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Trauma shock

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https://www.readbyqxmd.com/read/28207628/earlier-endpoints-are-required-for-hemorrhagic-shock-trials-among-severely-injured-patients
#1
Erin E Fox, John B Holcomb, Charles E Wade, Eileen M Bulger, Barbara C Tilley
BACKGROUND: Choosing the appropriate endpoint for a trauma hemorrhage control trial can determine the likelihood of its success. Recent Phase 3 trials and observational studies have used 24-h and/or 30-day all-cause mortality as the primary endpoint and some have not used exception from informed consent (EFIC), resulting in multiple failed trials. Five recent high-quality prospective studies among 4,064 hemorrhaging trauma patients provide new evidence to support earlier primary endpoints...
February 15, 2017: Shock
https://www.readbyqxmd.com/read/28203100/from-amino-acids-polymers-antimicrobial-peptides-and-histones-to-their-possible-role-in-the-pathogenesis-of-septic-shock-a-historical-perspective
#2
Isaac Ginsburg, Peter Vernon van Heerden, Erez Koren
This paper describes the evolution of our understanding of the biological role played by synthetic and natural antimicrobial cationic peptides and by the highly basic nuclear histones as modulators of infection, postinfectious sequelae, trauma, and coagulation phenomena. The authors discuss the effects of the synthetic polymers of basic poly α amino acids, poly l-lysine, and poly l-arginine on blood coagulation, fibrinolysis, bacterial killing, and blood vessels; the properties of natural and synthetic antimicrobial cationic peptides as potential replacements or adjuncts to antibiotics; polycations as opsonizing agents promoting endocytosis/phagocytosis; polycations and muramidases as activators of autolytic wall enzymes in bacteria, causing bacteriolysis and tissue damage; and polycations and nuclear histones as potential virulence factors and as markers of sepsis, septic shock, disseminated intravasclar coagulopathy, acute lung injury, pancreatitis, trauma, and other additional clinical disorders...
2017: Journal of Inflammation Research
https://www.readbyqxmd.com/read/28193297/pre-hospital-transfusion-of-packed-red-blood-cells-in-147-patients-from-a-uk-helicopter-emergency-medical-service
#3
Richard M Lyon, Eleanor de Sausmarez, Emily McWhirter, Gary Wareham, Magnus Nelson, Ashley Matthies, Anthony Hudson, Leigh Curtis, Malcolm Q Russell
BACKGROUND: Early transfusion of packed red blood cells (PRBC) has been associated with improved survival in patients with haemorrhagic shock. This study aims to describe the characteristics of patients receiving pre-hospital blood transfusion and evaluate their subsequent need for in-hospital transfusion and surgery. METHODS: The decision to administer a pre-hospital PRBC transfusion was based on clinical judgment. All patients transfused pre-hospital PRBC between February 2013 and December 2014 were included...
February 14, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28179972/septic-shock-of-unknown-origin-a-case-report-of-a-pseudoaneurysm-of-the-mitral-aortic-intervalvular-fibrosa
#4
Julio Gil, Hugo Antunes, Bruno Marmelo, Luis Abreu, Maria Luisa Goncalves, Luis Ferreira Dos Santos, Jose Costa Cabral
Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) is a rare complication of infective endocarditis and trauma, particularly of aortic valve surgery. Clinical symptoms are usually unspecific and generally due to complications. Transesophageal echocardiography (TEE) is the most commonly used exam to diagnose P-MAIVF. The main echocardiographic feature is the presence of a cavity communicating with the left ventricular outflow tract that expands during systole and collapses during diastole. Most frequent complications are formation of a fistulous tract and compression of adjacent structures...
March 2017: Journal of Clinical Medicine Research
https://www.readbyqxmd.com/read/28179016/shock-induced-endotheliopathy-shine-in-acute-critical-illness-a-unifying-pathophysiologic-mechanism
#5
REVIEW
PärIngemar Johansson, Jakob Stensballe, SisseRye Ostrowski
One quarter of patients suffering from acute critical illness such as severe trauma, sepsis, myocardial infarction (MI) or post cardiac arrest syndrome (PCAS) develop severe hemostatic aberrations and coagulopathy, which are associated with excess mortality. Despite the different types of injurious "hit", acutely critically ill patients share several phenotypic features that may be driven by the shock. This response, mounted by the body to various life-threatening conditions, is relatively homogenous and most likely evolutionarily adapted...
