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Trauma resuscitation

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https://www.readbyqxmd.com/read/28814248/pediatric-abdominal-trauma
#1
Tim Lynch
Abdominal trauma is present in approximately 25% of pediatric patients with major trauma and is the most common cause of unrecognized fatal injury in children. Pediatric abdominal trauma is typically blunt in nature with the spleen being the most common organ injured. Non-operative management is employed in over 95% of patients. Penetrating injuries are less common but often require operative management. Knowledge of specific mechanisms of injury aids the clinician in the diagnosis of specific injuries. Computed tomography (CT) is the gold standard in the identification of intra-abdominal injury...
August 14, 2017: Current Pediatric Reviews
https://www.readbyqxmd.com/read/28814247/fluid-and-medication-considerations-in-the-traumatized-patient
#2
Amita Misir
This article reviews fluid therapy and medications in pediatric trauma. For resuscitation in the setting of hemorrhagic shock, isotonic crystalloid solution is the first-line agent of choice. Colloid solutions offer no additional benefit, introduce possible increased risks and cost more than crystalloids. Blood products, starting with pRBCs, should be introduced after 20-40 ml/kg of crystalloid has been administered if there is ongoing need for volume replacement. The use of a massive transfusion protocol of 1:1:1 (if >30 kg) or 30:20:20 (if <30 kg) of pRBCs:FFP:platelets is suggested after an initial 30 ml/kg of pRBcs have been administered...
August 14, 2017: Current Pediatric Reviews
https://www.readbyqxmd.com/read/28806284/is-extracorporeal-cardiopulmonary-resuscitation-practical-in-severe-chest-trauma-a-systematic-review-in-single-center-of-developing-country
#3
Up Huh, Seunghwan Song, Sung Woon Chung, Sang-Pil Kim, Chung Won Lee, Hyo Young Ahn, Miju Bae, Seon Hee Kim
BACKGROUND: We report our experience with extracorporeal cardiopulmonary resuscitation (ECPR) in patients with rupture of heart and major vessels caused by severe chest trauma. METHODS: From April 2015 to May 2016, 10 patients with suspected injuries to the heart and major vessels following focused assessment with sonography in trauma or computed tomography were selected from patients admitted at a level I trauma centre presenting with cardiac tamponade and tension haemothorax due to severe chest trauma...
August 12, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28801841/the-use-of-aortic-balloon-occlusion-in-traumatic-shock-first-report-from-the-abo-trauma-registry
#4
M Sadeghi, K F Nilsson, T Larzon, A Pirouzram, A Toivola, P Skoog, K Idoguchi, Y Kon, T Ishida, Y Matsumara, J Matsumoto, V Reva, M Maszkowski, A Bersztel, E Caragounis, M Falkenberg, L Handolin, B Kessel, D Hebron, F Coccolini, L Ansaloni, J J Morrison, T M Hörer, M J Madurska
PURPOSE: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique for temporary stabilization of patients with non-compressible torso hemorrhage. This technique has been increasingly used worldwide during the past decade. Despite the good outcomes of translational studies, clinical studies are divided. The aim of this multicenter-international study was to capture REBOA-specific data and outcomes. METHODS: REBOA practicing centers were invited to join this online register, which was established in September 2014...
August 11, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/28801484/predicting-outcomes-in-traumatic-out-of-hospital-cardiac-arrest-the-relevance-of-utstein-factors
#5
Ben Beck, Janet E Bray, Peter Cameron, Lahn Straney, Emily Andrew, Stephen Bernard, Karen Smith
BACKGROUND: Given low survival rates in cases of traumatic out-of-hospital cardiac arrest (OHCA), there is a need to identify factors associated with outcomes. We aimed to investigate Utstein factors associated with achieving return of spontaneous circulation (ROSC) and survival to hospital in traumatic OHCA. METHODS: The Victorian Ambulance Cardiac Arrest Registry (VACAR) was used to identify cases of traumatic OHCA that received attempted resuscitation and occurred between July 2008 and June 2014...
