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https://www.readbyqxmd.com/read/29035926/damage-control-surgery-current-state-and-future-directions
#1
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...
October 14, 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29035924/rotational-therapy-in-thoracic-injuries-what-is-the-evidence
#2
Philipp Störmann, Ingo Marzi, Sebastian Wutzler
PURPOSE OF REVIEW: To review the current use of continuous lateral rotational therapy (CLRT) in patients with thoracic injuries and its impact on clinical course, complications and outcome. RECENT FINDINGS: Patient positioning is a key factor in the treatment of severe thoracic injuries and CLRT, and intermittent supine and prone position are basic options. There is a lack of randomized controlled studies for trauma patients with chest injury undergoing kinetic therapy as standard of care...
October 14, 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29035085/lung-microbiota-is-related-to-smoking-status-and-to-development-of-ards-in-critically-ill-trauma-patients
#3
Ariane R Panzer, Susan V Lynch, Chaz Langelier, Jason D Christie, Kathryn McCauley, Mary Nelson, Christopher K Cheung, Neal L Benowitz, Mitchell J Cohen, Carolyn S Calfee
RATIONALE: Cigarette smoking is associated with increased risk of acute respiratory distress syndrome (ARDS) in patients following severe trauma; however, mechanisms underlying this association are unknown. OBJECTIVES: To determine whether cigarette smoking contributes to ARDS development following trauma by altering community composition of the lung microbiota Methods: We studied lung microbiota of mechanically ventilated patients admitted to the intensive care unit (ICU) following severe blunt trauma using 16S rRNA gene amplicon sequencing of endotracheal aspirate (ETA) samples obtained upon ICU admission (n=74) and at 48 hours post-admission (n=30)...
October 16, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29033272/graduating-surgical-residents-lack-competence-in-critical-care-ultrasound
#4
Renuka Tripu, Margaret H Lauerman, Daniel Haase, Syeda Fatima, Jacob Glaser, Cassandra Cardarelli, Thomas M Scalea, Sarah Murthi
OBJECTIVE: Ultrasound provides accessible imaging for bedside diagnostics and procedural guidance, but may lead to misdiagnosis in untrained users. The main objective of this study was to determine observed and self-perceived competence with critical care ultrasound in graduated general surgery residents. DESIGN: The design of this study was a retrospective review. Ultrasound training program records were reviewed for number of prior ultrasound examinations performed, self-perceived competence, observed competence on faculty examinations, and intended future use of individual critical care ultrasound examinations...
October 13, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/29025454/an-audit-of-traumatic-brain-injury-tbi-in-a-busy-developing-world-trauma-service-exposes-a-significant-deficit-in-resources-available-to-manage-severe-tbi
#5
Ellen Jerome, Grant L Laing, John L Bruce, Ben Sartorius, Petra Brysiewicz, Damian L Clarke
BACKGROUND: Traumatic brain injury (TBI) affects large numbers of patients, both adults and children, and significant resources are needed to manage it. OBJECTIVE: To determine the burden of TBI and the adequacy of available resources to manage in the Pietermaritzburg Metropolitan Trauma Service (PMTS). METHODS: All patients with a TBI were identified from the hybrid electronic medical registry at Grey's and Edendale hospitals in Pietermaritzburg (PMB), KwaZulu-Natal, South Africa...
June 30, 2017: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
https://www.readbyqxmd.com/read/29024879/single-intervention-for-a-reduction-in-portable-chest-radiography-pcxr-in-cardiovascular-and-surgical-trauma-icus-and-associated-outcomes
#6
Joseph E Tonna, Kensaku Kawamoto, Angela P Presson, Chong Zhang, Mary C Mone, Robert E Glasgow, Richard G Barton, John R Hoidal, Yoshimi Anzai
PURPOSE: Studies suggest that "on-demand" radiography is equivalent to daily routine with regard to adverse events. In these studies, provider behavior is controlled. Pragmatic implementation has not been studied. MATERIALS AND METHODS: This was a quasi-experimental, pre-post intervention study. Medical directors of two intervention ICUs requested pCXRs be ordered on an on-demand basis at one time point, without controlling or monitoring behavior or providing follow-up...
October 5, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/29019796/monitoring-modalities-and-assessment-of-fluid-status-a-practice-management-guideline-from-the-eastern-association-for-the-surgery-of-trauma-east
#7
David S Plurad, William Chiu, Ali S Raja, Samuel M Galvagno, Uzer Khan, Dennis Y Kim, Samuel A Tisherman, Jeremy Ward, Mark E Hamill, Vicki Bennett, Brian Williams, Bryce Robinson
BACKGROUND: Fluid administration in critically ill surgical patients must be closely monitored to avoid complications. Resuscitation guided by invasive methods are not consistently associated with improved outcomes. As such, there has been increased use of Focused Ultrasound and Arterial Pulse Waveform Analysis (APWA) to monitor and aid resuscitation. An assessment of these methods using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework is presented...
