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https://www.readbyqxmd.com/read/29130951/prehospital-computed-tomography-angiography-in-acute-stroke-management
#1
Michael Kettner, Stefan Alexander Helwig, Andreas Ragoschke-Schumm, Lenka Schwindling, Safwan Roumia, Isabel Keller, Daniel Martens, Johann Kulikovski, Matthias Manitz, Martin Lesmeister, Silke Walter, Iris Quasar Grunwald, Thomas Schlechtriemen, Wolfgang Reith, Klaus Fassbender
BACKGROUND: An ambulance equipped with a computed tomography (CT) scanner, a point-of-care laboratory, and telemedicine capabilities (mobile stroke unit [MSU]) has been shown to enable the delivery of thrombolysis to stroke patients directly at the emergency site, thereby significantly decreasing time to treatment. However, work-up in an MSU that includes CT angiography (CTA) may also potentially facilitate triage of patients directly to the appropriate target hospital and specialized treatment, according to their individual vascular pathology...
October 31, 2017: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/29121893/association-of-pelvic-fracture-patterns-pelvic-binder-use-and-arterial-angio-embolization-with-transfusion-requirements-and-mortality-rates-a-7-year-retrospective-cohort-study
#2
Fabio Agri, Mylène Bourgeat, Fabio Becce, Kevin Moerenhout, Mathieu Pasquier, Olivier Borens, Bertrand Yersin, Nicolas Demartines, Tobias Zingg
BACKGROUND: Pelvic fractures are severe injuries with frequently associated multi-system trauma and a high mortality rate. The value of the pelvic fracture pattern for predicting transfusion requirements and mortality is not entirely clear. To address hemorrhage from pelvic injuries, the early application of pelvic binders is now recommended and arterial angio-embolization is widely used for controlling arterial bleeding. Our aim was to assess the association of the pelvic fracture pattern according to the Tile classification system with transfusion requirements and mortality rates, and to evaluate the correlation between the use of pelvic binders and arterial angio-embolization and the mortality of patients with pelvic fractures...
November 9, 2017: BMC Surgery
https://www.readbyqxmd.com/read/29117058/the-effect-of-time-to-international-normalized-ratio-reversal-on-intracranial-hemorrhage-evolution-in-patients-with-traumatic-brain-injury
#3
Hans Andrews, Katelyn Rittenhouse, Brian Gross, Frederick B Rogers
The incidence of geriatric traumatic brain injury (TBI) is increasing throughout the United States, with many of these patients taking anticoagulation (AC) medication. The purpose of this investigation was to determine the effect of time to international normalized ratio (INR) reversal on intracranial hemorrhage evolution in TBI patients taking prehospital AC medication. We hypothesized that rapid reversal of INR improves outcomes of head-injured patients taking AC medication. Admissions to a Level II trauma center between February 2011 and December 2013 were reviewed...
November 2017: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/29078871/shedding-new-light-on-rapidly-resolving-traumatic-acute-subdural-hematomas
#4
Magdalene Brooke, Atul Patel, Federico Castro-Moure, Gregory P Victorino
BACKGROUND: Rapidly resolving acute subdural hematomas (RRASDHs) have been described in case reports and case series but are still poorly understood. We hypothesized that a cohort analysis would confirm previously reported predictors of RRASDH including coagulopathy, additional intracranial hemorrhage, and low-density band on imaging. We also hypothesized that rapid resolution would be associated with improved trauma outcomes. METHODS: We reviewed all nonoperative acute subdural hematomas (ASDHs) treated at our center from 2011 to 2015...
November 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/29067429/association-of-prehospital-blood-product-transfusion-during-medical-evacuation-of-combat-casualties-in-afghanistan-with-acute-and-30-day-survival
#5
Stacy A Shackelford, Deborah J Del Junco, Nicole Powell-Dunford, Edward L Mazuchowski, Jeffrey T Howard, Russ S Kotwal, Jennifer Gurney, Frank K Butler, Kirby Gross, Zsolt T Stockinger
Importance: Prehospital blood product transfusion in trauma care remains controversial due to poor-quality evidence and cost. Sequential expansion of blood transfusion capability after 2012 to deployed military medical evacuation (MEDEVAC) units enabled a concurrent cohort study to focus on the timing as well as the location of the initial transfusion. Objective: To examine the association of prehospital transfusion and time to initial transfusion with injury survival...
