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coagulopathy of trauma

Ulysses S Torres, Daniel Nicoletti Cesar, Giuseppe DʼIppolito
Intramural hematomas can occur along any part of the gastrointestinal tract, being more common in the duodenum, jejunum, and ileum. Intramural colonic hematomas are very rare, and their main causes include abdominal trauma, anticoagulation, and coagulopathies. We report on a 27-year-old man with right lower quadrant pain for 1 day after a mild blunt trauma sustained during a soccer match. Computed tomography and magnetic resonance imaging evaluation revealed an intramural hematoma of the right colon, subsequently confirmed and drained through laparoscopic surgery...
October 18, 2016: Journal of Computer Assisted Tomography
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
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
Nils Kunze-Szikszay, Lennart A Krack, Pauline Wildenauer, Saskia Wand, Tim Heyne, Karoline Walliser, Christopher Spering, Martin Bauer, Michael Quintel, Markus Roessler
BACKGROUND: Hyperfibrinolysis (HF) is a major contributor to coagulopathy and mortality in trauma patients. This study investigated (i) the rate of HF during the pre-hospital management of patients with multiple injuries and (ii) the effects of pre-hospital tranexamic acid (TxA) administration on the coagulation system. METHODS: From 27 trauma patients with pre-hospital an estimated injury severity score (ISS) ≥16 points blood was obtained at the scene and on admission to the emergency department (ED)...
October 10, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Sharon Edwards, Jason Smith
Trauma is a leading cause of death and disability worldwide, in civilian environments and on the battlefield. Trauma-induced haemorrhage is the principal cause of potentially preventable death, which is generally attributable to a combination of vascular injury and coagulopathy. Survival rates following severe traumatic injury have increased due to advanced trauma management initiatives and treatment protocols, influenced by lessons learned from recent conflicts in Iraq and Afghanistan. The use of tourniquets and intraosseous needles, early blood and blood product transfusion, administration of tranexamic acid in pre-hospital settings, and consultant-led damage control resuscitation incorporating damage control surgery have all played their part...
October 6, 2016: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
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
Precilla V Veigas, Jeannie Callum, Sandro Rizoli, Bartolomeu Nascimento, Luis Teodoro da Luz
INTRODUCTION: Viscoelastic assays have been promoted as an improvement over traditional coagulation tests in the management of trauma patients. Rotational thromboelastometry (ROTEM®) has been used to diagnose coagulopathy and guide hemostatic therapy in trauma. This systematic review of clinical studies in trauma investigates the ROTEM® parameters thresholds used for the diagnosing coagulopathy, predicting and guiding transfusion and predicting mortality. METHODS: Systematic literature search was performed using MEDLINE, EMBASE and Cochrane databases...
October 3, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Daniele Poole, Andrea Cortegiani, Arturo Chieregato, Emanuele Russo, Concetta Pellegrini, Elvio De Blasio, Francesca Mengoli, Annalisa Volpi, Silvia Grossi, Lara Gianesello, Vanni Orzalesi, Francesca Fossi, Osvaldo Chiara, Carlo Coniglio, Giovanni Gordini
BACKGROUND: Traumatic coagulopathy is thought to increase mortality and its treatment to reduce preventable deaths. However, there is still uncertainty in this field, and available literature results may have been overestimated. METHODS: We searched the MEDLINE database using the PubMed platform. We formulated four queries investigating the prognostic weight of traumatic coagulopathy defined according to conventional laboratory testing, and the effectiveness in reducing mortality of three different treatments aimed at contrasting coagulopathy (high fresh frozen plasma/packed red blood cells ratios, fibrinogen, and tranexamic acid administration)...
2016: PloS One
Dara L Gottlieb, Jennifer Prittie, Yekaterina Buriko, Kenneth E Lamb
OBJECTIVE: To evaluate the presence of acute traumatic coagulopathy (ATC) in dogs and cats following blunt trauma and to relate coagulation variables with injury severity and admission variables. DESIGN: Prospective, single center, observational study from 2013 to 2014. SETTING: Urban private referral hospital. ANIMALS: Eighteen and 19 client-owned dogs and cats, respectively, sustaining blunt trauma within 8 hours of presentation without prior resuscitation; 17 healthy staff and client-owned control cats METHODS: Blood samples were collected upon presentation for measurement of blood gas, lactate, blood glucose, ionized calcium, PCV, total plasma protein, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, platelet count, and thromboelastography...
September 30, 2016: Journal of Veterinary Emergency and Critical Care
Jimei Yu, Chaojun Lu, Xiaohua Pan, Weihua Li
Adventitial cystic disease (ACD) of the common femoral vein is a rare vascular disorder. It becomes more difficult to recognize preoperatively especially when the femoral vein is affected. We report the case of a 62-year-old female patient who presented with a one-month history of painless swelling in her right lower extremity. She had no specific past medical history and no history of trauma, and had a full coagulopathy profile that was negative for any hypercoagulable syndrome. On examination, her lower right leg was significantly swollen with a palpable mass in her right inguinal region...
August 2016: Intractable & Rare Diseases Research
M Kvezereli-Kopadze, A Kvezereli-Kopadze, M Chikovani
The study was designed to investigate the 5 year old girl with rare bleeding disorder -deficiency of coagulation factor V. The diagnosis was based on detail family history, physical examination and para-clinical data analyses. The age of patient, purpura, this has been detected from early age, positive family history, non-controlled, longtime bleeding, inadequate trauma of the tongue, which did not resolve after surgery, strong hypocoagulation, which was slightly improved, after several plasma transfusions...
