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hypotensive trauma patients

Pauline K Park, Jeremy W Cannon, Wen Ye, Lorne H Blackbourne, John B Holcomb, William Beninati, Lena M Napolitano
BACKGROUND: The overall incidence and mortality of acute respiratory distress syndrome (ARDS) in civilian trauma settings have decreased over the past four decades; however, the epidemiology and impact of ARDS on modern combat casualty care are unknown. We sought to determine the incidence, risk factors, resource utilization, and mortality associated with ARDS in current combat casualty care. METHODS: This was a retrospective review of mechanically ventilated US combat casualties within the Department of Defense Trauma Registry (formerly the Joint Theater Trauma Registry) during Operation Iraqi Freedom/Enduring Freedom (October 2001 to August 2008) for ARDS development, resource utilization, and mortality...
November 2016: Journal of Trauma and Acute Care Surgery
J N Seheult, D J Triulzi, L H Alarcon, J L Sperry, A Murdock, M H Yazer
BACKGROUND/OBJECTIVES: The safety of administering uncrossmatched, group O, cold-stored, whole blood (cWB) during civilian trauma resuscitation was evaluated. METHODS/MATERIALS: Male trauma patients with haemorrhage-induced hypotension who received leuko-reduced uncrossmatched group O+, low titer (<50) anti-A and -B, platelet-replete cWB during initial resuscitation were included. The biochemical markers of haemolysis (lactate dehydrogenase, total bilirubin, haptoglobin, creatinine, serum potassium) were measured on the day of cWB receipt (day 0), and over the next 2 days, reports of transfusion reactions and total blood product administration in first 24 h of admission were recorded...
October 12, 2016: Transfusion Medicine
Yad R Yadav, Vijay Parihar, Hemant Namdev, Jitin Bajaj
Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. There is lack of uniformity in the treatment of CSDH amongst surgeons in terms of various treatment strategies. Clinical presentation may vary from no symptoms to unconsciousness. CSDH is usually diagnosed by contrast-enhanced computed tomography scan. Magnetic resonance imaging (MRI) scan is more sensitive in the diagnosis of bilateral isodense CSDH, multiple loculations, intrahematoma membranes, fresh bleeding, hemolysis, and the size of capsule...
October 2016: Asian Journal of Neurosurgery
Daniel W Spaite, Chengcheng Hu, Bentley J Bobrow, Vatsal Chikani, Bruce Barnhart, Joshua B Gaither, Kurt R Denninghoff, P David Adelson, Samuel M Keim, Chad Viscusi, Terry Mullins, Duane Sherrill
STUDY OBJECTIVE: Survival is significantly reduced by either hypotension or hypoxia during the out-of-hospital management of major traumatic brain injury. However, only a handful of small studies have investigated the influence of the combination of both hypotension and hypoxia occurring together. In patients with major traumatic brain injury, we evaluate the associations between mortality and out-of-hospital hypotension and hypoxia separately and in combination. METHODS: All moderate or severe traumatic brain injury cases in the preimplementation cohort of the Excellence in Prehospital Injury Care study (a statewide, before/after, controlled study of the effect of implementing the out-of-hospital traumatic brain injury treatment guidelines) from January 1, 2007, to March 31, 2014, were evaluated (exclusions: <10 years, out-of-hospital oxygen saturation ≤10%, and out-of-hospital systolic blood pressure <40 or >200 mm Hg)...
September 27, 2016: Annals of Emergency Medicine
Paul T Engels, Mete Erdogan, Sandy L Widder, Michael B Butler, Nelofar Kureshi, Kate Martin, Robert S Green
BACKGROUND: Although used primarily in the pediatric population for decades, the use of intraosseous (IO) devices in the resuscitation of severely injured adult trauma patients has recently become more commonplace. The objective of this study was to determine the experience level, beliefs and attitudes of trauma practitioners in Canada, Australia and New Zealand regarding the use of IO devices in adult trauma patients. METHODS: We administered a web-based survey to all members of 4 national trauma and emergency medicine organizations in Canada, Australia and New Zealand...
October 1, 2016: Canadian Journal of Surgery. Journal Canadien de Chirurgie
Kirsten Morrissey, Hilary Fairbrother
More than 1.7 million traumatic brain injuries occur in adults and children each year in the United States, with approximately 30% occurring in children aged < 14 years. Traumatic brain injury is a significant cause of morbidity and mortality in pediatric trauma patients. Early identification and management of severe traumatic brain injury is crucial in decreasing the risk of secondary brain injury and optimizing outcome. The main focus for early management of severe traumatic brain injury is to mitigate and prevent secondary injury, specifically by avoiding hypotension and hypoxia, which have been associated with poorer outcomes...
