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"Shock index"

Alexander E St John, Andrew M McCoy, Allison G Moyes, Francis X Guyette, Eileen M Bulger, Michael R Sayre
Introduction: The prehospital decision of whether to triage a patient to a trauma center can be difficult. Traditional decision rules are based heavily on vital sign abnormalities, which are insensitive in predicting severe injury. Prehospital lactate (PLac) measurement could better inform the triage decision. PLac's predictive value has previously been demonstrated in hypotensive trauma patients but not in a broader population of normotensive trauma patients transported by an advanced life support (ALS) unit...
March 2018: Western Journal of Emergency Medicine
Stephanie F Polites, Rachel M Nygaard, Pooja N Reddy, Martin D Zielinski, Chad J Richardson, Terri A Elsbernd, Branden M Petrun, Sean L Weinberg, Sherrie Murphy, Donald D Potter, Denise B Klinkner, Christopher R Moir
BACKGROUND: The 9th edition of ATLS recommends up to three crystalloid boluses in pediatric trauma patients with consideration of transfusion after the second bolus however this approach is debated. We aimed to determine if requirement of more than one fluid bolus predicts the need for transfusion. METHODS: 2010-2016 highest tier activation patients <15 years of age from two ACS Level I pediatric trauma centers were identified from prospectively maintained trauma databases...
March 12, 2018: Journal of Trauma and Acute Care Surgery
Todd O McKinley, Tyler McCarroll, Cameron Metzger, Ben L Zarzaur, Stephanie A Savage, Teresa M Bell, Greg E Gaski
BACKGROUND: Multiply injured patients are at risk of developing hemorrhagic shock and organ dysfunction. We determined how cumulative hypoperfusion predicted organ dysfunction by integrating serial shock index measurements. METHODS: In this study, we calculated Shock Volume (SHVL) which is a patient-specific index that quantifies cumulative hypoperfusion by integrating abnormally elevated shock index (heart rate/systolic blood pressure ≥ 0.9) values acutely after injury...
March 8, 2018: Journal of Trauma and Acute Care Surgery
Yongzheng Wang, Haiyang Chang, Wujie Wang, Wei Wang, Bin Liu, Zheng Li, Yuliang Li
RATIONALE: Pulmonary embolization is a life-threatening condition. The deployment of inferior vena cava (IVC) filter is the first choice for preventing embolus from the lower extremity. However, IVC filter complications are rare but not to be neglected. Penetration of the arterial wall may result in catastrophic damages. This case report describes a woman who suffered from retroperitoneal hemorrhage after placement of an IVC filter due to a pulmonary embolization. Her filter was found to have penetrated the right lumbar artery and caused the massive bleeding...
January 2018: Medicine (Baltimore)
Hyun Choi, Dinesh Krishnamoorthy
BACKGROUND: Pulmonary embolism (PE) during pregnancy remains one of the leading causes of maternal morbidity and mortality in the developed world. However, there is a paucity of high-quality evidence resulting in a lack of consensus in managing this group of patients. The aims of the study were to address the diagnostic utility of D-dimer for suspected PE in pregnant and post-partum patients and to identify any clinical presentation variables that are predictors of PE in this group of patients...
March 5, 2018: International Journal of Emergency Medicine
Onur Zorbozan, Arif A Cevik, Nurdan Acar, Engin Ozakin, Hamit Ozcelik, Alparslan Birdane, Fikri M Abu-Zidan
We aimed to define factors predicting mortality in patients having ST elevation myocardial infarction (STEMI) who had Primary Percutaneous Coronary Intervention (PCI) in our setting.This is a prospective study on patients presenting to the emergency department with STEMI who underwent PCI during a 12-month period. Physiological parameters were calculated using the vital signs and age of patients. Time-based factors in the institutional protocol were collected. Univariate analysis was performed to define significant factors that affected mortality...
March 2018: Medicine (Baltimore)
Luan Geraldo Ocaña Oliveira, Debora Tagliari, Mariana Juliato Becker, Thiago Adame, José Cruvinel Neto, Fernando Antônio Campelo Spencer Netto
OBJECTIVE: to verify the efficiency and usefulness of basic ultrasound training in trauma (FAST - Focused Assessment with Sonography in Trauma) for emergency physicians in the primary evaluation of abdominal trauma. METHODS: a longitudinal and observational study was carried out from 2015 to 2017, with 11 emergency physicians from Hospital Universitário do Oeste do Paraná, submitted to ultrasound training in emergency and trauma (USET® - SBAIT). FAST results started to be collected two months after the course...
