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https://www.readbyqxmd.com/read/29470190/blood-transfusion-management-in-the-severely-bleeding-military-patient
#1
Jennifer M Gurney, Philip C Spinella
PURPOSE OF REVIEW: Hemorrhage remains the primary cause of preventable death on the battlefield and in civilian trauma. Hemorrhage control is multifactorial and starts with point-of-injury care. Surgical hemorrhage control and time from injury to surgery is paramount; however, interventions in the prehospital environment and perioperative period affect outcomes. The purpose of this review is to understand concepts and strategies for successful management of the bleeding military patient...
April 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29462088/vascular-surgery-during-u-s-combat-operations-from-2002-2016-analysis-of-vascular-procedures-performed-to-inform-military-training
#2
Caryn A Turner, Capt Zsolt T Stockinger, Col Jennifer M Gurney
BACKGROUND: Vascular surgery constitutes approximately 6.5% of surgical procedures performed for combat injuries, yet general surgeons are increasingly unfamiliar with vascular surgery. This study examines the frequency and type of vascular surgical procedures performed during recent U.S. Military operations from 2002-2016. METHODS: A retrospective analysis of the Department of Defense Trauma Registry (DoDTR) was performed for all Role 2 and Role 3 MTFs, from January 2002 to May 2016...
February 17, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29443866/factors-associated-with-trauma-patients-length-of-stay-at-role-2-facilities-in-afghanistan-october-2009-to-september-2014
#3
Amanda Staudt, Jennifer Gurney, Krystal Valdez-Delgado, Mithun Suresh, Jennifer Trevino, Tuan Le, Jason Seery, Stacy Shackelford, Shawn Nessen, Elizabeth Mann-Salinas
BACKGROUND: Understanding patients' length of stay at far-forward Role 2 surgical units may help to determine support needs, stabilization requirements, pre-deployment training, and necessity of increased care capability prior to or during transport to a higher level of care. The objectives of this study were to 1) evaluate the amount of time patients spent at Role 2 and 2) determine factors associated with trauma patients' length of stay at Role 2. METHODS: We conducted a secondary data analysis of the Joint Trauma System Role 2 Database...
February 13, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29370066/abdominal-trauma-surgery-during-recent-u-s-combat-operations-from-2002-2016
#4
Zsolt T Stockinger, Caryn A Turner, Jennifer M Gurney
BACKGROUND: Abdominal surgery constitutes approximately 13% of surgical procedures performed for combat injuries. This study examines the frequencies and type of abdominal surgical procedures performed during recent U.S. Military operations. METHODS: A retrospective analysis of the Department of Defense Trauma Registry (DoDTR) was performed for all Role 2 (R2) and Role 3 (R3) medical treatment facilities (MTFs), from January 2002 to May 2016. The 273 ICD-9-CM procedure codes that were identified as abdominal surgical procedures were stratified into 24 groups based on anatomic and functional classifications and then grouped by whether or not they were laparoscopic...
January 24, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29369076/analysis-of-pediatric-trauma-in-combat-zone-to-inform-high-fidelity-simulation-predeployment-training
#5
Patrick T Reeves, Marc M Auerbach, Tuan D Le, Nicole W Caldwell, Mary J Edwards, Elizabeth A Mann-Salinas, Jennifer M Gurney, Zsolt T Stockinger, Matthew A Borgman
OBJECTIVES: The military uses "just-in-time" training to refresh deploying medical personnel on skills necessary for medical and surgical care in the theater of operations. The burden of pediatric care at Role 2 facilities has yet to be characterized; pediatric predeployment training has been extremely limited and primarily informed by anecdotal experience. The goal of this analysis was to describe pediatric care at Role 2 facilities to enable data-driven development of high-fidelity simulation training and core knowledge concepts specific to the combat zone...