October 2016: Pediatric Emergency Medicine Practice
D Brilej, D Stropnik, R Lefering, R Komadina
BACKGROUND: Early recognition and management of trauma related coagulopathy improves the outcome. Trauma facilities should implement an algorithm to identify the bleeding trauma patient with coagulopathy. OBJECTIVE: The scope of the paper is to identify the indicators of early coagulopathy and to optimize the indications for thromboelastometry and coagulation support. DESIGN: Cohort study based on data from trauma registry. SETTING: Data of 493 major trauma patients treated in GH Celje from 2006 to 2014 were included into The TraumaRegister DGU(®) (TR-DGU)...
September 22, 2016: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Julia Ausserer, Elizabeth Moritz, Matthias Stroehle, Hermann Brugger, Giacomo Strapazzon, Simon Rauch, Peter Mair
INTRODUCTION: In remote and mountainous areas, helicopter emergency medical systems (HEMS) are used to expedite evacuation and provide pre-hospital advanced trauma life support (ATLS) in major trauma victims. Aim of the study was to investigate feasibility of ATLS in HEMS mountain rescue missions and its influence on patient condition at hospital admission. PATIENTS: 58 major trauma victims (Injury Severity Score ≥16), evacuated by physician staffed HEMS from remote and mountainous areas in the State of Tyrol, Austria between 1...
September 8, 2016: Injury
Christopher P Michetti, Heather A Prentice, Elena Lita, Jeffrey Wright, Edmond Ng, Anna B Newcomb
BACKGROUND: We sought to examine the effect on blood usage of a new electronic order set restricting transfusion orders to specific evidence-based criteria for each unit (U) of red blood cells (RBC), plasma, and platelets. METHODS: Prospectively collected transfusion data for Trauma ICU patients were compared for the 12 months before (PRE) and 8 months after (POST) order set implementation. Criteria for RBC transfusion were 1 U only for hemoglobin <7 g/dL in stable patients or <8 g/dL with angina, myocardial infarction, or cardiogenic shock; 2 U for hemoglobin <5 g/dL; and multiple U in the presence of shock, hypotension, or bleeding...
November 2016: Journal of Trauma and Acute Care Surgery
Matthew M Carrick, Jan Leonard, Denetta S Slone, Charles W Mains, David Bar-Or
Hemorrhagic shock is a principal cause of death among trauma patients within the first 24 hours after injury. Optimal fluid resuscitation strategies have been examined for nearly a century, more recently with several randomized controlled trials. Hypotensive resuscitation, also called permissive hypotension, is a resuscitation strategy that uses limited fluids and blood products during the early stages of treatment for hemorrhagic shock. A lower-than-normal blood pressure is maintained until operative control of the bleeding can occur...
2016: BioMed Research International
Tobias Haltmeier, Elizabeth Benjamin, Stefano Siboni, Evren Dilektasli, Kenji Inaba, Demetrios Demetriades
PURPOSE: Prehospital endotracheal intubation (ETI) for traumatic brain injury (TBI) is a controversial issue. The aim of this study was to investigate the effect of prehospital ETI in patients with TBI. METHODS: Cohort-matched study using the US National Trauma Data Bank (NTDB) 2008-2012. Patients with isolated severe blunt TBI (AIS head ≥3, AIS chest/abdomen <3) and a field GCS ≤8 were extracted from NTDB. A 1:1 matching of patients with and without prehospital ETI was performed...
August 27, 2016: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Y E Chee, S E Liu, M G Irwin
Management of acute coagulopathy and blood loss during major vascular procedures poses a significant haemostatic challenge to anaesthetists. The acute coagulopathy is multifactorial in origin with tissue injury and hypotension as the precipitating factors, followed by dilution, hypothermia, acidemia, hyperfibrinolysis and systemic inflammatory response, all acting as a self-perpetuating spiral of events. The problem is confounded by the high prevalence of antithrombotic agent use in these patients and intraoperative heparin administration...
September 2016: British Journal of Anaesthesia
Shokei Matsumoto, Kazuhiko Sekine, Hiroyuki Funaoka, Tomohiro Funabiki, Taku Akashi, Kei Hayashida, Masayuki Shimizu, Mitsuhide Kitano
"Shock bowel" is one of the computed tomographic (CT) signs of hypotension, yet its clinical implications remain poorly understood. We evaluated how shock bowel affects clinical outcomes and the extent of intestinal epithelial damage in trauma patients by measuring the level of intestinal fatty acid binding protein (I-FABP). We reviewed the initial CT scans, taken in the emergency room, of 92 patients with severe blunt torso trauma who were consecutively admitted during a 24-month period. The data collected included CT signs of hypotension, I-FABP, feeding intolerance, and other clinical outcomes...
