The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Mar 2013
Comparative StudyHemodilution as a result of aggressive fluid resuscitation aggravates coagulopathy in a rat model of uncontrolled hemorrhagic shock.
The relationship between dilution caused by fluid resuscitation and blood coagulability during ongoing, uncontrolled hemorrhagic shock (UHS) remains unclear. We hypothesized that dilution caused by fluid resuscitation may impair blood coagulability in UHS. ⋯ In a rat model of UHS, aggressive fluid resuscitation aggravated hemodilution and blood coagulability as well as and bleeding but improved the hemodynamics and survival. There was a positive correlation between hemodilution and coagulation indexes. Hemodilution, as part of fluid therapy, may affect coagulopathy in UHS.
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J Trauma Acute Care Surg · Mar 2013
Randomized Controlled Trial Multicenter Study Comparative StudyA prospective multicenter comparison of levetiracetam versus phenytoin for early posttraumatic seizure prophylaxis.
Brain Trauma Foundation guidelines recommend seizure prophylaxis for preventing early posttraumatic seizure (PTS). Phenytoin (PHE) is commonly used. Despite a paucity of data in traumatic brain injury, levetiracetam (LEV) has been introduced as a potential replacement, which is more costly but does not require serum monitoring. The purpose of this study was to compare the efficacy of PHE with that of LEV for preventing early PTS. ⋯ Therapeutic study, level III.
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J Trauma Acute Care Surg · Mar 2013
Comparative Study Controlled Clinical TrialEffects of routine monitoring of delirium in a surgical/trauma intensive care unit.
Delirium is prevalent in surgical and trauma intensive care units (ICUs) and carries substantial morbidity. This study tested the hypothesis that daily administration of a diagnostic instrument for delirium in a surgical/trauma ICU decreases the time of institution of pharmacologic therapy and improves related outcomes. ⋯ Therapeutic study, level IV.
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J Trauma Acute Care Surg · Mar 2013
Historical ArticleAchilles' death: anatomical considerations regarding the most famous trauma of the Trojan War.
In Greek mythology, Achilles was a hero of the Trojan War, the central character and greatest warrior of Homer's Iliad. As Achilles died because of a small wound on his heel, the term "Achilles' heel" has come to mean a person's principal weakness. But is the human heel a really vulnerable part of our body? Could a non-poisonous arrow have caused Achilles' death? Should an arrow be necessarily poisonous in order to cause a lethal heel would? The purpose of this effort is to explain, from an anatomic point of view, how Achilles heel wounding could have led to his death. ⋯ Moreover, a combination of these two theories could have also taken place, i.e. a poisoned arrow traumatizing the posterior tibial artery and hence causing rapid diffusion of the poison as well as bleeding. Furthermore, infectious and/or immunologic bases regarding Achilles' death could be considered. In our opinion, a poisoned arrow was probably the crucial factor leading to the famous inglorious death of this famous glorious Homeric hero.
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J Trauma Acute Care Surg · Mar 2013
Comparative StudyInitial inferior vena cava diameter on computed tomographic scan independently predicts mortality in severely injured trauma patients.
In the trauma population, patients with physiologic compromise may present with "normal" vital signs. We hypothesized that the inferior vena cava (IVC) diameter could be used as a surrogate marker for hypovolemic shock and predict mortality in severely injured trauma patients. ⋯ Prognostic study, level III.