February 9, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28178160/extracorporeal-membrane-oxygenation-support-in-post-traumatic-cardiopulmonary-failure-a-10-year-single-institutional-experience
#6
Chun-Yu Lin, Feng-Chun Tsai, Hsiu-An Lee, Yuan-His Tseng
Patients with multiple traumas associated with cardiopulmonary failure have a high mortality rate; however, such patients can be temporarily stabilized using extracorporeal membrane oxygenation (ECMO), providing a bridge to rescue therapy. Using a retrospective study design, we aimed to clarify the prognostic factors of post-traumatic ECMO support.From March 2006 to July 2016, 43 adult patients (mean age, 37.3 ± 15.2 years; 7 females [16.3%]) underwent ECMO because of post-traumatic cardiopulmonary failure...
February 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28168570/early-enteral-nutrition-in-critically-ill-patients-esicm-clinical-practice-guidelines
#7
REVIEW
Annika Reintam Blaser, Joel Starkopf, Waleed Alhazzani, Mette M Berger, Michael P Casaer, Adam M Deane, Sonja Fruhwald, Michael Hiesmayr, Carole Ichai, Stephan M Jakob, Cecilia I Loudet, Manu L N G Malbrain, Juan C Montejo González, Catherine Paugam-Burtz, Martijn Poeze, Jean-Charles Preiser, Pierre Singer, Arthur R H van Zanten, Jan De Waele, Julia Wendon, Jan Wernerman, Tony Whitehouse, Alexander Wilmer, Heleen M Oudemans-van Straaten
PURPOSE: To provide evidence-based guidelines for early enteral nutrition (EEN) during critical illness. METHODS: We aimed to compare EEN vs. early parenteral nutrition (PN) and vs. delayed EN. We defined "early" EN as EN started within 48 h independent of type or amount. We listed, a priori, conditions in which EN is often delayed, and performed systematic reviews in 24 such subtopics. If sufficient evidence was available, we performed meta-analyses; if not, we qualitatively summarized the evidence and based our recommendations on expert opinion...
February 6, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28164043/pneumothorax-after-shoulder-arthroscopy-a-rare-but-life-threatening-complication
#8
Sven Bamps, Daan Renson, Stefaan Nijs, Sermon
INTRODUCTION: Arthroscopy has become a major diagnostic tool and treatment option for shoulder pathology. However rare, respiratory complications such as a pneumothorax have been reported in patients undergoing shoulder arthroscopy. Surgery - as well as anesthesiology-related factors and respiratory comorbidity have been hypothesized to intervene in the onset of respiratory complications. CASE REPORT: We report the case of a 42-year-old male patient who underwent an arthroscopy of the left shoulder...
September 2016: Journal of Orthopaedic Case Reports
https://www.readbyqxmd.com/read/28161028/update-on-traumatic-acute-spinal-cord-injury-part-1
#9
R Galeiras Vázquez, M E Ferreiro Velasco, M Mourelo Fariña, A Montoto Marqués, S Salvador de la Barrera
Traumatic spinal cord injury requires a multidisciplinary approach both for specialized treatment of the acute phase and for dealing with the secondary complications. A suspicion or diagnosis of spinal cord injury is the first step for a correct management. A review is made of the prehospital management and characteristics of the acute phase of spinal cord injury. Respiratory monitoring for early selective intubation, proper identification and treatment of neurogenic shock are essential for the prevention of secondary spinal cord injury...
February 1, 2017: Medicina Intensiva
https://www.readbyqxmd.com/read/28135676/horizontal-traumatic-laceration-of-the-pancreas-head-a-rare-case-report
#10
Atsushi Nanashima, Naoya Imamura, Yuki Tsuchimochi, Takeomi Hamada, Kouichi Yano, Masahide Hiyoshi, Yoshiro Fujii, Fumiaki Kawano, MitsuruTamura
INTRODUCTION: This case report is intended to inform acute care surgeons about treating rare horizontal laceration of the pancreas head caused by blunt trauma. CASE PRESENTATION: A 57-year-old woman who sustained blunt abdominal trauma during a car crash was transported to the emergency center of our hospital with unstable vital signs due to hemorrhagic shock. Computed tomography showed transection of the pancreas head and massive intra-abdominal hemorrhage. She was referred for emergency surgery because of a transient response...