July 2016: Georgian Medical News
D Brilej, D Stropnik, R Lefering, R Komadina
BACKGROUND: Early recognition and management of trauma related coagulopathy improves the outcome. Trauma facilities should implement an algorithm to identify the bleeding trauma patient with coagulopathy. OBJECTIVE: The scope of the paper is to identify the indicators of early coagulopathy and to optimize the indications for thromboelastometry and coagulation support. DESIGN: Cohort study based on data from trauma registry. SETTING: Data of 493 major trauma patients treated in GH Celje from 2006 to 2014 were included into The TraumaRegister DGU(®) (TR-DGU)...
September 22, 2016: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Yuanyang Zhang, Tie Bo Wu, Bernie J Daigle, Mitchell Cohen, Linda Petzold
BACKGROUND: Trauma is the leading cause of death between the ages of 1 to 44 in the United States. Blood loss is the primary cause of these deaths. The discrimination of states through which patients transition would be helpful in understanding the disease process, and in identification of critical states and appropriate interventions. Even though these states are strongly associated with patients' blood composition data, there has not been a way to directly identify them. Statistical tools such as hidden Markov models can be used to infer the discrete latent states from the blood composition data...
2016: BMC Medical Informatics and Decision Making
Jacob Chen, Xiaowu Wu, Jeffrey Keesee, Bin Liu, Daniel N Darlington, Andrew P Cap
INTRODUCTION: We have recently shown that human whole blood stored at 4°C maintains hemostatic and platelet function. In this study, we compared restoration of hemodynamic, metabolic and hemostatic function after limited resuscitation with rat fresh whole blood, rat stored whole blood, or Lactated Ringers in traumatized rats. METHODS: Rat whole blood was stored for 10 days at 4°C for evaluation of hemostatic function. Polytrauma was performed on isoflurane-anesthetized Sprague-Dawley rats (350-450 g) by damage to the intestines, liver, right leg skeletal muscle and right femur fracture, followed by 40% hemorrhage...
September 19, 2016: Shock
James Winearls, Michael Reade, Helen Miles, Andrew Bulmer, Don Campbell, Klaus Görlinger, John F Fraser
Hemorrhage in the setting of severe trauma is a leading cause of death worldwide. The pathophysiology of hemorrhage and coagulopathy in severe trauma is complex and remains poorly understood. Most clinicians currently treating trauma patients acknowledge the presence of a coagulopathy unique to trauma patients-trauma-induced coagulopathy (TIC)-independently associated with increased mortality. The complexity and incomplete understanding of TIC has resulted in significant controversy regarding optimum management...
October 2016: Anesthesia and Analgesia
Arulselvi Subramanian, Venencia Albert, Biplab Mishra, Shilpi Sanoria, Ravindra Mohan Pandey
BACKGROUND: The literature suggests an association of pancreatic enzymes with systemic inflammation resulting in secondary organ injury and dysfunction following trauma. Elevation in serum enzymes may not always be predictive of pancreatic disease, and can reflect extra pancreatic production. OBJECTIVES: This study was conducted to evaluate the rise in serum pancreatic enzyme levels with the incidence of organ failure following trauma. PATIENTS AND METHODS: A retrospective review was performed on critically injured patients from December 2009 to March 2010...
May 2016: Trauma Monthly
Matthew Keane
Multiple organ failure is a significant complication in traumatic injury, and can be exacerbated by a failure to adequately monitor and control trauma patients' core body temperature in emergency departments (EDs). Nearly half of trauma patients are hypothermic on arrival at emergency departments, often due to factors beyond the control of emergency service responders and during on-scene resuscitation attempts. This article examines the physiology of the 'triad of death' -hypothermia, metabolic acidosis and coagulopathy - to highlight the importance of monitoring and maintaining normothermia, or normal body temperature, which is between 36°C and 37...
September 2016: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
J Zwingmann, R Lefering, M Feucht, N P Südkamp, P C Strohm, T Hammer
BACKGROUND: Data of the TraumaRegister DGU® were analyzed to derive survival rates, neurological outcome and prognostic factors of patients who had suffered traumatic cardiac arrest in the early treatment phase. METHODS: The database of the TraumaRegister DGU® from 2002 to 2013 was analyzed. The main focus of this survey was on different time points of performed resuscitation. Descriptive and multivariate analyses (logistic regression) were performed with the neurological outcome (Glasgow Outcome Scale) and survival rate as the target variable...
2016: Critical Care: the Official Journal of the Critical Care Forum
Brandon W Godfrey, Ashley Martin, Paul J Chestovich, Gordon H Lee, Nichole K Ingalls, Vilas Saldanha
INTRODUCTION: Improvised Explosive Devices (IED) are the primary wounding mechanism for casualties in Operation Enduring Freedom. Patients can sustain devastating traumatic amputations, which are unlike injuries seen in the civilian trauma sector. This is a database analysis of the largest patient registry of multiple traumatic amputations. METHODS: The Joint Theater Trauma Registry was queried for patients with a traumatic amputation from 2009 to 2012. Data obtained included the Injury Severity Score (ISS), Glasgow Coma Score (GCS), blood products, transfer from theatre, and complications including DVT, PE, infection (Acinetobacter and fungal), acute renal failure, and rhabdomyolysis...
August 17, 2016: Injury
Keyvan Eghbal, Fariborz Ghaffarpasand
BACKGROUND: Several injuries in cervical region as complications of acupuncture have been previously reported in the literature including cord and medulla oblongata injuries, subdural empyema and cervical hematoma. Spinal cord subdural hematoma is a rare condition mainly associated with coagulopathy, trauma and iatrogenic procedures. We herein report an acute cervical subdural hematoma following cervical acupuncture for neck and shoulder pain. CASE DESCRIPTION: A 74-year-old woman presented with progressive quadriparesis and sensory deficit after receiving acupuncture in neck and shoulder...
August 30, 2016: World Neurosurgery
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