January 23, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29341131/a-retrospective-study-of-feline-trauma-patients-admitted-to-a-referral-centre
#6
T Hernon, M Gurney, S Gibson
OBJECTIVE: To identify prognostic information and provide recommendations for management of feline trauma patients. METHODS: Retrospective analysis of case records for 185 cats presented as emergency trauma cases to a referral hospital between February 2009 and December 2013. Each case was assigned a severity score from 1 (very minor injuries) to 6 (moribund, dying). The data were analysed using Mann-Whitney U and Spearman's rank correlation tests. Logistic regression was used to calculate odds ratios...
January 17, 2018: Journal of Small Animal Practice
https://www.readbyqxmd.com/read/29334570/the-effect-of-prehospital-transport-time-injury-severity-and-blood-transfusion-on-survival-of-us-military-casualties-in-iraq
#7
Russ S Kotwal, Laura L F Scott, Jud C Janak, Bruce W Tarpey, Jeffrey T Howard, Edward L Mazuchowski, Frank K Butler, Stacy A Shackelford, Jennifer M Gurney, Zsolt T Stockinger
BACKGROUND: Reducing time from injury to care can optimize trauma patient outcomes. A previous study of prehospital transport of US military casualties during the Afghanistan conflict demonstrated the importance of time and treatment capability for combat casualty survival. METHODS: A retrospective descriptive analysis was conducted to analyze battlefield data collected on US military combat casualties during the Iraq conflict from March 19, 2003 to August 31, 2010...
January 12, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29067429/association-of-prehospital-blood-product-transfusion-during-medical-evacuation-of-combat-casualties-in-afghanistan-with-acute-and-30-day-survival
#8
Stacy A Shackelford, Deborah J Del Junco, Nicole Powell-Dunford, Edward L Mazuchowski, Jeffrey T Howard, Russ S Kotwal, Jennifer Gurney, Frank K Butler, Kirby Gross, Zsolt T Stockinger
Importance: Prehospital blood product transfusion in trauma care remains controversial due to poor-quality evidence and cost. Sequential expansion of blood transfusion capability after 2012 to deployed military medical evacuation (MEDEVAC) units enabled a concurrent cohort study to focus on the timing as well as the location of the initial transfusion. Objective: To examine the association of prehospital transfusion and time to initial transfusion with injury survival...
October 24, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28591075/comparison-of-the-vacuum-mattress-versus-the-spine-board-alone-for-immobilization-of-the-cervical-spine-injured-patient-a-biomechanical-cadaveric-study
#9
Mark L Prasarn, Per Kristian Hyldmo, Laura A Zdziarski, Evan Loewy, Dewayne Dubose, MaryBeth Horodyski, Glenn R Rechtine
STUDY DESIGN: A biomechanical cadaveric study. OBJECTIVE: We sought to determine the amount of motion generated in an unstable cervical spine fracture with use of the vacuum mattress versus the spine board alone. Our hypothesis is that the vacuum mattress will better immobilize an unstable cervical fracture. SUMMARY OF BACKGROUND DATA: Trauma patients in the United States are immobilized on a rigid spine board, whereas in many other places, vacuum mattresses are used with the proposed advantages of improved comfort and better immobilization of the spine...
December 15, 2017: Spine
https://www.readbyqxmd.com/read/28542295/therapeutic-benefits-of-phosphodiesterase-4b-inhibition-after-traumatic-brain-injury
#10
Nicole M Wilson, Mark E Gurney, W Dalton Dietrich, Coleen M Atkins
Traumatic brain injury (TBI) initiates a deleterious inflammatory response that exacerbates pathology and worsens outcome. This inflammatory response is partially mediated by a reduction in cAMP and a concomitant upregulation of cAMP-hydrolyzing phosphodiesterases (PDEs) acutely after TBI. The PDE4B subfamily, specifically PDE4B2, has been found to regulate cAMP in inflammatory cells, such as neutrophils, macrophages and microglia. To determine if PDE4B regulates inflammation and subsequent pathology after TBI, adult male Sprague Dawley rats received sham surgery or moderate parasagittal fluid-percussion brain injury (2 ± 0...
