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https://www.readbyqxmd.com/read/28921846/improvement-of-polytrauma-management-quality-inspection-of-a-newly-introduced-course-concept
#1
Ingo Gräff, Shahab Ghamari, Sylvia Schacher, Procula Glien, Rolf Fimmers, Torsten Baehner, Se-Chan Kim
RATIONALE, AIMS, AND OBJECTIVES: A systematic literature search for training course concepts for care of severely injured and severely ill patients respecting improvement of process and outcome yielded little data. For several years, the University Hospital of Bonn has hosted a shock-room management course which, on the one hand, communicates human factor aspects and, on the other hand, pursues interdisciplinary and interprofessional team training. The Bonn shock-room management course (BSM-course®) differs from other courses in both format and principles...
September 17, 2017: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/28915215/mechanisms-involved-in-secondary-cardiac-dysfunction-in-animal-models-of-trauma-and-hemorrhagic-shock
#2
Nick M Wilson, Johanna Wall, Veena Naganathar, Karim Brohi, Henry D De'Ath
Clinical evidence reveals the existence of a trauma-induced secondary cardiac injury (TISCI) that is associated with poor patient outcomes. The mechanisms leading to TISCI in injured patients are uncertain. Conversely, animal models of trauma hemorrhage have repeatedly demonstrated significant cardiac dysfunction following injury, and highlighted mechanisms through which this might occur. The aim of this review was to provide an overview of the animal studies describing TISCI and its pathophysiology.Basic science models of trauma show evidence of innate immune system activation via Toll-like receptors, the exact protagonists of which remain unclear...
October 2017: Shock
https://www.readbyqxmd.com/read/28914713/the-hyperfibrinolytic-phenotype-is-the-most-lethal-and-resource-intense-presentation-of-fibrinolysis-in-massive-transfusion-patients
#3
John R Taylor, Erin E Fox, John B Holcomb, Sandro Rizoli, Kenji Inaba, Martin A Schreiber, Karen Brasel, Thomas M Scalea, Charles E Wade, Eileen Bulger, Bryan A Cotton
BACKGROUND: Among bleeding patients, we hypothesized that the hyperfibrinolytic (HF) phenotype would be associated with the highest mortality, while shutdown (SD) patients would have the greatest complication burden. METHODS: Severely injured patients predicted to receive a massive transfusion at 12 level-1 trauma centers were randomized to one of two transfusion ratios as described in the PROPPR trial. Fibrinolysis phenotypes were determined based on admission clot lysis at 30 minutes (LY30): SD ≤0...
September 13, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28910469/prehospital-administration-of-tranexamic-acid-by-ground-forces-in-afghanistan-the-prehospital-trauma-registry-experience
#4
Steven G Schauer, Michael D April, Jason F Naylor, Jonathan Wiese, Kathy L Ryan, Andrew D Fisher, Cord W Cunningham, Noah Mitchell, Mark A Antonacci
BACKGROUND: Tranexamic acid (TXA) was shown to reduce overall mortality and death secondary to hemorrhage in a large prospective study. This intervention is time sensitive. As such, the Tactical Combat Casualty Care (TCCC) guidelines recommend use of this low-cost, safe intervention among patients with possible hemorrhagic shock, penetrating trauma to the thorax or trunk, or extremity amputation. OBJECTIVE: Prehospital administration of TXA by ground forces in the Afghanistan combat theater is described...
2017: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/28904675/von-willebrand-s-disease-case-report-and-review-of-literature
#5
Hanae Echahdi, Brahim El Hasbaoui, Mohamed El Khorassani, Aomar Agadr, Mohamed Khattab
Von Willebrand Disease (VWD) is the most common human inherited bleeding disorder due to a defect of Von Willebrand Factor (VWF), which a glycoprotein crucial for platelet adhesion to the subendothelium after vascular injury. VWD include quantitative defects of VWF, either partial (type 1 with VWF levels < 50 IU/dL) or virtually total (type 3 with undetectable VWF levels) and also qualitative defects of VWF (type 2 variants with discrepant antigenic and functional VWF levels). The most bleeding forms of VWD usually do not concern type 1 patients with the mildest VWF defects (VWF levels between 30 and 50IU/dL)...
