Current opinion in critical care
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Curr Opin Crit Care · Dec 2013
ReviewUtility of simultaneous interventional radiology and operative surgery in a dedicated suite for seriously injured patients.
In recent years, combined interventional radiology and operative suites have been proposed and are now becoming operational in select trauma centres. Given the infancy of this technology, this review aims to review the rationale, benefits and challenges of hybrid suites in the management of seriously injured patients. ⋯ Hybrid suites offer tremendous potential to expedite haemorrhage control in trauma patients. Outcome evaluations from trauma units that currently have operational hybrid suites are required to establish clearer guidelines and criteria for patient management.
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Haemorrhage from major trauma is a significant cause of death worldwide. The UK Defence Medical Service (UK-DMS) has had significant experience in managing severely injured and shocked trauma casualties over the last decade. This has led to the integration of rotational thromboelastometry (ROTEM) into damage control resuscitation delivered at Camp Bastion Field Hospital in Afghanistan. This review aims to describe the rationale for its use and how its use has evolved by UK-DMS. ⋯ ROTEM provides a means to rapidly assess coagulation in trauma casualties, allowing targeted use of blood products. It provides information on clot initiation strength and breakdown. However, its use in trauma has still to be fully evaluated.
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This article reviews the latest operative trauma surgery techniques and strategies, which have been published in the last 10 years. Many of the articles we reviewed come directly from combat surgery experience and may be also applied to the severely injured civilian trauma patient and in the context of terrorist attacks on civilian populations. ⋯ The last 10 years of conflict has produced a wealth of experience and novel techniques in operative trauma surgery. The articles we review here are essential for the contemporary care of the severely injured trauma patient, whether they are card for in a level 1 trauma center or in a field hospital at the edge of a battlefield.
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Curr Opin Crit Care · Dec 2013
ReviewMeasuring renal function in critically ill patients: tools and strategies for assessing glomerular filtration rate.
Alterations in kidney function are common in critically ill patients and are generally assessed by changes in serum creatinine (sCr) or urine output, which are considered surrogates for glomerular filtration rate (GFR) but do not reflect the overall kidney function. There is a great need for more reliable measurements of glomerular filtration in order to guide diagnosis and therapy for acute kidney injury. In this review, we will focus on recent advances to measure GFR that could help to better evaluate kidney function and improve patient care. ⋯ Standardized assays for sCr measurements, the use of a more precise scale with more frequent measurements, and the interpretation of the results based on patient's characteristics can increase the clinical value of sCr. New endogenous and exogenous markers will provide a more precise estimation. Imaging techniques are being developed and will probably be available in the near future. New gold standards for glomerular filtration will help in the development and improvement in the use of new biomarkers of kidney injury.
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Although early acute traumatic coagulopathy has received much recent attention, the procoagulopathy that often follows appears less appreciated. Thromboembolic disease following trauma is common and lethal, but very effective prophylactic strategies are available. These strategies are variably implemented because of the difficulty in quantifying the magnitude of procoagulopathy in individual patients. ⋯ The logical next step following from the improved pathophysiological understanding of the procoagulopathy of trauma should be a simultaneous clinical trial of procoagulopathy diagnosis and thromboembolic prophylaxis.