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https://www.readbyqxmd.com/read/29112094/thrombelastography-early-amplitudes-in-bleeding-and-coagulopathic-trauma-patients-results-from-a-multicenter-study
#1
Thomas H Laursen, Martin A S Meyer, Anna Sina P Meyer, Tina Gaarder, Paal A Naess, Jakob Stensballe, Sisse R Ostrowski, Pär I Johansson
BACKGROUND: Early amplitudes in the viscoelastic hemostatic assays Thrombelastography (TEG) and Rotation Thromboelastometry (ROTEM) provide fast results, which is critical in resuscitation of bleeding patients. This study investigated associations between TEG early amplitudes and standard TEG variables in a large multicenter cohort of moderately to severely injured trauma patients admitted at three North European level 1 Trauma Centers. METHODS: Prospective observational study of 404 trauma patients with clinical suspicion of severe injury from London, UK, Copenhagen, Denmark and Oslo, Norway...
November 3, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29065860/assessment-of-haemostasis-in-patients-undergoing-emergent-neurosurgery-by-rotational-elastometry-and-standard-coagulation-tests-a-prospective-observational-study
#2
Christoph Ellenberger, Najia Garofano, Gleicy Barcelos, John Diaper, Gordana Pavlovic, Marc Licker
BACKGROUND: Rotational elastometry (ROTEM) has been shown useful to monitor coagulation in trauma patients and in major elective surgery. In this study, we aimed to evaluate the utility of ROTEM to identify hemostatic disturbances and to predict the need for transfusion, compared with standard coagulation tests (SCTs) in patients undergoing emergent neurosurgery. METHODS: Over a four-year period, adult patients who met criteria for emergent neurosurgery lasting more than 90 min were included in the study...
October 24, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/29018563/pharmacotherapy-of-post-traumatic-stress-disorder-going-beyond-the-guidelines
#3
EDITORIAL
Jonathan Davidson
SUMMARY: This article discusses the study of Harpaz-Rotem and associates, who examined patterns of medication use in first-diagnosed veterans with post-traumatic stress disorder (PTSD). It considers the difference between practice guidelines and actual prescribing; selectively identifies issues with antidepressants, antipsychotics, benzodiazepines and prazosin; and reviews the possible impact of new medications in the pipeline. DECLARATION OF INTERESTS: In the past 36 months, J...
November 2016: BJPsych Open
https://www.readbyqxmd.com/read/28969328/viscoelastometry-guided-fresh-frozen-plasma-infusion-for-postpartum-haemorrhage-obs2-an-observational-study
#4
P W Collins, R Cannings-John, D Bruynseels, S Mallaiah, J Dick, C Elton, A Weeks, J Sanders, N Aawar, J Townson, K Hood, J Hall, K Harding, R Gauntlett, R Collis
Background: Postpartum haemorrhage (PPH) can be exacerbated by haemostatic failure. Based on data from trauma studies, empirical infusions of fresh frozen plasma (FFP) are often given during severe PPH if coagulation tests are unavailable. This study observed a cohort of women with moderate/severe PPH in whom FFP infusion was guided by the use of viscoelastometric point-of-care testing (VE-POCT) and clinical assessment. Methods: Women were enrolled into this observational study when blood loss was measured or suspected to be about 1000 mL...
September 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28846577/rotational-thromboelastometry-significantly-optimizes-transfusion-practices-for-damage-control-resuscitation-in-combat-casualties
#5
Nicolas J Prat, Andrew D Meyer, Nichole K Ingalls, Julie Trichereau, Joseph J DuBose, Andrew P Cap
BACKGROUND: Up to 40% of combat casualties with a truncal injury die of massive hemorrhage before reaching a surgeon. This hemorrhage can be prevented with damage control resuscitation (DCR) methods, which are focused on replacing shed whole blood by empirically transfusing blood components in a 1:1:1:1 ratio of platelets:fresh frozen plasma:erythrocytes:cryoprecipitate (PLT:FFP:RBC:CRYO). Measurement of hemostatic function with rotational thromboelastometry (ROTEM) may allow optimization of the type and quantity of blood products transfused...
