The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Dec 2015
Multicenter StudyThe role of computed tomographic scan in ongoing triage of operative hepatic trauma: A Western Trauma Association multicenter retrospective study.
A subset of patients explored for abdominal injury have persistent hepatic bleeding on postoperative computed tomography (CT) and/or angiography, either not identified or not manageable at initial laparotomy. To identify patients at risk for ongoing hemorrhage and guide triage to angiography, we investigated the relationship of early postoperative CT scan with outcomes in operative hepatic trauma. ⋯ Care management/therapeutic study, level IV; epidemiologic/prognostic study, level III.
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J Trauma Acute Care Surg · Dec 2015
Subcapsular hematoma in blunt splenic injury: A significant predictor of failure of nonoperative management.
In patients with blunt splenic injury (BSI), patient selection, angiography, and embolization have contributed to low nonoperative management (NOM) failure rates. Despite these advances, some patients will fail NOM. We noted that a significant proportion of NOM failures had subcapsular hematomas (SCHs) identified on imaging. We sought to determine if there is a correlation between SCH and higher risk of NOM failure after BSI. ⋯ Therapeutic study, level IV.
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J Trauma Acute Care Surg · Dec 2015
Role of computed tomography angiography in the management of Zone II penetrating neck trauma in patients with clinical hard signs.
The Western Trauma Association (WTA) describes the management of Zone 2 penetrating neck trauma (PNT) and recommends neck exploration (NE) for patients with clinical hard signs (HS). We hypothesize that in stable patients with HS, the management of PNT augmented by computed tomography angiography (CTA) results in fewer negative NE results. ⋯ Care management/therapeutic study, level IV.
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J Trauma Acute Care Surg · Dec 2015
Addition of low-dose valproic acid to saline resuscitation provides neuroprotection and improves long-term outcomes in a large animal model of combined traumatic brain injury and hemorrhagic shock.
Combined traumatic brain injury (TBI) and hemorrhagic shock (HS) is highly lethal. In a nonsurvival model of TBI + HS, addition of high-dose valproic acid (VPA) (300 mg/kg) to hetastarch reduced brain lesion size and associated swelling 6 hours after injury; whether this would have translated into better neurologic outcomes remains unknown. It is also unclear whether lower doses of VPA would be neuroprotective. We hypothesized that addition of low-dose VPA to normal saline (NS) resuscitation would result in improved long-term neurologic recovery and decreased brain lesion size. ⋯ In this long-term survival model of TBI + HS, addition of low-dose VPA to saline resuscitation resulted in attenuated neurologic impairment, faster neurologic recovery, smaller brain lesion size, and a quicker normalization of cognitive functions.
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J Trauma Acute Care Surg · Dec 2015
Shock-induced systemic hyperfibrinolysis is attenuated by plasma-first resuscitation.
We developed a hemorrhagic shock animal model to replicate an urban prehospital setting where resuscitation fluids are limited to assess the effect of saline versus plasma in coagulopathic patients. An in vitro model of whole blood dilution with saline exacerbated tissue plasminogen activator (tPA)-mediated fibrinolysis, while plasma dilution did not change fibrinolysis. We hypothesize that shock-induced hyperfibrinolysis can be attenuated by resuscitation with plasma while exacerbated by saline. ⋯ Systemic hyperfibrinolysis is driven by hypoperfusion and associated with increased levels of tPA. Plasma is a superior resuscitation fluid to NS in a prehospital model of severe hemorrhagic shock as it attenuates hyperfibrinolysis and improves systemic perfusion.