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Damage control resuscitation

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https://www.readbyqxmd.com/read/29156155/leukotriene-b4-indicates-lung-injury-and-on-going-inflammatory-changes-after-severe-trauma-in-a-porcine-long-term-model
#1
Philipp Störmann, Birgit Auner, Lukas Schimunek, Rafael Serve, Klemens Horst, Tim-P Simon, Roman Pfeifer, Kernt Köhler, Frank Hildebrand, Sebastian Wutzler, Hans-Christoph Pape, Ingo Marzi, Borna Relja
BACKGROUND: Recognizing patients at risk for pulmonary complications (PC) is of high clinical relevance. Migration of polymorphonuclear leukocytes (PMN) to inflammatory sites plays an important role in PC, and is tightly regulated by specific chemokines including interleukin (IL)-8 and other mediators such as leukotriene (LT)B4. Previously, we have reported that LTB4 indicated early patients at risk for PC after trauma. Here, the relevance of LTB4 to indicating lung integrity in a newly established long-term porcine severe trauma model (polytrauma, PT) was explored...
December 2017: Prostaglandins, Leukotrienes, and Essential Fatty Acids
https://www.readbyqxmd.com/read/29132584/damage-control-advances-in-trauma-resuscitation
#2
EDITORIAL
Amal Mattu
No abstract text is available yet for this article.
February 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29132576/management-of-major-vascular-injuries-neck-extremities-and-other-things-that-bleed
#3
REVIEW
Chris Evans, Tim Chaplin, David Zelt
Vascular injuries represent a significant burden of mortality and disability. Blunt injuries to the neck vessels can present with signs of stroke either immediately or in a delayed fashion. Most injuries are detected with computed tomography angiography and managed with either antiplatelet medications or anticoagulation. In contrast, patients with penetrating injuries to the neck vessels require airway management, hemorrhage control, and damage control resuscitation before surgical repair. The keys to diagnosis and management of peripheral vascular injury include early recognition of the injury; hemorrhage control with direct pressure, packing, or tourniquets; and urgent surgical consultation...
February 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29132575/acute-management-of-the-traumatically-injured-pelvis
#4
REVIEW
Steven Skitch, Paul T Engels
Severe pelvic trauma is a challenging condition. The pelvis can create multifocal hemorrhage that is not easily compressible nor managed by traditional surgical methods such as tying off a blood vessel or removing an organ. Its treatment often requires reapproximation of bony structures, damage control resuscitation, assessment for associated injuries, and triage of investigations, as well as multimodality hemorrhage control (external fixation, preperitoneal packing, angioembolization, REBOA [resuscitative endovascular balloon occlusion of the aorta]) by multidisciplinary trauma specialists (general surgeons, orthopedic surgeons, endovascular surgeons/interventional radiologists)...
February 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29132511/resuscitation-for-hypovolemic-shock
#5
REVIEW
Kyle J Kalkwarf, Bryan A Cotton
Hemorrhage is the leading cause of preventable deaths in trauma patients. After presenting a brief history of hemorrhagic shock resuscitation, this article discusses damage control resuscitation and its adjuncts. Massively bleeding patients in hypovolemic shock should be treated with damage control resuscitation principles including limited crystalloid, whole blood or balance blood component transfusion to permissive hypotension, preventing hypothermia, and stopping bleeding as quickly as possible.
December 2017: Surgical Clinics of North America
https://www.readbyqxmd.com/read/29123911/perimortem-cesarean-delivery-and-subsequent-emergency-hysterectomy-new-strategy-for-maternal-cardiac-arrest
#6
Mayako Goto, Hiroaki Watanabe, Kazuhide Ogita, Tetsuya Matsuoka
Cases: Perimortem cesarean delivery (PMCD) is the only way to resuscitate pregnant women in cardiac arrest, and has been found to increase maternal resuscitation rate by increasing circulating plasma volume. However, many obstetricians have not experienced a case of PMCD, as situations requiring it are rare. We report our strategy for cases of maternal cardiac arrest, on the basis of a review of published work, and present two case reports from our medical center. Outcomes: In case 1, PMCD led to death by massive bleeding...
October 2017: Acute Medicine & Surgery
https://www.readbyqxmd.com/read/29123853/high-grade-traumatic-torso-visceral-injury-with-hemodynamic-instability-effectiveness-of-transarterial-embolization-using-n-butyl-cyanoacrylate
#7
REVIEW
Junya Tsurukiri, Shoichi Ohta, Akira Hoshiai, Hidefumi Sano, Eitaro Okumura, Nobuhiko Tsubouchi, Hiroyuki Konishi, Tetsuo Yukioka
Trauma patients with uncontrolled hemorrhage encountering coagulopathy are often associated with poor outcome. Recently, the concept of damage control interventional radiology, which focuses on "speedy stoppage of bleeding" by interventional radiology among trauma patients with hemodynamic instability and acute traumatic coagulopathy, was proposed as an alternative to damage control surgery. N-butyl cyanoacrylate (NBCA) has been used as a liquid embolic agent in various non-traumatic situations, where it has been shown to have a high technical success rate and low recurrent bleeding rate, especially in patients with coagulopathy...