September 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28845475/combat-exposure-severity-is-associated-with-reduced-cortical-thickness-in-combat-veterans-a-preliminary-report
#6
Lynnette A Averill, Chadi G Abdallah, Robert H Pietrzak, Christopher L Averill, Steven M Southwick, John H Krystal, Ilan Harpaz-Rotem
BACKGROUND: Chronic stress and related physiological responses are known to have deleterious effects on neural integrity. Combat exposure is a notoriously pathogenic stressor and with over 2 million U.S. troops deployed to active combat zones since 2001, there is an urgent need to advance our understanding of its potential neural impact. Previous evidence suggests structural alterations in PTSD and more recent studies have explored cortical thinning specifically. This preliminary study investigates the impact of combat exposure on cortical thickness, controlling for history of early life stress and age...
January 2017: Chronic stress
https://www.readbyqxmd.com/read/28688890/any-changes-in-recent-massive-transfusion-practices-in-a-tertiary-level-institution
#7
Romi Sinha, David Roxby
BACKGROUND & OBJECTIVES: A previous review of transfusion practices in our institution between 1998 and 2008 showed a trend of high ratios of red cells (RC) to plasma (FFP) and platelets to RC towards the later years of review period. The aim of the study was to further evaluate transfusion practices in the form of blood product usage and outcomes following massive transfusion (MT) METHODS: All adult patients with critical bleeding who received a MT (defined as ≥10 units of RC in 24h) in 2008 and between January 2010 and December 2014 were identified...
June 8, 2017: Transfusion and Apheresis Science
https://www.readbyqxmd.com/read/28688660/impact-of-tranexamic-acid-on-coagulation-and-inflammation-in-murine-models-of-traumatic-brain-injury-and-hemorrhage
#8
Ryan M Boudreau, Mark Johnson, Rosalie Veile, Lou Ann Friend, Holly Goetzman, Timothy A Pritts, Charles C Caldwell, Amy T Makley, Michael D Goodman
BACKGROUND: Posttraumatic coagulopathy and inflammation can exacerbate secondary cerebral damage after traumatic brain injury (TBI). Tranexamic acid (TXA) has been shown clinically to reduce mortality in hemorrhaging and head-injured trauma patients and has the potential to mitigate secondary brain injury with its reported antifibrinolytic and antiinflammatory properties. We hypothesized that TXA would improve posttraumatic coagulation and inflammation in a murine model of TBI alone and in a combined injury model of TBI and hemorrhage (TBI/H)...
July 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28632435/relative-effects-of-plasma-fibrinogen-concentrate-and-factor-xiii-on-rotem-coagulation-profiles-in-an-in-vitro-model-of-massive-transfusion-in-trauma
#9
David E Schmidt, Märit Halmin, Agneta Wikman, Anders Östlund, Anna Ågren
Massive traumatic haemorrhage is aggravated through the development of trauma-induced coagulopathy, which is managed by plasma transfusion and/or fibrinogen concentrate administration. It is yet unclear whether these treatments are equally potent in ensuring adequate haemostasis, and whether additional factor XIII (FXIII) administration provides further benefits. In this study, we compared ROTEM whole blood coagulation profiles after experimental massive transfusion with different transfusion regimens in an in vitro model of dilution- and transfusion-related coagulopathy...
October 2017: Scandinavian Journal of Clinical and Laboratory Investigation
https://www.readbyqxmd.com/read/28624047/viscoelastic-monitoring-in-pediatric-trauma-a-survey-of-pediatric-trauma-society-members
#10
Robert T Russell, Ilan I Maizlin, Adam M Vogel
BACKGROUND: Viscoelastic monitoring (VEM), including thromboelastography (TEG) and rotational thromboelastometry (ROTEM) in the setting of goal-directed hemostatic resuscitation has been shown to improve outcomes in adult trauma. The American College of Surgeons (ACS) Committee on Trauma recommends that "thromboelastography should be available at level I and level II trauma centers". The purpose of this study is to determine the current availability and utilization of VEM in pediatric trauma...
June 15, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28622572/differential-predictive-value-of-ptsd-symptom-clusters-for-mental-health-care-among-iraq-and-afghanistan-veterans-following-ptsd-diagnosis
#11
Noelle B Smith, Jack Tsai, Robert H Pietrzak, Joan M Cook, Rani Hoff, Ilan Harpaz-Rotem
OBJECTIVES: Veterans from the recent conflicts in Iraq and Afghanistan are being diagnosed with posttraumatic stress disorder (PTSD) at high rates. This study examined characteristics associated with mental health service utilization, specifically psychotherapy, through the Department of Veterans Affairs (VA), in a large cohort of Iraq and Afghanistan veterans newly diagnosed with PTSD. METHOD: This study utilized national VA administrative data from Iraq and Afghanistan veterans following an initial diagnosis of PTSD and completed a self-report measure of PTSD symptoms between Fiscal Years 2008-2012 (N=52,456; 91...
