The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Jan 2020
Randomized Controlled TrialSeverity of hemorrhage and the survival benefit associated with plasma: Results from a randomized prehospital plasma trial.
Recent randomized clinical trial evidence demonstrated a survival benefit with the use of prehospital plasma in patients at risk of hemorrhagic shock. We sought to characterize the survival benefit associated with prehospital plasma relative to the blood transfusion volume over the initial 24 hours. We hypothesized that the beneficial effects of prehospital plasma would be most robust in those with higher severity of hemorrhage. ⋯ Therapeutic, Level I.
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J Trauma Acute Care Surg · Nov 2019
Randomized Controlled TrialKetamine infusion for pain control in elderly patients with multiple rib fractures: Results of a randomized controlled trial.
Rib fractures are associated with increased mortality, particularly in the elderly. While opiate-based pain regimens remain the cornerstone of rib fracture management, issues related to opioids have driven research into alternative analgesics. Adjunctive ketamine use in lieu of opioids continues to increase but little evidence exists to support its efficacy or safety within the elderly trauma population. ⋯ Therapeutic, level I.
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J Trauma Acute Care Surg · Nov 2019
Randomized Controlled Trial Multicenter StudyImplementation of a prehospital air medical thawed plasma program: Is it even feasible?
The Prehospital Air Medical Plasma (PAMPer) trial demonstrated a 30-day survival benefit among hypotensive trauma patients treated with prehospital plasma during air medical transport. We characterized resources, costs and feasibility of air medical prehospital plasma program implementation. ⋯ Therapeutic, level III.
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J Trauma Acute Care Surg · Nov 2019
Randomized Controlled TrialMissing expectations: Windlass tourniquet use without formal training yields poor results.
Despite significant attempts to educate civilians in hemorrhage control, the majority remain untrained. We sought to determine if laypersons can successfully apply one of three commercially available tourniquets; including those endorsed by the United States Military and the American College of Surgeons. ⋯ No one should die of extremity hemorrhage, and civilians are our first line of defense. We demonstrate that when an untrained layperson is handed a commonly accepted tourniquet, failure is unacceptably high. Current devices are not intuitive and require training beyond the enclosed instructions. Plans to further evaluate this cohort after formal "Stop the Bleed" training are underway.
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J Trauma Acute Care Surg · Oct 2019
Randomized Controlled TrialKetamine/propofol admixture vs etomidate for intubation in the critically ill: KEEP PACE Randomized clinical trial.
Periintubation hypotension is associated with poor outcomes in the critically ill. We aimed to determine if an admixture of ketamine and propofol for emergent endotracheal intubation in critically ill patients was superior to etomidate. Primary endpoint was the change in mean arterial pressure from baseline to 5 minutes postdrug administration. ⋯ Therapeutic/Care Management, level II.