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Trauma resuscitation

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https://www.readbyqxmd.com/read/29040202/re-examination-of-a-battlefield-trauma-golden-hour-policy
#1
Jeffrey T Howard, Russ S Kotwal, Alexis R Santos, Matthew J Martin, Zsolt T Stockinger
BACKGROUND: Most combat casualties who die, do so in the prehospital setting. Efforts directed toward alleviating prehospital combat trauma death, known as killed in action (KIA) mortality, have the greatest opportunity for eliminating preventable death. METHODS: 4,542 military casualties injured in Afghanistan from September 11, 2001 to March 31, 2014 were included in this retrospective analysis to evaluate proposed explanations for observed KIA reduction following a mandate by Secretary of Defense Robert M...
October 16, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29035926/damage-control-surgery-current-state-and-future-directions
#2
Daniel Benz, Zsolt J Balogh
PURPOSE OF REVIEW: Damage control surgery (DCS) represents a staged surgical approach to the treatment of critically injured trauma patients. Originally described in the context of hepatic trauma and postinjury-induced coagulopathy, the indications for DCS have expanded to the management of extra abdominal trauma and to the management of nontraumatic acute abdominal emergencies. Despite being an accepted treatment algorithm, DCS is based on a limited evidence with current concerns of the variability in practice indications, rates and adverse outcomes in poorly selected patient cohorts...
October 14, 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29035925/acute-kidney-injury-in-trauma-patients
#3
Anatole Harrois, Nicolas Libert, Jacques Duranteau
PURPOSE OF REVIEW: To review epidemiology and pathophysiology of acute kidney injury (AKI) in trauma patients and propose strategies that aim at preventing AKI after trauma. RECENT FINDINGS: AKI in trauma patients has been reported to be as frequent as 50% with an association to a prolonged length of stay and a raise in mortality. Among the specific risk factors encountered in trauma patients, hemorrhagic shock, rhabdomyolysis severity, age, and comorbidities are independently associated with AKI occurrence...
October 14, 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29022788/developing-a-simplified-clinical-prediction-score-for-mortality-in-patients-with-cerebral-gunshot-wounds-the-maritzburg-score
#4
V Y Kong, J Odendaal, B Sartorius, D L Clarke, J L Bruce, G L Laing, T Esterhuizen
Introduction Cerebral gunshot wounds are highly lethal and literature on the clinical scores for mortality prediction is limited. Materials and methods A retrospective study was undertaken over a 5-year period at the Pietermaritzburg Metropolitan Trauma Service in South Africa. A simplified clinical prediction score was developed based on clinical and/or physiological variables readily available in the resuscitation room. Results A total of 102 patients were included; 92% (94/102) were male and the mean age was 29 years; 22% (22/102) died during the admission...
September 15, 2017: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/29019796/monitoring-modalities-and-assessment-of-fluid-status-a-practice-management-guideline-from-the-eastern-association-for-the-surgery-of-trauma-east
#5
David S Plurad, William Chiu, Ali S Raja, Samuel M Galvagno, Uzer Khan, Dennis Y Kim, Samuel A Tisherman, Jeremy Ward, Mark E Hamill, Vicki Bennett, Brian Williams, Bryce Robinson
BACKGROUND: Fluid administration in critically ill surgical patients must be closely monitored to avoid complications. Resuscitation guided by invasive methods are not consistently associated with improved outcomes. As such, there has been increased use of Focused Ultrasound and Arterial Pulse Waveform Analysis (APWA) to monitor and aid resuscitation. An assessment of these methods using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework is presented...
October 11, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29016494/maternal-and-neonatal-outcomes-in-indicated-preterm-births-based-on-the-intended-mode-of-delivery
#6
Spencer G Kuper, Rachel A Sievert, Robin Steele, Joseph R Biggio, Alan T Tita, Lorie M Harper
OBJECTIVE: To compare maternal and neonatal outcomes in women who underwent induction of labor or planned cesarean delivery in indicated preterm births before 34 weeks of gestation. METHODS: We conducted a retrospective cohort study of all indicated singleton preterm births (23-34 weeks of gestation) in a tertiary center from 2011 to 2014. The primary maternal outcome was a composite of early postpartum hemorrhage, blood transfusion, operative complications, postpartum complications, and clinical chorioamnionitis...
October 6, 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28988805/prediction-of-massive-blood-transfusion-in-battlefield-trauma-development-and-validation-of-the-military-acute-severe-haemorrhage-mash-score
#7
Jacqueline V Mclennan, Kevin C Mackway-Jones, Jason E Smith
BACKGROUND: The predominant cause of preventable trauma death is bleeding, and many of these patients need resuscitation with massive blood transfusion. In resource-constrained environments, early recognition of such patients can improve planning and reduce wastage of blood products. No existing decision rule is sufficiently reliable to predict those patients requiring massive blood transfusion. This study aims to produce a decision rule for use on arrival at hospital for patients sustaining battlefield trauma...
