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https://www.readbyqxmd.com/read/27913815/-volume-therapy-in-the-severely-injured-patient-recommendations-and-current-guidelines
#1
Sigune Kaske, Marc Maegele
BACKGROUND: Volume therapy is a cornerstone of early resuscitation of severely injured trauma patients, but the optimal strategy remains under debate. A recent Cochrane review could not find evidence for or against early volume replacement or large versus small amounts of fluid. METHOD: Current recommendations and guidelines regarding volume therapy in severely injured patients are summarized based upon the updated European Trauma Guideline on the management of major bleeding and coagulopathy following trauma (fourth edition) and the S3-Guideline Polytrauma and combined with a selective review of the literature...
December 2, 2016: Der Unfallchirurg
https://www.readbyqxmd.com/read/27908524/genetic-correlation-between-alcohol-preference-and-conditioned-fear-exploring-a-functional-relationship
#2
Julia A Chester, Marcus M Weera
Post-traumatic stress disorder (PTSD) and alcohol-use disorders have a high rate of co-occurrence, possibly because they are regulated by common genes. In support of this idea, mice selectively bred for high (HAP) alcohol preference show greater fear potentiated startle (FPS), a model for fear-related disorders such as PTSD, compared to mice selectively bred for low (LAP) alcohol preference. This positive genetic correlation between alcohol preference and FPS behavior suggests that the two traits may be functionally related...
November 23, 2016: Alcohol
https://www.readbyqxmd.com/read/27906870/effectiveness-of-low-molecular-weight-heparin-versus-unfractionated-heparin-to-prevent-pulmonary-embolism-following-major-trauma-a-propensity-matched-analysis
#3
James P Byrne, William Geerts, Stephanie A Mason, David Gomez, Christopher Hoeft, Ryan Murphy, Melanie Neal, Avery B Nathens
BACKGROUND: Pulmonary embolism (PE) is a leading cause of delayed mortality in patients with severe injury. While low molecular weight heparin (LMWH) is often favored over unfractionated heparin (UH) for thromboprophylaxis, evidence is lacking to demonstrate an effect on the occurrence of PE. This study compared the effectiveness of LMWH versus UH to prevent PE in patients following major trauma. METHODS: Data for adults with severe injury who received thromboprophylaxis with LMWH or UH were derived from the American College of Surgeons Trauma Quality Improvement Program (2012-2015)...
November 30, 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27895945/congenital-renal-fusion-and-ectopia-in-the-trauma-patient
#4
Andrew A Rosenthal, Jordan J Ditchek, Seong K Lee, Rafael Sanchez, Chauniqua Kiffin, Dafney L Davare, Eddy H Carrillo
We present two separate cases of young male patients with congenital kidney anomalies (horseshoe and crossed fused renal ectopia) identified following blunt abdominal trauma. Despite being rare, ectopic and fusion anomalies of the kidneys are occasionally noted in a trauma patient during imaging or upon exploration of the abdomen. Incidental renal findings may influence the management of traumatic injuries to preserve and protect the patient's renal function. Renal anomalies may be asymptomatic or present with hematuria, flank or abdominal pain, hypotension, or shock, even following minor blunt trauma or low velocity impact...
2016: Case Reports in Emergency Medicine
https://www.readbyqxmd.com/read/27894499/resuscitative-endovascular-balloon-occlusion-of-the-aorta-indications-outcomes-and-training
#5
REVIEW
Lena M Napolitano
Exsanguinating torso hemorrhage is a leading killer of trauma patients. The most appropriate means of hemorrhage control must be used. Trauma surgeons should have expertise with all approaches for prompt hemorrhage control [laparotomy, thoracotomy, resuscitative endovascular balloon occlusion of the aorta (REBOA), and resuscitative thoracotomy]. REBOA is an exciting adjunct for hemorrhage control as it can be deployed quickly and placed percutaneously. Balloon inflation can vary dependent on patient physiology...
January 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/27894494/optimal-fluid-therapy-for-traumatic-hemorrhagic-shock
#6
REVIEW
Ronald Chang, John B Holcomb
The resuscitation of traumatic hemorrhagic shock has undergone a paradigm shift in the last 20 years with the advent of damage control resuscitation (DCR). Major principles of DCR include minimization of crystalloid, permissive hypotension, transfusion of a balanced ratio of blood products, and goal-directed correction of coagulopathy. In particular, plasma has replaced crystalloid as the primary means for volume expansion for traumatic hemorrhagic shock. Predicting which patient will require DCR by prompt and accurate activation of a massive transfusion protocol, however, remains a challenge...
