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Haemorrhagic shock

Andreas Klinger, Patrick Sperling, Hendrik Jansen, Johannes Wirbelauer, Daniel Vergho, Florian Seitz, Norbert Roewer, Thomas Meyer, Ralf Michael Muellenbach
A 16-month-old boy suffers a massive trauma (open dislocated pelvic fracture and decollement with haemorrhagic shock) due to a traffic accident. We present the characteristics and obstacles in the prehospital and early hospital emergency care of this severe and rare trauma in a pediatric patient with an emphasis on medical-operational tactics.
March 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Vikram Khanna, Kashish Khanna, Maddur Srinivas
A day-old neonate presented with bowel obstruction and an abdominal mass. Exploratory laparotomy revealed complete tubular midgut duplication from duodeno-jejunal junction up to terminal ileum which was communicating with the ileum distally. At the proximal end, another 5×5 cm duplication cyst was identified and excised. Postoperatively, complaints were relieved. During follow-up, 99m-Tc-pertechnetate-SPECT scan showed ectopic gastric mucosa in lower abdomen and in the right hemithorax. CECT-chest showed a 3×3 cm foregut duplication cyst, but there were no respiratory symptoms...
March 15, 2018: BMJ Case Reports
Tan Ming Ngan Aloysius, Vishalkumar G Shelat
Gestational choriocarcinoma is a rare and aggressive type of gestational trophoblastic neoplasia, which is characterized by early vascular invasion and widespread metastases. Choriocarcinoma metastasizes hematogenously, and bleeding from metastases is common. Splenic rupture from a metastatic tumour is exceedingly rare, with only a few reports. We report a case of a 41-year-old female presenting with acute abdomen and haemorrhagic shock secondary to splenic rupture from metastatic choriocarcinoma, which was managed with emergency laparoscopic splenectomy...
February 2018: Annals of Hepato-Biliary-Pancreatic Surgery
Yuesheng Shen, Wenjin Zhu, Mengye Zhao, Guige Zhao, Geng Niu, Yuwei Bai, Bo Yang, Chao Chen, Hongli Zhu
Polymerized porcine hemoglobin (pPolyHb), a kind of glutaraldehyde-polymerized haemoglobin-based oxygen carrier, was developed as a potential red blood substitute for clinical applications. Assessment of its absorption, distribution, and metabolism is a major determinant of its safety and efficacy. In this study, a series of pharmacokinetic parameters of pPolyHb were measured and calculated in different animal models, such as the top-load model, the 50% exchange transfusion model and the haemorrhagic shock model...
March 11, 2018: Artificial Cells, Nanomedicine, and Biotechnology
S D Yang, P Q Li, Y G Huang, W Li, L Z Ma, L Wu, N Wang, J M Lu, W Q Chen, Guang-Ming Liu, Y M Xiong, Y L Chen, Ying Zhang
Enterovirus A-71 (EV-A71) may be fatal, but the natural history, symptoms, and signs are poorly understood. This study aimed to examine the natural history of fatal EV-A71 infection and to identify the symptoms and signs of early warning of deterioration. This was a clinical observational study of fatal cases of EV-A71 infection treated at five Chinese hospitals between 1 January 2010 and 31 December 2012. We recorded and analysed 91 manifestations of EV-A71 infection in order to identify early prognosis indicators...
March 12, 2018: Epidemiology and Infection
Tetsuya Yumoto, Hiromichi Naito, Takashi Yorifuji, Hiroki Maeyama, Yoshinori Kosaki, Hirotsugu Yamamoto, Kohei Tsukahara, Takaaki Osako, Atsunori Nakao
OBJECTIVE: We tested whether Cushing's sign could predict severe traumatic brain injury (TBI) requiring immediate neurosurgical intervention (BI-NSI) in children after blunt trauma. DESIGN: Retrospective cohort study using Japan Trauma Data Bank. SETTING: Emergency and critical care centres in secondary and tertiary hospitals in Japan. PARTICIPANTS: Children between the ages of 2 and 15 years with Glasgow Coma Scale motor scores of 5 or less at presentation after blunt trauma from 2004 to 2015 were included...
March 3, 2018: BMJ Open
Oscar Thabouillot, K Bertho, E Rozenberg, N-C Roche, G Boddaert, D Jost, J-P Tourtier
INTRODUCTION: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique to control haemorrhage by placing a retrograde catheter in an artery and inflating a balloon at its tip. This retrospective study aimed to evaluate the proportion of injured people who could potentially have benefited from this technique prior to hospitalisation, including on the scene or during transport. METHODS: A retrospective analysis was conducted of all patients with trauma registered in the Paris Fire Brigade emergency medical system between 1 January and 31 December 2014...