September 28, 2017: Injury
https://www.readbyqxmd.com/read/28988067/the-effect-of-resuscitation-strategy-on-the-longitudinal-immuno-inflammatory-response-to-blunt-trauma
#8
Alexander Bonde, Ask Tybjærg Nordestgaard, Rasmus Kirial, Peter Svenningsen, Martin Sillesen
INTRODUCTION: Resuscitation strategies following blunt trauma have been linked to immuno-inflammatory complications leading to systemic inflammatory syndrome (SIRS), sepsis and multiple organ failure (MOF). The effect of resuscitation strategy on longitudinal inflammation marker trajectories is, however, unknown. We hypothesized that the effect of resuscitation strategy extends beyond the trauma-related coagulopathy, perhaps affecting the longitudinal immuno-inflammatory response to injury...
September 28, 2017: Injury
https://www.readbyqxmd.com/read/28985969/modifiable-factors-associated-with-survival-after-out-of-hospital-cardiac-arrest-in-the-pan-asian-resuscitation-outcomes-study
#9
Hideharu Tanaka, Marcus E H Ong, Fahad J Siddiqui, Matthew H M Ma, Hiroshi Kaneko, Kyung Won Lee, Kentaro Kajino, Chih-Hao Lin, Han Nee Gan, Pairoj Khruekarnchana, Omer Alsakaf, Nik H Rahman, Nausheen E Doctor, Pryseley Assam, Sang Do Shin
STUDY OBJECTIVE: The study aims to identify modifiable factors associated with improved out-of-hospital cardiac arrest survival among communities in the Pan-Asian Resuscitation Outcomes Study (PAROS) Clinical Research Network: Japan, Singapore, South Korea, Malaysia, Taiwan, Thailand, and the United Arab Emirates (Dubai). METHODS: This was a prospective, international, multicenter cohort study of out-of-hospital cardiac arrest in the Asia-Pacific. Arrests caused by trauma, patients who were not transported by emergency medical services (EMS), and pediatric out-of-hospital cardiac arrest cases (<18 years) were excluded from the analysis...
October 3, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28985912/patterns-of-vasopressor-utilization-during-the-resuscitation-of-massively-transfused-trauma-patients
#10
Galinos Barmparas, Navpreet K Dhillon, Eric Jt Smith, Russell Mason, Nicolas Melo, Gretchen M Thomsen, Daniel R Margulies, Eric J Ley
BACKGROUND: The use of vasopressors (VP) in the resuscitation of massively transfused trauma patients might be considered a marker of inadequate resuscitation. We sought to characterize the utilization of VP in patients receiving massive transfusion and examine the association of their use with mortality. METHODS: Trauma patients admitted from January 2011 to October 2016 receiving massive transfusion, defined as 3 units of pRBC within the first hour from admission, were selected for analysis...
September 27, 2017: Injury
https://www.readbyqxmd.com/read/28982391/the-impact-of-early-thromboelastography-directed-therapy-in-trauma-resuscitation
#11
Mohamed Mohamed, Karl Majeske, Gul R Sachwani, Kristin Kennedy, Mina Salib, Michael McCann
BACKGROUND: Conventional coagulation tests do not provide an accurate representation of the complex nature of trauma induced coagulopathy. Thrombelastography provides a prompt global overview of all dynamic sequential aspects of trauma induced coagulopathy. The objective of this study was to evaluate the impact of using thrombelastography on blood products utilization, crystalloids utilization, hospital, and intensive care using length of stay, and cost savings. METHODS: We retrospectively reviewed 134 patients (May of 2012 to February of 2015) meeting Class I trauma activation...
October 5, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28980203/correction-to-common-pediatric-medical-emergencies-in-office-practice
#12
Bharat Mehra, Suresh Gupta
The published online version contains an inadvertent error. On page 8, under the heading "Approach to a Child with Trauma" there is a box with "Primary Survey & Resuscitation".
October 2, 2017: Indian Journal of Pediatrics
https://www.readbyqxmd.com/read/28975653/analysis-of-skeletal-muscle-microcirculation-in-a-porcine-polytrauma-model-with-haemorrhagic-shock
#13
Zhi Qiao, Klemens Horst, Michel Teuben, Johannes Greven, Luxu Yin, Yannik Kalbas, René H Tolba, Hans-Christoph Pape, Frank Hildebrand, Roman Pfeifer
Polytraumatised patients with haemorrhagic shock are prone to develop systemic complications, such as SIRS (systemic inflammatory response syndrome), ARDS (acute respiratory distress syndrome) and MOF (multiple organ failure). The pathomechanism of severe complications following trauma is multifactorial, and it is believed that microcirculatory dysfunction plays an important role. The aim of this study was to determine the changes in the microcirculation in musculature over time during shock and subsequent resuscitation in a porcine model of haemorrhagic shock and polytrauma...
