The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Mar 2014
Persistent inflammation-immunosuppression catabolism syndrome, a common manifestation of patients with enterocutaneous fistula in intensive care unit.
Persistent inflammation-immunosuppression catabolism syndrome (PICS) is a newly proposed concept that has replaced late multiple-organ failure and prolongs surgical intensive care unit (ICU) duration. Enterocutaneous fistula (ECF) is one of the most challenging complications in the practice of surgery. However, no studies have been performed connecting PICS with ECF. ⋯ Prognostic study, level III.
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J Trauma Acute Care Surg · Mar 2014
Repeal of the concealed weapons law and its impact on gun-related injuries and deaths.
Senate Bill 1108 (SB-1108) allows adult citizens to carry concealed weapons without a permit and without completion of a training course. It is unclear whether the law creates a "deterrent factor" to criminals or whether it escalates gun-related violence. We hypothesized that the enactment of SB-1108 resulted in an increase in gun-related injuries and deaths (GRIDs) in southern Arizona. ⋯ Epidemiologic study, level III.
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J Trauma Acute Care Surg · Mar 2014
Mortality after ground-level fall in the elderly patient taking oral anticoagulation for atrial fibrillation/flutter: a long-term analysis of risk versus benefit.
Elderly patients with atrial fibrillation or flutter who experience ground-level falls are at risk for lethal head injuries. Patients on oral anticoagulation (OAC) for thromboprophylaxis may be at higher risk for these head injuries. Trauma surgeons treating these patients face a difficult choice: (1) continue OAC to minimize stroke risk while increasing the risk of a lethal head injury or (2) discontinue OAC to avoid intracranial hemorrhage while increasing the risk of stroke. To inform this choice, we conducted a retrospective cohort study to assess long-term outcomes and risk factors for mortality after presentation with a ground-level fall among patients with and without OAC. ⋯ Epidemiologic/prognostic study, level III.
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J Trauma Acute Care Surg · Mar 2014
Assessment of pelvic fractures resulting from the 2010 Haiti earthquake: opportunities for improved care.
On January 12, 2010, a catastrophic 7.0 magnitude earthquake shook the Haitian capital of Port-au-Prince. Because of their sudden and destructive nature, earthquakes can result in unfamiliar mass casualty situations accompanied by devastating orthopedic injuries. Evaluation of the pelvic fractures resulting from this earthquake revealed several factors that we hope will facilitate optimal preparation and planning for future disaster situations. ⋯ Epidemiologic study, level III; therapeutic study, level V.
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J Trauma Acute Care Surg · Mar 2014
Tranexamic acid corrects fibrinolysis in the presence of acidemia in a swine model of severe ischemic reperfusion.
Tranexamic acid (TXA) is an antifibrinolytic with anti-inflammatory properties associated with improved outcomes when administered to trauma patients at risk for bleeding; however, its efficacy is unknown in acidemia. We evaluated the efficacy of TXA on hyperfibrinolysis using an established porcine traumatic hemorrhage ischemic shock model. ⋯ TXA rapidly and fully reverses hyperfibrinolysis despite severe acidemia in a porcine trauma model. TXA is a promising adjunct to trauma resuscitation that is easily administered in austere or prehospital settings.