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Damage control resuscitation

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https://www.readbyqxmd.com/read/29764844/second-look-laparostomy-for-perforated-gangrenous-gastric-volvulus-to-prevent-total-gastrectomy
#1
Paul K Okeny, Omar Abbassi, Ali Warsi
A 42-year-old Caucasian woman presented to the emergency department with severe upper abdominal pain and vomiting. Clinically, she was septic, and abdominal examination suggested peritonitis. Following immediate resuscitation, the patient was stabilised and underwent urgent contrast-enhanced CT of the abdomen and pelvis. This revealed a mesenteroaxial gastric volvulus with traction on the mesentery and a small volume of free fluid. She underwent laparotomy revealing gangrenous gastric fundus perforation complicated by persistent intraoperative hypotension...
May 15, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29745298/impact-of-a-prehospital-discrimination-between-trauma-patients-with-or-without-early-acute-coagulopathy-of-trauma-and-the-need-for-damage-control-resuscitation-rationale-and-design-of-a-multicenter-randomized-phase-ii-trial
#2
Martin Tonglet, Frédéric Swerts, Vincenzo D'Orio, Didier Moens, François-Xavier Lens, Jérémy Alves, Maximilien Thoma, Bernard Kreps, Pierre Youata Towo, Romain Betz, Gerard Decoster B, Michèle Guillaume, Eddy Husson, Anne Françoise Donneau, Jean Louis Poplavsky, Jean Marc Minon, Alexandre Guysen
BACKGROUND: The evidence of the Trauma Induced Coagulopathy Clinical Score (TICCS) accuracy has been evaluated in several studies but the potential effect of its use on patient outcomes needs to be evaluated. The primary objective of this study is to evaluate the impact on mortality of a prehospital discrimination between trauma patients with or without a potential need for damage control resuscitation. METHODS: The trial will be designed as randomized phase II clinical trial with comparison of the experimental protocol against the standard of care...
May 10, 2018: Acta Chirurgica Belgica
https://www.readbyqxmd.com/read/29741715/forward-surgical-team-experience-fste-is-associated-with-increased-confidence-with-combat-surgeon-trauma-skills
#3
D Joshua Mancini, Brian P Smith, Travis M Polk, C William Schwab
Introduction: Little is known regarding the confidence of military surgeons prior to combat zone deployment. Military surgeons are frequently deployed without peers experienced in combat surgery. We hypothesized that forward surgical team experience (FSTE) increases surgeon confidence with critical skill sets. Methods: We conducted a national survey of military affiliated personnel. We used a novel survey instrument that was piloted and validated by experienced military surgeons to collect demographics, education, practice patterns, and confidence parameters for trauma and surgical critical care skills...
May 8, 2018: Military Medicine
https://www.readbyqxmd.com/read/29726010/lower-versus-higher-oxygen-concentrations-titrated-to-target-oxygen-saturations-during-resuscitation-of-preterm-infants-at-birth
#4
REVIEW
Kei Lui, Lisa J Jones, Jann P Foster, Peter G Davis, See Kwee Ching, Ju Lee Oei, David A Osborn
BACKGROUND: Initial resuscitation with air is well tolerated by most infants born at term. However, the optimal fractional inspired oxygen concentration (FiO2 - proportion of the breathed air that is oxygen) targeted to oxygen saturation (SpO2 - an estimate of the amount of oxygen in the blood) for infants born preterm is unclear. OBJECTIVES: To determine whether lower or higher initial oxygen concentrations, when titrated according to oxygen saturation targets during the resuscitation of preterm infants at birth, lead to improved short- and long-term mortality and morbidity...
May 4, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29685615/effectiveness-and-safety-of-continuous-neuromuscular-blockade-in-trauma-patients-with-an-open-abdomen-a-follow-up-study
#5
Susan E Smith, Susan E Hamblin, Oscar D Guillamondegui, Oliver L Gunter, Bradley M Dennis
BACKGROUND: Neuromuscular blocking agents (NMBA) have been associated with decreased time to fascial closure following damage control laparotomy (DCL). Changes in resuscitation over the last decade bring this practice into question. METHODS: A retrospective cohort study of adults who underwent DCL between 2009 and 2015 was conducted at an ACS-verified level 1 trauma center. The study group (NMBA+) received continuous NMBA within 24 h of DCL. Data collected included demographics, resuscitative fluids, mortality, and complications...
