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Trauma coagulopathy

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https://www.readbyqxmd.com/read/28930957/clot-dynamics-and-mortality-the-ma-r-ratio
#1
Stephanie A Savage, Ben L Zarzaur, Timothy H Pohlman, Brian L Brewer, Louis J Magnotti, Martin A Croce, Garrett H Lim, Ali C Martin
INTRODUCTION: The coagulopathy of trauma, illustrated by a short R-time, is common and well understood. The physiology behind this may be early thrombin burst with rapid clot formation. Rapid consumption of fibrinogen, however, may result in weak clot and substrate depletion, resulting in low MA. While these characteristics are interesting, utilizing thromboelastography (TEG) to identify those at risk of subsequent bleeding diathesis, especially in those who do not demonstrate early signs of physiologic derangement, is challenging...
October 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28924070/-a-case-of-cerebral-venous-sinus-thrombosis-secondary-to-subclinical-basedow-disease
#2
Ichiro Kawahara, Keisuke Toyoda, Makoto Hirose, Naoki Kitagawa
Cerebral venous sinus thrombosis(CVST)is a rare condition accounting for <1% of all strokes. It has been linked to a multitude of risk factors, including infections, oral contraceptive use, coronary disease, malignant disease, trauma, surgery, coagulopathy and several others. However, the association between hyperthyroidism and CVST is poorly understood. We describe here a rare case of CVST, secondary to subclinical Basedow disease. A 68-year-old woman with general fatigue, headache, speech disturbance and slow behavior was admitted to our hospital...
September 2017: No Shinkei Geka. Neurological Surgery
https://www.readbyqxmd.com/read/28923612/deceased-organ-donation-from-pediatric-donors-does-the-literature-really-help-us-implication-for-more-powerful-guidelines
#3
M Mojtabaee, F Sadegh Beigee, F Ghorbani
BACKGROUND: Brain-dead pediatric donors have always been the focus of attention because of the higher quality, utility, and possibility of their organ donation. However, donors under the age of 5 years always necessitate making more challenging management efforts, which are not clearly implied in most parts of the guidelines. METHODS: The data obtained from 79 brain-dead pediatric donors of the Organ Procurement Unit of Masih Daneshvari Hospital, Tehran, Iran, were assessed...
October 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28920070/prevalence-and-associated-factors-of-acute-traumatic-coagulopathy-a-cross-sectional-study
#4
Hojjat Derakhshanfar, Ali Vafaei, Ali Tabatabaey, Shamila Noori
INTRODUCTION: Acute traumatic coagulopathy (ATC) is defined as having evidence of coagulopathy in patients with severe trauma. The aim of this preliminary study was to assess the prevalence and associated factors of ATC in severely traumatic patients presenting to emergency department (ED). METHODS: In this retrospective cross sectional study, all patients with severe traumatic injury and available coagulation profile, presenting to the EDs of two major trauma centers in Tehran, Iran, during one year, were studied...
2017: Emergency (Tehran, Iran)
https://www.readbyqxmd.com/read/28918481/fibrinolysis-in-trauma-a-review
#5
REVIEW
M J Madurska, K A Sachse, J O Jansen, T E Rasmussen, J J Morrison
Fibrinolytic dysregulation is an important mechanism in traumatic coagulopathy. It is an incompletely understood process that consists of a spectrum ranging from excessive breakdown (hyperfibrinolysis) and the shutdown of fibrinolysis. Both hyperfibrinolysis and shutdown are associated with excess mortality and post-traumatic organ failure. The pathophysiology appears to relate to endothelial injury and hypoperfusion, with several molecular markers identified in playing a role. Although there are no universally accepted diagnostic tests, viscoelastic studies appear to offer the greatest potential for timely identification of patients presenting with fibrinolytic dysregulation...
September 16, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/28891977/polytrauma-defined-by-the-new-berlin-definition-a-validation-test-based-on-propensity-score-matching-approach
#6
Cheng-Shyuan Rau, Shao-Chun Wu, Pao-Jen Kuo, Yi-Chun Chen, Peng-Chen Chien, Hsiao-Yun Hsieh, Ching-Hua Hsieh
Background: Polytrauma patients are expected to have a higher risk of mortality than that obtained by the summation of expected mortality owing to their individual injuries. This study was designed to investigate the outcome of patients with polytrauma, which was defined using the new Berlin definition, as cases with an Abbreviated Injury Scale (AIS) ≥ 3 for two or more different body regions and one or more additional variables from five physiologic parameters (hypotension [systolic blood pressure ≤ 90 mmHg], unconsciousness [Glasgow Coma Scale score ≤ 8], acidosis [base excess ≤ -6...
