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https://www.readbyqxmd.com/read/28822390/physiologic-features-of-brain-death
#1
Eno-Obong Essien, Kristina Fioretti, Thomas M Scalea, Deborah M Stein
Brain death is known to be associated with physiologic derangements but their incidence is poorly described. Knowledge of the changes that occur during brain death is important for management of the potential organ donor. Thus, we sought to characterize the pathophysiology that occurs during brain death in patients with traumatic injuries. All brain-dead patients over a 10-year period were identified from the trauma registry at a level 1 urban trauma center. Patient demographics, injury characteristics, and clinical data for defining organ dysfunction were reviewed for the 24 hours surrounding brain-death declaration...
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28822384/clinical-characteristics-of-trauma-patients-requiring-hydrocortisone-treatment-for-refractory-hypotension
#2
Gina Kim, Jeffrey Young
Corticosteroids play an important role in responding to physiologic stress in the human body. However, its application in critical care remains heavily debated. The purpose of this study was to identify patient characteristics associated with receiving stress-dose steroids during the intensive care unit stay after traumatic injury and its effect on in-hospital mortality. Patients admitted to the University of Virginia trauma center between January 1, 2011, and December 31, 2015, were identified using our Trauma Registry...
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28814248/pediatric-abdominal-trauma
#3
Tim Lynch
Abdominal trauma is present in approximately 25% of pediatric patients with major trauma and is the most common cause of unrecognized fatal injury in children. Pediatric abdominal trauma is typically blunt in nature with the spleen being the most common organ injured. Non-operative management is employed in over 95% of patients. Penetrating injuries are less common but often require operative management. Knowledge of specific mechanisms of injury aids the clinician in the diagnosis of specific injuries. Computed tomography (CT) is the gold standard in the identification of intra-abdominal injury...
August 14, 2017: Current Pediatric Reviews
https://www.readbyqxmd.com/read/28807193/does-increased-prehospital-time-lead-to-a-trial-of-life-effect-for-patients-with-blunt-trauma
#4
Thomas W Clements, Kelly Vogt, S Morad Hameed, Neil Parry, Andrew W Kirkpatrick, Sean C Grondin, Elijah Dixon, Jessica McKee, Chad G Ball
BACKGROUND: Variance in prehospital time among severely injured blunt trauma patients is dependent upon numerous factors. Effects on subsequent mortality and trauma team activation (TTA) rates are also unclear. The primary aim of this study was to evaluate the relationship between prehospital time and mortality at level I trauma referral centers amongst critically blunt injured patients. MATERIALS AND METHODS: This multiinstitutional study from three geographically distinct level I trauma centers analyzed all severely blunt injured patients (Injury Severity Score [ISS] ≥12)...
August 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28765023/a-multicenter-retrospective-cohort-study-of-talk-and-die-after-traumatic-brain-injury
#5
Keita Shibahashi, Kazuhiro Sugiyama, Yoshihiro Okura, Hidenori Hoda, Yuichi Hamabe
BACKGROUND: Patients who "talk and die" after traumatic brain injury (TBI) are potentially salvageable. The reported incidences and risk factors for the "talk and die" phenomenon are conflicting, and do not take into account recent improvements in trauma care. The aim of this study was to determine the incidences of "talk and die" after TBI in a modern trauma care system, as well as associated risk factors. METHODS: We identified patients who experienced TBI (abbreviated injury scale 3-5) between 2004 and 2015 who talked on admission (i...
July 29, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28756471/the-research-agenda-for-trauma-critical-care
#6
REVIEW
Karim Asehnoune, Zsolt Balogh, Giuseppe Citerio, Andre Cap, Timothy Billiar, Nino Stocchetti, Mitchell J Cohen, Paolo Pelosi, Nicola Curry, Christine Gaarder, Russell Gruen, John Holcomb, Beverley J Hunt, Nicole P Juffermans, Mark Maegele, Mark Midwinter, Frederick A Moore, Michael O'Dwyer, Jean-François Pittet, Herbert Schöchl, Martin Schreiber, Philip C Spinella, Simon Stanworth, Robert Winfield, Karim Brohi
In this research agenda on the acute and critical care management of trauma patients, we concentrate on the major factors leading to death, namely haemorrhage and traumatic brain injury (TBI). In haemostasis biology, the results of randomised controlled trials have led to the therapeutic focus moving away from the augmentation of coagulation factors (such as recombinant factor VIIa) and towards fibrinogen supplementation and administration of antifibrinolytics such as tranexamic acid. Novel diagnostic techniques need to be evaluated to determine whether an individualised precision approach is superior to current empirical practice...
July 29, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28745856/severe-traumatic-brain-injury-in-children-an-evidence-based-review-of-emergency-department-management-digest
#7
Kirsten Morrissey, Hilary Fairbrother, Michelle N Vazquez
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 22, 2016: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/28738952/medication-errors-in-injured-patients
#8
Scott C Dolejs, Christopher F Janowak, Ben L Zarzaur
Trauma patients are vulnerable to medication error given multiple handoffs throughout the hospital. The purpose of this study was to assess trends in medication errors in trauma patients and the role these errors play in patient outcomes. Injured adults admitted from 2009 to 2015 to a Level I trauma center were included. Medication errors were determined based on a nurse-driven, validated, and prospectively maintained database. Multivariable logistic regression modeling was used to control for differences between groups...