April 18, 2018: American Journal of Surgery
https://www.readbyqxmd.com/read/29664514/-damage-control-resuscitation-in-pediatric-severe-trauma
#6
Adriana Wegner Araya
INTRODUCTION: Trauma is an important cause of morbidity and mortality in the pediatric population. It has the first place in mortality in our country without considering perinatal pathologies and congenital malformations. An important percentage of early and late deaths secondary to this cau se, as well as its sequelae, could be prevented with optimal and timely resuscitation. OBJECTIVE: To review the applicability of damage control resuscitation (DCR) in severe pediatric trauma, with emphasis on medical management...
February 2018: Revista Chilena de Pediatría
https://www.readbyqxmd.com/read/29657727/preoperative-fluid-restriction-for-trauma-patients-with-hemorrhagic-shock-decreases-ventilator-days
#7
Shigenari Matsuyama, Ryusuke Miki, Hirotada Kittaka, Haruki Nakayama, Shota Kikuta, Satoshi Ishihara, Shinichi Nakayama
Aim: In recent years, with the concept of damage control resuscitation, hemostasis and preoperative fluid restriction have been carried out, but there is controversy regarding the effectiveness of fluid restriction. Methods: From April 2007 to March 2013, 101 trauma patients presented with hemorrhagic shock (systolic blood pressure ≤90 mmHg) at the prehospital or emergency department and were admitted to Hyogo Emergency Medical Center (Hyogo, Japan). They underwent emergency hemostasis by surgery and transcatheter arterial embolization...
April 2018: Acute Medicine & Surgery
https://www.readbyqxmd.com/read/29644270/importance-of-the-capability-for-complete-resuscitative-treatment-combining-surgery-and-interventional-radiology-for-potentially-lethal-multiple-injuries-a-case-report
#8
Hiroyuki Otsuka, Toshiki Sato, Keiji Sakurai, Hiromichi Aoki, Takeshi Yamagiwa, Shinichi Iizuka, Sadaki Inokuchi
Background: Recently, trauma management has been complicated owing to the introduction of damage-control strategies and interventional radiology. Here, we discuss important aspects regarding survival of patients with severe trauma. Case presentation: A 74-year-old Japanese woman experienced a traffic accident on a highway. On arrival, paramedics were unable to measure her blood pressure, and her condition deteriorated. The patient was immediately transferred to our hospital in a physician-staffed emergency helicopter, during which she was administered emergency blood transfusions...
October 2017: Trauma Case Reports
https://www.readbyqxmd.com/read/29643121/fast-in-the-deployed-military-setting
#9
Nicholas James Carter, D Gay
INTRODUCTION: Focused assessment with sonography in trauma (FAST) is historically an effective method of assessing the patient in the trauma bay in order to aid decision-making and optimise patient outcomes. However, in the UK civilian practice, the use of FAST may decline given a recent change in National Institute for Health and Care Excellence guidance as a result of improvement in CT availability and resuscitation techniques. METHOD: In the Role 3 Medical Treatment Facility, Camp Bastion, 187 patients with trauma who received FAST in the trauma bay in 2014 were reviewed to determine the accuracy of FAST in the deployed environment...
April 10, 2018: Journal of the Royal Army Medical Corps
https://www.readbyqxmd.com/read/29630130/inhibitive-effects-of-microrna-34a-on-protecting-against-ischemia-reperfusion-injury-of-vital-organs-in-hemorrhagic-shock-pregnant-mice
#10
L-B Qin, Z-Y Li, H Li, X-Q Fan, H-G Liu, X-M Dong, W-Y Jia
OBJECTIVE: Hemorrhagic shock is a common vital condition in obstetrics, and major treatment consists of bleeding control and liquid resuscitation. MicroRNA (miR) has been found to regulate multiple diseases. However, its expression profile in hemorrhagic shock or effects on the ischemia-reperfusion injury in pregnant mice has not been reported yet. PATIENTS AND METHODS: This study generated rat hemorrhagic shock pregnant model, on which real-time quantitative PCR was used to measure miR-34a expressions...