October 24, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28991676/sulfonylurea-drug-pretreatment-and-functional-outcome-in-diabetic-patients-with-acute-intracerebral-hemorrhage
#6
Jason J Chang, Yasser Khorchid, Ali Kerro, L Goodwin Burgess, Nitin Goyal, Anne W Alexandrov, Andrei V Alexandrov, Georgios Tsivgoulis
PURPOSE: Intracerebral hemorrhage (ICH) is associated with poor clinical outcome and high mortality. Sulfonylurea (SFU) use may be a viable therapy for inhibiting sulfonylurea receptor-1 and NCCa-ATP channels and reducing perihematomal edema and blood-brain barrier disruption. We sought to evaluate the effects of prehospital SFU use with outcomes in diabetic patients with acute ICH. METHODS: We retrospectively analyzed a cohort of diabetic patients presenting with acute ICH at a tertiary care center...
October 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/28957927/the-nurse-s-management-of-shock-and-hemorrhage
#7
(no author information available yet)
: Editor's note: From its first issue in 1900 through to the present day, AJN has unparalleled archives detailing nurses' work and lives over more than a century. These articles not only chronicle nursing's growth as a profession within the context of the events of the day, but also reveal prevailing societal attitudes about women, health care, and human rights. Today's nursing school curricula rarely include nursing's history, but it's a history worth knowing. To this end, From the AJN Archives highlights articles selected to fit today's topics and times...
October 2017: American Journal of Nursing
https://www.readbyqxmd.com/read/28930960/prehospital-administration-of-freeze-dried-plasma-is-it-the-solution-for-trauma-casualties
#8
Amir Shlaifer, Maya Siman-Tov, Irina Radomislensky, Kobi Peleg, Avi Shina, Erez Nachum Baruch, Elon Glassberg, Avraham Yitzhak
BACKGROUND: Hemorrhage is the leading cause of possible preventable death in the battlefield. There is an increasing evidence for the effectiveness of blood component therapy in general, and plasma infusion in particular but their use is less applicable in the prehospital setting due to logistic difficulties. Israeli Defense Force has implemented the use of freeze-dried plasma (FDP) at the point of injury (POI), this adoption of FDP use entailed doubts regarding the feasibility and effectiveness of this practice...
October 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28930937/administration-of-hypertonic-solutions-for-hemorrhagic-shock-a-systematic-review-and-meta-analysis-of-clinical-trials
#9
REVIEW
Meng-Che Wu, Tin-Yun Liao, Erica M Lee, Yueh-Sheng Chen, Wan-Ting Hsu, Meng-Tse Gabriel Lee, Po-Yang Tsou, Shyr-Chyr Chen, Chien-Chang Lee
BACKGROUND: Several clinical trials on hypertonic fluid administration have been completed, but the results have been inconclusive. The objective of this study is to summarize current evidence for treating hypovolemic patients with hypertonic solutions by performing a systematic review and meta-analysis. METHODS: Major electronic databases were searched from inception through June 2014. We included only randomized controlled trials involving hemorrhagic shock patients treated with hypertonic solutions...
November 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28910469/prehospital-administration-of-tranexamic-acid-by-ground-forces-in-afghanistan-the-prehospital-trauma-registry-experience
#10
Steven G Schauer, Michael D April, Jason F Naylor, Jonathan Wiese, Kathy L Ryan, Andrew D Fisher, Cord W Cunningham, Noah Mitchell, Mark A Antonacci
BACKGROUND: Tranexamic acid (TXA) was shown to reduce overall mortality and death secondary to hemorrhage in a large prospective study. This intervention is time sensitive. As such, the Tactical Combat Casualty Care (TCCC) guidelines recommend use of this low-cost, safe intervention among patients with possible hemorrhagic shock, penetrating trauma to the thorax or trunk, or extremity amputation. OBJECTIVE: Prehospital administration of TXA by ground forces in the Afghanistan combat theater is described...
