Current opinion in critical care
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Curr Opin Crit Care · Dec 2009
ReviewAirway management and initial resuscitation of the trauma patient.
This review will analyze and comment on selected recent literature pertaining to airway management and initial fluid resuscitation in the trauma patient. It will also review airway devices currently being used in the trauma setting. ⋯ As trauma continues to be a major cause of morbidity and mortality worldwide, the use of newer airway adjuncts needs to be specifically investigated in trauma patients, as this population frequently has airway management difficulties. Further research is also required to elucidate the type and amount of fluid that will provide an adequate organ perfusion without increasing nonsurgical bleeding.
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Curr Opin Crit Care · Dec 2009
ReviewFinancial and intellectual conflicts of interest: confusion and clarity.
To examine the literature on competing interests for individuals and organizations involved in healthcare and to determine the nature and extent of the problem, and the most effective methods of management. ⋯ Transparency is a necessary, but not a sufficient component in managing bias. Organizations should develop integrated systems for declaring, monitoring and managing financial interests; insight into other forms of bias could be improved through educational programmes. Marketing masquerading as education should be prohibited for undergraduates and trainees, and by professional organizations. Universities and journals should separate their conflicted roles as regulators and beneficiaries in commercial relationships.
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To bring together in one review article, the most current and relevant evidence relating to military trauma resuscitation. ⋯ The review aims to educate the readership in recent advances in trauma practice, culminating in a novel empiric massive transfusion algorithm seamlessly guiding the clinician through the initial resuscitation stage resulting in reduced mortality, morbidity, coagulopathy and decreased overall blood product usage.
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Alterations of the renal microcirculation can promote the development of acute kidney injury through the interlinked occurrence of renal hypoxia and activation of inflammatory pathways. This review focuses on the recent advances in this area, and discusses the possible therapeutic interventions that might be derived from these insights. ⋯ Knowledge of the pathophysiological mechanisms of acute kidney injury emphasizes the importance of the role of the microcirculation in its development. Preventive and therapeutic approach should be based on restoring the homeostasis between nitric oxide, reactive oxygen species and renal oxygenation.