August 24, 2016: Shock
Peep Talving, Konstantinos Chouliaras, Alexander Eastman, Margaret Lauerman, Pedro G Teixeira, Joseph DuBose, Joseph Minei, Thomas Scalea, Demetrios Demetriades
BACKGROUND: Discontinuity of the bowel following intestinal injury and resection is a common practice in damage control procedures for severe abdominal trauma. However, there are concerns that complete occlusion of the bowel, especially in the presence of hypotension or edema that may result in ischemic bowel changes or increase bacterial or toxin translocation. METHODS: This was a retrospective study from three Level-1 trauma centers. Included were trauma patients who required bowel resection and damage control...
August 19, 2016: World Journal of Surgery
Yann Daniel, S Habas, L Malan, J Escarment, J-S David, S Peyrefitte
BACKGROUND: Despite the early uses of tourniquets and haemostatic dressings, blood loss still accounts for the vast majority of preventable deaths on the battlefield. Over the last few years, progress has been made in the management of such injuries, especially with the use of damage control resuscitation concepts. The early application of these procedures, on the field, may constitute the best opportunity to improve survival from combat injury during remote operations. DATA SOURCES: Currently available literature relating to trauma-induced coagulopathy treatment and far-forward transfusion was identified by searches of electronic databases...
August 16, 2016: Journal of the Royal Army Medical Corps
Akin Akakin, Baran Yilmaz, Murat Şakir Ekşi, Emel Ece Özcan-Ekşi, Mustafa Kemal Demir, Zafer Orkun Toktaş, Deniz Konya
Cranial chronic subdural hematoma (CSH) occurs secondary to trauma or just spontaneously. In this clinical report, the authors presented a 39-year-old male patient who was admitted with cranial CSH. In further assessment of the patient, the authors found an underlying cerebrospinal fluid (CSF) leak at the level of cervical spine. Following evacuation of the CSH, it recurred. In the second session, the hematoma was re-evacuated and the CSF fistula repaired. The CSH did not recur again. In young adult patients with recurrent CSH and prior presence of bilateral CSH, a survey for an underlying spinal CSF leak should be considered in the differential, especially in the background of trauma...
September 2016: Journal of Craniofacial Surgery
I Vulkov, Pl Bozhinov
No matter how severe is head injury during pregnancy, it can threaten both- the maternal and (or) the fetal life. The risk derives from systemic and cerebral consequences of high intracranial pressure, hypotension, anemia or expanding mass lessions in the cranial cavity. The specific hormonal background of the mother may contribute the better outcome after traumatic brain injury (TBI). Pregnancy and trauma push the doctors to create different and specific management than the usual case. Investigating literature data we figure out the initial assessment, management priorities for resuscitation of the head injured pregnant patient, concidering the specific anatomic and physiologic changes during pregnancy...
2016: Akusherstvo i Ginekologii︠a︡
Lacy E Lowry, Jonathan A Goldner
BACKGROUND: Spontaneous splenic rupture associated with anticoagulant use is a rare but potentially lethal disorder. Lack of prompt recognition can be associated with poor patient outcomes. The use of novel oral anticoagulants is becoming more common and thus consideration of this disorder while evaluating a patient who presents with abdominal pain while using these agents is extremely important. This is the first reported case of spontaneous splenic rupture associated with apixaban. CASE PRESENTATION: We describe the clinical case of an 83-year-old white man who complained of sudden severe abdominal pain 5 days into a hospital stay for acute-on-chronic congestive heart failure and exacerbation of chronic obstructive pulmonary disease...
2016: Journal of Medical Case Reports
Jeffrey M Tessier, Billy Moore, Bradley Putty, Rajesh R Gandhi, Therese M Duane
BACKGROUND: Data on antimicrobial prophylaxis for open fractures is limited, with many protocols based on expert recommendations. These protocols include aminoglycosides (AGs) for fractures with significant soft tissue injury, but these drugs are associated with acute kidney injury (AKI) in other settings; this risk has not been defined for open fracture prophylaxis. METHODS: We performed a retrospective study from May 2012 to October 2014 at our Level 1 trauma center...
August 8, 2016: Surgical Infections
Alex K Bonnecaze, Sarah Ellen Elza Stephens, Peter John Miller
Clostridium sordellii is a spore-forming anaerobic Gram-positive rod that has rarely been reported to cause disease in humans. Resultant mortality from infection is estimated at nearly 70% and is most often correlated with gynaecological procedures, intravenous drug abuse or trauma. C. sordellii infection often presents similarly to toxic shock syndrome (TSS); notable features of infection include refractory hypotension, haemoconcentration and marked leucocytosis. Although clinically similar to TSS, a notable difference is C...
2016: BMJ Case Reports
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