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Trauma shock

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https://www.readbyqxmd.com/read/29778416/the-use-of-the-shock-index-as-a-predictor-of-active-bleeding-in-trauma-patients
#1
Andrea Campos-Serra, Sandra Montmany-Vioque, Pere Rebasa-Cladera, Heura Llaquet-Bayo, Raquel Gràcia-Roman, Anna Colom-Gordillo, Salvador Navarro-Soto
INTRODUCTION: Vital signs indicate the presence of bleeding only after large amounts of blood have been lost, with high morbidity and mortality. The Shock Index (SI) is a hemorrhage indicator with a cut-off point for the risk of bleeding at 0.9. The aim of this study is to assess whether a cut-off of≥0.8 is more sensitive for detecting occult bleeding, providing for early initiation of therapeutic maneuvers. METHODS: SI analytical validation study of severe trauma patients older than 16 years of age...
May 16, 2018: Cirugía Española
https://www.readbyqxmd.com/read/29777581/in-vivo-performance-of-a-visible-wavelength-optical-sensor-for-monitoring-intestinal-perfusion-and-oxygenation
#2
Mitchell B Robinson, Anna M Wisniowiecki, Ryan J Butcher, Mark A Wilson, M Nance Ericson, Gerard L Cote
Traumatic injury resulting in hemorrhage is a prevalent cause of death worldwide. The current standard of care for trauma patients is to restore hemostasis by controlling bleeding and administering intravenous volume resuscitation. Adequate resuscitation to restore tissue blood flow and oxygenation is critical within the first hours following admission to assess severity and avoid complications. However, current clinical methods for guiding resuscitation are not sensitive or specific enough to adequately understand the patient condition...
May 2018: Journal of Biomedical Optics
https://www.readbyqxmd.com/read/29771572/inhibition-of-ubiquitin-activating-enzyme-protects-against-organ-injury-after-intestinal-ischemia-reperfusion
#3
Shingo Matsuo, Andrew Chaung, Deanna Liou, Ping Wang, Weng-Lang Yang
Intestinal ischemia-reperfusion (I/R) occurs in various clinical settings, such as transplantation, acute mesenteric arterial occlusion, trauma and shock. I/R injury causes severe systemic inflammation, leading to multiple organ dysfunction associated with high mortality. The ubiquitin proteasome pathway has been indicated in the regulation of inflammation, particularly through NF-κB signaling pathway. PYR-41 is a small molecular compound that selectively inhibits ubiquitin-activating enzyme E1. A mouse model of intestinal I/R injury by clamping the superior mesenteric artery for 45 minutes was performed to evaluate the effect of PYR-41 treatment on organ injury and inflammation...
May 17, 2018: American Journal of Physiology. Gastrointestinal and Liver Physiology
https://www.readbyqxmd.com/read/29768405/pathology-and-causes-of-death-in-stranded-humpback-whales-megaptera-novaeangliae-from-brazil
#4
Kátia Regina Groch, Josué Díaz-Delgado, Milton C C Marcondes, Adriana Castaldo Colosio, Elitieri B Santos-Neto, Vítor Luz Carvalho, Gisele Silva Boos, Ana Carolina Oliveira de Meirelles, Hernani Gomes da Cunha Ramos, Juliana Plácido Guimarães, João Carlos Gomes Borges, Jociery Einhardt Vergara-Parente, Judy A St Leger, Antonio Fernández, José Luiz Catão-Dias
This study describes the pathologic findings of 24 humpback whales (Megaptera novaeangliae) found stranded along the Brazilian coast from 2004 to 2016. Eighteen (75%) animals evaluated were found stranded alive. From these, 13 died naturally on shore and five were euthanized. Six died at sea and were washed ashore. Of the 24, 19 (79.2%) were calves, four (16.7%) were juveniles, and one (4.2%) was an adult. The most probable cause of stranding and/or death (CSD) was determined in 23/24 (95.8%) individuals. In calves, CSD included neonatal respiratory distress (13/19; 68...
2018: PloS One
https://www.readbyqxmd.com/read/29766124/routine-repeat-head-ct-may-not-be-necessary-for-patients-with-mild-tbi
#5
Claire B Rosen, Diego D Luy, Molly R Deane, Thomas M Scalea, Deborah M Stein
Background: Routine repeat cranial CT (RHCT) is standard of care for CT-verified traumatic brain injury (TBI). Despite mixed evidence, those with mild TBI are subject to radiation and expense from serial CT scans. Thus, we investigated the necessity and utility of RHCT for patients with mild TBI. We hypothesized that repeat head CT in these patients would not alter patient care or outcomes. Methods: We retrospectively studied patients suffering from mild TBI (Glasgow Coma Scale (GCS) score 13-15) and treated at the R Adams Cowley Shock Trauma Center from November 2014 through January 2015...