February 19, 2018: Revista do Colégio Brasileiro de Cirurgiões
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
Feng Hai, Chen Xueming, Zhang Zhiwen, Li Chenyu, Fang Jie, Zhang Zhe, Lian Lishan, Zhu Renming, Yu Hongzhi, Liu Bin
OBJECTIVE: To evaluate the safety and efficacy of selective catheter-directed thrombolysis in treating acute massive pulmonary thromboembolism (AMPTE). MATERIALS AND METHODS: Twenty-six AMPTE patients were enrolled between March 2010 and March 2013. A Uni*Fuse infusion system was inserted into the main pulmonary artery thrombus. The thrombolytic regimen included an intraoperative bolus injection of 250,000 IU urokinase, followed by continuous thrombolytic infusion of 5,000IU/kg...
February 15, 2018: Annals of Vascular Surgery
Cheng-Shyuan Rau, Shao-Chun Wu, Peng-Chen Chien, Pao-Jen Kuo, Yi-Chun Chen, Hsiao-Yun Hsieh, Ching-Hua Hsieh, Hang-Tsung Liu
BACKGROUND: In trauma patients, pancreatic injury is rare; however, if undiagnosed, it is associated with high morbidity and mortality rates. Few predictive models are available for the identification of pancreatic injury in trauma patients with elevated serum pancreatic enzymes. In this study, we aimed to construct a model for predicting pancreatic injury using a decision tree (DT) algorithm, along with data obtained from a population-based trauma registry in a Level I trauma center...
February 6, 2018: International Journal of Environmental Research and Public Health
Morgan Schellenberg, Aaron Strumwasser, Daniel Grabo, Damon Clark, Kazuhide Matsushima, Kenji Inaba, Demetrios Demetriades
Shock Index (SI = heart rate/systolic blood pressure) predicts outcomes among trauma patients. Studies have also shown that the change in SI between the field and Emergency Department (ED) arrival (Delta SI) predicts mortality in trauma. Given the lack of reliable prehospital data, Delta SI may more accurately prognosticate if used within the ED. All trauma patients arriving to our Level I trauma center in 2014 were reviewed. Patients were matched for age, gender, mechanism of injury, and injury severity score...
October 1, 2017: American Surgeon
Vincent Roolvink, Veemal V Hemradj, Jan Paul Ottervanger, Arnoud Wj van 't Hof, Jan-Henk E Dambrink, At Marcel Gosselink, Elvin Kedhi, Harry Suryapranata
BACKGROUND: The association between chronic beta-blocker treatment and haemodynamics at admission in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention is not well studied. We investigated the impact of chronic beta-blocker treatment on the risk of cardiogenic shock and pre-shock at admission in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention. METHODS AND RESULTS: A total of 4907 patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention were included in the study...
January 1, 2018: European Heart Journal. Acute Cardiovascular Care
Ikuto Takeuchi, Kazuhiko Omori, Hiroki Nagasawa, Kei Jitsuiki, Takashi Iso, Akihiko Kondo, Kouhei Ishikawa, Hiromichi Ohsaka, Youichi Yanagawa
OBJECTIVE: We retrospectively investigated all of the intoxicated patients who were transported by a doctor helicopter (DH) in eastern Shizuoka between April 2004 and December 2015 to determine when air medical transport was used in cases of toxic exposure. METHODS: Subjects were divided into 2 groups: an outpatient group of subjects who went home after receiving a medical evaluation and treatment and an admission group. RESULTS: The outpatient and admission groups included 17 and 31 subjects, respectively...
January 2018: Air Medical Journal
Justin E Richards, Thomas M Scalea, Michael A Mazzeffi, Peter Rock, Samuel M Galvagno
BACKGROUND: Early hyperglycemia is associated with multiple organ failure (MOF) after traumatic injury; however, few studies have considered the contribution of depth of clinical shock. We hypothesize that when considered simultaneously, glucose and lactate are associated with MOF in severely injured blunt trauma patients. METHODS: We performed a retrospective investigation at a single tertiary care trauma center. Inclusion criteria were patient age ≥18 years, injury severity score (ISS) >15, blunt mechanism of injury, and an intensive care unit length of stay >48 hours...