2017: Pan African Medical Journal
https://www.readbyqxmd.com/read/28904652/-role-of-trauma-damage-control-orthopaedic-in-polytraumas-a-case-of-pelvic-disjunction-associated-with-hip-dislocation-with-vascular-injury
#6
Tarik Madani, El Mehdi El Alouani, Younes Mhammdi, Mohammed Kharmaz, Mohamed El Ouadghiri, Abdou Lahlou, Lamrani Moulay Omar, Ahmed El Bardouni, Mustapha Mahfoud, Mohamed Saleh Berrada
The knowledge of the pathophysiology of patients with severe trauma and the hemodynamic and inflammatory consequences of initial surgical management has led many surgeons to change their approach to the treatment of patients with severe polytraumas associated with lesions of the pelvis or of limbs by integrating the principles of sequential treatment or Trauma Damage Control Orthopaedic (TDCO). We report the case of a patient involved in a public road accident, admitted to hospital in a state of shock with pelvic disjunction and hip dislocation complicated by vascular injury in the same limb...
2017: Pan African Medical Journal
https://www.readbyqxmd.com/read/28886784/development-of-a-new-infusion-protocol-for-austere-trauma-resuscitations
#7
Stewart A Stancil
Intravenous fluid therapy for hemorrhagic shock has undergone enormous changes since it was first conducted almost 200 years ago. In the past 40 years especially, practices have dramatically changed with regards to fluid resuscitation. In pre-hospital, combat, austere, and rural emergency medicine the stakes are especially high to deliver an effective and logical resuscitation fluid strategy to a patient that is suffering from hemorrhagic shock. This article follows a prior article published in July 2014. It highlights the development of new cutting edge intravenous therapy regimens that maximize hemodynamic outcomes that can be effected by those providers that care for injured patients without the benefit of ample resources...
September 2017: Air Medical Journal
https://www.readbyqxmd.com/read/28885956/combat-casualties-and-severe-shock-risk-factors-for-death-at-role-3-military-facilities
#8
Michelle F Buehner, Brian J Eastridge, James K Aden, Joseph J DuBose, Lorne H Blackbourne, Ramon F Cestero
BACKGROUND: Although significant research has been conducted on combat casualties receiving blood products, there is limited data for the subpopulation presenting in shock. The purpose of this study was to evaluate combat casualties arriving to a role 3 facility with an initial systolic blood pressure (SBP) ≤ 90 in order to identify clinical characteristics and associations between presentation, transfusion therapy, and mortality outcomes. METHODS: The Department of Defense Trauma Registry was queried from 2001 to 2010 for trauma-related casualties who arrived at a role 3 combat surgical facility with a SBP ≤ 90...
September 2017: Military Medicine
https://www.readbyqxmd.com/read/28885470/poor-microcirculatory-flow-dynamics-are-associated-with-endothelial-cell-damage-and-glycocalyx-shedding-following-traumatic-hemorrhagic-shock
#9
David N Naumann, Jon Hazeldine, Mark J Midwinter, Sam D Hutchings, Paul Harrison
BACKGROUND: Endothelial cell damage and glycocalyx shedding following trauma can increase the risk of inflammation, coagulopathy, vascular permeability and death. Bedside sublingual video-microscopy may detect worse flow and perfusion associated with this endotheliopathy. We compared markers of endotheliopathy with physical flow dynamics following traumatic hemorrhagic shock (THS). METHODS: Sublingual incident dark field video-microscopy was performed at three time-points following injury (<10h; 10-30h; and 30-50h)...
September 5, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28883735/hollow-viscus-injuries-predictors-of-outcome-and-role-of-diagnostic-delay
#10
Andrea Mingoli, Marco La Torre, Gioia Brachini, Gianluca Costa, Genoveffa Balducci, Barbara Frezza, Giovanna Sgarzini, Bruno Cirillo
INTRODUCTION: Hollow viscus injuries (HVIs) are uncommon but potentially catastrophic conditions with high mortality and morbidity rates. The aim of this study was to analyze our 16-year experience with patients undergoing surgery for blunt or penetrating bowel trauma to identify prognostic factors with particular attention to the influence of diagnostic delay on outcome. METHODS: From our multicenter trauma registry, we selected 169 consecutive patients with an HVI, enrolled from 2000 to 2016...