2017: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/28887388/minocycline-in-acute-cerebral-hemorrhage-an-early-phase-randomized-trial
#11
RANDOMIZED CONTROLLED TRIAL
Abdelrahman Y Fouda, Andrea S Newsome, Samantha Spellicy, Jennifer L Waller, Wenbo Zhi, David C Hess, Adviye Ergul, David J Edwards, Susan C Fagan, Jeffrey A Switzer
BACKGROUND AND PURPOSE: Minocycline is under investigation as a neurovascular protective agent for stroke. This study evaluated the pharmacokinetic, anti-inflammatory, and safety profile of minocycline after intracerebral hemorrhage. METHODS: This study was a single-site, randomized controlled trial of minocycline conducted from 2013 to 2016. Adults ≥18 years with primary intracerebral hemorrhage who could have study drug administered within 24 hours of onset were included...
October 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28886790/hemodynamic-deterioration-in-lateral-compression-pelvic-fracture%C3%A2-after-prehospital-pelvic-circumferential-compression%C3%A2-device%C3%A2-application
#12
Alan A Garner, Jeremy Hsu, Anne McShane, Adam Sroor
Increased fracture displacement has previously been described with the application of pelvic circumferential compression devices (PCCDs) in patients with lateral compression-type pelvic fracture. We describe the first reported case of hemodynamic deterioration temporally associated with the prehospital application of a PCCD in a patient with a complex acetabular fracture with medial displacement of the femoral head. Active hemorrhage from a site adjacent to the acetabular fracture was subsequently demonstrated on angiography...
September 2017: Air Medical Journal
https://www.readbyqxmd.com/read/28878305/effects-of-intensive-blood-pressure-reduction-on-acute-intracerebral-hemorrhage-a-systematic-review-and-meta-analysis
#13
Shun Gong, Chao Lin, Danfeng Zhang, Xiangyi Kong, Jigang Chen, Chunhui Wang, Zhenxing Li, Rongbin Chen, Ping Sheng, Yan Dong, Lijun Hou
Current opinions about the effect of intensive blood pressure (BP) reduction for acute intracerebral hemorrhage (ICH) are inconsistent. We performed a meta-analysis to evaluate the efficacy and safety of intensive BP reduction for acute ICH by analyzing data from several recent randomized controlled trials (RCTs). There were six eligible studies that met the inclusion criteria, for a total of 4,385 acute ICH patients in this meta-analysis. After analyzing these data, we found differences between intensive and standard BP lowering treatment groups in total mortality rates, unfavorable outcomes, hematoma expansion, neurologic deterioration, and severe hypotension were not significant...
September 6, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28832355/prehospital-hemostatic-resuscitation-to-achieve-zero-preventable-deaths-after-traumatic-injury
#14
Philip C Spinella, Andrew P Cap
PURPOSE OF REVIEW: To describe how hemostatic resuscitation can be used in the prehospital phase of resuscitation to reduce preventable deaths after traumatic injury. RECENT FINDINGS: Hemorrhagic shock is the leading cause of death that is preventable after injury. The National Academy of Sciences, recently, recommended that achievement of zero preventable deaths after traumatic injury should be the goal of a national trauma system. In the United States, there are an estimated 25 000 preventable deaths per year in the prehospital phase of resuscitation because of traumatic hemorrhagic shock...
November 2017: Current Opinion in Hematology
https://www.readbyqxmd.com/read/28766306/interpretation-of-brain-ct-scans-in-the-field-by-critical-care-physicians-in-a-mobile-stroke-unit
#15
Maren Ranhoff Hov, Erik Zakariassen, Thomas Lindner, Terje Nome, Kristi G Bache, Jo Røislien, Jostein Gleditsch, Volker Solyga, David Russell, Christian G Lund
BACKGROUND AND PURPOSE: In acute stroke, thromboembolism or spontaneous hemorrhage abruptly reduces blood flow to a part of the brain. To limit necrosis, rapid radiological identification of the pathological mechanism must be conducted to allow the initiation of targeted treatment. The aim of the Norwegian Acute Stroke Prehospital Project is to determine if anesthesiologists, trained in prehospital critical care, may accurately assess cerebral computed tomography (CT) scans in a mobile stroke unit (MSU)...