February 27, 2018: Journal of the Royal Army Medical Corps
Jean Stéphane David, Pierre Bouzat, Mathieu Raux
Over the last 20 years, numerous studies have fairly consistently reported an improvement in the prognosis of patients with severe trauma after the establishment of a trauma network. These systems can be either exclusive, in which all patients are referred only to a small number of specifically designated centres that meet strict criteria, or inclusive, in which patients may be referred to any hospital of a particular area according to capacity, which is observed in France. Hospitals are classified (level 1 to level 3) according to their technical facilities and the number of patients admitted for severe trauma, knowing that studies have also shown an improvement of the outcome for the most severely injured patients (haemorrhagic shock, severe head trauma), in hospitals with the greatest technical facilities and the most important activity...
February 21, 2018: Anaesthesia, Critical Care & Pain Medicine
Zheng-Qiu Lin, Xiu-Zhi Ye, Wei-Liang Wang, Guo-Qing Zhu, Bing-Ju Xie, Liang-le Liu
OBJECTIVE: To investigate feasibility and curative effect of superselective arterial embolization for the treatment of massive haemorrhage from pelvic fracture. METHODS: From March 2008 to February 2016, clinical data of 65 patients with massive haemorrhage from pelvic fracture were collected and analyzed, and patients were divided into non-embolic and embolic group according to whether perform vascular thrombosis. Thirty-three patients were in non-embolic group including 26 males and 7 females aged from 21 to 64 years old with an average of(39...
December 25, 2017: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
Olivier Javaudin, A Baillon, N Varin, C Martinaud, T Pouget, C Civadier, B Clavier, A Sailliol
BACKGROUND: Haemorrhagic shock remains the leading cause of preventable death in overseas and austere settings. Transfusion of blood components is critical in the management of this kind of injury. For French naval and ground military units, this supply often takes too long considering the short shelf-life of red blood cell concentrates (RBCs) and the limited duration of transport in cooling containers (five to six days). Air-drop supply could be an alternative to overcome these difficulties on the condition that air-drop does not cause damage to blood units...
February 12, 2018: Journal of the Royal Army Medical Corps
Jordan Bade-Boon, Joseph K Mathew, Mark C Fitzgerald, Biswadev Mitra
BACKGROUND: Blunt thoracic aortic injury (BTAI) is an uncommon diagnosis, usually developing as a consequence of high-impact acceleration-deceleration mechanisms. Timely diagnosis may enable early resuscitation and reduction of shear forces, essential to prevent worsening of the injury prior to definitive management. Death is commonly due to haemorrhagic shock, but clinical features may be absent until sudden and massive haemorrhage. OBJECTIVES: The aim of this systematic review was to determine the proportion of patients with BTAI who present with unstable vital signs...
February 9, 2018: Emergency Medicine Journal: EMJ
Alexander Ziebart, Christian Möllmann, Andreas Garcia-Bardon, Jens Kamuf, Moritz Schäfer, Rainer Thomas, Erik K Hartmann
BACKGROUND: During early treatment of haemorrhagic shock maintenance of cerebral and end-organ oxygen supply by fluid resuscitation is mandatory. Gelatin-polysuccinat (GP) recently regained attention despite a still unclear risk profile and widely unknown effects on cerebral and peripheral microcirculation. This study investigates the effects of GP versus balanced electrolyte solution (BEL) with focus on cerebral regional oxygen saturation and peripheral microcirculation in a porcine haemorrhagic shock model...
February 9, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
H Rupprecht, H Dormann, A Marx, K Gaab
We report a case of a 62 year old patient, who was hospitalised due to haemorrhagic shock. The cause was a rupture of the pulmonary artery due to metastasis of a renal cell carcinoma. This cause is now reported for the first time. The primary tumour (pT2,pN0,M0,R0) was resected 25 years ago. This case demonstrates that after curative nephrectomy pulmonary metastasis can occur, even after decades. This is why patients of this type need lifelong follow-up.
February 9, 2018: Aktuelle Urologie
L J Terceros-Almanza, C García-Fuentes, S Bermejo-Aznárez, I J Prieto Del Portillo, C Mudarra-Reche, H Domínguez-Aguado, R Viejo-Moreno, J Barea-Mendoza, R Gómez-Soler, I Casado-Flores, M Chico-Fernández
OBJECTIVE: To validate the diagnostic ability of six different scores to predict massive bleeding in a prehospital setting. DESIGN: Retrospective cohort. SETTING: Prehospital attention of patients with severe trauma. SUBJECTS: Subjects with more than 15 years, a history of severe trauma (defined by code 15 criteria), that were initially assisted in a prehospital setting by the emergency services between January 2010 and December 2015 and were then transferred to a level one trauma center in Madrid...