October 3, 2017: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
https://www.readbyqxmd.com/read/28975231/death-and-cardiac-arrest-in-u-s-triathlon-participants-1985-to-2016-a-case-series
#14
Kevin M Harris, Lawrence L Creswell, Tammy S Haas, Taylor Thomas, Monica Tung, Erin Isaacson, Ross F Garberich, Barry J Maron
Background: Reports of race-related triathlon fatalities have raised questions regarding athlete safety. Objective: To describe death and cardiac arrest among triathlon participants. Design: Case series. Setting: United States. Participants: Participants in U.S. triathlon races from 1985 to 2016. Measurements: Data on deaths and cardiac arrests were assembled from such sources as the U...
September 19, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28973104/use-of-resuscitative-endovascular-balloon-occlusion-of-the-aorta-for-proximal-aortic-control-in-patients-with-severe-hemorrhage-and-arrest
#15
Megan Brenner, William Teeter, Melanie Hoehn, Jason Pasley, Peter Hu, Shiming Yang, Anna Romagnoli, Jose Diaz, Deborah Stein, Thomas Scalea
Importance: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a percutaneous transfemoral balloon technique used in select centers for resuscitation and temporary hemostasis, often instead of emergency department thoracotomy. The ability to perform aortic occlusion (AO) with an intravascular device allows focused occlusion at the most distal level to perfuse proximal regions while slowing hemorrhage to injured areas. Objective: To describe what is to date the largest single-institution experience with REBOA in the United States...
September 27, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28969894/targeting-resuscitation-to-normalization-of-coagulating-status-hyper-and-hypocoagulability-after-severe-injury-are-both-associated-with-increased-mortality
#16
Hunter B Moore, Ernest E Moore, Ioannis N Liras, Charles Wade, Benjamin R Huebner, Clay Cothren Burlew, Fredric M Pieracci, Angela Sauaia, Bryan A Cotton
INTRODUCTION: The prevalence and impact of hypercoagulability (hypo) in severely injured patients early after injury remains unclear. We hypothesize that the predominant phenotype of postinjury coagulopathy is hypercoagulability (hyper) and it is associated with increased mortality. MATERIAL AND METHODS: Blood samples from 141 healthy volunteers assayed with thrombelastography (TEG) were used to identify thresholds of hypo and hypercoagulability (above 95th/below the 5(th)percentile) in four TEG indices...
September 18, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28966194/open-abdomen-in-trauma-and-critical-care
#17
Eleanor R Fitzpatrick
The open abdomen technique and temporary abdominal closure after damage control surgery is fast becoming the standard of care for managing intra-abdominal bleeding and infectious or ischemic processes in critically ill patients. Expansion of this technique has evolved from damage control surgery in severely injured trauma patients to use in patients with abdominal compartment syndrome due to acute pancreatitis and other disorders. Subsequent therapies after use of the open abdomen technique and temporary abdominal closure are resuscitation in the intensive care unit and planned reoperation to manage the underlying cause of bleeding, infection, or ischemia...
October 2017: Critical Care Nurse
https://www.readbyqxmd.com/read/28964391/-bilateral-proximal-pulmonary-embolism-without-associated-hypoxemia-case-report
#18
M Bahloul, K Chtara, O Turki, M M Kammoun, W Bouaziz, M Bouaziz
INTRODUCTION: Pulmonary embolism is a classic complication in intensive care. It is characterized by hypoxemia secondary to perturbed ventilation/perfusion ratios. We report a case of proximal and bilateral pulmonary embolism that occurred without associated hypoxemia. A spiral computed tomography (CT) scan was performed to explore unexplained fever in a patient with a negative infectious investigation. We discuss the mechanisms underlying the absence of hypoxemia in this patient. CLINICAL CASE: A 43-year-old patient with no significant pathological history was admitted to intensive care for the management of multiple injuries following a road accident...
October 2017: J Med Vasc
https://www.readbyqxmd.com/read/28963613/cardiothoracic-injuries-after-cardiopump-cpr-a-report-of-two-cases-and-review-of-the-literature
#19
Martin Kolopp, Angélique Franchi, Patrick Grafiadis, Laurent Martrille
Although many clinical trials have demonstrated its efficacy during active compression-decompression cardiopulmonary resuscitation (ACD-CPR), the Ambu® CardioPump seems likely to cause severe and sometimes lethal injuries. In this paper, we report two cases observed at the Institute of Legal Medicine of Nancy, France. A 67-year-old man collapsed in the street, in the presence of witnesses, and without any sign of trauma. The autopsy revealed a flail chest, a wound of the left ventricle, a rupture of the right ventricle, and a wrenching of the inferior vena cava...
September 29, 2017: International Journal of Legal Medicine
https://www.readbyqxmd.com/read/28958369/balanced-resuscitation-in-trauma-management
#20
REVIEW
Paul M Cantle, Bryan A Cotton
Over the past decade substantial knowledge has been gained in understanding both the coagulopathy of trauma and the complications associated with aggressive crystalloid-based resuscitation. Balanced resuscitation, which includes permissive hypotension, limiting crystalloid use, and the transfusion of blood products in ratios similar to whole blood, has changed the previous standard of care. Prompt initiation of massive transfusion and the protocolled use of 1:1:1 product ratios have improved the morbidity and mortality of patients with trauma in hemorrhagic shock...
October 2017: Surgical Clinics of North America
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