The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Aug 2018
Multicenter Study Observational StudyIndependent predictors of survival after traumatic atlanto-occipital dissociation.
Atlanto-occipital dissociation (AOD) occurs when the skull base is forcibly separated from the vertebral column. Existing literature on AOD is sparse and risk factors for mortality are unknown. This study determined independent predictors of survival after AOD. ⋯ Progonostic/Epidemiological, level III; Therapeutic, level IV.
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J Trauma Acute Care Surg · Aug 2018
ReviewOn the complexity of shark bite wounds: From associated bacteria to trauma management and wound repair.
The mouth of a shark is a breeding ground for a large variety of bacteria which can easily get transferred onto a human body in the event of a shark bite. Here, we review infections originating from shark oral bacterial flora, which originate from the microbiome of its prey, as well as from the surroundings where an incident takes place. We use the example of an incident which occurred in an aquarium involving a sandtiger shark, Carcharias taurus. In addition to a succinct analysis and interpretation of the wound and recovery process, an overview of currently known bacteria associated with shark bite wounds is given, as well as a summary of the effects of various previously tested antibiotics on bacteria derived from blacktip sharks, Carcharhinus limbatus, bull sharks, C. leucas, and tiger sharks, Galeocerdo cuvier.
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J Trauma Acute Care Surg · Aug 2018
Observational StudyThe impact of age on the innate immune response and outcomes after severe sepsis/septic shock in trauma and surgical intensive care unit patients.
Advancing age is a strong risk factor for adverse outcomes across multiple disease processes. However, septic surgical and trauma patients are unique in that they incur two or more inflammatory insults. The effects of advanced age on sepsis pathophysiology and outcomes remain unclear. ⋯ Prognostic, level II.
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J Trauma Acute Care Surg · Aug 2018
Extending the golden hour for Zone 1 resuscitative endovascular balloon occlusion of the aorta: Improved survival and reperfusion injury with intermittent versus continuous resuscitative endovascular balloon occlusion of the aorta of the aorta in a porcine severe truncal hemorrhage model.
Noncompressible hemorrhage can be controlled using resuscitative endovascular balloon occlusion of the aorta (REBOA). Prolonged ischemia limits REBOA application during Zone 1 deployment. Intermittent inflation/deflation may effectively mitigate this problem. ⋯ Intermittent REBOA can maintain supraceliac hemorrhage control while decreasing distal ischemia in a swine model. Prolonged survival times, decreased acidosis, and lower resuscitation requirements indicate that this technique could potentially extend Zone 1 REBOA deployment times. Schedules based on MAP may be superior to time-based regimens.