The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Oct 2015
Failure to clear elevated lactate predicts 24-hour mortality in trauma patients.
Lactate clearance is a standard resuscitation goal in patients in nontraumatic shock but has not been investigated adequately as a tool to identify trauma patients at risk of dying. Our objective was to determine if trauma patients with impaired lactate clearance have a higher 24-hour mortality rate than patients whose lactate concentration normalizes. ⋯ Prognostic study, level III.
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J Trauma Acute Care Surg · Oct 2015
Prehospital use of hemostatic dressings by the Israel Defense Forces Medical Corps: A case series of 122 patients.
Hemostatic dressings are advanced topical dressings designed to control hemorrhage by enhancing clot formation. These dressings may be effective when used on injuries sustained in junctional zones. The Israeli Defense Forces Medical Corps (IDF-MC) chose to equip its medical personnel with the QuikClot Combat Gauze. There is a paucity of data describing clinical use and results of hemostatic dressing especially at the point of injury. The purpose of this article was to report the IDF-MC experience with prehospital use of the QuikClot Combat Gauze in junctional zones in a case series retrieved from the IDF Trauma Registry. ⋯ Therapeutic study, level V.
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J Trauma Acute Care Surg · Oct 2015
Observational StudyThe impact of blood transfusions in deceased organ donors on the outcomes of 1,884 renal grafts from United Network for Organ Sharing Region 5.
Historically, strategies to reduce acute rejection and improve graft survival in kidney transplant recipients included blood transfusions (BTs) before transplantation. While advents in recipient immunosuppression strategies have replaced this practice, the impact of BTs in the organ donor on recipient graft outcomes has not been evaluated. We hypothesize that BTs in organ donors after neurologic determination of death (DNDDs) translate into improved recipient renal graft outcomes, as measured by a decrease in delayed graft function (DGF). ⋯ Therapeutic study, level III; epidemiologic/prognostic study, level II.
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J Trauma Acute Care Surg · Oct 2015
Admission hematocrit predicts the need for transfusion secondary to hemorrhage in pediatric blunt trauma patients.
Pediatric trauma uses a substantial amount of resources. Quick and cost-effective measures that can be used to identify children with clinically relevant injuries are essential to resource allocation and optimization of patient care. Admission hematocrit is rapid and inexpensive, causes minimal harm, and can potentially aid in critical decision making. We hypothesize that admission hematocrit predicts the need for transfusion in pediatric blunt trauma patients. ⋯ Epidemiologic/prognostic study, level III.
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J Trauma Acute Care Surg · Oct 2015
Ratio-driven resuscitation predicts early fascial closure in the combat wounded.
Operation Iraqi Freedom and Operation Enduring Freedom have seen the highest rates of combat casualties since Vietnam. These casualties often require massive transfusion (MT) and immediate surgical attention to control hemorrhage. Clinical practice guidelines dictate ratio-driven resuscitation (RDR) for patients requiring MT. With the transition from crystalloid to blood product resuscitation, we have seen fewer open abdomens in combat casualties. We sought to determine the effect RDR has on achieving early definitive abdominal fascial closure in combat casualties undergoing exploratory laparotomy. ⋯ Therapeutic study, level III.