September 11, 2017: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/28885470/poor-microcirculatory-flow-dynamics-are-associated-with-endothelial-cell-damage-and-glycocalyx-shedding-following-traumatic-hemorrhagic-shock
#7
David N Naumann, Jon Hazeldine, Mark J Midwinter, Sam D Hutchings, Paul Harrison
BACKGROUND: Endothelial cell damage and glycocalyx shedding following trauma can increase the risk of inflammation, coagulopathy, vascular permeability and death. Bedside sublingual video-microscopy may detect worse flow and perfusion associated with this endotheliopathy. We compared markers of endotheliopathy with physical flow dynamics following traumatic hemorrhagic shock (THS). METHODS: Sublingual incident dark field video-microscopy was performed at three time-points following injury (<10h; 10-30h; and 30-50h)...
September 5, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28858139/platelet-derived-microvesicles-a-potential-therapy-for-trauma-induced-coagulopathy
#8
Ernesto Lopez, Amit K Srivastava, Shibani Pati, John B Holcomb, Charles E Wade
Trauma patients are often affected by a hypocoagulable condition referred as trauma-induced coagulopathy (TIC) for which few therapeutic options exist. One available treatment is fresh platelets transfusion, although, It is not efficacious enough and it has a number of limitations; therefore, we reviewed the literature to propose an alternative therapy based on platelet-derived microvesicles (PMVs), which are cellular fragments surrounded by extracellular membrane and filled with cytoplasmic content. This concept is supported by a large number of studies in which the hypercoagulable role of PMVs has been demonstrated and associated with thrombosis-related conditions...
August 29, 2017: Shock
https://www.readbyqxmd.com/read/28857805/precision-correction-of-coagulopathy-or-prothrombin-complex-concentrates-reversal-options-for-dabigatran-following-trauma
#9
Matthew D Neal, Jerrold H Levy
No abstract text is available yet for this article.
August 30, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28844370/technology-is-there-sufficient-evidence-to-change-practice-in-point-of-care-management-of-coagulopathy
#10
REVIEW
Michael Fabbro, Anne M Winkler, Jerrold H Levy
Currently, hemostasis is one of the most widely researched topics in perioperative medicine. As investigators learn more about the complexity of coagulation, developing tests with the ability to rapidly monitor coagulation and guide targeted therapy is the key to optimizing hemostasis management. There is mounting evidence that algorithmic transfusion using point-of-care (POC) testing can reduce red cell and platelet transfusions and major bleeding after cardiac surgery. Integrating these tests during cardiac surgery and trauma management is especially important because these groups use the most blood products within a health system and the risks of transfusion are well documented...
May 19, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28831518/-viscoelasticity-based-treatment-of-bleeding-injuries
#11
Marc Maegele, Michael Caspers, Herbert Schöchl
Uncontrolled bleeding is the leading preventable cause of death in patients with multiple injuries. Currently, trauma-induced coagulopathy is seen as an independent disease entity influencing survival. Severely bleeding trauma patients are often treated with classical blood products in predefined ratios (damage control resuscitation). Viscoelasticity-based and target-oriented approaches could possibly be given priority. Viscoelasticity-based diagnostics and therapy enable the qualitative investigation of whole blood and provide therapeutically usable information on initiation, dynamics and sustainability of thrombus formation...
August 22, 2017: Der Unfallchirurg
https://www.readbyqxmd.com/read/28827507/presentation-coagulopathy-and-persistent-acidosis-predict-complications-in-orthopaedic-trauma-patients
#12
Benjamin R Childs, Daniel R Verhotz, Timothy A Moore, Heather A Vallier
OBJECTIVES: To evaluate the ability of measures of coagulopathy and acidosis to predict complications. We hypothesize that increased coagulopathy and acidosis over the first 60 hours of hospitalization will result in increased rates of infection and mortality. DESIGN: Prospective, observational. SETTING: Level 1 trauma center. PATIENTS: Three hundred and seventy-six skeletally mature patients with an Injury Severity Score (ISS) greater than 16 who were surgically treated for high energy fractures of the femur, pelvic ring, acetabulum, and/or spine...
August 15, 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28822390/physiologic-features-of-brain-death
#13
Eno-Obong Essien, Kristina Fioretti, Thomas M Scalea, Deborah M Stein
Brain death is known to be associated with physiologic derangements but their incidence is poorly described. Knowledge of the changes that occur during brain death is important for management of the potential organ donor. Thus, we sought to characterize the pathophysiology that occurs during brain death in patients with traumatic injuries. All brain-dead patients over a 10-year period were identified from the trauma registry at a level 1 urban trauma center. Patient demographics, injury characteristics, and clinical data for defining organ dysfunction were reviewed for the 24 hours surrounding brain-death declaration...