August 11, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28795675/-clinical-application-of-abdominal-lifting-and-compression-cardiopulmonary-resuscitation-method-for-treatment-of-patients-with-cardiac-arrest
#6
Haishan Li, Liu Ji, Jingjing Wang
OBJECTIVE: To investigate the clinical application of rhythmic abdominal lifting and compression cardiopulmonary resuscitation (ALC-CPR) in cardiac arrest (CA) patients with conventional cardiopulmonary resuscitation (CPR) contraindication (chest rib fracture, chest trauma, etc.). METHODS: The clinical data of patients with CA in emergency department of Hefei Second People's Hospital from June 2015 to December 2016 were analyzed retrospectively, and the patients with weights 40-150 kg and CA≤20 minutes, and resuscitated with ALC-CPR were selected...
August 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28794661/focused-assessment-with-sonography-for-trauma-current-perspectives
#7
REVIEW
Sorravit Savatmongkorngul, Sirote Wongwaisayawan, Rathachai Kaewlai
Focused assessment with sonography for trauma (FAST) is a part of resuscitation of trauma patients recommended by international panel consensus. The purpose of FAST is to identify free fluid, which necessarily means blood in acute trauma patients. In this article, the authors focused on various aspects of FAST in the emergency department, prehospital care, pediatric setting, training and general pearls/pitfalls. Detailed techniques and interpretation of FAST are beyond the scope of this article.
2017: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/28791071/periorbital-and-mediastinal-emphysema-after-upper-gastrointestinal-endoscopy-case-report-of-a-rare-complication
#8
Thankappan Lekha, Leelakrishnan Venkatakrishnan, Karuppannasamy Divya, Perumal Lavanya
PURPOSE: To report a rare case of periorbital emphysema concurrent with cervicofacial and mediastinal emphysema in an elderly woman who underwent upper gastrointestinal endoscopy for chronic liver disease. CASE REPORT: An elderly woman with decompensated chronic liver disease presented with features of periorbital, facial, and mediastinal emphysema, characterized with crepitant swelling over the right periorbital area, face, neck, and mediastinum after undergoing upper gastrointestinal endoscopy...
July 2017: Journal of Ophthalmic & Vision Research
https://www.readbyqxmd.com/read/28780982/validation-of-the-criteria-for-early-critical-care-resource-use-in-assessing-the-effectiveness-of-field-triage
#9
Ki Ok Ahn, Sang Chul Kim, Ju Ok Park, Sang Do Shin, Kyoung Jun Song, Ki Jeong Hong
BACKGROUND: This study aimed to validate the criteria for early critical care resource (CCR) use as an outcome predictor for seriously injured patients triaged in the field by comparing the effectiveness of the criteria for early CCR use with that of criteria defined by an Injury Severity Score (ISS) >15. METHODS: We analysed data from seriously injured trauma patients who were triaged using a field triage protocol by emergency medical service providers (EMS-ST patients)...
July 31, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28780315/closed-loop-communication-improves-task-completion-in-pediatric-trauma-resuscitation
#10
Ibrahim Abd El-Shafy, Jennifer Delgado, Meredith Akerman, Francesca Bullaro, Nathan A M Christopherson, Jose M Prince
BACKGROUND: Pediatric trauma care requires effective and clear communication in a time-sensitive manner amongst a variety of disciplines. Programs such as Crew Resource Management in aviation have been developed to systematically prevent errors. Similarly, teamSTEPPS has been promoted in healthcare with a strong focus on communication. We aim to evaluate the ability of closed-loop communication to improve time-to-task completion in pediatric trauma activations. METHODS: All pediatric trauma activations from January to September, 2016 at an American College of Surgeons verified level I pediatric trauma center were video recorded and included in the study...
August 2, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28771656/transfusion-practice-in-trauma-resuscitation
#11
Ashley M Eckel, John R Hess
Recognition of the acute coagulopathy of trauma and the limits of reconstituting whole blood with conventional blood components has led to a radical change in the way trauma patients with severe injuries are resuscitated. Massive transfusion protocols (MTP) have evolved toward the administration of conventional blood components in fixed ratios. Administration of a 1:1:1 unit ratio of fresh frozen plasma to whole-blood-derived platelets to packed red blood cells is now the most common strategy and the stated goal of directors of >80% of the level I trauma centers in the United States...
