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Trauma Resuscitation: SEC ACEP

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35 papers 0 to 25 followers Sources for presentation on Trauma Resus
Haleema Shakur, Ian Roberts, Raúl Bautista, José Caballero, Tim Coats, Yashbir Dewan, Hesham El-Sayed, Tamar Gogichaishvili, Sanjay Gupta, Jorge Herrera, Beverley Hunt, Pius Iribhogbe, Mario Izurieta, Hussein Khamis, Edward Komolafe, María-Acelia Marrero, Jorge Mejía-Mantilla, Jaime Miranda, Carlos Morales, Oluwole Olaomi, Fatos Olldashi, Pablo Perel, Richard Peto, P V Ramana, R R Ravi, Surakrant Yutthakasemsunt
BACKGROUND: Tranexamic acid can reduce bleeding in patients undergoing elective surgery. We assessed the effects of early administration of a short course of tranexamic acid on death, vascular occlusive events, and the receipt of blood transfusion in trauma patients. METHODS: This randomised controlled trial was undertaken in 274 hospitals in 40 countries. 20 211 adult trauma patients with, or at risk of, significant bleeding were randomly assigned within 8 h of injury to either tranexamic acid (loading dose 1 g over 10 min then infusion of 1 g over 8 h) or matching placebo...
July 3, 2010: Lancet
Timothy C Nunez, Igor V Voskresensky, Lesly A Dossett, Ricky Shinall, William D Dutton, Bryan A Cotton
BACKGROUND: Massive transfusion (MT) occurs in about 3% of civilian and 8% of military trauma patients. Although many centers have implemented MT protocols, most do not have a standardized initiation policy. The purpose of this study was to validate previously described MT scoring systems and compare these to a simplified nonlaboratory dependent scoring system (Assessment of Blood Consumption [ABC] score). METHODS: Retrospective cohort of all level I adult trauma patients transported directly from the scene (July 2005 to June 2006)...
February 2009: Journal of Trauma
Frédéric Lapostolle, Jean Luc Sebbah, James Couvreur, François Xavier Koch, Dominique Savary, Karim Tazarourte, Gerald Egman, Lynda Mzabi, Michel Galinski, Frédéric Adnet
INTRODUCTION: Hypothermia is common in trauma victims and is associated with an increase in mortality. Its causes are not well understood. Our objective was to identify the factors influencing the onset of hypothermia during pre-hospital care of trauma victims. METHODS: This was a multicenter, prospective, open, observational study in a pre-hospital setting. RESULTS: A total of 448 patients were included. Hypothermia (<35 °C) on hospital arrival was present in 64/448 patients (14%)...
July 31, 2012: Critical Care: the Official Journal of the Critical Care Forum
Jason L Sperry, Juan B Ochoa, Scott R Gunn, Louis H Alarcon, Joseph P Minei, Joseph Cuschieri, Matthew R Rosengart, Ronald V Maier, Timothy R Billiar, Andrew B Peitzman, Ernest E Moore
OBJECTIVE: The detrimental effects of coagulopathy, hypothermia, and acidosis are well described as markers for mortality after traumatic hemorrhage. Recent military experience suggests that a high fresh frozen plasma (FFP):packed red blood cell (PRBC) transfusion ratio improves outcome; however, the appropriate ratio these transfusion products should be given remains to be established in a civilian trauma population. METHODS: Data were obtained from a multicenter prospective cohort study evaluating clinical outcomes in blunt injured adults with hemorrhagic shock...
November 2008: Journal of Trauma
Anne F Eder, Beth A Dy, Jaime M Perez, Michele Rambaud, Richard J Benjamin
BACKGROUND: The American Red Cross began preferentially distributing plasma from male donors in 2007 and subsequently observed an 80% decrease in reported cases of transfusion-related acute lung injury (TRALI) after plasma transfusion. Plasma distributions from male donors now exceed 99% for groups A, B, and O, but only approximately 60% for group AB. We evaluated the ongoing risk of TRALI and the ABO blood group of involved plasma donors. STUDY DESIGN AND METHODS: The rate of suspected TRALI per distributed components before (2006) and after (2008-2011) implementing the predominantly male-donor plasma strategy is compared...