2017: PloS One
https://www.readbyqxmd.com/read/28514618/aerobic-or-resistance-exercise-or-both-in-dieting-obese-older-adults
#11
RANDOMIZED CONTROLLED TRIAL
Dennis T Villareal, Lina Aguirre, A Burke Gurney, Debra L Waters, David R Sinacore, Elizabeth Colombo, Reina Armamento-Villareal, Clifford Qualls
BACKGROUND: Obesity causes frailty in older adults; however, weight loss might accelerate age-related loss of muscle and bone mass and resultant sarcopenia and osteopenia. METHODS: In this clinical trial involving 160 obese older adults, we evaluated the effectiveness of several exercise modes in reversing frailty and preventing reduction in muscle and bone mass induced by weight loss. Participants were randomly assigned to a weight-management program plus one of three exercise programs - aerobic training, resistance training, or combined aerobic and resistance training - or to a control group (no weight-management or exercise program)...
May 18, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/27661422/resuscitation-and-treatment-of-shock
#12
Michael J Beltran, Tyson E Becker, Richard K Hurley, Jennifer M Gurney, Roman A Hayda
Hemorrhage continues to be the most common cause of death among service members wounded in combat. Injuries that were previously nonsurvivable in previous wars are now routinely seen by combat surgeons in forward surgical units, the result of improvements in body armor, the universal use of field tourniquets to control extremity hemorrhage at the point of injury, and rapid air evacuation strategies. Combat orthopaedic surgeons remain a vital aspect of the forward surgical unit, tasked with assisting general surgical colleagues in the resuscitation of patients in hemorrhagic shock while also addressing traumatic amputations, open and closed long bone fractures, and mechanically unstable pelvic trauma...
October 2016: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/27383587/chronic-cognitive-dysfunction-after-traumatic-brain-injury-is-improved-with-a-phosphodiesterase-4b-inhibitor
#13
David J Titus, Nicole M Wilson, Julie E Freund, Melissa M Carballosa, Kevin E Sikah, Concepcion Furones, W Dalton Dietrich, Mark E Gurney, Coleen M Atkins
UNLABELLED: Learning and memory impairments are common in traumatic brain injury (TBI) survivors. However, there are no effective treatments to improve TBI-induced learning and memory impairments. TBI results in decreased cAMP signaling and reduced cAMP-response-element binding protein (CREB) activation, a critical pathway involved in learning and memory. TBI also acutely upregulates phosphodiesterase 4B2 (PDE4B2), which terminates cAMP signaling by hydrolyzing cAMP. We hypothesized that a subtype-selective PDE4B inhibitor could reverse the learning deficits induced by TBI...
July 6, 2016: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
https://www.readbyqxmd.com/read/27348349/current-concepts-in-midface-fracture-management
#14
Alf L Nastri, Ben Gurney
PURPOSE OF REVIEW: Management of midface trauma is complex and challenging and requires a clear understanding of the facial buttress system, subunit anatomy and inter-relationships. Too often clinicians attempt surgical repair without adequate knowledge of the common complications associated with poor reduction and improper sequencing of fracture repair. This review outlines a working approach to the identification and management of such injuries, and the definitive management of common injury patterns...
August 2016: Current Opinion in Otolaryngology & Head and Neck Surgery
https://www.readbyqxmd.com/read/27257717/metabolism-and-toxicological-analysis-of-synthetic-cannabinoids-in-biological-fluids-and-tissues
#15
REVIEW
B C Presley, S M R Gurney, K S Scott, S L Kacinko, B K Logan
Synthetic cannabinoids, which began proliferating in the United States in 2009, have gone through numerous iterations of modification to their chemical structures. More recent generations of compounds have been associated with significant adverse outcomes following use, including cognitive and psychomotor impairment, seizures, psychosis, tissue injury and death. These effects increase the urgency for forensic and public health laboratories to develop methods for the detection and identification of novel substances, and apply these to the determination of their metabolism and disposition in biological samples...
