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prehospital hemorrhage death

Zachary D W Dezman, Chen Gao, Shiming Yang, Peter Hu, Li Yao, Hsiao-Chi Li, Chein-I Chang, Colin Mackenzie
OBJECTIVE: Recent advancements in trauma resuscitation have shown a great benefit of early identification and control of hemorrhage, which is the most common cause of death in injured patients. We introduce a new analytical approach, anomaly detection (AD), as an alternative method to the traditional logistic regression (LR) method in predicting which injured patients receive transfusions, intensive care, and other interventions. METHODS: We abstracted routinely collected prehospital vital sign data from patient records (adult patients who survived more than 15 minutes after being directly admitted to a level 1 trauma center)...
December 5, 2016: Prehospital Emergency Care
Vincent Roule, Pierre Ardouin, Katrien Blanchart, Adrien Lemaitre, Julien Wain-Hobson, Damien Legallois, Joachim Alexandre, Rémi Sabatier, Paul Milliez, Farzin Beygui
BACKGROUND: Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion strategy in patients with ST-elevation myocardial infarction (STEMI), but its benefit over prehospital fibrinolysis (FL) is not clear. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials in which outcomes of patients with STEMI managed with FL early in the prehospital setting versus PPCI were compared. RESULTS: Compared with PPCI, FL was consistently associated with similar rates of short-term (30-90 days) death (relative risk [RR] 0...
November 5, 2016: Critical Care: the Official Journal of the Critical Care Forum
Bijan Shams Kheirabadi, Nahir Miranda, Irasema B Terrazas, Mary D Gonzales, Rose C Grimm, Michael A Dubick
BACKGROUND: Prehospital, small-volume resuscitation of combat casualties with a synthetic colloid (6% hydroxyethyl starch [HES] 670/0.75) has been recommended when blood or blood components are unavailable. We studied hemostatic effects of a newer synthetic colloid (6% HES, 130/0.4) compared with either a natural colloid (albumin) or to crystalloids in an uncontrolled hemorrhage model. METHODS: Spontaneously breathing New Zealand white rabbits (3.4 ± 0.1 kg) were anesthetized, instrumented, and subjected to a splenic injury with uncontrolled bleeding...
January 2017: Journal of Trauma and Acute Care Surgery
Matthew M Carrick, Jan Leonard, Denetta S Slone, Charles W Mains, David Bar-Or
Hemorrhagic shock is a principal cause of death among trauma patients within the first 24 hours after injury. Optimal fluid resuscitation strategies have been examined for nearly a century, more recently with several randomized controlled trials. Hypotensive resuscitation, also called permissive hypotension, is a resuscitation strategy that uses limited fluids and blood products during the early stages of treatment for hemorrhagic shock. A lower-than-normal blood pressure is maintained until operative control of the bleeding can occur...
2016: BioMed Research International
Robert T Gerhardt, Elon Glassberg, John B Holcomb, Robert L Mabry, Martin B Schreiber, Philip C Spinella
BACKGROUND: Uncontrolled major hemorrhage and delayed evacuation remain substantial contributors to potentially survivable combat death, along with mission, environment, terrain, logistics, and hostile action. Life-saving interventions and the onset of acute traumatic coagulopathy (ATC) may also contribute. OBJECTIVE: Analyze US casualty records from the DoD Trauma Registry, using International Normalized Ratio (INR) of 1.5 for onset of ATC. METHODS: Retrospective cohort study from September 2007 to June 2011, inclusive...
September 2016: Shock
Hadi Khoshmohabat, Shahram Paydar, Hossein Mohammad Kazemi, Behnam Dalfardi
CONTEXT: In today's modern world, despite the multiple advances made in the field of medicine, hemorrhagic shock is still the main cause of battlefield mortality and the second most prevalent cause of mortality in civilian trauma. Hemostatic agents can play a key role in establishing hemostasis in prehospital situations and preventing hemorrhage-associated death. In this respect, this article aims to review different aspects of known hemostatic agents. EVIDENCE ACQUISITION: A comprehensive search of the academic scientific databases for relevant keywords was conducted; relevant articles were compiled and assessed...
February 2016: Trauma Monthly
Philip C Spinella, Jeremy G Perkins, Andrew P Cap
The lessons learned regarding the resuscitation of traumatic hemorrhagic shock are numerous and come from a better understanding of the epidemiology, pathophysiology, and experience in this population over 10-plus years of combat operations. We have now come to better understand that the greatest benefit in survival can come from improved treatment of hemorrhage in the prehospital phase of care. We have learned that there is an endogenous coagulopathy that occurs with severe traumatic injury secondary to oxygen debt and that classic resuscitation strategies for severe bleeding based on crystalloid or colloid solutions exacerbate coagulopathy and shock for those with life-threatening hemorrhage...