March 2018: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/29627883/platelet-transfusion-increases-risk-for-acute-respiratory-distress-syndrome-in-non-massively-transfused-blunt-trauma-patients
#11
George Kasotakis, Nichole Starr, Erek Nelson, Bedabrata Sarkar, Peter Ashley Burke, Daniel George Remick, Ronald Gary Tompkins
PURPOSE: While damage control resuscitation is known to confer a survival advantage in severely injured patients, high-ratio blood component therapy should be initiated only in carefully selected trauma patients, due to the morbidity associated with blood product use. With this project, we aim to identify the effect of platelet transfusion in non-massively transfused bluntly injured patients. METHODS: The Glue Grant database was retrospectively queried and severely injured blunt trauma patients who underwent non-massive transfusion were identified...
April 7, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29613950/-immediate-effects-of-blood-donation-on-physical-and-cognitive-performance-a-randomized-controlled-double-blinded-trial
#12
Håkon S Eliassen, Tor Hervig, Sebastian Backlund, Joar Sivertsen, Vegard Vereiede Iversen, Morten Kristoffersen, Eivind Wengaard, Arne Gramstad, Theodor Fosse, Christopher K Bjerkvig, Torunn Apelseth, Heidi Doughty, Geir Strandenes
BACKGROUND: The success of implementing Damage Control Resuscitation principles pre-hospital has been at the expense of several logistic burdens including the requirements for resupply, and the question of donor safety during the development of whole blood programs. Previous studies have reported effects on physical performance after blood donation, however none have investigated the effects of blood donation on cognitive performance. METHOD: We describe a prospective double blinded, randomized controlled study comprised of a battery of tests: three cognitive tests, and VO2max testing on a cycle ergometer...
March 22, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29594359/-vascular-surgical-training-concept-for-military-surgeons-in-germany
#13
REVIEW
M Engelhardt, K Elias, B Friemert, K Klemm, C Willy
BACKGROUND: Due to the increasing threat of terrorist attacks and assassinations even in Europe, the interest in management of severe vascular injuries, which, with an increased incidence of 10% are to be expected with such penetrating wounds, is also growing; however, with increasing subspecialization in surgery there is a threat that the know-how in vascular surgery will become lost among non-vascular surgical specialists. Therefore, the Germany military established an educational program, the so-called DUOplus concept, to ensure that future military surgeons acquire and retain the experience and skills to fulfill the demanding role of a deployed surgeon...
March 28, 2018: Der Unfallchirurg
https://www.readbyqxmd.com/read/29554037/adaptive-and-platform-trials-in-remote-damage-control-resuscitation
#14
Juliana Tolles, Roger J Lewis
The traditional approach to clinical trial design requires assuming precise values for multiple unknown parameters, resulting is a trial design that is unlikely to perform well if one or more of those assumptions turn out to be incorrect. During conduct of the trial, trial characteristics are often held fixed, even if incoming data suggest that one or more design assumptions were incorrect. This leads to an increased risk of a failed trial. In contrast, an adaptive clinical trial is designed to take advantage of partial, incoming data during the conduct of the trial, modifying key clinical trial characteristics according to prespecified rules, in order to avoid a failed or inconclusive trial, improve statistical efficacy, better treat patients within the trial, or achieve other scientific or ethical goals...
March 16, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29547998/damage-control-resuscitation-supplemented-with-vasopressin-in-a-severe-polytrauma-model-with-traumatic-brain-injury-and-uncontrolled-internal-hemorrhage
#15
J Michael Dickson, Xu Wang, Alexander E St John, Esther B Lim, Susan A Stern, Nathan J White
Introduction: Traumatic brain injury (TBI) and hemorrhagic shock (HS) are the leading causes of traumatic death worldwide and particularly on the battlefield. They are especially challenging when present simultaneously (polytrauma), and clear blood pressure end points during fluid resuscitation are not well described for this situation. The goal of this study is to evaluate for any benefit of increasing blood pressure using a vasopressor on brain blood flow during initial fluid resuscitation in a swine polytrauma model...