March 2018: Anesthesia and Analgesia
Nicholas Caputo, James Reilly, Marc Kanter, Jason West
BACKGROUND: The shock index (SI), calculated as HR/SBP, is a simple hemodynamic marker that may be used to assess for the presence of occult shock in trauma patients. The normal range for a healthy adult patient is 0.5 to 0.7. Recently, studies have demonstrated that tachypnea is the most important predictor of cardiac arrest in hospital wards and is an important indicator of derangements across multiple organ systems. As such, we have sought to determine whether the inclusion of the patient's respiratory rate to the already existing shock index (called the Respiratory Adjusted Shock Index- RASI), calculated as HR/SBP*(RR/10), will improve the overall diagnostic accuracy of detecting patients in early occult shock...
December 14, 2017: Journal of Trauma and Acute Care Surgery
Wen-Zhe Fan, Ying-Qiang Zhang, Wang Yao, Yu Wang, Guo-Sheng Tan, Yong-Hui Huang, Jian-Yong Yang, Jia-Ping Li
PURPOSE: To evaluate the utility of emergent transcatheter arterial embolization for spontaneously ruptured hepatocellular carcinoma (HCC) in patients with Child-Pugh class C (CPC) liver cirrhosis presenting hemorrhagic shock. MATERIALS AND METHODS: A study of all 94 patients was retrospectively conducted from January 2006 to January 2016. Sixty patients underwent conservative treatment (control group) and 34 underwent embolization. RESULTS: Embolization provided better stabilization of hemodynamic status than conservative treatment (91...
December 14, 2017: Journal of Vascular and Interventional Radiology: JVIR
Bing Liu, MingYuan Liu, LiHong Yan, JunWei Yan, Jiang Wu, XueFei Jiao, MingJin Guo
Objective This study was performed to evaluate the efficacy and feasibility of percutaneous mechanical thrombectomy (PMT) combined with catheter-directed thrombolysis (CDT) in patients with acute pulmonary embolism (APE) and lower extremity deep venous thrombosis (LEDVT). Methods In total, 20 consecutive patients with APE and LEDVT were prospectively selected for PMT combined with CDT. Mechanical thrombus fragmentation and aspiration using a pigtail rotation catheter followed by CDT was performed in each patient...
February 2018: Journal of International Medical Research
Jessica Londoño, César Niño, James Díaz, Carlos Morales, Jimmy León, Elisa Bernal, Cesar Vargas, Leonardo Mejía, Carolina Hincapié, Johana Ascuntar, Alba León, Fabián Jaimes
BACKGROUND: lactate has shown utility in assessing the prognosis of patients admitted to the hospital with confirmed or suspected shock. Some findings of the physical examination might replace it as screening tool. We asked to determine the correlation and association between clinical perfusion parameters and lactate at the time of admission; the correlation between the change in clinical parameters and lactate clearance after 6 and 24 hours of resuscitation and; the association between clinical parameters, lactate and mortality...
December 4, 2017: Shock
Cristhian Potes, Bryan Conroy, Minnan Xu-Wilson, Christopher Newth, David Inwald, Joseph Frassica
BACKGROUND: Early recognition and timely intervention are critical steps for the successful management of shock. The objective of this study was to develop a model to predict requirement for hemodynamic intervention in the pediatric intensive care unit (PICU); thus, clinicians can direct their care to patients likely to benefit from interventions to prevent further deterioration. METHODS: The model proposed in this study was trained on a retrospective cohort of all patients admitted to a tertiary PICU at a single center in the United States, and validated on another retrospective cohort of all patients admitted to the PICU at a single center in the United Kingdom...
November 20, 2017: Critical Care: the Official Journal of the Critical Care Forum
Stefan Heschl, Emily Andrew, Anthony de Wit, Stephen Bernard, Marcus Kennedy, Karen Smith
OBJECTIVE: The optimal volume and type of intravenous fluid for the treatment of blood loss in the prehospital setting is controversial. The use of red cell concentrates (RCCs) may be associated with improved outcomes; however, the administration of blood products is limited to physicians in many jurisdictions. We sought to describe the characteristics of RCC transfusions in a paramedic-staffed helicopter emergency medical system in Victoria, Australia. METHODS: We performed a retrospective analysis of all cases where paramedics consulted the responsible physician for approval of RCC transfusion between July 2011 and December 2015 in Victoria, Australia...
November 17, 2017: Emergency Medicine Australasia: EMA
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