October 11, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29018173/a-pilot-study-of-surgical-telementoring-for-leg-fasciotomy
#8
Max Talbot, E J Harvey, G K Berry, R Reindl, H Tien, D J Stinner, G Slobogean
INTRODUCTION: Acute extremity compartment syndrome requires rapid decompression. In remote locations, distance, weather and logistics may delay the evacuation of patients with extremity trauma beyond the desired timeline for compartment release. The aim of this study was to establish the feasibility of performing telementored surgery for leg compartment release and to identify methodological issues relevant for future research. METHODS: Three anaethetists and one critical care physician were recruited as operators...
October 10, 2017: Journal of the Royal Army Medical Corps
https://www.readbyqxmd.com/read/28993038/capnography-in-the-emergency-department-a-review-of-uses-waveforms-and-limitations
#9
Brit Long, Alex Koyfman, Michael A Vivirito
BACKGROUND: Capnography has many uses in the emergency department (ED) and critical care setting, most commonly cardiac arrest and procedural sedation. OBJECTIVE OF THE REVIEW: This review evaluates several indications concerning capnography beyond cardiac arrest and procedural sedation in the ED, as well as limitations and specific waveforms. DISCUSSION: Capnography includes the noninvasive measurement of CO2, providing information on ventilation, perfusion, and metabolism in intubated and spontaneously breathing patients...
October 6, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28989885/impact-of-severity-of-illness-on-the-function-of-the-hypothalamo-pituitary-gonadal-axis-in-postmenopausal-women-with-acute-severe-illness-implications-for-predicting-disease-outcome
#10
Suresh Vaikkakara, Marella Neelima Raj, Alok Sachan, Alladi Mohan, Bhuma Vengamma, P V L N Srinivas Rao, Arun Mukka, Chiruvella Sravani, Amaresh P Reddy
BACKGROUND: While elevated levels of estradiol were predictive of mortality in critically ill surgical and trauma patients, their ability to predict outcome in nonsurgical patients has not been studied. We aimed to study the determinants of gonadotropin levels in acutely ill postmenopausal women with nonsurgical disease and the impact of changes in the gonadal axis on the outcome of these patients. METHODS: Thirty-five postmenopausal women admitted to medical intensive care with acute severe illness and having a Simplified Acute Physiology Score (SAPS II score) ≥30 (in-hospital mortality rate ≥ 10%) were recruited...
September 2017: Indian Journal of Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28989141/melanotic-macule-in-conjunction-with-a-giant-cell-fibroma
#11
Samantha D Seitz, Thanhphuong N Dinh, Thomas Yh Yoon
INTRODUCTION: The aim of this study is to describe a case of a melanotic macule found in conjunction with a giant cell fibroma (GCF). For oral pigmented lesions without an identifiable etiologic factor, critical factors in determining the differential diagnosis are clinical history, symmetry, and uniformity of the lesions. Potential differential diagnosis includes racial pigmentation, endocrine disturbance, Peutz-Jeghers syndrome, trauma, hemochromatosis, oral malignant melanoma, or idiopathic etiology and melanotic macules...
October 1, 2017: Journal of Contemporary Dental Practice
https://www.readbyqxmd.com/read/28979986/geographic-diffusion-and-implementation-of-acute-care-surgery-an-uneven-solution-to-the-national-emergency-general-surgery-crisis
#12
Jasmine A Khubchandani, Angela M Ingraham, Vijaya T Daniel, Didem Ayturk, Catarina I Kiefe, Heena P Santry
Importance: Owing to lack of adequate emergency care infrastructure and decline in general surgery workforce, the United States faces a crisis in access to emergency general surgery (EGS) care. Acute care surgery (ACS), an organized system of trauma, general surgery, and critical care, is a proposed solution; however, ACS diffusion remains poorly understood. Objective: To investigate geographic diffusion of ACS models of care and characterize the communities in which ACS implementation is lagging...
October 4, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28979540/iatrogenic-forearm-compartment-syndrome
#13
Ahmed Elmorsy, James Nutt, Nick Taylor, Justin Kirk-Bayley, Sean Hughes
Limb compartment syndrome may be sequelae of trauma, but in the context of critical care blood sampling, arterial damage may have profound consequences. We describe a series of three cases and their progress and discuss guidelines for prevention of this potentially devastating occurrence in critically ill patients.