January 17, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28133146/-damage-control-surgery-for-perforation-of-colon-cancer
#11
Takeshi Ebihara, Motohiko Yamada, Katsushu Simizu, Koji Amano, Masahiro Kawada, Genta Sawada, Yusuke Tsunetoshi, Ken Nakata, Akihiro Usui, Masaki Tujie, Yutaka Kimura, Satoru Munakata, Yasuki Nakata, Junya Fujita
Perforation due to colon cancer maycause peritonitis and septic shock. In these cases, we maynot be able to rescue the patients in spite of emergencysurgical intervention; in these conditions, owing to limitations of operation time, it is difficult for us to assess the state or extent of the disease and to perform an ideal oncological surgerywith dissection of lymph nodes. To overcome these limitations, we introduce the concept of "damage control surgery" developed in the trauma region to treat perforations of colon cancer...
November 2016: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/28130346/the-use-of-whole-body-computed-tomography-in-major-trauma-variations-in-practice-in-uk-trauma-hospitals
#12
Ian Ayenga Sammy, Hridesh Chatha, Omar Bouamra, Marisol Fragoso-Iñiguez, Fiona Lecky, Antoinette Edwards
INTRODUCTION: Whole-body CT (WBCT) use in patients with trauma in England and Wales is not well documented. WBCT in trauma can reduce time to definitive care, thereby increasing survival. However, its use varies significantly worldwide. METHODS: We performed a retrospective observational study of Trauma Audit and Research Network (TARN) data from 2012 to 2014. The proportion of adult patients receiving WBCT during initial resuscitation at major trauma centres (MTCs) and trauma units/non-designated hospitals (TUs/NDHs) was compared...
January 27, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28129263/tissue-injury-suppresses-fibrinolysis-following-hemorrhagic-shock-in-non-human-primates-rhesus-macaque
#13
Antoni R Macko, Hunter Moore, Andrew P Cap, M Adam Meledeo, Ernest E Moore, Forest R Sheppard
BACKGROUND: Hypoperfusion is associated with hyperfibrinolysis and early death from exsanguination, while tissue trauma is associated with hypofibrinolysis and delayed death from organ failure. We sought to elucidate the effects of injury patterns on fibrinolysis phenotypes using a non-human primate (NHP) model. METHODS: NHPs were randomized to three injury groups (n=8/group): 60 min severe pressure-targeted controlled hemorrhagic shock (HS); HS + soft tissue injury (HS+); or HS + soft tissue injury + femur fracture (HS++)...
January 26, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28127711/how-to-manage-tension-gastrothorax-a-case-report-of-tension-gastrothorax-with-multiple-trauma-due-to-traumatic-diaphragmatic-rupture
#14
Naofumi Bunya, Keigo Sawamoto, Shuji Uemura, Takashi Toyohara, Yukino Mori, Ryoko Kyan, Kei Miyata, Hideto Irifune, Keisuke Harada, Eichi Narimatsu
BACKGROUND: Tension gastrothorax is a kind of obstructive shock with prolapse and distention of the stomach into the thoracic cavity. Progressive gastric distension leads to mediastinal shift, reduced venous return, decreased cardiac output, and ultimately cardiac arrest. Therefore, it is crucial to decompress the stomach distension for the initial resuscitation of tension gastrothorax. CASE PRESENTATION: A 75-year-old female was transported to our resuscitation bay due to motor vehicle crash...
December 2017: International Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28122406/similar-change-in-platelets-and-leucocytes-24%C3%A2-h-after-injury-is-associated-with-septic-shock-a-week-later
#15
Saskia Jol, Falco Hietbrink, Luke P H Leenen, Leo Koenderman, Karlijn J P van Wessem
BACKGROUND: Septic shock is a severe complication in polytrauma patients. Early identification of patients at risk can guide future prevention strategies. Platelets (PLTs) and leucocytes presumably play an important role in the post-injury inflammatory response. The role of early changes in PLT and leucocyte counts was investigated in search for the aetiology of the development of septic complications. METHODS: Polytrauma patients (aged 16-80 years) admitted to the intensive care unit with an expected stay of at least 3 days were included...