January 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/27893618/early-resuscitation-with-lyophilized-plasma-provides-equal-neuroprotection-compared-with-fresh-frozen-plasma-in-a-large-animal-survival-model-of-traumatic-brain-injury-and-hemorrhagic-shock
#7
Ihab Halaweish, Ted Bambakidis, Vahagn C Nikolian, Patrick Georgoff, Peter Bruhn, Patryk Piascik, Lisa Buckley, Ashok Srinivasan, Baoling Liu, Yongqing Li, Hasan B Alam
BACKGROUND: Combined traumatic brain injury (TBI) and hemorrhagic shock (HS) is highly lethal. In previous models of combined TBI + HS, we showed that early resuscitation with fresh frozen plasma (FFP) improves neurologic outcomes. Delivering FFP, however, in austere environments is difficult. Lyophilized plasma (LP) is a logistically superior alternative to FFP, but data are limited regarding its efficacy for treatment of TBI. We conducted this study to determine the safety and long-term outcomes of early treatment with LP in a large animal model of TBI + HS...
December 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27883130/nanobubbles-cavitation-shock-waves-and-traumatic-brain-injury
#8
Upendra Adhikari, Ardeshir Goliaei, Max L Berkowitz
Collapse of bubbles, microscopic or nanoscopic, due to their interaction with the impinging pressure wave produces a jet of particles moving in the direction of the wave. If there is a surface nearby, the high-speed jet particles hit it, and as a result damage to the surface is produced. This cavitation effect is well known and intensely studied in case of microscopic sized bubbles. It can be quite damaging to materials, including biological tissues, but it can also be beneficial when controlled, like in case of sonoporation of biological membranes for the purpose of drug delivery...
November 24, 2016: Physical Chemistry Chemical Physics: PCCP
https://www.readbyqxmd.com/read/27876077/post-traumatic-acute-kidney-injury-a-cross-sectional-study-of-trauma-patients
#9
Wei-Hung Lai, Cheng-Shyuan Rau, Shao-Chun Wu, Yi-Chun Chen, Pao-Jen Kuo, Shiun-Yuan Hsu, Ching-Hua Hsieh, Hsiao-Yun Hsieh
BACKGROUND: The causes of post-traumatic acute kidney injury (AKI) are multifactorial, and shock associated with major trauma has been proposed to result in inadequate renal perfusion and subsequent AKI in trauma patients. This study aimed to investigate the true incidence and clinical presentation of post-traumatic AKI in hospitalized adult patients and its association with shock at a Level I trauma center. METHODS: Detailed data of 78 trauma patients with AKI and 14,504 patients without AKI between January 1, 2009 and December 31, 2014 were retrieved from the Trauma Registry System...
November 22, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/27869558/polynitroxylated-pegylated-hemoglobin-a-novel-small-volume-therapeutic-for-traumatic-brain-injury-resuscitation-comparison-to-whole-blood-and-dose-response-evaluation
#10
Erik C Brockman, Travis C Jackson, C Edward Dixon, Hulya Bayir, Robert Clark, Vincent A Vagni, Keri L Janesko, Catherine Byrd, Li Ma, Carleton J C Hsia, Patrick M Kochanek
: Resuscitation with polynitroxylated pegylated hemoglobin (PNPH), a PEGylated bovine hemoglobin decorated with nitroxides, eliminated the need for fluid administration, reduced ICP and brain edema, and produced neuroprotection in vitro and in vivo vs. lactated Ringer's (LR) in experimental traumatic brain injury (TBI) plus hemorrhagic shock (HS). HYPOTHESIS: Resuscitation with PNPH will improve acute physiology vs. whole blood after TBI+HS and will be safe and effective across a wide dosage range...