August 2017: Southern Medical Journal
https://www.readbyqxmd.com/read/28767544/compensatory-reserve-index-performance-of-a-novel-monitoring-technology-to-identify-the-bleeding-trauma-patient
#12
Michael Johnson, Abdul Alarhayem, Victor Convertino, Robert Carter, Kevin Chung, Ronald Stewart, John Myers, Daniel Dent, Lilian Liao, Ramon Cestero, Susannah Nicholson, Mark Muir, Martin Schwacha, David Wampler, Mark DeRosa, Brian Eastridge
INTRODUCTION: Hemorrhage is one of the most substantial causes of death after traumatic injury. Standard measures, including systolic blood pressure (SBP), are poor surrogate indicators of physiologic compromise until compensatory mechanisms have been overwhelmed. Compensatory Reserve Index (CRI) is a novel monitoring technology with the ability to assess physiologic reserve. We hypothesized CRI would be a better predictor of physiologic compromise secondary to hemorrhage than traditional vital signs...
August 1, 2017: Shock
https://www.readbyqxmd.com/read/28765353/hemostatic-management-of-trauma-induced-coagulopathy
#13
Janise B Phillips, Phillip L Mohorn, Rebecca E Bookstaver, Tanya O Ezekiel, Christopher M Watson
Trauma-induced coagulopathy is a primary factor in many trauma-related fatalities. Management hinges upon rapid diagnosis of coagulation abnormalities and immediate administration of appropriate hemostatic agents. Use of crystalloids and packed red blood cells has traditionally been the core of trauma resuscitation, but current massive transfusion protocols include combination therapy with fresh frozen plasma and predefined ratios of platelets to packed red blood cells, limiting crystalloid administration. Hemostatic agents such as tranexamic acid, prothrombin complex concentrate, fibrinogen concentrate, and, in cases of refractory bleeding, recombinant activated factor VIIa may also be warranted...
August 2017: Critical Care Nurse
https://www.readbyqxmd.com/read/28765125/sepsis-and-critical-illness-research-center-investigators-protocols-and-standard-operating-procedures-for-a-prospective-cohort-study-of-sepsis-in-critically-ill-surgical-patients
#14
Tyler J Loftus, Juan C Mira, Tezcan Ozrazgat-Baslanti, Gabriella L Ghita, Zhongkai Wang, Julie A Stortz, Babette A Brumback, Azra Bihorac, Mark S Segal, Stephen D Anton, Christiaan Leeuwenburgh, Alicia M Mohr, Philip A Efron, Lyle L Moldawer, Frederick A Moore, Scott C Brakenridge
INTRODUCTION: Sepsis is a common, costly and morbid cause of critical illness in trauma and surgical patients. Ongoing advances in sepsis resuscitation and critical care support strategies have led to improved in-hospital mortality. However, these patients now survive to enter state of chronic critical illness (CCI), persistent low-grade organ dysfunction and poor long-term outcomes driven by the persistent inflammation, immunosuppression and catabolism syndrome (PICS). The Sepsis and Critical Illness Research Center (SCIRC) was created to provide a platform by which the prevalence and pathogenesis of CCI and PICS may be understood at a mechanistic level across multiple medical disciplines, leading to the development of novel management strategies and targeted therapies...
August 1, 2017: BMJ Open
https://www.readbyqxmd.com/read/28762448/comparison-of-warm-fluid-and-cold-fluid-resuscitation-during-uncontrolled-hemorrhagic-shock-model-in-rats
#15
Serkan Dilmen, Mehmet Eryılmaz, Salih Müjdat Balkan, Muhittin Serdar, Murat Durusu, Ali Osman Yıldırım, Sanem Aslıhan Dilmen
BACKGROUND: This study was designed to compare the effects of resuscitation with cold and warm fluid on survival time, rate and volume of hemorrhage, hemodynamics, hypothermia, coagulopathy, acid-base balance, hematocrit, lactate, and base deficit during uncontrolled hemorrhagic shock (HS) model in rats. METHODS: HS model was created with splenic vascular and parenchymal injury in 29 rats under ketamine and xylazine anesthesia. Thirty minutes after the hemorrhage, the rats were randomized to receive 14...