January 25, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/28120281/the-nexus-of-trauma-victimization-and-mental-health-disorders-among-incarcerated-adults-in-spain
#16
Francisco Caravaca Sánchez, Javier Navarro Zaragoza, Noelle E Fearn, Michael G Vaughn
Victimization and exposure to trauma, commonly linked to co-occurring mental health disorders, are prevalent among prison populations. The purpose of this study is to shed light on the prevalence of various kinds of victimization and trauma exposure at distinct life stages (childhood, adulthood and during prison) among incarcerated persons in Spain. The research team surveyed a random sample of 453 male and female inmates, serving time in two Spanish prisons, to gather information on experiences of physical and sexual victimization in both childhood and adulthood along with the presence or absence of in-prison treatment for a mental health disorder(s)...
January 25, 2017: Psychiatric Quarterly
https://www.readbyqxmd.com/read/28117180/the-role-of-resuscitative-endovascular-balloon-occlusion-of-the-aorta-reboa-as-an-adjunct-to-acls-in-non-traumatic-cardiac-arrest-a-review-of-key-concepts-physiology-current-evidence-and-future-directions
#17
James Daley, Jonathan James Morrison, John Sather, Lisa Hile
Non-traumatic cardiac arrest is a major public health problem that carries an extremely high mortality rate. If we hope to increase the survivability of this condition, it is imperative that alternative methods of treatment are given due consideration. Balloon occlusion of the aorta can be used as a method of circulatory support in the critically ill patient. Intra-aortic balloon pumps have been used to temporize patients in cardiogenic shock for decades. More recently, resuscitative endovascular balloon occlusion of the aorta (REBOA) has been utilized in the patient in hemorrhagic shock or cardiac arrest secondary to trauma...
January 12, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28107308/acute-right-heart-failure-after-hemorrhagic-shock-and-trauma-pneumonectomy-a-management-approach-a-blinded-randomized-controlled-animal-trial-using-inhaled-nitric-oxide
#18
Andrea L Lubitz, Lars O Sjoholm, Amy Goldberg, Abhijit Pathak, Thomas Santora, Thomas E Sharp, Markus Wallner, Remus M Berretta, Lauren A Poole, Jichuan Wu, Marla R Wolfson
BACKGROUND: Hemorrhagic shock and pneumonectomy causes an acute increase in pulmonary vascular resistance (PVR). The increase in PVR and right ventricular (RV) afterload leads to acute RV failure, thus reducing left ventricular (LV) preload and output. Inhaled nitric oxide (iNO) lowers PVR by relaxing pulmonary arterial smooth muscle without remarkable systemic vascular effects. We hypothesized that with hemorrhagic shock and pneumonectomy, iNO can be used to decrease PVR and mitigate right heart failure...
2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28103991/-study-on-sweat-gland-regeneration-induced-by-microenvironment-of-three-dimensional-bioprinting
#19
B Yao, J F Xie, S Huang, X B Fu
Sweat glands are abundant in the body surface and essential for thermoregulation. Sweat glands fail to conduct self-repair in patients with large area of burn and trauma, and the body temperature of patients increases in hot climate, which may cause shock or even death. Now, co-culture system, reprogramming, and tissue engineering have made progresses in inducing sweat gland regeneration, but the inductive efficiency and duration need to be improved. Cellular microenvironment can regulate cell biological behavior, including cell migration and cell differentiation...
January 20, 2017: Zhonghua Shao Shang za Zhi, Zhonghua Shaoshang Zazhi, Chinese Journal of Burns
https://www.readbyqxmd.com/read/28099381/daily-propranolol-administration-reduces-persistent-injury-associated-anemia-following-severe-trauma-and-chronic-stress
#20
Ines G Alamo, Kolenkode B Kannan, Letitia E Bible, Tyler J Loftus, Harry Ramos, Philip A Efron, Alicia M Mohr
BACKGROUND: Following severe trauma, patients develop a norepinephrine-mediated persistent, injury-associated anemia. This anemia is associated with suppression of bone marrow erythroid colony growth, along with decreased iron levels, and elevated erythropoietin (EPO) levels, which are insufficient to promote effective erythropoiesis. The impact of norepinephrine on iron regulators such as ferroportin, transferrin and transferrin receptor-1 (TFR-1) are unknown. Using a clinically relevant rodent model of lung contusion (LC), hemorrhagic shock (HS), and chronic stress (CS), we hypothesize that daily propranolol (BB), a non-selective beta-blocker, restores bone marrow function and improves iron homeostasis...
January 17, 2017: Journal of Trauma and Acute Care Surgery
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