November 21, 2016: Journal of Neurotrauma
https://www.readbyqxmd.com/read/27862591/patient-experiences-of-acute-myeloid-leukemia-aml-a-qualitative-study-about-diagnosis-illness-understanding-and-treatment-decision-making
#11
Thomas W LeBlanc, Laura J Fish, Catherine T Bloom, Areej El-Jawahri, Debra M Davis, Susan C Locke, Karen E Steinhauser, Kathryn I Pollak
PURPOSE: Patients with acute myeloid leukemia (AML) face a unique, difficult situation characterized by sudden changes in health, complex information, and pressure to make quick treatment decisions amid sizeable tradeoffs. Yet, little is known about patients' experiences with AML. We used qualitative methods to learn about their experiences with diagnosis and treatment decision-making, to identify areas for improvement. METHODS: We recruited hospitalized patients with AML to participate in semi-structured qualitative interviews about their experiences being diagnosed with AML, receiving information, and making a treatment decision...
November 15, 2016: Psycho-oncology
https://www.readbyqxmd.com/read/27857892/arterial-ammonia-levels-prognostic-marker-in-traumatic-hemorrhage
#12
Anurag Singla, Satinder Kaur, Navjot Kaur, C S Gill
BACKGROUND: In blunt trauma, extent of hemorrhage cannot be determined by physical examination, and vital signs may also not give clear picture in all the patients, especially young healthy ones. Hemorrhagic shock has been reported to increase blood ammonia levels. Arterial ammonia was analyzed in blunt trauma abdomen patients and correlated with shock index (SI). Its predictive value was determined for timely decision of intervention. MATERIALS AND METHODS: Hundred blunt trauma abdomen patients presented in the emergency ward of tertiary care hospital were included in the study...
October 2016: International Journal of Applied and Basic Medical Research
https://www.readbyqxmd.com/read/27855566/experimental-investigation-of-cavitation-as-a-possible-damage-mechanism-in-blast-induced-traumatic-brain-injury-in-post-mortem-human-subject-heads
#13
Robert S Salzar, Derrick Treichler, Andrew Wardlaw, Greg Weiss, Jacques Goeller
The potential of blast induced traumatic brain injury from the mechanism of localized cavitation of the cerebral spinal fluid is investigated. While the mechanism and criteria for non-impact blast-induced TBI injury is still unknown, this study demonstrates that local cavitation in the CSF layer of the cranial volume could contribute to these injuries. The cranial contents of three post mortem human surrogate cephali were replaced with both a normal saline solution, and a ballistic gel mixture with a simulated CSF layer...
November 17, 2016: Journal of Neurotrauma
https://www.readbyqxmd.com/read/27848054/incidence-and-predictive-risk-factors-of-postoperative-sepsis-in-orthopedic-trauma-patients
#14
Nikita Lakomkin, Vasanth Sathiyakumar, Brandon Wick, Michelle S Shen, A Alex Jahangir, Hassan Mir, William T Obremskey, Ashley C Dodd, Manish K Sethi
BACKGROUND: Postoperative sepsis is associated with high mortality and the national costs of septicemia exceed those of any other diagnosis. While numerous studies in the basic orthopedic science literature suggest that traumatic injuries facilitate the development of sepsis, it is currently unclear whether orthopedic trauma patients are at increased risk. The purpose of this study was thus to assess the incidence of sepsis and determine the risk factors that significantly predicted septicemia following orthopedic trauma surgery...
November 15, 2016: Journal of Orthopaedics and Traumatology: Official Journal of the Italian Society of Orthopaedics and Traumatology
https://www.readbyqxmd.com/read/27846895/development-and-validation-of-a-prehospital-prediction-model-for-acute-traumatic-coagulopathy
#15
Ithan D Peltan, Ali Rowhani-Rahbar, Lisa K Vande Vusse, Ellen Caldwell, Thomas D Rea, Ronald V Maier, Timothy R Watkins
BACKGROUND: Acute traumatic coagulopathy (ATC) is a syndrome of early, endogenous clotting dysfunction that afflicts up to 30% of severely injured patients, signaling an increased likelihood of all-cause and hemorrhage-associated mortality. To aid identification of patients within the likely therapeutic window for ATC and facilitate study of its mechanisms and targeted treatment, we developed and validated a prehospital ATC prediction model. METHODS: Construction of a parsimonious multivariable logistic regression model predicting ATC - defined as an admission international normalized ratio >1...
