The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Aug 2013
The nature and extent of war injuries sustained by combat specialty personnel killed and wounded in Afghanistan and Iraq, 2003-2011.
Previous studies regarding combat wounding have a limited translational capacity due to inclusion of soldiers from all military branches and occupational specialties as well as a lack of information regarding soldiers who died in theater. ⋯ The nature and extent of trauma sustained by combat-specific personnel seems to be different from that experienced by all soldiers deployed to a war zone.
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J Trauma Acute Care Surg · Aug 2013
Randomized Controlled TrialEffect of video laryngoscopy on trauma patient survival: a randomized controlled trial.
Many resuscitation scenarios include the use of emergency intubation to support injured patients. New video-guided airway management technology is available, which may minimize the risk to patients from this procedure. ⋯ Use of the GlideScope did not influence survival to hospital discharge among all patients and was associated with longer intubation times than direct laryngoscopy. Among the video laryngoscope cohort, a smaller subgroup of severe head injury trauma patients identified retrospectively seemed to be associated with a greater incidence of hypoxia of 80% or less and mortality.
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J Trauma Acute Care Surg · Aug 2013
Acute lethal crush-injured rats can be successfully rescued by a single injection of high-dose dexamethasone through a pathway involving PI3K-Akt-eNOS signaling.
Crush syndrome (CS) is characterized by ischemia/reperfusion-induced rhabdomyolysis and the subsequent onset of systemic inflammation. CS is associated with a high mortality, even when patients are treated with conventional therapy. We hypothesized that treatment of lethal CS rat model with dexamethasone (DEX) have therapeutic effects on the laboratory findings and clinical course and outcome. ⋯ These results indicate that high-dose DEX reduces systemic inflammation and contributes to the improved survival rate in a rat CS model.
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J Trauma Acute Care Surg · Aug 2013
Early implementation of continuous renal replacement therapy optimizes casualty evacuation for combat-related acute kidney injury.
The purpose of this report was to review the initial use and feasibility of continuous renal replacement therapy (CRRT) among combat casualties in a war zone. Although rapid evacuation to more advanced levels of care has emerged as the standard approach, life-threatening sequelae of acute kidney injury (AKI) can preclude safe patient evacuation. For the first time in US combat casualty care, a sustained, intensivist-led CRRT program was initiated during 2010 at an Air Force theater hospital. ⋯ Intensivist-led CRRT is an effective therapeutic adjunct in the treatment of combat-related AKI. Provision of this extracorporeal therapy provides physiologic stabilization of casualties who might otherwise succumb to the sequelae of combat-related renal failure. These findings suggest that a self-sustaining CRRT program can be successfully implemented in combat support hospitals.
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J Trauma Acute Care Surg · Aug 2013
Transfusion strategies and development of acute respiratory distress syndrome in combat casualty care.
Damage-control resuscitation (DCR) has been advocated to reduce mortality in military and civilian settings. However, DCR and excessive crystalloid resuscitation may be associated with a higher incidence of acute respiratory distress syndrome (ARDS). We sought to examine the impact of resuscitation strategies on ARDS development in combat casualty care. ⋯ In modern combat casualty care, increased plasma and crystalloid infusion were identified as independent risk factors for ARDS. These findings support a practice of decreased plasma/crystalloid transfusion in trauma resuscitation once hemorrhage control is established to achieve the mortality benefit of DCR and ARDS prevention.