June 13, 2017: Psychiatry Research
https://www.readbyqxmd.com/read/28590357/rotem-significantly-optimizes-transfusion-practices-for-damage-control-resuscitation-in-combat-casualties
#12
Nicolas J Prat, Andrew D Meyer, Nichole K Ingalls, Julie Trichereau, Joseph J DuBose, Andrew P Cap
BACKGROUND: Up to 40% of combat casualties with a truncal injury die of massive hemorrhage before reaching a surgeon. This hemorrhage can be prevented with damage control resuscitation (DCR) methods, which are focused on replacing shed whole blood (WB) by empirically transfusing blood components in a 1:1:1:1 ratio of platelets:plasma:erythrocytes:cryoprecipitate (PLT:FFP:RBC:CRYO). Measurement of hemostatic function with thromboelastometry (ROTEM) may allow optimization of the type and quantity of blood products transfused...
June 6, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28549445/fibrinogen-early-in-severe-trauma-study-feisty-study-protocol-for-a-randomised-controlled-trial
#13
James Winearls, Martin Wullschleger, Elizabeth Wake, Catherine Hurn, Jeremy Furyk, Glenn Ryan, Melita Trout, James Walsham, Anthony Holley, Jeremy Cohen, Megan Shuttleworth, Wayne Dyer, Gerben Keijzers, John F Fraser, Jeffrey Presneill, Don Campbell
BACKGROUND: Haemorrhage is a leading cause of death in severe trauma. Fibrinogen plays a critical role in maintaining haemostasis in traumatic haemorrhage. Early fibrinogen replacement is recommended by several international trauma guidelines using either fibrinogen concentrate (FC) or cryoprecipitate (Cryo). There is limited evidence to support one product over the other with widespread geographic and institutional variation in practice. This pilot trial is the first randomised controlled trial comparing FC to Cryo in traumatic haemorrhage...
May 26, 2017: Trials
https://www.readbyqxmd.com/read/28509684/histone-complexed-dna-fragments-levels-are-associated-with-coagulopathy-endothelial-cell-damage-and-increased-mortality-after-severe-pediatric-trauma
#14
Robert T Russell, Sarah C Christiaans, Tate Nice, Morgan Banks, Vincent Mortellaro, Charity Morgan, Amy Duhachek-Stapelman, Steven J Lisco, Jeffrey D Kerby, Brant M Wagener, Mike K Chen, Jean-François Pittet
BACKGROUND: The release of damage-associated molecular pattern molecules (DAMPs) in the extracellular space secondary to injury has been shown to cause systemic activation of the coagulation system and endothelial cell damage. We hypothesized that pediatric trauma patients with increased levels of histone-complexed DNA fragments (hcDNA) would have evidence of coagulopathy and endothelial damage that would be associated with poor outcomes. METHODS: We conducted a prospective observational study of 149 pediatric trauma patients and 62 control patients at two level 1 pediatric trauma centers from 2013-2016...
May 15, 2017: Shock
https://www.readbyqxmd.com/read/28457980/reversal-of-trauma-induced-coagulopathy-using-first-line-coagulation-factor-concentrates-or-fresh-frozen-plasma-retic-a-single-centre-parallel-group-open-label-randomised-trial
#15
Petra Innerhofer, Dietmar Fries, Markus Mittermayr, Nicole Innerhofer, Daniel von Langen, Tobias Hell, Gottfried Gruber, Stefan Schmid, Barbara Friesenecker, Ingo H Lorenz, Mathias Ströhle, Verena Rastner, Susanne Trübsbach, Helmut Raab, Benedikt Treml, Dieter Wally, Benjamin Treichl, Agnes Mayr, Christof Kranewitter, Elgar Oswald
BACKGROUND: Effective treatment of trauma-induced coagulopathy is important; however, the optimal therapy is still not known. We aimed to compare the efficacy of first-line therapy using fresh frozen plasma (FFP) or coagulation factor concentrates (CFC) for the reversal of trauma-induced coagulopathy, the arising transfusion requirements, and consequently the development of multiple organ failure. METHODS: This single-centre, parallel-group, open-label, randomised trial was done at the Level 1 Trauma Center in Innsbruck Medical University Hospital (Innsbruck, Austria)...