2018: Trauma surgery & acute care open
https://www.readbyqxmd.com/read/29764673/comparison-between-thromboelastography-and-conventional-coagulation-test-should-we-abandon-conventional-coagulation-tests-in-polytrauma-patients
#6
Jaume Tur Martínez, Patrizio Petrone, Alexander Axelrad, Corrado P Marini
INTRODUCTION: TEG provides an in-vivo assessment of viscoelastic clot strength in whole blood compared with CCT, which may not reflect the influence of platelets. The aim of this study was to compare TEG vs. CCT in trauma patients stratified by mechanism of injury (MOI) and pre-existing coagulation status. METHODS: A retrospective, observational study of 230 polytrauma patients admitted to a University Hospital Level 1 Trauma Center, with TEG and CCT on admission stratified by MOI: multiple trauma (MT), isolated traumatic brain injury (TBI) or MT+TBI...
May 12, 2018: Cirugía Española
https://www.readbyqxmd.com/read/29763393/defining-community-and-consultation-for-emergency-research-that-requires-an-exception-from-informed-consent
#7
Samuel A Tisherman
Trauma care requires rapid interventions to optimize the chances for survival. Many patients are either in shock or unconscious and are, therefore, unable to provide informed consent even for standard procedures. Research-related interventions must similarly be initiated rapidly with no opportunity to obtain consent from the patient or the patient's legally authorized representative. Federal regulations allow for an exception from informed consent in these circumstances once the investigators complete a process of community consultation and public disclosure...
May 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29731409/penetrating-anorectal-injury-caused-by-a-wild-boar-attack-a-case-report
#8
Ichiro Okano, Yuki Midorikawa, Nobumasa Kushima, Yui Watanabe, Takuya Sugiyama, Katsutaka Mitachi, Kazuaki Shinohara, Takatoshi Sawada, Katsunori Inagaki
Wild boar attacks have rarely been reported in the medical literature. This is the case of an 83-year-old male farmer who was assaulted from behind by an injured adult wild boar. He presented with hemorrhagic shock after sustaining injuries to the right profunda femoris artery and right sciatic nerve as well as significant soft-tissue injuries, bilateral iliac wing fractures, an open pneumothorax, and an anorectal injury. The anorectal injury was treated with fecal diversion but was complicated by soft-tissue infection in the surrounding dead space...
May 3, 2018: Wilderness & Environmental Medicine
https://www.readbyqxmd.com/read/29728151/development-and-validation-of-a-pre-hospital-red-flag-alert-for-activation-of-intra-hospital-haemorrhage-control-response-in-blunt-trauma
#9
Sophie Rym Hamada, Anne Rosa, Tobias Gauss, Jean-Philippe Desclefs, Mathieu Raux, Anatole Harrois, Arnaud Follin, Fabrice Cook, Mathieu Boutonnet, Arie Attias, Sylvain Ausset, Mathieu Boutonnet, Gilles Dhonneur, Jacques Duranteau, Olivier Langeron, Catherine Paugam-Burtz, Romain Pirracchio, Guillaume de St Maurice, Bernard Vigué, Alexandra Rouquette, Jacques Duranteau
BACKGROUND: Haemorrhagic shock is the leading cause of early preventable death in severe trauma. Delayed treatment is a recognized prognostic factor that can be prevented by efficient organization of care. This study aimed to develop and validate Red Flag, a binary alert identifying blunt trauma patients with high risk of severe haemorrhage (SH), to be used by the pre-hospital trauma team in order to trigger an adequate intra-hospital standardized haemorrhage control response: massive transfusion protocol and/or immediate haemostatic procedures...
May 5, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29722563/damage-associated-molecular-patterns-damps-in-resuscitated-hemorrhagic-shock-are-mitigated-by-peritoneal-fluid-administration
#10
Paul J Matheson, Mark A Eid, Matthew A Wilson, Victoria S Graham, Samuel A Matheson, Jessica Lee Weaver, Cynthia D Downard, Jason W Smith
INTRODUCTION: Conventional resuscitation (CR) of hemorrhagic shock (HS), a significant cause of trauma mortality, is I.V. blood and fluids. CR restores central hemodynamics, but vital organ flow can drop causing hypoperfusion, hypoxia, Damage-Associated Molecular Patterns (DAMPs), and remote organ dysfunction (i.e., lung). CR plus Direct Peritoneal Resuscitation (DPR) prevents intestinal and hepatic hypoperfusion. We hypothesized that DPR prevents lung injury in HS/CR by altering DAMPs...