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28821516/a-retrospective-review-of-paediatric-head-injuries-in-asia-a-pan-asian-trauma-outcomes-study-patos-collaboration
#14
Shu-Ling Chong, Uzma Rahim Khan, Indumathy Santhanam, Jun Seok Seo, Quan Wang, Sabariah Faizah Jamaluddin, Quoc Ai Hoang Trong, Su Yah Chew, Marcus Eng Hock Ong
OBJECTIVE: We aim to examine the mechanisms of head-injured children presenting to participating centres in the Pan Asian Trauma Outcomes Study (PATOS) and to evaluate the association between mechanism of injury and severe outcomes. DESIGN AND SETTING: We performed a retrospective review of medical records among emergency departments (EDs) of eight PATOS centres, from September 2014 - August 2015. PARTICIPANTS: We included children <16 years old who presented within 24 hours of head injury and were admitted for observation or required a computed tomography (CT) of the brain from the ED...
August 18, 2017: BMJ Open
https://www.readbyqxmd.com/read/28774762/epidemiology-of-mild-traumatic-brain-injury-with-intracranial-hemorrhage-focusing-predictive-models-for-neurosurgical-intervention
#15
Alessandro Orlando, A Stewart Levy, Matthew M Carrick, Allen Tanner, Charles W Mains, David Bar-Or
OBJECTIVE: To adumbrate differences in neurosurgical intervention (NI) rates between intracranial hemorrhage (ICH) types in mild traumatic brain injuries (mTBIs), and help identify which ICH types are most likely to benefit from the creation of predictive models for NI. METHODS: This was a multi-center retrospective study of adult patients over three years at four Trauma Centers in the USA. Patients were included if they presented with a mTBI (GCS 13-15) and a head CT positive for ICH...
July 31, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28771656/transfusion-practice-in-trauma-resuscitation
#16
REVIEW
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/28767796/mortality-predictors-in-patients-with-pelvic-fractures-from-blunt-trauma
#17
Wagner Oséas Corrêa, Vinícius Guilherme Rocha Batista, Erisvaldo Ferreira Cavalcante, Michael Pereira Fernandes, Rafael Fortes, Gabriela Zamunaro Lopes Ruiz, Carla Jorge Machado, Mario Pastore
Objective: to analyze the association of mortality with sociodemographic and clinical variables, as well as lesions and complication in patients with pelvic trauma due to blunt trauma. Methods: we conducted a retrospective, observational study with five-year trauma record data. Death was considered as the main stratification variable for the analyzes. We used the Student t test to compare means, the Chi-Square or Fisher exact test for proportions, and the Wilcoxon-Mann Whitney test for medians...
May 2017: Revista do Colégio Brasileiro de Cirurgiões
https://www.readbyqxmd.com/read/28765479/early-intracardiac-thrombus-and-pulmonary-embolus-after-trauma
#18
Neel Desai, Julia Heid, Andrew Leitch
Here, we present the case of a patient with the findings of an early intracardiac thrombus and a pulmonary embolus after major trauma. A large clot was identified extending from the inferior vena cava into the right atrium and ventricle in the setting of preserved right ventricular function. Post-traumatic intracardiac thrombus is extremely rare and no comparable cases have previously been described in the absence of a congenital heart defect and obvious myocardial injury. Best practice afterpost-traumatic intracardiac thrombus is not well established but we found that early inferior vena cava filter placement and treatment with therapeutic coagulation resulted in clinical improvement, resolution of the thrombus and no further emboli...
July 31, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28765353/hemostatic-management-of-trauma-induced-coagulopathy
#19
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/28764996/coagulopathy-as-a-predictor-of-mortality-after-penetrating-traumatic-brain-injury
#20
Lindley E Folkerson, Duncan Sloan, Elizabeth Davis, Ryan S Kitagawa, Bryan A Cotton, John B Holcomb, Jeffrey S Tomasek, Charles E Wade
STUDY HYPOTHESIS: Traumatic brain injury (TBI) is a leading cause of mortality with penetrating TBI (p-TBI) patients having worse outcomes. These patients are more likely to be coagulopathic than blunt TBI (b-TBI) patients, thus we hypothesize that coagulopathy would be an early predictor of mortality. METHODS: We identified highest-level trauma activation patients who underwent an admission head CT and had ICU admission orders from August 2009-May 2013, excluding those with polytrauma and anticoagulant use...
July 5, 2017: American Journal of Emergency Medicine
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