June 2017: Lancet Haematology
https://www.readbyqxmd.com/read/28452841/are-we-over-treating-insect-bite-related-periorbital-cellulitis-in-children-the-experience-of-a-large-tertiary-care-pediatric-hospital
#16
Nadav Friedel, Dennis Scolnik, Ayelet Rimon, Rotem Orbach, Sharon Laat, Miguel M Glatstein
INTRODUCTION: Preseptal (periorbital) and orbital cellulitis are potentially catastrophic infections near the eye. Preseptal cellulitis is far more common, and although classically reported to be associated with dacrocystitis, sinusitis/upper respiratory infection, trauma/surgery, or infection from contiguous areas, it can also be associated with insect bites. The objective of this study was to determine the prevalence of insect bite-associated preseptal cellulitis and to compare clinical findings and outcomes of these patients with those having other causes for the condition...
April 25, 2017: American Journal of Therapeutics
https://www.readbyqxmd.com/read/28403868/the-use-of-viscoelastic-haemostatic-assays-in-goal-directing-treatment-with-allogeneic-blood-products-a-systematic-review-and-meta-analysis
#17
REVIEW
Mathilde Fahrendorff, Roberto S Oliveri, Pär I Johansson
BACKGROUND: Management of the critically bleeding patient can be encountered in many medical and surgical settings. Common for these patients is a high risk of dying from exsanguination secondary to developing coagulopathy. The purpose of this meta-analysis was to systematically review and assess randomised controlled trials (RCTs) performed on patients in acute need for blood transfusions due to bleeding to evaluate the effect of viscoelastic haemostatic assay (VHA) guidance on bleeding, transfusion requirements and mortality...
April 13, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28380019/thromboelastometric-analysis-of-the-risk-factors-for-return-of-spontaneous-circulation-in-adult-patients-with-out-of-hospital-cardiac-arrest
#18
Hiroyuki Koami, Yuichiro Sakamoto, Ryota Sakurai, Miho Ohta, Hisashi Imahase, Mayuko Yahata, Mitsuru Umeka, Toru Miike, Futoshi Nagashima, Takashi Iwamura, Kosuke Chris Yamada, Satoshi Inoue
It is well known that coagulopathy is observed in patients with out-of-hospital cardiac arrest (OHCA). Thrombolytic therapy for those patients has been controversial until now. The purpose of this study was to identify a significant predictor for return of spontaneous circulation (ROSC) of OHCA patients in the emergency department (ED) using whole blood viscoelastic testing. Adult non-trauma OHCA patients transported to our hospital that underwent thromboelastometry (ROTEM) during cardiopulmonary resuscitation between January 2013 and December 2015 were enrolled in this study...
2017: PloS One
https://www.readbyqxmd.com/read/28336026/viscoelastic-studies-effective-tools-for-trauma-and-surgical-resuscitation-efforts
#19
Dagoberto Salinas
Trauma-induced coagulopathy (TIC) is an abrupt disruption of all hemostatic components of coagulation resulting from severe tissue injury and hypoperfusion. The effective management of TIC has remained elusive to clinicians using traditional laboratory methods, challenging efforts to improve outcomes related to uncontrolled bleeding. Recent initiatives have aimed to reduce TIC-associated morbidity and mortality, further invoking trauma experts to explore innovative modalities in the field of viscoelastic studies, such as thromboelastography (TEG) and rotational thromboelastometry (ROTEM)...
April 2017: AORN Journal
https://www.readbyqxmd.com/read/28302286/viscoelastic-hemostatic-assays-in-the-management-of-the-pediatric-trauma-patient
#20
Christine M Leeper, Barbara A Gaines
Viscoelastic hemostatic assays (VHA), such as TEG and ROTEM, are whole blood tests that depict functional coagulation both numerically and graphically. The development of rapid VHA technology, which allows for the first data points to result within minutes of test initiation, has increased the utility of these tests in the treatment of trauma patients. Both adult and pediatric centers have integrated VHAs into trauma resuscitation and transfusion protocols. Literature regarding the use of VHAs for injured children is limited...
February 2017: Seminars in Pediatric Surgery
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