July 2013: Transfusion
Arash Afshari, Anne Wikkelsø, Jesper Brok, Ann Merete Møller, Jørn Wetterslev
BACKGROUND: Severe bleeding and coagulopathy as a result of massive transfusion are serious clinical conditions that are associated with high mortality. Thromboelastography (TEG) and thromboelastometry (ROTEM) are increasingly used to guide transfusion strategy but their roles remain disputed. OBJECTIVES: To systematically assess the benefits and harms of a TEG or ROTEM guided transfusion strategy in randomized trials involving patients with severe bleeding. SEARCH STRATEGY: Randomized clinical trials (RCTs) were identified from electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 9); MEDLINE; EMBASE; Science Citation Index Expanded; International Web of Science; CINAHL; LILACS; and the Chinese Biomedical Literature Database (up to 31st October 2010)...
March 16, 2011: Cochrane Database of Systematic Reviews
Luis Teodoro Da Luz, Bartolomeu Nascimento, Ajith Kumar Shankarakutty, Sandro Rizoli, Neill Kj Adhikari
INTRODUCTION: The understanding of coagulopathies in trauma has increased interest in thromboelastography (TEG®) and thromboelastometry (ROTEM®), which promptly evaluate the entire clotting process and may guide blood product therapy. Our objective was to review the evidence for their role in diagnosing early coagulopathies, guiding blood transfusion, and reducing mortality in injured patients. METHODS: We considered observational studies and randomized controlled trials (MEDLINE, EMBASE, and Cochrane databases) to February 2014 that examined TEG®/ROTEM® in adult trauma patients...
September 27, 2014: Critical Care: the Official Journal of the Critical Care Forum
Mark Walsh, Stephanie Fritz, Daniel Hake, Michael Son, Sarah Greve, Manar Jbara, Swetha Chitta, Braxton Fritz, Adam Miller, Mary K Bader, Jonathon McCollester, Sophia Binz, Alyson Liew-Spilger, Scott Thomas, Anton Crepinsek, Faisal Shariff, Victoria Ploplis, Francis J Castellino
Trauma-induced coagulopathy (TIC) is a recently described condition which traditionally has been diagnosed by the common coagulation tests (CCTs) such as prothrombin time/international normalized ratio (PT/INR), activated partial thromboplastin time (aPTT), platelet count, and fibrinogen levels. The varying sensitivity and specificity of these CCTs have led trauma coagulation researchers and clinicians to use Viscoelastic Tests (VET) such as Thromboelastography (TEG) to provide Targeted Thromboelastographic Hemostatic and Adjunctive Therapy (TTHAT) in a goal directed fashion to those trauma patients in need of hemostatic resuscitation...
2016: Current Drug Targets
Takayuki Ogura, Alan Kawarai Lefor, Mamoru Masuda, Shigeki Kushimoto
BACKGROUND: Determination of the need for massive transfusion (MT) is essential for early activation of a MT protocol. The Traumatic Bleeding Severity Score (TBSS) predicts the need for MT accurately, but takes time to determine because systolic blood pressure after a 1000mL of crystalloid infusion is used. The aim of this study is to determine the how well the Modified TBSS (age, sonography, pelvic fracture, serum lactate and systolic blood pressure on arrival) predicts the need for MT (accuracy)...