2017: Therapeutics and Clinical Risk Management
https://www.readbyqxmd.com/read/28876563/defining-predictors-of-mortality-in-pediatric-trauma-patients
#11
P Brysiewicz, D L Clarke, B Sartorius, J L Bruce, G L Laing
BACKGROUND: The aim of this study was to describe our cohort of pediatric trauma patients and to analyze their physiological data. The intention was to highlight the difficulty in using systolic blood pressure (SBP) readings in this population and to investigate the role of base excess (BE) in predicting clinical outcomes in pediatric trauma patien. METHOD: The Pietermaritzburg Metropolitan Trauma Service (PMTS) maintains a prospective digital trauma registry, and all pediatric trauma patients admitted to the service for the period January 2012 - July 2016 were included...
September 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28871580/successful-treatment-of-blunt-musculophrenic-artery-injury-by-transcatheter-arterial-embolization-a-case-report
#12
Tohru Sawamoto, Hiromichi Aoki, Hiroyuki Otsuka, Seiji Morita, Shigeaki Inoue, Yoshihide Nakagawa, Sadaki Inokuchi
An 86-year-old woman was transported by ambulance after jumping from the second floor of a building. Upon arrival, the blood pressure was stable; however, computed tomography indicated the presence of an anterior mediastinal hematoma. Eight hours after arrival, the patient exhibited shock. The blood pressure increased with rapid infusion. Emergency angiography was performed. Extravasation from the musculophrenic artery, which branches off from the left internal mammary artery, was observed. Transcatheter arterial embolization was performed and bleeding was controlled...
September 20, 2017: Tokai Journal of Experimental and Clinical Medicine
https://www.readbyqxmd.com/read/28864030/a-fatal-outbreak-of-st11-carbapenem-resistant-hypervirulent-klebsiella-pneumoniae-in-a-chinese-hospital-a-molecular-epidemiological-study
#13
Danxia Gu, Ning Dong, Zhiwei Zheng, Di Lin, Man Huang, Lihua Wang, Edward Wai-Chi Chan, Lingbin Shu, Jiang Yu, Rong Zhang, Sheng Chen
BACKGROUND: Hypervirulent Klebsiella pneumoniae strains often cause life-threatening community-acquired infections in young and healthy hosts, but are usually sensitive to antibiotics. In this study, we investigated a fatal outbreak of ventilator-associated pneumonia caused by a new emerging hypervirulent K pneumoniae strain. METHODS: The outbreak occurred in the integrated intensive care unit of a new branch of the Second Affiliated Hospital of Zhejiang University (Hangzhou, China)...
August 29, 2017: Lancet Infectious Diseases
https://www.readbyqxmd.com/read/28861425/single-incision-video-assisted-thoracoscopic-evaluation-and-emergent-surgery-for-severe-lung-and-chest-wall-injury-after-thoracic-trauma-in-a-water-park
#14
Julio Sesma, Melodie Alvarez, Francisco Lirio, Carlos Galvez, Maria Galiana, Benno Baschwitz, Francisca Fornes, Sergio Bolufer
Thoracic trauma is a challenging situation with potential severe chest wall and intrathoracic organ injuries. We present a case of emergent surgery in a 23-year-old man with hemorrhagic shock due to massive lung and chest wall injury after thoracic trauma in a water slide. We performed a SI-VATS approach in order to define intrathoracic and chest wall injuries, and once checked the extension of the chest wall injury, we added a middle size thoracotomy just over the affected area in order to stabilize rib fractures with Judet plates, that had caused massive laceration in left lower lobe (LLL) and injured the pericardium causing myocardical tear...