February 2017: J Intensive Care Soc
https://www.readbyqxmd.com/read/28977759/the-role-of-danger-signals-in-the-pathogenesis-and-perpetuation-of-critical-illness
#14
Kevin C Ma, Edward J Schenck, Maria A Pabon, Augustine M K Choi
The innate immune system induces inflammation through induction of multiple pathways including the TNFα/NF-κB signaling as well as the NLRP3 inflammasome cascade activation with production of inflammatory molecules. Pathogen associated molecular patterns are immunogenic costimulatory molecules that can activate the innate immune system in the presence of foreign pathogens. These molecularly distinct, foreign, particles initiate inflammatory and cell death cascades of the innate immune response through the binding of pathogen recognition receptors such as toll like receptors...
October 4, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28976034/comparison-of-two-blood-sampling-techniques-for-the-determination-of-coagulation-parameters-in-the-horse-jugular-venipuncture-and-indwelling-intravenous-catheter
#15
C J Mackenzie, C M McGowan, G Pinchbeck, H B Carslake
BACKGROUND: Evaluation of coagulation status is an important component of critical care. Ongoing monitoring of coagulation status in hospitalised horses has previously been via serial venipuncture due to concerns that sampling directly from the intravenous catheter (IVC) may alter the accuracy of the results. Adverse effects such as patient anxiety and trauma to the sampled vessel could be avoided by the use of an indwelling IVC for repeat blood sampling. OBJECTIVES: To compare coagulation parameters from blood obtained by jugular venipuncture with IVC sampling in critically ill horses...
October 4, 2017: Equine Veterinary Journal
https://www.readbyqxmd.com/read/28970769/pattern-of-referrals-of-head-injury-to-the-university-college-hospital-ibadan
#16
A O Adeleye
BACKGROUND: Although there are now many neurosurgical units in Nigeria, cases of head injury (HI) continue to present in the University College Hospital, UCH, Ibadan, from hospitals all over the country. OBJECTIVE: This report aims to highlight the contemporary patterns of referrals of cases of head injury for neurosurgery in Ibadan. METHOD: The study emanated from an analysis of registry of cases of head injury managed in our practice covering a 7-year period at the UCH Ibadan...
June 2017: Annals of Ibadan Postgraduate Medicine
https://www.readbyqxmd.com/read/28970658/pain-measurement-in-mechanically-ventilated-patients-with-traumatic-brain-injury-behavioral-pain-tools-versus-analgesia-nociception-index
#17
Ali Jendoubi, Ahmed Abbes, Salma Ghedira, Mohamed Houissa
INTRODUCTION: Pain is highly prevalent in critically ill trauma patients, especially those with a traumatic brain injury (TBI). Behavioral pain tools such as the behavioral pain scale (BPS) and critical-care pain observation tool are recommended for sedated noncommunicative patients. Analysis of heart rate variability (HRV) is a noninvasive method to evaluate autonomic nervous system activity. The analgesia nociception index (ANI) device (Physiodoloris(®), MDoloris Medical Systems, Loos, France) allows noninvasive HRV analysis...
September 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28970179/creation-and-efficacy-of-a-cadaver-based-prosection-anatomical-course-for-critical-care-advanced-practice-providers
#18
Melissa K Stewart, Stephen Gondek, Roslyn Green, Jason Young, Raeanna C Adams, Timothy Nunez
OBJECTIVE: Intensive care units (ICUs) increasingly rely on advanced practice providers (APPs) to care for critically ill patients. Our institutional APPs perceived functional anatomical knowledge deficits. To meet this need, a cadaver-based prosection course was developed. The purpose of our study was to describe and evaluate the learner-perceived course efficacy. DESIGN: A precourse survey collected participant demographics. Precourse and postcourse surveys assessed perceived confidence in 13 anatomical areas...
September 29, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28966194/open-abdomen-in-trauma-and-critical-care
#19
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
https://www.readbyqxmd.com/read/28965751/the-accuracy-of-acuity-scoring-tools-to-predict-24-h-mortality-in-traumatic-brain-injury-patients-a-guide-to-triage-criteria
#20
Zohre Najafi, Hossien Zakeri, Amir Mirhaghi
BACKGROUND AND AIM: Prompt identification of traumatic brain injury (TBI) is vital for patients in critical condition; however, it is not clear which acuity scoring tools are associated with short-term mortality. The aim of this study was to determine the accuracy of acuity scoring tools and 24-h mortality among TBI patients in both prehospital and hospital settings. METHODS: This study was an observational, prospective cohort, in which patients with TBI were followed from the accident scene to the hospital...
September 28, 2017: International Emergency Nursing
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