July 2017: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
https://www.readbyqxmd.com/read/28757925/passive-leg-raising-simple-and-reliable-technique-to-prevent-fluid-overload-in-critically-ill-patients
#16
Farahnak Assadi
BACKGROUND: Dynamic measures, the response to stroke volume (SV) to fluid loading, have been used successfully to guide fluid management decisions in critically ill patients. However, application of dynamic measures is often inaccurate to predict fluid responsiveness in patients with arrhythmias, ventricular dysfunction or spontaneously breathing critically ill patients. Passive leg raising (PLR) is a simple bedside maneuver that may provide an accurate alternative to guide fluid resuscitation in hypovolemic critically ill patients...
2017: International Journal of Preventive Medicine
https://www.readbyqxmd.com/read/28743338/-clinical-characteristics-and-prognosis-in-patients-with-high-plasma-level-of-procalcitonin-an-analysis-in-188-patients
#17
Chuli Pan, Wei Cui, Feifei Zhou, Junwei Tu, Xiuhui Lin, Libin Li, Gensheng Zhang
OBJECTIVE: To investigate the clinical characteristics and prognosis of patients with high level of plasma procalcitonin (PCT > 100 μg/L), and to improve the clinician's understanding, diagnosis and treatment of this kind of patients. METHODS: A retrospective study was conducted. The clinical data of patients with plasma PCT over 100 μg/L within 48 hours of admission admitted to Second Affiliated Hospital of Zhejiang University School of Medicine from February 2013 to December 2016 were collected, and the clinical characteristics were analyzed...
July 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28742815/il33-mediated-ilc2-activation-and-neutrophil-il5-production-in-the-lung-response-after-severe-trauma-a-reverse-translation-study-from-a-human-cohort-to-a-mouse-trauma-model
#18
Jing Xu, Jesse Guardado, Rosemary Hoffman, Hui Xu, Rami Namas, Yoram Vodovotz, Li Xu, Mostafa Ramadan, Joshua Brown, Heth R Turnquist, Timothy R Billiar
BACKGROUND: The immunosuppression and immune dysregulation that follows severe injury includes type 2 immune responses manifested by elevations in interleukin (IL) 4, IL5, and IL13 early after injury. We hypothesized that IL33, an alarmin released early after tissue injury and a known regulator of type 2 immunity, contributes to the early type 2 immune responses after systemic injury. METHODS AND FINDINGS: Blunt trauma patients admitted to the trauma intensive care unit of a level I trauma center were enrolled in an observational study that included frequent blood sampling...
July 2017: PLoS Medicine
https://www.readbyqxmd.com/read/28742797/a-comparison-of-selective-aortic-arch-perfusion-and-resuscitative-endovascular-balloon-occlusion-of-the-aorta-for-the-management-of-hemorrhage-induced-traumatic-cardiac-arrest-a-translational-model-in-large-swine
#19
Ed B G Barnard, James E Manning, Jason E Smith, Jason M Rall, Jennifer M Cox, James D Ross
BACKGROUND: Survival rates remain low after hemorrhage-induced traumatic cardiac arrest (TCA). Noncompressible torso hemorrhage (NCTH) is a major cause of potentially survivable trauma death. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) at the thoracic aorta (Zone 1) can limit subdiaphragmatic blood loss and allow for IV fluid resuscitation when intrinsic cardiac activity is still present. Selective Aortic Arch Perfusion (SAAP) combines thoracic aortic balloon hemorrhage control with intra-aortic oxygenated perfusion to achieve return of spontaneous circulation (ROSC) when cardiac arrest has occurred...
July 2017: PLoS Medicine
https://www.readbyqxmd.com/read/28737565/use-of-resuscitative-endovascular-balloon-occlusion-of-the-aorta-in-a-multidisciplinary-approach
#20
Carolina Nilsson, Linda Bilos, Tal Hörer, Artai Pirouzram
The usage of resuscitative endovascular balloon occlusion of the aorta, also known as aortic balloon occlusion, is an emerging method for bleeding control as a bridge to definitive treatment in trauma management. We describe a trauma case where resuscitative endovascular balloon occlusion of the aorta was used as part of the EndoVascular hybrid Trauma and bleeding Management concept to facilitate transient hemorrhage control and thereby to permit damage control surgery. The case is an illustration of the adoption of a multidisciplinary approach...
July 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
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