April 2016: U.S. Army Medical Department Journal
Bijan Shams Kheirabadi, Nahir Miranda, Irasema B Terrazas, Amber N Voelker, Rose C Grimm, Michael A Dubick
BACKGROUND: Plasma infusion with or without red blood cells is the current military standard of care for prehospital resuscitation of combat casualties. We examined possible advantages of early and limited resuscitation with fresh plasma compared with a single plasma protein or crystalloid solutions in an uncontrolled hemorrhage model in rabbits. METHODS: Anesthetized spontaneously breathing rabbits (3.3 ± 0.1 kg) were instrumented and subjected to a splenic uncontrolled hemorrhage...
July 2016: Journal of Trauma and Acute Care Surgery
Joseph F Rappold, Grant V Bochicchio
Despite the tremendous advances and successes in the care of combat casualties over the past 15 years of war, noncompressible torso hemorrhage (NCTH) remains the most likely source of potentially preventable death (approx. 25%) on the battlefield. This is also likely true for civilian victims of blunt and penetrating trauma. Various devices and therapeutic interventions have been, and are being, developed in an attempt to reduce morbidity and mortality for patients with NCTH. Examples include the use of prehospital blood and blood products, tranexamic acid, specially designed tourniquets for junctional hemorrhage control, retrograde endovascular balloon occlusion of the aorta, intracavity foam, expandable hemostatic sponges, and intravascular nanoparticles to suspended animation...
April 2016: Transfusion
John D Yonge, Martin A Schreiber
BACKGROUND: Implications from the pragmatic, randomize, optimal platelet and plasma ratios (PROPPR) trial are critical for remote damage control resuscitation (DCR). Utilizing DCR principals in remote settings can combat early mortality from hemorrhage. Identifying the appropriate transfusion strategy is mandatory prior to adopting prehospital hemostatic resuscitation strategies. STUDY DESIGN AND METHODS: The PROPPR study was examined in relation to the following questions: 1) Why is it important to have blood products in the prehospital setting?; 2) Which products should be investigated for prehospital hemostatic resuscitation?; 3) What is the appropriate ratio of blood product transfusion?; and 4) What are the appropriate indications for hemostatic resuscitation? RESULTS: PROPPR demonstrates that early and balanced blood product transfusion ratios reduced mortality in all patients at 3 hours and death from exsanguination at 24 hours (p = 0...
April 2016: Transfusion
Elizabeth K Powell, William R Hinckley, Adam Gottula, Kimberly W Hart, Christopher J Lindsell, Jason T McMullan
BACKGROUND: Hemorrhage is a leading cause of death in traumatically injured patients. Currently, the importance of earlier administration of packed red blood cells (pRBC) to improve outcomes is limited. We evaluated the association of earlier pRBC administration and mortality when compared with later transfusion initiation. METHODS: This single-center retrospective cohort study of trauma patients transported by a single helicopter service from the scene of injury to an urban academic trauma center included patients receiving at least one unit of pRBC within 24 hours of hospital arrival...
September 2016: Journal of Trauma and Acute Care Surgery
Jacob Chen, Avi Benov, Roy Nadler, Geva Landau, Alex Sorkin, James K Aden, John F Kragh, Elon Glassberg
BACKGROUND: Junctional hemorrhage is a common cause of battlefield death but little is known about testing of junctional tourniquet models by medics. The purpose of the testing described herein is to assess military experience in junctional tourniquet use in simulated prehospital care. METHODS: Fourteen medics were to use the following four junctional tourniquets: Combat Ready Clamp (CRoC), Abdominal Aortic Junctional Tourniquet (AAJT), Junctional Emergency Treatment Tool (JETT), and SAM Junctional Tourniquet (SJT)...
2016: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
Sureerat Suwatcharangkoon, Emma Meyers, Cristina Falo, J Michael Schmidt, Sachin Agarwal, Jan Claassen, Stephan A Mayer
IMPORTANCE: Loss of consciousness (LOC) is a common presenting symptom of subarachnoid hemorrhage (SAH) that is presumed to result from transient intracranial circulatory arrest. OBJECTIVE: To clarify the association between LOC at onset of SAH, complications while in the hospital, and long-term outcome after SAH. DESIGN, SETTING, AND PARTICIPANTS: A retrospective analysis was conducted of 1460 consecutively treated patients with spontaneous SAH who were part of a prospective observational cohort study at a large urban academic medical center (the Columbia University SAH Outcomes Project or SHOP)...