April 2017: Acute Medicine & Surgery
https://www.readbyqxmd.com/read/29122112/prehospital-transfusion-for-gastrointestinal-bleeding
#8
Maile E Parker, Mohammad A Khasawneh, Cornelius A Thiels, Kathleen S Berns, James R Stubbs, Donald H Jenkins, Scott P Zietlow, Martin D Zielinski
OBJECTIVE: Gastrointestinal (GI) bleeding is a common medical emergency with significant morbidity and mortality. Many patients are coagulopathic, which may perpetuate bleeding. Remote damage control resuscitation, including early correction of coagulopathy and anemia, may benefit exsanguinating patients with GI bleeding. METHODS: We conducted a retrospective review of patients with acute GI bleeding who received packed red blood cells (pRBC) and/or plasma during transportation to our institution between 2010 and 2014...
November 2017: Air Medical Journal
https://www.readbyqxmd.com/read/29115207/self-evaluated-competence-in-trauma-reception
#9
Kristin Julia Steinthorsdottir, Peter Svenningsen, Rasmus Fabricius, Lars Bo Svendsen, Jens Hillingsø, Martin Sillesen
INTRODUCTION: No formal training requirements exist for trauma teams in Denmark. The aim of this study was to investigate the point prevalence level of training and the self-evaluated competence of doctors involved in trauma care. METHODS: On two nights, all doctors on call at departments involved in trauma care were interviewed and answered a structured questionnaire pertaining to their level of training and self-evaluated level of competence in relevant skills...
November 2017: Danish Medical Journal
https://www.readbyqxmd.com/read/29099239/physician-approaches-to-conflict-with-families-surrounding-end-of-life-decision-making-in-the-icu-a-qualitative-study
#10
Hashim M Mehter, Jessica B McCannon, Jack A Clark, Renda Soylemez Wiener
RATIONALE: Families of critically ill patients are often asked to make difficult decisions to pursue, withhold or withdraw aggressive care or resuscitative measures, exercising "substituted judgment" from the imagined standpoint of the patient. Conflict may arise between intensive care unit (ICU) physicians and family members regarding the optimal course of care. OBJECTIVES: To characterize how ICU physicians approach and manage conflict with surrogates regarding end-of-life decision-making...
November 3, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/29097176/how-shall-we-transfuse-hippolyta
#11
Brendan C Graham, Lindsey J Graham, Carl H Rose, Jeffrey L Winters
The US Department of Defense recently made the decision to open direct ground combat roles to women. Blood product transfusion is an essential component of the US Military guidelines for tactical combat casualty care and damage control resuscitation, but blood transfusion carries with it the specific side effect of alloimmunization-a uniquely significant side effect for young women who may desire subsequent pregnancies. Presently to be considered are the changes that may need to be made to blood transfusion in the setting of battlefield medicine to optimally care for combat-injured women, as a majority of the existing data regarding the risks of transfusion in the trauma setting involve predominantly men...
October 31, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29088951/update-on-critical-care-for-acute-spinal-cord-injury-in-the-setting-of-polytrauma
#12
John K Yue, Ethan A Winkler, Jonathan W Rick, Hansen Deng, Carlene P Partow, Pavan S Upadhyayula, Harjus S Birk, Andrew K Chan, Sanjay S Dhall
Traumatic spinal cord injury (SCI) often occurs in patients with concurrent traumatic injuries in other body systems. These patients with polytrauma pose unique challenges to clinicians. The current review evaluates existing guidelines and updates the evidence for prehospital transport, immobilization, initial resuscitation, critical care, hemodynamic stability, diagnostic imaging, surgical techniques, and timing appropriate for the patient with SCI who has multisystem trauma. Initial management should be systematic, with focus on spinal immobilization, timely transport, and optimizing perfusion to the spinal cord...
November 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29077174/clinical-significance-of-dynamic-measurements-of-seric-tnf-%C3%AE-hmgbl-and-nse-levels-and-aeeg-monitoring-in-neonatal-asphyxia
#13
X-H Zhang, B-L Zhang, S-M Guo, P Wang, J-W Yang
OBJECTIVE: This study investigates the clinical value of monitoring blood levels of tumor necrosis factor-α (TNF-α), high mobility group protein Bl (HMGBl), and neuron-specific enolase (NSE), and examining an amplitude-integrated electroencephalogram (aEEG) for the diagnosis and short-term prognosis of brain damage caused by neonatal asphyxia. PATIENTS AND METHODS: Sixty full-term neonates born in Yidu Central Hospital from January to December 2015 were enrolled in the study...
October 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/29067785/pre-hospital-transfusion-of-red-blood-cells-in-civilian-trauma-patients
#14
M Rehn, A E Weaver, S Eshelby, J Røislien, D J Lockey
INTRODUCTION: The current management of severely injured patients includes damage control resuscitation strategies that minimise the use of crystalloids and emphasise earlier transfusion of red blood cells (RBC) to prevent coagulopathy. In 2012, London's air ambulance (LAA) became the first UK civilian pre-hospital service to routinely carry RBC to the trauma scene. OBJECTIVE: To investigate the effect of pre-hospital RBC transfusion (phRTx) on overall blood product consumption...