November 16, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27843049/acute-hospital-administration-of-amiodarone-and-or-lidocaine-in-shockable-patients-presenting-with-out-of-hospital-cardiac-arrest-a-nationwide-cohort-study
#16
Chien-Hua Huang, Ping-Hsun Yu, Min-Shan Tsai, Po-Ya Chuang, Tzung-Dau Wang, Chih-Yen Chiang, Wei-Tien Chang, Matthew Huei-Ming Ma, Chao-Hsiun Tang, Wen-Jone Chen
BACKGROUND: Terminating ventricular fibrillation (VF) or pulseless ventricular tachyarrhythmia (VT) is critical for successful resuscitation of patients with shockable cardiac arrest. In the event of shock-refractory VF, applicable guidelines suggest use of anti-arrhythmic agents. However, subsequent long-term outcomes remain unclear. A nationwide cohort study was therefore launched, examining 1-year survival rates in patients given amiodarone and/or lidocaine for cardiac arrest. METHODS: Medical records accruing between years 2004 and 2011 were retrieved from the Taiwan National Health Insurance Research Database (NHIRD) for review...
November 9, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27822945/validation-of-the-shock-index-modified-shock-index-and-age-shock-index-for-predicting-mortality-of-geriatric-trauma-patients-in-emergency-departments
#17
Soon Yong Kim, Ki Jeong Hong, Sang Do Shin, Young Sun Ro, Ki Ok Ahn, Yu Jin Kim, Eui Jung Lee
The shock index (SI), modified shock index (MSI), and age multiplied by SI (Age SI) are used to assess the severity and predict the mortality of trauma patients, but their validity for geriatric patients is controversial. The purpose of this investigation was to assess predictive value of the SI, MSI, and Age SI for geriatric trauma patients. We used the Emergency Department-based Injury In-depth Surveillance (EDIIS), which has data from 20 EDs across Korea. Patients older than 65 years who had traumatic injuries from January 2008 to December 2013 were enrolled...
December 2016: Journal of Korean Medical Science
https://www.readbyqxmd.com/read/27821370/ptsd-social-anxiety-disorder-and-trauma-an-examination-of-the-influence-of-trauma-type-on-comorbidity-using-a-nationally-representative-sample
#18
Katherine A McMillan, Gordon J G Asmundson
Posttraumatic stress disorder (PTSD) and social anxiety disorder (SAD) are highly comorbid (Collimore et al., 2010). Trauma may present a shared environmental factor contributing to the development of comorbidity; however, existent research has been hampered by use of restrictive samples and limitations in the range of traumas investigated. The current study examines the relationship between a broad range of potentially traumatic events and the comorbidity between PTSD and SAD using Wave 2 of the National Epidemiological Survey of Alcohol and Related Conditions (n=34,653)...
October 18, 2016: Psychiatry Research
https://www.readbyqxmd.com/read/27815579/extracorporeal-membrane-oxygenation-improves-coagulopathy-in-an-experimental-traumatic-hemorrhagic-model
#19
M Larsson, P Forsman, P Hedenqvist, A Östlund, J Hultman, A Wikman, L Riddez, B Frenckner, M Bottai, C-M Wahlgren
PURPOSE: Hemorrhage is the most common cause of preventable death after trauma. Coagulopathy plays a central role in uncontrolled bleeding and is caused by multiple factors. Extracorporeal Membrane Oxygenation (ECMO) is an established treatment for patients with respiratory failure and has in recent years also been used in severely injured trauma patients with cardiopulmonary failure and coexisting bleeding shock. The aim of this study was to evaluate the effect of ECMO on hypothermia, acidosis, and coagulopathy in a traumatic hemorrhagic rabbit model...
November 4, 2016: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/27805998/big-children-or-little-adults-a-statewide-analysis-of-adolescent-isolated-severe-traumatic-brain-injury-outcomes-at-pediatric-versus-adult-trauma-centers
#20
Brian W Gross, Mathew M Edavettal, Alan D Cook, Cole D Rinehart, Caitlin A Lynch, Eric H Bradburn, Daniel Wu
BACKGROUND: The appropriate managing center for adolescent trauma patients is debated. We sought to determine whether outcome differences existed for adolescent severe traumatic brain injury (sTBI) patients treated at pediatric versus adult trauma centers. We hypothesized that no difference in mortality, functional status at discharge (FSD) or overall complication rate would be observed between center types. METHODS: All adolescent trauma patients (aged 15-17 years) presenting with isolated sTBI (head Abbreviated Injury Scale [AIS] score ≥3; all other AIS body region scores ≤2) to accredited level I-II trauma centers in Pennsylvania from 2003-2015 were extracted from the Pennsylvania Trauma Outcome Study database...
October 31, 2016: Journal of Trauma and Acute Care Surgery
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