January 2016: JAMA Neurology
Ben Thurston, Sharfuddin Chowdhury, Sorin Edu, Andrew J Nicol, Pradeep Harkison Navsaria
BACKGROUND: Haemorrhage is responsible for about a third of in-hospital trauma deaths. The CRASH-2 trial demonstrated that early administration of tranexamic acid, ideally within 3 hours, can reduce mortality from trauma-associated bleeding by up to 32%. OBJECTIVE: To explore whether, in our trauma network in a middle-income country, patients arrived at hospital soon enough after injury for tranexamic acid administration to be effective and safe. METHODS: A prospective cohort study of 50 consecutive patients admitted to our trauma unit was undertaken...
March 2015: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
Mikael Gellerfors, Joacim Linde, Dan Gryth
Massive hemorrhage with coagulopathy is one of the leading causes of preventable death in the battlefield. The development of freeze-dried plasma (FDP) allows for early treatment with coagulation-optimizing resuscitation fluid in the prehospital setting. This report describes the first prehospital use of FDP in a patient with carotid artery injury due to a high-velocity gunshot wound (HVGSW) to the neck. It also describes in-flight constitution and administration of FDP in a Medevac Helicopter. Early administration of FDP may contribute to hemodynamic stabilization and reduction in trauma-induced coagulopathy and acidosis...
October 2015: Prehospital and Disaster Medicine
Kenji Inaba, Stefano Siboni, Shelby Resnick, Jay Zhu, Monica Darlene Wong, Tobias Haltmeier, Elizabeth Benjamin, Demetrios Demetriades
BACKGROUND: Unlike in the military setting, where the use of tourniquets has been well established, in the civilian sector their use has been far less uniform. The purpose of this study was to examine the outcomes associated with the use of tourniquets for civilian extremity trauma. STUDY DESIGN: Adult (≥18 years) patients admitted to our institution with an extremity injury requiring tourniquet application from January 2007 to June 2014 were retrospectively reviewed...
August 2015: Journal of Trauma and Acute Care Surgery
Andrew W Kirkpatrick, Anthony LaPorta, Susan Brien, Tim Leslie, Elon Glassberg, Jessica McKee, Chad G Ball, Heather E Wright Beatty, Jocelyn Keillor, Derek J Roberts, Homer Tien
Bleeding to death is the most preventable cause of posttraumatic death worldwide. Despite the fact that many of these deaths are anatomically salvageable with relatively basic surgical interventions, they remain lethal in actuality in prehospital environments when no facilities and skills exist to contemplate undertaking basic damage control surgery (DCS). With better attention to prehospital control of extremity hemorrhage, intracavitary bleeding (especially intraperitoneal) remains beyond the scope of prehospital providers...
June 2015: Canadian Journal of Surgery. Journal Canadien de Chirurgie
Joshua B Brown, Jason L Sperry, Anisleidy Fombona, Timothy R Billiar, Andrew B Peitzman, Francis X Guyette
BACKGROUND: Hemorrhage is the leading cause of survivable death in trauma and resuscitation strategies including early RBC transfusion have reduced this. Pre-trauma center (PTC) RBC transfusion is growing and preliminary evidence suggests improved outcomes. The study objective was to evaluate the association of PTC RBC transfusion with outcomes in air medical trauma patients. STUDY DESIGN: We conducted a retrospective cohort study of trauma patients transported by helicopter to a Level I trauma center from 2007 to 2012...
May 2015: Journal of the American College of Surgeons
Bijan S Kheirabadi, Krystal K Valdez-Delgado, Irasema B Terrazas, Nahir Miranda, Michael A Dubick
BACKGROUND: Reports of survival benefits of early transfusion of plasma with red blood cells (1:1 ratio) in trauma patients suggest that plasma may be a better fluid to replace Hextend for battlefield resuscitation. We studied possible advantages of prehospital resuscitation with plasma compared with Hextend or albumin in a model of uncontrolled hemorrhage. METHODS: Male New Zealand white rabbits (3.3 ± 0.1 kg) were anesthetized, instrumented, and subjected to a splenic injury with uncontrolled bleeding...
April 2015: Journal of Trauma and Acute Care Surgery
Przemysław Kluj, Dawid Aleksandrowicz, Waldemar Machała, Tomasz Gaszyński
Isolated limb hemorrhage represents 60% of avoidable deaths and remains the leading cause of death in combat zone. Ideal tourniquet must be light, durable and cheap. They should completely stop the flow of arterial blood in the limb, and their attachment should be quick and easy. Tourniquets applied in correct location save lives by stopping the bleeding. Their use in civil environment appear to be particularly relevant in the mass casualties events. Modern bandages used by the military, were designed mostly in the form of an elastic bandage, which attachment has to be easy and quick...
February 2015: Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego
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