May 3, 2018: American Journal of Physiology. Lung Cellular and Molecular Physiology
https://www.readbyqxmd.com/read/29721496/the-role-of-plasma-transfusion-in-massive-bleeding-protecting-the-endothelial-glycocalyx
#11
REVIEW
Stefano Barelli, Lorenzo Alberio
Massive hemorrhage is a leading cause of death worldwide. During the last decade several retrospective and some prospective clinical studies have suggested a beneficial effect of early plasma-based resuscitation on survival in trauma patients. The underlying mechanisms are unknown but appear to involve the ability of plasma to preserve the endothelial glycocalyx. In this mini-review, we summarize current knowledge on glycocalyx structure and function, and present data describing the impact of hemorrhagic shock and resuscitation fluids on glycocalyx...
2018: Frontiers in Medicine
https://www.readbyqxmd.com/read/29702205/sex-differences-in-a-rabbit-eyeblink-conditioning-model-of-ptsd
#12
Bernard G Schreurs, Carrie Smith-Bell, Lauren B Burhans
We have developed a rabbit model of posttraumatic stress disorder (PTSD) which recapitulates several core features of PTSD, particularly hyperarousal and conditioned responding to trauma-associated cues. The work conducted with this model has all been done in male rabbits and given sex differences in PTSD prevalence, it is important to expand our animal model of PTSD to include female rabbits to determine if they develop core features of PTSD, and if those core features can be treated. This is particularly important because, contrary to human studies, nearly all animal studies have found that males are consistently more vulnerable to various forms of acute and chronic stress than females...
April 24, 2018: Neurobiology of Learning and Memory
https://www.readbyqxmd.com/read/29697510/the-incidence-of-transfusion-related-acute-lung-injury-at-a-large-urban-tertiary-medical-center-a-decade-s-experience
#13
David E Meyer, Jacob W Reynolds, Rhonda Hobbs, Yu Bai, Beth Hartwell, Matthew J Pommerening, Erin E Fox, Charles E Wade, John B Holcomb, Bryan A Cotton
BACKGROUND: While transfusion-related acute lung injury (TRALI) remains the primary cause of transfusion-related fatalities (37%), recent reports estimate the incidence of TRALI at 0.008% per unit of plasma transfused and 0.004% per all products transfused. Because blood banks have moved toward male-predominant plasma, TRALI appears, anecdotally, to have been reduced to an extremely rare event. The purpose of this study was to estimate the current incidence of TRALI at a large, urban center known for its early and aggressive use of plasma in the setting of trauma, hemorrhagic shock, and massive transfusion...
April 23, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29683829/harmful-or-physiologic-diagnosing-fibrinolysis-shutdown-in-a-trauma-cohort-with-rotational-thromboelastometry
#14
J Carolina Gomez-Builes, Sergio A Acuna, Bartolomeu Nascimento, Fabiana Madotto, Sandro B Rizoli
BACKGROUND: Despite its central role in early trauma coagulopathy, abnormal fibrinolysis continues to be poorly understood. Excessive fibrinolysis is a known contributor to mortality. Recent studies with thromboelastography (TEG) suggest decreased fibrinolysis (or shutdown) may be just as harmful. Considering the broad use of 2 different viscoelastic assays, which are not interchangeable, we proposed for the first time to define and characterize fibrinolysis shutdown using rotational thromboelastometry (ROTEM)...
April 19, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29678197/resuscitative-endovascular-balloon-occlusion-of-the-aorta-performed-by-emergency-physicians-for-traumatic-hemorrhagic-shock-a-case-series-from-japanese-emergency-rooms
#15
Ryota Sato, Akira Kuriyama, Rei Takaesu, Nobuhiro Miyamae, Wataru Iwanaga, Hayato Tokuda, Takehiro Umemura
BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA), which has been increasingly used for the management of hemorrhagic shock, is a less invasive strategy for the management of patients with very severe hemorrhage. However, its effectiveness remains controversial. METHODS: This retrospective case series included trauma patients who underwent REBOA for hemorrhagic shock due to trauma in four Japanese tertiary care emergency centers from January 2013 to March 2017...