March 14, 2018: Military Medicine
https://www.readbyqxmd.com/read/29538225/interventional-vitamin-c-a-strategy-for-attenuation-of-coagulopathy-and-inflammation-in-a-swine-polytrauma-model
#16
Penny S Reynolds, Bernard J Fisher, Jacquelyn McCarter, Christopher Sweeney, Erika J Martin, Paul Middleton, Matthew Ellenberg, Evan Fowler, Donald F Brophy, Alpha A Fowler, Bruce D Spiess, Ramesh Natarajan
BACKGROUND: Coagulopathy and inflammation induced by hemorrhagic shock and traumatic injury are associated with increased mortality and morbidity. Vitamin C (VitC) is an antioxidant with potential protective effects on the pro-inflammatory and pro-coagulant pathways. We hypothesized that high-dose VitC administered as a supplement to fluid resuscitation would attenuate inflammation, coagulation dysfunction, and end-organ tissue damage in a swine model of polytrauma and hemorrhage. METHODS: Male Sinclair swine (n = 24; mean body weight 27 kg) were anesthetized, intubated, mechanically ventilated, and instrumented for physiological monitoring...
March 12, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29533448/prehospital-medicine-and-the-future-will-ecmo-ever-play-a-role
#17
David Macku, Pavel Hedvicak, John Quinn, Vladimir Bencko
Due to the hybrid warfare currently experienced by multiple NATO coalition and NATO partner nations, the tactical combat casualty care (TCCC) paradigm is greatly challenged. One of the major challenges to TCCC is the ad hoc extension phase in resource-poor environments, referred to as prolonged field care (PFC) and forward resuscitative care (FRC). The nuanced clinical skills with limited resources required by warfighters and auxiliary health care professionals to mitigate death on the battlefield and prevent morbidity and mortality in the PFC phase represent a balance that is still under review...
December 0: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/29493552/pediatric-trauma-transfusion-and-cognitive-aids
#18
Anna Clebone
PURPOSE OF REVIEW: Trauma is the most common cause of pediatric mortality. Much of the research that led to life-saving interventions in adults, however, has not been replicated in the pediatric population. Children have important physiologic and anatomic differences from adults, which impact hemostasis and transfusion. Hemorrhage is a leading cause of death in trauma, and children have important differences in their coagulation profiles. Transfusion strategies, including the massive transfusion protocol and use of antifibrinolytics, are still controversial...
April 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29474273/damage-control-resuscitation-in-pediatric-trauma
#19
Meghan Gilley, Suzanne Beno
PURPOSE OF REVIEW: Damage control resuscitation is an overall management strategy used in trauma patients to rapidly restore physiologic stability, while mitigating hypothermia, coagulopathy and acidosis. We review the evidence and current practice of damage control resuscitation in pediatric trauma patients with a specific focus on fluid management. RECENT FINDINGS: There have been a number of studies over the last several years examining crystalloid fluid resuscitation, balanced blood product transfusion practice and hemostatic agents in pediatric trauma...
June 2018: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/29462086/emergency-sternal-intraosseous-access-for-warm-fresh-whole-blood-transfusion-in-damage-control-resuscitation-sternal-intraosseous-access-in-dcr
#20
Christopher Kalhagen Bjerkvig, Theodor Fosse, Torunn Oveland Apelseth, Joar Sivertsen, Hanne Braathen, Håkon Skogrand Eliassen, Anne Berit Guttormsen, Andrew P Cap, Geir Strandenes
BACKGROUND: Intraosseous (IO) vascular access is increasingly used as an emergency tool for achieving access to the systemic circulation in critically ill patients. The role of IO transfusion of blood in Damage Control Resuscitation is however questionable due to possible inadequate flow rate and hemolysis. Some experts claim that IO transfusion is contraindicated. In this study we have challenged this statement by looking at flow rates of autologous fresh whole blood reinfusion and hemolysis using two of the commonly used FDA-approved and CE-marked sternal needles...
February 17, 2018: Journal of Trauma and Acute Care Surgery
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