June 2016: American Journal of Emergency Medicine
Matthew M Carrick, Catherine Anne Morrison, Nicole M Tapia, Jan Leonard, James W Suliburk, Michael A Norman, Francis J Welsh, Bradford G Scott, Kathy R Liscum, Sally R Raty, Matthew J Wall, Kenneth L Mattox
BACKGROUND: Hemorrhagic shock is responsible for one third of trauma related deaths. We hypothesized that intraoperative hypotensive resuscitation would improve survival for patients undergoing operative control of hemorrhage following penetrating trauma. METHODS: Between July 1, 2007, and March 28, 2013, penetrating trauma patients aged 14 years to 45 years with a systolic blood pressure of 90 mm Hg or lower requiring laparotomy or thoracotomy for control of hemorrhage were randomized 1:1 based on a target minimum mean arterial pressure (MAP) of 50 mm Hg (experimental arm, LMAP) or 65 mm Hg (control arm, HMAP)...
June 2016: Journal of Trauma and Acute Care Surgery
I Ibrahim, W P Chor, K M Chue, C S Tan, H L Tan, F J Siddiqui, M Hartman
BACKGROUND: Arterial base deficit (BD) has been widely used in trauma patients since 1960. However, trauma management has also evolved significantly in the last 2 decades. The first objective of this study was to systematically review the literature on the relationship between arterial BD as a prognostic marker for trauma outcomes (mortality, significant injuries, and major complications) in the acute setting. The second objective was to evaluate arterial BD as a prognosis marker, specifically, in the elderly and in patients with positive blood alcohol levels...
March 2016: American Journal of Emergency Medicine
Deborah M Siegal, John T Curnutte, Stuart J Connolly, Genmin Lu, Pamela B Conley, Brian L Wiens, Vandana S Mathur, Janice Castillo, Michele D Bronson, Janet M Leeds, Florie A Mar, Alex Gold, Mark A Crowther
BACKGROUND: Bleeding is a complication of treatment with factor Xa inhibitors, but there are no specific agents for the reversal of the effects of these drugs. Andexanet is designed to reverse the anticoagulant effects of factor Xa inhibitors. METHODS: Healthy older volunteers were given 5 mg of apixaban twice daily or 20 mg of rivaroxaban daily. For each factor Xa inhibitor, a two-part randomized placebo-controlled study was conducted to evaluate andexanet administered as a bolus or as a bolus plus a 2-hour infusion...
December 17, 2015: New England Journal of Medicine
Lindsay C Bridges, Brett H Waibel, Mark A Newell
Permissive hypotension is a component of damage control resuscitation that aims to provide a directed, controlled resuscitation, while countering the "lethal triad." This principle has not been specifically studied in elderly (ELD) trauma patients (≥55 years). Given the ELD population's lack of physiologic reserve and risk of inadequate perfusion with "normal" blood pressures, we hypothesized that utilized a permissive hypotension strategy in ELD trauma patients would result in worse outcomes compared with younger patients (18-54 years)...
August 2015: American Surgeon
Stephan Glund, Joachim Stangier, Michael Schmohl, Dietmar Gansser, Stephen Norris, Joanne van Ryn, Benjamin Lang, Steven Ramael, Viktoria Moschetti, Fredrik Gruenenfelder, Paul Reilly, Jörg Kreuzer
BACKGROUND: Idarucizumab is a monoclonal antibody fragment that binds dabigatran with high affinity in a 1:1 molar ratio. We investigated the safety, tolerability, and efficacy of increasing doses of idarucizumab for the reversal of anticoagulant effects of dabigatran in a two-part phase 1 study (rising-dose assessment and dose-finding, proof-of-concept investigation). Here we present the results of the proof-of-concept part of the study. METHODS: In this randomised, placebo-controlled, double-blind, proof-of-concept phase 1 study, we enrolled healthy volunteers (aged 18-45 years) with a body-mass index of 18·5-29·9 kg/m(2) into one of four dose groups at SGS Life Sciences Clinical Research Services, Belgium...