October 24, 2017: Transfusion Medicine
https://www.readbyqxmd.com/read/29058589/translational-evidence-for-two-distinct-patterns-of-neuroaxonal-injury-in-sepsis-a-longitudinal-prospective-translational-study
#15
Johannes Ehler, Lucinda K Barrett, Valerie Taylor, Michael Groves, Francesco Scaravilli, Matthias Wittstock, Stephan Kolbaske, Annette Grossmann, Jörg Henschel, Martin Gloger, Tarek Sharshar, Fabrice Chretien, Francoise Gray, Gabriele Nöldge-Schomburg, Mervyn Singer, Martin Sauer, Axel Petzold
BACKGROUND: Brain homeostasis deteriorates in sepsis, giving rise to a mostly reversible sepsis-associated encephalopathy (SAE). Some survivors experience chronic cognitive dysfunction thought to be caused by permanent brain injury. In this study, we investigated neuroaxonal pathology in sepsis. METHODS: We conducted a longitudinal, prospective translational study involving (1) experimental sepsis in an animal model; (2) postmortem studies of brain from patients with sepsis; and (3) a prospective, longitudinal human sepsis cohort study at university laboratory and intensive care units (ICUs)...
October 23, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29055663/damage-control-concept-and-implementation
#16
B Malgras, B Prunet, X Lesaffre, G Boddaert, S Travers, P-J Cungi, E Hornez, O Barbier, H Lefort, S Beaume, M Bignand, J Cotte, P Esnault, J-L Daban, J Bordes, E Meaudre, J-P Tourtier, S Gaujoux, S Bonnet
The concept of damage control (DC) is based on a sequential therapeutic strategy that favors physiological restoration over anatomical repair in patients presenting acutely with hemorrhagic trauma. Initially described as damage control surgery (DCS) for war-wounded patients with abdominal penetrating hemorrhagic trauma, this concept is articulated in three steps: surgical control of lesions (hemostasis, sealing of intestinal spillage), physiological restoration, then surgery for definitive repair. This concept was quickly adapted for intensive care management under the name damage control resuscitation (DCR), which refers to the modalities of hospital resuscitation carried out in patients suffering from traumatic hemorrhagic shock within the context of DCS...
October 18, 2017: Journal of Visceral Surgery
https://www.readbyqxmd.com/read/29040202/re-examination-of-a-battlefield-trauma-golden-hour-policy
#17
Jeffrey T Howard, Russ S Kotwal, Alexis R Santos, Matthew J Martin, Zsolt T Stockinger
BACKGROUND: Most combat casualties who die, do so in the prehospital setting. Efforts directed toward alleviating prehospital combat trauma death, known as killed in action (KIA) mortality, have the greatest opportunity for eliminating preventable death. METHODS: 4,542 military casualties injured in Afghanistan from September 11, 2001 to March 31, 2014 were included in this retrospective analysis to evaluate proposed explanations for observed KIA reduction following a mandate by Secretary of Defense Robert M...
October 16, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29035926/damage-control-surgery-current-state-and-future-directions
#18
Daniel Benz, Zsolt J Balogh
PURPOSE OF REVIEW: Damage control surgery (DCS) represents a staged surgical approach to the treatment of critically injured trauma patients. Originally described in the context of hepatic trauma and postinjury-induced coagulopathy, the indications for DCS have expanded to the management of extra abdominal trauma and to the management of nontraumatic acute abdominal emergencies. Despite being an accepted treatment algorithm, DCS is based on a limited evidence with current concerns of the variability in practice indications, rates and adverse outcomes in poorly selected patient cohorts...
December 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29017652/-hydrogen-can-alleviate-post-cardiac-arrest-myocardium-injury-in-rabbits
#19
Jingao Wang, Jiyan Lin, Minwei Zhang, Yujing He, Xiaowen Pan, Chengbin Yang, Dongmei Cai
OBJECTIVE: To investigate the effects of hydrogen (H2) on myocardium injury post-cardiac arrest (CA) in rabbits. METHODS: Sixty New Zealand rabbits were randomly divided into H2 treatment group (n = 30) and control group (n = 30) by random number table. The rabbit CA model was established by means of electrical stimulation of external membrane, both groups were mechanically ventilated. Cardiopulmonary resuscitation (CPR) was performed after 6 minutes of nonintervention, and stopped after restoration of spontaneous circulation (ROSC)...
October 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28966194/open-abdomen-in-trauma-and-critical-care
#20
Eleanor R Fitzpatrick
The open abdomen technique and temporary abdominal closure after damage control surgery is fast becoming the standard of care for managing intra-abdominal bleeding and infectious or ischemic processes in critically ill patients. Expansion of this technique has evolved from damage control surgery in severely injured trauma patients to use in patients with abdominal compartment syndrome due to acute pancreatitis and other disorders. Subsequent therapies after use of the open abdomen technique and temporary abdominal closure are resuscitation in the intensive care unit and planned reoperation to manage the underlying cause of bleeding, infection, or ischemia...
October 2017: Critical Care Nurse
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