February 4, 2018: Medicina Intensiva
Anthony J Hudson, Geir Strandenes, Christopher K Bjerkvig, Marius Svanevik, Elon Glassberg
Many standard trauma management guidelines advocate the early use of endotracheal intubation and positive pressure ventilation as key treatment interventions in haemorrhagic shock. The evidence for using these airway and ventilation strategies to manage a circulation problem is unclear. The potentially harmful effects of drug assisted intubation and positive pressure ventilation include reduced cardiac output, apnoea, hypoxia, hypocapnoea (due to inadvertent hyperventilation) and unnecessarily prolonged on-scene times...
January 31, 2018: Journal of Trauma and Acute Care Surgery
Kaashif Aqeeb Ahmad, Monica Michelle Bennett, Samiya Fatima Ahmad, Reese Hunter Clark, Veeral Nalin Tolia
OBJECTIVE: There are no large studies evaluating pulmonary haemorrhage (PH) in premature infants. We sought to quantify the clinical characteristics, morbidities and mortality associated with early PH. DESIGN: Data were abstracted from the Pediatrix Clinical Data Warehouse, a large de-identified data set. For incidence calculations, we included infants from 340 Pediatrix United States Neonatal Intensive Care Units from 2005 to 2014 without congenital anomalies. Infants <28 weeks' gestation with PH within 7 days of birth were then matched with two controls for birth weight, gestational age, gender, antenatal steroid exposure, day of life 0 or 1 intubation and multiple gestation...
January 27, 2018: Archives of Disease in Childhood. Fetal and Neonatal Edition
Jan-Dirk Vermeij, Willeke F Westendorp, Diederik Wj Dippel, Diederik van de Beek, Paul J Nederkoorn
BACKGROUND: Stroke is the main cause of disability in high-income countries and ranks second as a cause of death worldwide. Infections occur frequently after stroke and may adversely affect outcome. Preventive antibiotic therapy in the acute phase of stroke may reduce the incidence of infections and improve outcome. In the previous version of this Cochrane Review, published in 2012, we found that antibiotics did reduce the risk of infection but did not reduce the number of dependent or deceased patients...
January 22, 2018: Cochrane Database of Systematic Reviews
Dorothy Ng, Aparna Ghosh, Mark Jit, Suranjith L Seneviratne
Dengue viral infections are endemic or epidemic in virtually all tropical countries. Among individuals infected with the dengue virus, severe dengue syndromes (i.e., dengue haemorrhagic fever and dengue shock syndromes) tend to affect only some and this may be due to a combination of host genetic susceptibility and viral factors. In this review article we analyse and discuss the present knowledge of non-human leucocyte antigen host genetic susceptibility to severe dengue syndromes. The relevance of genetic polymorphisms in the pathways of antigen recognition, uptake, processing and presentation, activation of interferon α responses, mast cell and complement activation and T cell activation and dengue disease severity has been reviewed and analysed...
January 17, 2018: Transactions of the Royal Society of Tropical Medicine and Hygiene
Lewis S Gall, Ross A Davenport
PURPOSE OF REVIEW: The role of antifibrinolytics in trauma haemorrhage and early coagulopathy remains controversial with respect to patient selection, dosage, timing of treatment, and risk of thrombotic complications. This review presents our current understanding of the mechanisms of fibrinolysis in trauma, diagnostic evaluation, and the evidence base for treatment. RECENT FINDINGS: Excessive fibrinolysis following severe injury is a major component of acute traumatic coagulopathy and contributes to the high mortality from trauma haemorrhage...
April 2018: Current Opinion in Anaesthesiology
Susilo Chandra, Hrishikesh Kulkarni, Martin Westphal
Red blood cell (RBC) transfusion might be life-saving in settings with acute blood loss, especially uncontrolled haemorrhagic shock. However, there appears to be a catch-22 situation reflected by the facts that preoperative anaemia represents an independent risk factor for postoperative morbidity and mortality, and that RBC transfusion might also contribute to adverse clinical outcomes. This dilemma is further complicated by the difficulty to define the "best" transfusion trigger and strategy. Since one size does obviously not fit all, a personalised approach is merited...
December 28, 2017: Critical Care: the Official Journal of the Critical Care Forum
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