August 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/28861040/a-case-of-acoustic-shock-with-post-trauma-trigeminal-autonomic-activation
#15
Alain Londero, Nicolas Charpentier, Damien Ponsot, Philippe Fournier, Laurent Pezard, Arnaud J Noreña
This study reports the case of an acoustic shock injury (ASI), which did not result in a significant hearing loss, but was followed by manifold chronic symptoms both within (tinnitus, otalgia, tingling in the ear, tension in the ear, and red tympanum) and outside the ears (blocked nose, pain in the neck/temporal region). We suggest that these symptoms may result from a loop involving injury to middle ear muscles, peripheral inflammatory processes, activation and sensitization of the trigeminal nerve, the autonomic nervous system, and central feedbacks...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28859918/vital-sign-based-shock-scores-are-poor-at-triaging-south-african-trauma-patients
#16
Robert Barnes, Damian Clarke, Zane Farina, Benn Sartorius, Petra Brysiewicz, Grant Laing, John Bruce, Victor Kong
BACKGROUND: Traumatic shock cannot be diagnosed by a single physiological measurement and a number of vital sign based combined shock scores (CSS) have been proposed to identify and triage trauma patients with shock. This audit uses data from a prospectively entered electronic trauma registry to compare the ability of these CSS to predict in-hospital mortality, need for surgery, need for blood transfusion and ICU admission. MATERIALS AND METHODS: The data used in the study was obtained from the Hybrid Electronic Medical Record (HEMR) in Pietermaritzburg from January 2012-September 2015...
August 28, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28856045/in-silico-and-in-vitro-investigation-of-a-photonic-monitor-for-intestinal-perfusion-and-oxygenation
#17
Mitchell B Robinson, Ryan J Butcher, Mark A Wilson, M Nance Ericson, Gerard L Coté
The quantification of visceral organ oxygenation after trauma-related systemic hypovolemia and shock is critical to enable effective resuscitation. In this work, a photoplethysmography-based (PPG) sensor was specifically designed for probing the perfusion and oxygenation condition of intestinal tissue with the ultimate goal to monitor patients post trauma to guide resuscitation. Through Monte Carlo modeling, suitable optofluidic phantoms were determined, the wavelength and separation distance for the sensor was optimized, and sensor performance for the quantification of tissue perfusion and oxygenation was tested on the in-vitro phantom...
August 1, 2017: Biomedical Optics Express
https://www.readbyqxmd.com/read/28855960/resuscitative-endovascular-balloon-occlusion-of-the-aorta-in-trauma-a-systematic-review-of-the-literature
#18
REVIEW
Emiliano Gamberini, Federico Coccolini, Beatrice Tamagnini, Costanza Martino, Vittorio Albarello, Marco Benni, Marcello Bisulli, Nicola Fabbri, Tal Martin Hörer, Luca Ansaloni, Carlo Coniglio, Marco Barozzi, Vanni Agnoletti
AIMS: Resuscitative endovascular balloon occlusion of the aorta has been a hot topic in trauma resuscitation during these last years. The aims of this systematic review are to analyze when, how, and where this technique is performed and to evaluate preliminary results. METHODS: The literature search was performed on online databases in December 2016, without time limits. Studies citing endovascular balloon occlusion of the aorta in trauma were retrieved for evaluation...
2017: World Journal of Emergency Surgery: WJES
https://www.readbyqxmd.com/read/28855779/trauma-team-activation-not-just-for-trauma-patients
#19
Phoenix Vuong, Jason Sample, Mary Ellen Zimmermann, Pierre Saldinger
Specialized trauma teams have been shown to improve outcomes in critically injured patients. At our institution, an the American College of Surgeons Committee on trauma level I Trauma center, the trauma team activation (TTA) criteria includes both physiologic and anatomic criteria, but any attending physician can activate the trauma team at their discretion outside criteria. As a result, the trauma team has been activated for noninjured patients meeting physiologic criteria secondary to nontraumatic hemorrhage...
July 2017: Journal of Emergencies, Trauma, and Shock
https://www.readbyqxmd.com/read/28855767/whats-new-in-emergencies-trauma-and-shock-age-and-trauma-geriatric-trauma-patients-and-geriatric-trauma-ward-services
#20
EDITORIAL
Christian Zeckey, Christian Kammerlander
No abstract text is available yet for this article.
July 2017: Journal of Emergencies, Trauma, and Shock
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