August 15, 2015: Lancet
Nicholas D Caputo, Marc Kanter, Robert Fraser, Ronald Simon
BACKGROUND: Biomarkers such as serum lactate, anion gap (AG), and base excess (BE) have been shown to be of use in determining shock in patients with seemingly normal vital signs. We seek to determine if these biomarkers can be used interchangeably in patients with trauma in the emergency setting based on their test characteristics and correlation to each other. METHODS: A prospective observational cohort study was undertaken at an urban level 1 trauma center. Baseline vital signs, point-of-care BE, AG, and serum lactate were recorded in all patients who presented for trauma...
September 2015: American Journal of Emergency Medicine
John B Holcomb, Barbara C Tilley, Sarah Baraniuk, Erin E Fox, Charles E Wade, Jeanette M Podbielski, Deborah J del Junco, Karen J Brasel, Eileen M Bulger, Rachael A Callcut, Mitchell Jay Cohen, Bryan A Cotton, Timothy C Fabian, Kenji Inaba, Jeffrey D Kerby, Peter Muskat, Terence O'Keeffe, Sandro Rizoli, Bryce R H Robinson, Thomas M Scalea, Martin A Schreiber, Deborah M Stein, Jordan A Weinberg, Jeannie L Callum, John R Hess, Nena Matijevic, Christopher N Miller, Jean-Francois Pittet, David B Hoyt, Gail D Pearson, Brian Leroux, Gerald van Belle
IMPORTANCE: Severely injured patients experiencing hemorrhagic shock often require massive transfusion. Earlier transfusion with higher blood product ratios (plasma, platelets, and red blood cells), defined as damage control resuscitation, has been associated with improved outcomes; however, there have been no large multicenter clinical trials. OBJECTIVE: To determine the effectiveness and safety of transfusing patients with severe trauma and major bleeding using plasma, platelets, and red blood cells in a 1:1:1 ratio compared with a 1:1:2 ratio...
February 3, 2015: JAMA: the Journal of the American Medical Association
Juan C Duchesne, Lewis J Kaplan, Zsolt J Balogh, Manu L N G Malbrain
Secondary intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are closely related to fluid resuscitation. IAH causes major deterioration of the cardiac function by affecting preload, contractility and afterload. The aim of this review is to discuss the different interactions between IAH, ACS and resuscitation, and to explore a new hypothesis with regard to damage control resuscitation, permissive hypotension and global increased permeability syndrome. Review of the relevant literature via PubMed search...
2015: Anaesthesiology Intensive Therapy
Ryan Gerecht
No abstract text is available yet for this article.
April 2014: JEMS: a Journal of Emergency Medical Services
James S Davis, Salman Alsafran, Cheryl D Richie, Joshua W Moore, Nicholas Namias, Carl I Schulman
Normal saline (NS) is not used for trauma resuscitation because of its potential for acidosis. Lactated Ringer's (LR) is preferred instead. However, the two crystalloids have never been compared in trauma patients. We hypothesized that NS would be an acceptable fluid for resuscitation in the trauma patient. In 2011, a Level I trauma center switched resuscitation fluid from LR to NS. Admissions before and after the change were retrospectively reviewed. Demographics, vitals, blood work, and fluid intake were recorded over 24 hours...
March 2014: American Surgeon
Chih-Hung Wang, Wen-Han Hsieh, Hao-Chang Chou, Yu-Sheng Huang, Jen-Hsiang Shen, Yee Hui Yeo, Huai-En Chang, Shyr-Chyr Chen, Chien-Chang Lee
OBJECTIVE: Hemorrhage is responsible for most deaths that occur during the first few hours after trauma. Animal models of trauma have shown that restricting fluid administration can reduce the risk of death; however, studies in patients are difficult to conduct due to logistical and ethical problems. To maximize the value of the existing evidence, we performed a meta-analysis to compare liberal versus restricted fluid resuscitation strategies in trauma patients. DATA SOURCES: Medline and Embase were systemically searched from inception to February 2013...
April 2014: Critical Care Medicine
2016-04-28 14:34:39
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