July 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28737081/hypotension-of-%C3%A2-110-mmhg-is-associated-with-increased-mortality-in-south-african-patients-after-trauma
#9
D L Clarke, P Brysiewicz, B Sartorius, J L Bruce, G L Laing
INTRODUCTION: This study used data from a prospectively maintained trauma database to assess the level of systolic blood pressure at which mortality rates for trauma begin to increase and to compare systolic blood pressure with base deficit as a predictor of outcome. METHODOLOGY: The Pietermaritzburg Metropolitan Trauma Service maintains a prospective digital trauma registry. All trauma patients admitted to the service for the period January 2012-January 2015 were included...
March 1, 2017: Scandinavian Journal of Surgery: SJS
https://www.readbyqxmd.com/read/28733043/perioperative-hypotension-and-discharge-outcomes-in-non-critically-injured-trauma-patients-a-single-centre-retrospective-cohort-study
#10
Nadav Sheffy, Itay Bentov, Brianna Mills, Bala G Nair, G Alec Rooke, Monica S Vavilala
BACKGROUND: There is a lack of information on the effect of age on perioperative care and outcomes after minor trauma in the elderly. We examined the association between perioperative hypotension and discharge outcome among non-critically injured adult patients. METHODS: We conducted a retrospective study of non-critically ill patients (ISS <9 or discharged within less than 24h) who received anaesthesia care for surgery and Recovery Room care at a level-1 trauma centre between 5/1/2012 and 11/30/2013...
June 24, 2017: Injury
https://www.readbyqxmd.com/read/28724441/computed-tomography-during-initial-management-and-mortality-among-hemodynamically-unstable-blunt-trauma-patients-a-nationwide-retrospective-cohort-study
#11
Yusuke Tsutsumi, Shingo Fukuma, Asuka Tsuchiya, Tatsuyoshi Ikenoue, Yosuke Yamamoto, Sayaka Shimizu, Miho Kimachi, Shunichi Fukuhara
BACKGROUND: Although many hemodynamically unstable trauma patients undergo computed tomography (CT) to identify a source of bleeding, this practice is currently only recommended by a few guidelines. To clarify whether CT has harmful effects among these patients, we examined the association between CT during initial management and mortality among unstable blunt trauma patients. METHODS: This was a retrospective cohort study based on Japan Trauma Data Bank 2004-2014 registry data...
July 19, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28716309/arginine-vasopressin-copeptin-and-the-development-of-relative-avp-deficiency-in-hemorrhagic-shock
#12
Carrie A Sims, Yuxia Guan, Meredith Bergey, Rebecca Jaffe, Lilias Holmes-Maguire, Niels Martin, Patrick Reilly
BACKGROUND: Arginine vasopressin (AVP) is critical for maintaining vasomotor tone and low levels have been associated with the development of irreversible shock. We investigated the clinical relationship between AVP, copeptin (the C-terminal fragment of the AVP precursor), and the development of relative AVP deficiency following hemorrhagic shock. METHODS: A prospective, observational study of 21 hypotensive (SBP<90 mmHg X 2) or presumptively bleeding trauma patients was conducted...
June 24, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28712898/iatrogenic-vertebral-artery-injury-during-anterior-cervical-spine-surgery-a-systematic-review
#13
REVIEW
Qing Guan, Long Chen, Ye Long, Zhou Xiang
BACKGROUND: Iatrogenic vertebral artery injury (VAI) during anterior cervical surgery is rare but potentially catastrophic. METHOD: The causes, presentation, diagnosis, management, prognosis, and prevention of VAI were reviewed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. English-language studies and case reports published from 1980 to 2017 were retrieved. Data on diagnosis, surgical procedures and approach, site and cause of VAI, management, outcomes, and VA status were extracted...
July 13, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28711170/early-selenium-treatment-for-traumatic-brain-injury-does-it-improve-survival-and-functional-outcome
#14
Hosseinali Khalili, Rebecka Ahl, Yang Cao, Shahram Paydar, Gabriel Sjölin, Amin Niakan, Gholamreza Dabiri, Shahin Mohseni
BACKGROUND: Traumatic brain injury (TBI) is a major cause of death and debility following trauma. The initial brain tissue insult is worsened by secondary reactive responses including oxidative stress reactions, inflammatory changes and subsequent permanent neurologic deficits. Effective agents to improve functional outcome and survival following TBI are scarce. Selenium is an antioxidant which has shown to reduce oxidative stress. This study examines the effect of intravenous selenium (Selenase(®)) treatment in patients with severe TBI on functional outcome and survival in a prospective study design...