July 2016: Forensic Science Review
https://www.readbyqxmd.com/read/25384506/knee-chondrolysis-by-infusion-of-bupivacaine-with-epinephrine-through-an-intra-articular-pain-pump-catheter-after-arthroscopic-acl-reconstruction
#16
Jordan Z Buchko, Tanner Gurney-Dunlop, Jason J Shin
BACKGROUND: Postoperative knee chondrolysis caused by continuous intra-articular pain pumps infusing bupivacaine with epinephrine is a rare but serious complication. PURPOSE: To determine the association between postoperative intra-articular infusion of bupivacaine with epinephrine and the development of knee chondrolysis in patients who have undergone arthroscopic anterior cruciate ligament reconstruction (ACLR). The authors hypothesized that the development of knee chondrolysis after ACLR is associated with postoperative high-dose intra-articular bupivacaine with epinephrine infusion...
February 2015: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/24630360/occupant-accelerations-and-injury-potential-during-an-ambulance-to-curb-impact
#17
Ellen L Lee, Wilson C Hayes
This paper presents real world acceleration data for an ambulance driving up and over a curb. A full scale reenactment was performed for a litigated case in which a patient on a gurney in an ambulance claimed a variety of bodily injuries after the ambulance struck a curb. A height and weight matched surrogate rode on the gurney during the tests. Results demonstrated that peak vehicle and occupant accelerations never exceeded 1.1g's. To address the claimed injuries, the accelerations likely sustained by the patient were compared to those experienced during daily life...
April 2014: Forensic Science International
https://www.readbyqxmd.com/read/23121294/haemophagocytic-lymphohistiocytosis-in-a-patient-with-severe-burns
#18
J R S Porter, J Handy, H Yarranton, S Gurney
Recently, increasing attention has been drawn to haemophagocytic lymphohistiocytosis as a potentially under-diagnosed condition in critically ill patients with severe sepsis. It is thought to be caused by a highly stimulated, but ineffective, immune system. We report the case of a patient suffering from major burns who, despite extensive investigations showing the absence of concurrent sepsis or infection, developed haemophagocytic lymphohistiocytosis refractory to treatment. We believe that this is the first report suggestive of haemophagocytic lymphohistiocytosis triggered by a burns injury...
April 2013: Anaesthesia
https://www.readbyqxmd.com/read/22183615/adiponectin-protects-against-hyperoxic-lung-injury-and-vascular-leak
#19
Sean M Sliman, Rishi B Patel, Jason P Cruff, Sainath R Kotha, Christie A Newland, Carrie A Schrader, Shariq I Sherwani, Travis O Gurney, Ulysses J Magalang, Narasimham L Parinandi
Adiponectin (Ad), an adipokine exclusively secreted by the adipose tissue, has emerged as a paracrine metabolic regulator as well as a protectant against oxidative stress. Pharmacological approaches of protecting against clinical hyperoxic lung injury during oxygen therapy/treatment are limited. We have previously reported that Ad inhibits the NADPH oxidase-catalyzed formation of superoxide from molecular oxygen in human neutrophils. Based on this premise, we conducted studies to determine whether (i) exogenous Ad would protect against the hyperoxia-induced barrier dysfunction in the lung endothelial cells (ECs) in vitro, and (ii) endogenously synthesized Ad would protect against hyperoxic lung injury in wild-type (WT) and Ad-overexpressing transgenic (AdTg) mice in vivo...
November 2013: Cell Biochemistry and Biophysics
https://www.readbyqxmd.com/read/21085945/low-renal-oximetry-correlates-with-acute-kidney-injury-after-infant-cardiac-surgery
#20
Gabe E Owens, Karen King, James G Gurney, John R Charpie
Acute kidney injury (AKI) is a frequent complication after cardiopulmonary bypass surgery during infancy. Standard methods for evaluating renal function are not particularly sensitive nor are proximate indicators of renal dysfunction that allow intervention in real time. Near-infrared spectroscopy (NIRS) is a newer noninvasive technology that continuously evaluates regional oximetry and may correlate with renal injury and adverse outcomes after cardiac surgery in infants. This prospective observational study enrolled 40 infants (age, <12 months) undergoing biventricular repair...
February 2011: Pediatric Cardiology
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