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Trauma bleeding

Henna Wong, Nicola Curry, Simon J Stanworth
PURPOSE OF REVIEW: Death from uncontrolled haemorrhage is one of the leading causes of trauma-related mortality and is potentially preventable. Advances in understanding the mechanisms of trauma-induced coagulopathy (TIC) have focused attention on the role of blood products and procoagulants in mitigating the sequelae of TIC and how these therapies can be improved. RECENT FINDINGS: A host of preclinical and clinical studies have evaluated blood product availability and efficacy in trauma...
October 15, 2016: Current Opinion in Critical Care
So Ra Kwon, Sang Ook Ha, Young Taeck Oh, You Dong Sohn
The typical presentation of intussusception includes intermittent severe abdominal pain, vomiting, rectal bleeding, and the presence of an abdominal mass. We present a case of intussusception after abdominal blunt trauma along with a literature review. A 4-year-old girl was admitted to the emergency department after a bicycle accident. She complained of progressively worsening abdominal pain, but there was no vomiting, fever, bloody stool, or abdominal mass. She was finally diagnosed with traumatic intussusception by ultrasonography and treated with air reduction...
March 2016: Clin Exp Emerg Med
J Willis Kiessling, Dean A Hertzler, David E M Drucker, Heather S Spader
BACKGROUND: This case report illustrates the need to evaluate the possibility of multiple arterial sources when presented with a frontal epidural hematoma associated with facial trauma. CASE DESCRIPTION: Our patient presented after being struck in the face by a baseball. Computed tomography (CT) of the brain revealed a large frontal epidural hematoma. Intraoperatively, bleeding from a frontal branch of the middle meningeal artery was encountered and cauterized, and the hematoma was removed...
October 14, 2016: World Neurosurgery
Pilar Anton-Martin, Bruno Braga, Stephen Megison, Janna Journeycake, Jessica Moreland
Severe trauma may cause refractory life-threatening respiratory failure requiring extracorporeal membrane oxygenation (ECMO). Concurrent traumatic brain injury, however, complicates the use of ECMO because of the major risk of intracranial bleeding with systemic anticoagulation. Craniotomy and/or craniectomy for hematoma evacuation during ECMO are extremely high-risk procedures secondary to ongoing anticoagulation, and there are only a few such case reports in the literature.We present the case of a child with multiple thoracic injuries and life-threatening respiratory failure supported on ECMO...
October 4, 2016: Pediatric Emergency Care
Philbert Y Van, Martin A Schreiber
PURPOSE OF REVIEW: The traumatically injured patient is at high risk for developing venous thromboembolism. Clinical practice guidelines developed by the American College of Chest Physicians and the Eastern Association for the Surgery of Trauma recognize the importance of initiating thromboprophylaxis, but the guidelines lack specific recommendations regarding the timing and dose of pharmacologic thromboprophylaxis. We review the literature regarding initiation of thromboprophylaxis in different injuries, the use of inferior vena cava filters, laboratory monitoring, dosing regimens, and the use of antiplatelet therapy...
October 5, 2016: Current Opinion in Critical Care
Chase L Andreason, Timothy H Pohlman
The timely recognition of shock secondary to hemorrhage from severe facial trauma or as a complication of complex oral and maxillofacial surgery presents formidable challenges. Specific hemostatic disorders are induced by hemorrhage and several extreme homeostatic imbalances may appear during or after resuscitation. Damage control resuscitation has evolved from massive transfusion to a more complex therapeutic paradigm that includes hemodynamic resuscitation, hemostatic resuscitation, and homeostatic resuscitation...
November 2016: Oral and Maxillofacial Surgery Clinics of North America
Marco Zuin, Gianluca Rigatelli, Stefano Ferraresi, Pietro Zonzin, Loris Roncon
We report the case of a 35-year-old man who developed a massive pulmonary embolism (PE) after spine surgery. After an accidental axial fall, the patient developed a spinal epidural hematoma (SHE). Because major trauma, recent surgery and known bleeding risk are considered absolute contraindications to systemic thrombolysis, the patient was treated with catheter-directed therapy (CDT). CDT remains a useful treatment in massive PE, especially when systemic thrombolysis is contraindicated or has failed.
September 30, 2016: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Ibrahim Eker, Soner Yilmaz, Rıza Aytac Cetinkaya, Aytekin Unlu, Aysel Pekel, Cengizhan Acikel, Sebahattin Yilmaz, Orhan Gursel, İsmail Yaşar Avci
BACKGROUND: Platelet suspensions (PSs) are stored at room temperature. However, recent reports show that PSs stored at 4 °C possess superior hemostatic properties. We compared the viabilities and thrombin generation capacities of PSs stored either at 4 °C or 22 °C hours. MATERIALS AND METHODS: Twenty units of apheresis derived platelets (ADPs) from 20 male donors and 20 units of random platelet suspensions (RPSs) from another 20 male donors were obtained...
