The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · May 2015
Observational StudyInfluence of intra-abdominal pressure on the specificity of pulse pressure variations to predict fluid responsiveness.
The positive predictive value of pulse pressure variations (ΔPP) to discriminate patients who should respond to volume expansion (VE) may be altered in mechanically ventilated patients. Our goal was to determine whether intra-abdominal pressure (IAP) measurements could discriminate patients with true-positive ΔPP values versus patients with false-positive ΔPP values. ⋯ Diagnostic study, level II.
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J Trauma Acute Care Surg · May 2015
Evaluation of the safety and feasibility of resuscitative endovascular balloon occlusion of the aorta.
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is one of the ultimately invasive procedures for managing a noncompressive torso injury. Since it is less invasive than resuscitative open aortic cross-clamping, its clinical application is expected. ⋯ Therapeutic/care management, level V.
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J Trauma Acute Care Surg · May 2015
Acute traumatic coagulopathy: Whole blood thrombelastography measures the tip of the iceberg.
Thrombelastography (TEG) is suggested as an optimal instrument for the identification of acute traumatic coagulopathy-induced alterations in coagulation status. Patient whole blood (WB) used in TEG analysis is generally collected from a large blood vessel containing representative systemic blood, often close to 40% hematocrit (Hct). Trauma patients often exhibit bleeding from the microvasculature. This study examines early coagulation function changes at the simulated microvascular level based on altered Hct and pH in vitro through TEG analyses of normal donor blood. ⋯ Acidemia-induced coagulopathy at the level of the capillary Hct (1) is more severe than at higher Hct levels (larger blood vessels), (2) shows that simulated resuscitation with NS causes greater increases in clot time and decreases in clot strength beyond that which occurs with plasma replacement, and (3) may not accurately be portrayed through common TEG practice of testing systemic WB of greater than 30% Hct.
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J Trauma Acute Care Surg · May 2015
Absence of clinical findings reliably excludes unstable cervical spine injuries in children 5 years or younger.
Increased accessibility and rapidity of computed tomography (CT) have led to increased use and radiation exposure to pediatric trauma patients. The thyroid is radiosensitive and therefore at risk for developing malignancy from radiation exposure during cervical spine CT. This analysis aimed to determine which preelementary trauma patients warrant cervical spine CT by defining incidence and clinical characteristics of preelementary cervical spine injury. ⋯ Therapeutic study, level IV.