July 8, 2017: Injury
https://www.readbyqxmd.com/read/28693491/hypoxia-and-hypotension-in-patients-intubated-by-physician-staffed-helicopter-emergency-medical-services-a-prospective-observational-multi-centre-study
#15
Geir Arne Sunde, Mårten Sandberg, Richard Lyon, Knut Fredriksen, Brian Burns, Karl Ove Hufthammer, Jo Røislien, Akos Soti, Helena Jäntti, David Lockey, Jon-Kenneth Heltne, Stephen J M Sollid
BACKGROUND: The effective treatment of airway compromise in trauma and non-trauma patients is important. Hypoxia and hypotension are predictors of negative patient outcomes and increased mortality, and may be important quality indicators of care provided by emergency medical services. Excluding cardiac arrests, critical trauma and non-trauma patients remain the two major groups to which helicopter emergency medical services (HEMS) are dispatched. Several studies describe the impact of pre-hospital hypoxia or hypotension on trauma patients, but few studies compare this in trauma and non-trauma patients...
July 11, 2017: BMC Emergency Medicine
https://www.readbyqxmd.com/read/28685464/hemoglobin-based-oxygen-carrier-hboc-development-in-trauma-previous-regulatory-challenges-lessons-learned-and-a-path-forward
#16
Peter E Keipert
Historically, hemoglobin-based oxygen carriers (HBOCs) were being developed as "blood substitutes," despite their transient circulatory half-life (~ 24 h) vs. transfused red blood cells (RBCs). More recently, HBOC commercial development focused on "oxygen therapeutic" indications to provide a temporary oxygenation bridge until medical or surgical interventions (including RBC transfusion, if required) can be initiated. This included the early trauma trials with HemAssist (®) (BAXTER), Hemopure (®) (BIOPURE) and PolyHeme (®) (NORTHFIELD) for resuscitating hypotensive shock...
2017: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/28642485/sphingosine-1-phosphate-treatment-can-ameliorate-microvascular-leakage-caused-by-combined-alcohol-intoxication-and-hemorrhagic-shock
#17
Travis M Doggett, Natascha G Alves, Sarah Y Yuan, Jerome W Breslin
Fluid resuscitation following hemorrhagic shock is often problematic, with development of prolonged hypotension and edema. In addition, many trauma patients are also intoxicated, which generally worsens outcomes. We directly investigated how alcohol intoxication impacts hemorrhagic shock and resuscitation-induced microvascular leakage using a rat model with intravital microscopic imaging. We also tested the hypothesis that an endothelial barrier-protective bioactive lipid, sphingosine-1-phosphate (S1P), could ameliorate the microvascular leakage following alcohol intoxication plus hemorrhagic shock and resuscitation...
June 22, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28638005/sclerosing-mesenteritis-causing-chylous-ascites-and-small-bowel-perforation
#18
Huei-Wen Lim, Keith S Sultan
BACKGROUND Sclerosing mesenteritis (SM) is a rare idiopathic inflammation and fibrosis of the mesentery. Its etiology and pathogenesis remain unclear. It has been linked to abdominal trauma related to peritoneal dialysis, recent abdominal surgery, idiopathic inflammatory disorder, paraneoplastic syndrome, ischemia/infection, and autoimmunity. Abdominal CT is the most sensitive imaging modality, and diagnosis is usually confirmed by surgical biopsy. Patients most often present with abdominal pain, nausea, vomiting, diarrhea, and weight loss, and less commonly with chylous ascites and small bowel obstruction...
June 22, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28632581/multicenter-retrospective-study-of-noncompressible-torso-hemorrhage-anatomic-locations-of-bleeding-and-comparison-of-endovascular-versus-open-approach
#19
Ronald Chang, Erin E Fox, Thomas J Greene, Brian J Eastridge, Ramyar Gilani, Kevin K Chung, Stacia M DeSantis, Joseph J DuBose, Jeffrey S Tomasek, Gerald R Fortuna, Valerie G Sams, S Rob Todd, Jeanette M Podbielski, Charles E Wade, John B Holcomb
BACKGROUND: Rational development of technology for rapid control of noncompressible torso hemorrhage (NCTH) requires detailed understanding of what is bleeding. Our objectives were to describe the anatomic location of truncal bleeding in patients presenting with NCTH and compare endovascular (ENDO) management versus open (OPEN) management. METHODS: This is a retrospective study of adult trauma patients with NCTH admitted to four urban Level I trauma centers in the Houston and San Antonio metropolitan areas in 2008 to 2012...
July 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28616155/severe-pelvic-fracture-with-profound-hypotension-a-case-report-and-treatment-algorithm
#20
Chadwick J Knight, Igor Wanko Mboumi, Errington C Thompson
Approximately 9% of all blunt trauma patients suffer pelvic fractures. These fractures can range from insignificant and requiring almost no therapy to massive destruction of the pelvic ring with associated with multisystem injury and life-threatening hypotension which mandates the attention of the trauma surgeon, the orthopedic surgeon, the interventional radiologists and possibly other subspecialists. We present a case of a patient who presented to the emergency room in extremis from massive bleeding from a complex pelvic fracture...
June 2017: Journal of Surgical Case Reports
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