September 28, 2016: Transfusion and Apheresis Science
Benilde Cosmi
Idiopathic or unprovoked venous thromboembolism is an event occurring in the absence of any apparent provoking or triggering environmental risk factors, such as surgery, trauma, and immobilization. Areas covered: Unprovoked VTE can be associated with occult cancer, but only limited, and not extensive cancer screening, may be warranted, as the rate of occult cancer is low in such patients. Routine thrombophilia testing is not currently recommended as it does not influence the management of the disease. The duration of anticoagulation for unprovoked VTE after the first three months is still debated as the disease tends to recur regardless of treatment duration...
October 14, 2016: Expert Review of Cardiovascular Therapy
Stefan Candefjord, Johan Winges, Ahzaz Ahmad Malik, Yinan Yu, Thomas Rylander, Tomas McKelvey, Andreas Fhager, Mikael Elam, Mikael Persson
Traumatic brain injury is the leading cause of death and severe disability for young people and a major public health problem for elderly. Many patients with intracranial bleeding are treated too late, because they initially show no symptoms of severe injury and are not transported to a trauma center. There is a need for a method to detect intracranial bleedings in the prehospital setting. In this study, we investigate whether broadband microwave technology (MWT) in conjunction with a diagnostic algorithm can detect subdural hematoma (SDH)...
October 13, 2016: Medical & Biological Engineering & Computing
Nasim Shahidi Hamedani, Heiko Rühl, Julia Janina Zimmermann, Tim Heiseler, Johannes Oldenburg, Günter Mayer, Bernd Pötzsch, Jens Müller
Activated protein C (APC) is a critical regulator of thrombin formation and thereby protects against thrombosis. On the other hand, overwhelming formation of APC increases the risk of bleeding such as in trauma-induced coagulopathy. Thus, pharmacological inhibition of APC activity may improve blood clottability in certain clinical situations. In this study, we demonstrate that the DNA aptamer HS02-52G binds with fast onset (1.118 ± 0.013 × 10(5) M(-1) s(-1)) to APC and possesses a long residence time of 13...
October 13, 2016: Nucleic Acid Therapeutics
Jean-Guillaume Meusnier, Charles Dewar, Erti Mavrovi, Frederic Caremil, Pierre-Francois Wey, Jean-Yves Martinez
BACKGROUND: Junctional hemorrhage (i.e., between the trunk and limbs) are too proximal for a tourniquet and difficult to compress. These hemorrhages are responsible for 20% of preventable deaths by bleeding on the battlefield. The majority of these involve the groin area. Devices allowing a proximal compression for arterial axes have been recently developed. OBJECTIVE: The purpose of this study was to compare the use of two junctional- tourniquet models, the Combat Ready Clamp (CRoC®) and the SAM® Junctional Tourniquet (SJT), in simulated out-of-hospital trauma care when tourniquets were ineffective to stop the arterial flow...
2016: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
Anna Jarosz, Sylweriusz Kosiński, Tomasz Darocha, Peter Paal, Robert Gałązkowski, Hubert Hymczak, Rafał Drwiła
OBJECTIVES: When establishing the Severe Hypothermia Treatment Centre, certain problems and pitfalls regarding the qualification for extracorporeal rewarming were encountered. The authors shared their experience and opened a discussion with other centers that deal with severe, accidental hypothermia. DESIGN: Retrospective analysis of medical records of all patients examined by the hypothermia coordinator. SETTING: Patients consulted and treated by the Severe Hypothermia Treatment Centre...
May 13, 2016: Journal of Cardiothoracic and Vascular Anesthesia
Ranabir Pal, Ashok Munivenkatappa, Amit Agrawal, Geetha R Menon, Sagar Galwankar, P Rama Mohan, S Satish Kumar, B V Subrahmanyam
BACKGROUND: A reliable prediction of outcome for the victims of traumatic brain injury (TBI) on admission is possible from concurrent data analysis from any systematic real-time registry. OBJECTIVE: To determine the clinical relevance of the findings from our TBI registry to develop prognostic futuristic models with readily available traditional and novel predictors. MATERIALS AND METHODS: Prospectively collected data using predesigned pro forma were analyzed from the first phase of a trauma registry from a South Indian Trauma Centre, compatible with computerized management system at electronic data entry and web data entry interface on demographics, clinical, management, and discharge status...