April 21, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29675258/livedo-reticularis-a-cutaneous-clue-to-an-underlying-endocrine-crisis
#16
Natasha Shrikrishnapalasuriyar, Mirena Noyvirt, Philip Evans, Bethan Gibson, Elin Foden, Atul Kalhan
A 54-year-old woman was admitted to hospital with a presumed allergic reaction to a single dose of amoxicillin given for a suspected upper respiratory tract infection. She complained of chest tightness although there was no wheeze or stridor. On examination, she was pyrexial, tachycardic, hypertensive and had a diffuse mottled rash on her lower limbs. Her initial investigations showed raised inflammatory markers. She was treated in the intensive care for a presumed anaphylactic reaction with an underlying sepsis...
2018: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/29675023/increased-plasma-levels-of-danger-associated-molecular-patterns-are-associated-with-immune-suppression-and-postoperative-infections-in-patients-undergoing-cytoreductive-surgery-and-hyperthermic-intraperitoneal-chemotherapy
#17
Guus P Leijte, Hettie Custers, Jelle Gerretsen, Amon Heijne, Johannes Roth, Thomas Vogl, Gert J Scheffer, Peter Pickkers, Matthijs Kox
Introduction: Danger-associated molecular patterns (DAMPs) can elicit immune responses and may subsequently induce an immune-suppressed state. Previous work showed that increased plasma levels of DAMPs are associated with immune suppression and increased susceptibility toward infections in trauma patients. Like trauma, major surgical procedures, such as cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC), are also thought to cause profound DAMP release...
2018: Frontiers in Immunology
https://www.readbyqxmd.com/read/29670226/analysis-for-patient-survival-after-open-abdomen-for-torso-trauma-and-the-impact-of-achieving-primary-fascial-closure-a-single-center-experience
#18
Yu-Pao Hsu, Yon-Cheong Wong, Chih-Yuan Fu, Shang-Yu Wang, Chien-Hung Liao, Chun-Hsiang Ou Yang, Kuo-Ching Yuan
Open abdomen indicates the abdominal fascia is unclosed to abbreviate surgery and to reduce physiological stress. However, complications and difficulties in patient care are often encountered after operation. During May 2008 to March 2013, we performed a prospective protocol-directed observation study regarding open abdomen use in trauma patients. Bogota bag is the temporary abdomen closure initially but negative pressure dressing is used later. A goal-directed ICU care is applied and primary fascial closure is the primary endpoint...
April 18, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29668565/the-effects-of-genetic-3-mercaptopyruvate-sulfurtransferase-deficiency-in-murine-traumatic-hemorrhagic-shock
#19
Michael Gröger, Martin Wepler, Ulrich Wachter, Tamara Merz, Oscar McCook, Sandra Kress, Britta Lukaschewski, Sebastian Hafner, Markus Huber-Lang, Enrico Calzia, Michael Georgieff, Noriyuki Nagahara, Csaba Szabó, Peter Radermacher, Clair Hartmann
INTRODUCTION: Hemorrhagic shock is a major cause of death after trauma. An additional blunt chest trauma independently contributes to mortality upon the development of an acute lung injury (ALI) by aggravating pathophysiological consequences of hemorrhagic shock. The maintenance of hydrogen sulfide availability is known to play an important role during hemorrhage and ALI. We therefore tested the impact of a genetic 3-mercaptopyruvate sulfurtransferase mutation (Δ3-MST) in a resuscitated murine model of traumatic-hemorrhagic shock...
April 17, 2018: Shock
https://www.readbyqxmd.com/read/29664891/reinventing-the-wheel-impact-of-prolonged-antibiotic-exposure-on-multi-drug-resistant-ventilator-associated-pneumonia-in-trauma-patients
#20
Richard H Lewis, John P Sharpe, Joseph M Swanson, Timothy C Fabian, Martin A Croce, Louis J Magnotti
INTRODUCTION: Multi-drug resistant (MDR) strains of both Acinetobacter baumannii (AB) and Pseudomonas aeruginosa (PA) as causative VAP pathogens are becoming increasingly common. Still, the risk factors associated with this increased resistance have yet to be elucidated. The purpose of this study was to examine the changing sensitivity patterns of these pathogens over time and determine which risk factors predict MDR in trauma patients with VAP. METHODS: Patients with either AB or PA VAP over 10 years were stratified by pathogen sensitivity (sensitive (SEN) and MDR), age, severity of shock and injury severity...
April 16, 2018: Journal of Trauma and Acute Care Surgery
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