July 27, 2017: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
https://www.readbyqxmd.com/read/28745691/-causal-relationships-in-stroke-and-kidney-injury
#16
A M Gerdt, A M Shutov, M V Menzorov, E A Gubareva
AIM: To assess the frequency, severity, and causes of acute kidney injury (AKI) in patients with stroke. SUBJECTS AND METHODS: 272 patients (143 men and 129 women) (mean age, 66.7±11.6 years) with stroke were examined. The 2008 European Stroke Organization (ESO) guidelines were used to diagnose stroke, to determine indications for and contraindications to thrombolytic therapy, and to evaluate its efficiency. Hemorrhagic and ischemic strokes (HS and IS) were diagnosed in 52 (19%) and 220 (81%) patients, respectively...
2017: Terapevticheskiĭ Arkhiv
https://www.readbyqxmd.com/read/28742797/a-comparison-of-selective-aortic-arch-perfusion-and-resuscitative-endovascular-balloon-occlusion-of-the-aorta-for-the-management-of-hemorrhage-induced-traumatic-cardiac-arrest-a-translational-model-in-large-swine
#17
RANDOMIZED CONTROLLED TRIAL
Ed B G Barnard, James E Manning, Jason E Smith, Jason M Rall, Jennifer M Cox, James D Ross
BACKGROUND: Survival rates remain low after hemorrhage-induced traumatic cardiac arrest (TCA). Noncompressible torso hemorrhage (NCTH) is a major cause of potentially survivable trauma death. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) at the thoracic aorta (Zone 1) can limit subdiaphragmatic blood loss and allow for IV fluid resuscitation when intrinsic cardiac activity is still present. Selective Aortic Arch Perfusion (SAAP) combines thoracic aortic balloon hemorrhage control with intra-aortic oxygenated perfusion to achieve return of spontaneous circulation (ROSC) when cardiac arrest has occurred...
July 2017: PLoS Medicine
https://www.readbyqxmd.com/read/28742231/different-resuscitation-strategies-and-novel-pharmacologic-treatment-with-valproic-acid-in-traumatic-brain-injury
#18
REVIEW
Simone E Dekker, Vahagn C Nikolian, Martin Sillesen, Ted Bambakidis, Patrick Schober, Hasan B Alam
Traumatic brain injury (TBI) is a leading cause of death in young adults, and effective treatment strategies have the potential to save many lives. TBI results in coagulopathy, endothelial dysfunction, inflammation, cell death, and impaired epigenetic homeostasis, ultimately leading to morbidity and/or mortality. Commonly used resuscitation fluids such as crystalloids or colloids have several disadvantages and might even be harmful when administered in large quantities. There is a need for next-generation treatment strategies (especially in the prehospital setting) that minimize cellular damage, improve survival, and enhance neurological recovery...
July 25, 2017: Journal of Neuroscience Research
https://www.readbyqxmd.com/read/28713330/access-to-thrombolysis-for-non-resident-and-resident-stroke-patients-a-registry-based-comparative-study-from-berlin
#19
Ludwig Schlemm, Guillaume Turc, Heinrich J Audebert, Martin Ebinger
OBJECTIVES: Stroke can happen to people away from home. It is unknown whether non-resident and resident stroke patients have equal access to thrombolysis. MATERIALS AND METHODS: Consecutive patients cared for by the Stroke Emergency Mobile between 2011 and 2016 after prompting suspicion of acute stroke during the emergency call were included in our registry. Patients were categorized as residents or non-residents based on their main address. Clinical characteristics, thrombolysis rates, and time intervals from symptom onset/last seen well to alarm and to thrombolysis were compared between groups adjusting for age, pre-stroke modified Rankin Scale (mRS) score, and National Institutes of Health Stroke Scale (NIHSS) score...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28712527/clinical-presentation-to-the-emergency-department-predicts-subarachnoid-hemorrhage-associated-myocardial-injury
#20
Khalil M Yousef, Elizabeth Crago, Theodore F Lagattuta, Marilyn Hravnak
INTRODUCTION: Aneurysmal subarachnoid hemorrhage (aSAH) is frequently seen in emergency departments. Secondary injury, such as subarachnoid hemorrhage-associated myocardial injury (SAHMI), affects one third of survivors and contributes to poor outcomes. SAHMI is not attributed to ischemia from myocardial disease but can result in hypotension and arrhythmias. It is important that emergency nurses recognize which clinical presentation characteristics are predictive of SAHMI to initiate proper interventions...
July 13, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
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