July 2016: International Journal of Critical Illness and Injury Science
Madhuradhar Chegondi, Jun Sasaki, André Raszynski, Balagangadhar R Totapally
OBJECTIVE: To evaluate the hemoglobin threshold for red cell transfusion in children admitted to a pediatric intensive care unit (PICU). METHODS: Retrospective chart review study. Tertiary care PICU. Critically ill pediatric patients requiring blood transfusion. No intervention. RESULTS: We analyzed the charts of all children between 1 month and 21 years of age who received packed red blood cell (PRBC) transfusions during a 2-year period. The target patients were identified from our blood bank database...
July 2016: Transfusion Medicine and Hemotherapy
Jiro Kimura, Kenji Okumura, Hideki Katagiri, Alan Kawarai Lefor, Ken Mizokami, Tadao Kubota
INTRODUCTION: Omental hemorrhage results from rupture of the omental vessels. There are many causes of omental hemorrhage including trauma, aneurysm, and vasculitis. Idiopathic omental hemorrhage is a rare cause of an acute abdomen, which is potentially life-threatening. We report a patient with idiopathic omental hemorrhage, which may have been caused by overeating. CASE PRESENTATION: A 29-year-old man without a history of trauma, bleeding disorders, or other significant medical history, presented with left upper quadrant pain, which began after overeating the previous evening...
October 4, 2016: International Journal of Surgery Case Reports
Carlo R Bartoli, Jooeun Kang, David Zhang, Jessica Howard, Michael Acker, Pavan Atluri, Tadashi Motomura
BACKGROUND: Supraphysiologic shear stress from continuous-flow left ventricular assist devices (LVADs) accelerates von Willebrand factor (vWF) degradation and predisposes patients to nonsurgical bleeding. It is unknown whether unique design characteristics of LVADs differentially affect vWF degradation. We tested the hypothesis that the centrifugal-flow EVAHEART (Evaheart, Houston, TX) left ventricular assist system (LVAS), which was designed to minimize shear stress (low operational revolutions per minute [rpm], larger flow gaps, low shear stress, flat H-Q curve), reduced vWF degradation versus the axial-flow HeartMate II (Thoratec, Pleasanton, CA) LVAD...
October 4, 2016: Annals of Thoracic Surgery
Harlan M Krumholz, Angela Hsieh, Rachel P Dreyer, John Welsh, Nihar R Desai, Kumar Dharmarajan
BACKGROUND: The risk of rehospitalization is elevated in the immediate post-discharge period and declines over time. It is not known if the extent and timing of risk vary across readmission diagnoses, suggesting that recovery and vulnerability after discharge differ by physiologic system. OBJECTIVE: We compared risk trajectories for major readmission diagnoses in the year after discharge among all Medicare fee-for-service beneficiaries hospitalized with heart failure (HF), acute myocardial infarction (AMI), or pneumonia from 2008-2010...
2016: PloS One
Kai Oliver Jensen, Leonhard Held, Andrea Kraus, Frank Hildebrand, Philipp Mommsen, Ladislav Mica, Guido A Wanner, Peter Steiger, Rudolf M Moos, Hans-Peter Simmen, Kai Sprengel
BACKGROUND: Although under discussion, induced hypothermia (IH) is an established therapy for patients with cardiac arrest or traumatic brain injuries. The influences on coagulopathy and bleeding tendency in severely injured patients (SIP) with concomitant traumatic brain injury are most widely unclear. Therefore, the aim of this study was to quantify the effect of mild IH in SIP with concomitant severe traumatic brain injuries on transfusion rate and mortality. METHODS: In this retrospective multi-centre study, SIP from three European level-1 trauma centres with an ISS ≥16 between 2009 and 2011 were included...
October 6, 2016: European Journal of Medical Research
J C Oldroyd, K M Venardos, N J Aoki, A J Zatta, Z K McQuilten, L E Phillips, N Andrianopoulos, D J Cooper, P A Cameron, J P Isbister, E M Wood
BACKGROUND: The Australian and New Zealand (ANZ) Massive Transfusion (MT) Registry (MTR) has been established to improve the quality of care of patients with critical bleeding (CB) requiring MT (≥ 5 units red blood cells (RBC) over 4 h). The MTR is providing data to: (1) improve the evidence base for transfusion practice by systematically collecting data on transfusion practice and clinical outcomes; (2) monitor variations in practice and provide an opportunity for benchmarking, and feedback on practice/blood product use; (3) inform blood supply planning, inventory management and development of future clinical trials; and (4) measure and enhance translation of evidence into policy and patient blood management guidelines...
October 6, 2016: BMC Research Notes
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