improvement initiatives in our EMS system, we collected electronic monitoring data to evaluate peri-intubation vital signs changes occurring during prehospital RSI...
January 3, 2018: Prehospital Emergency Care
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