J Trauma
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By geographic necessity, rural trauma patients must be initially stabilized at local community hospitals before transfer for definitive care. In this study, it was hypothesized that telemedicine consults with trauma surgeons from a Level I trauma center online while the patient was still in the community hospital ED could positively affect care. ⋯ Telemedicine provides a virtual online trauma surgeon to assist with the resuscitation and stabilization of the major trauma patient in a small community hospital. These preliminary results show a positive impact on rural trauma patient care at the local community hospital.
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One of the perceived advantages of a hemoglobin-based blood substitute is the provision of oxygen-carrying capacity. Although the hemodynamic response to the infusion of acellular hemoglobin solutions has been extensively studied, less is known about the oxygen transport dynamics of such solutions. We hypothesized that acellular hemoglobin solutions are useful oxygen carriers in anemic states and that higher P50 solutions transport O2 more efficiently than low P50 solutions. We sought to quantify O2 transport dynamics of hemoglobin solutions in an isovolemic hemodilution model in swine. ⋯ Acellular hemoglobin solutions provide a significant contribution to O2 delivery and consumption, particularly in severe anemia, in this model of isovolemic exchange. The differences in the P50 of the two hemoglobin solutions do not appear to significantly influence oxygen dynamics over the range of hematocrits studied.
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Hemorrhagic shock-induced splanchnic hypoperfusion has been implicated as a priming event in the two event model of multiple organ failure (MOF). We have previously shown that early postinjury neutrophil (PMN) priming identifies the injured patient at risk for MOF. Recent in vitro studies have demonstrated that postshock mesenteric lymph primes isolated human neutrophils. We hypothesize that lymphatic diversion before hemorrhagic shock abrogates systemic PMN priming and subsequent lung injury. ⋯ Post-hemorrhagic shock mesenteric lymph primes circulating PMNs, promotes lung PMN accumulation, and provokes acute lung injury. Lymphatic diversion abrogates these pathologic events. These observations further implicate the central role of mesenteric lymph in hemorrhagic shock-induced lung injury. Characterizing the PMN priming agents could provide insight into the pathogenesis of postinjury MOF and ultimately new therapeutic strategies.
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Multicenter Study
Management of traumatic lung injury: a Western Trauma Association Multicenter review.
Improved outcomes following lung injury have been reported using "lung sparing" techniques. ⋯ Blunt traumatic lung injury has higher mortality primarily due to associated extrathoracic injuries. Major resections are required more commonly than previously reported. While "minor" resections, if feasible, are associated with improved outcome, trauma surgeons should be facile in a wide range of technical procedures for the management of lung injuries.
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A Level I trauma center recently underwent a policy change wherein airway management of the trauma patient is under the auspices of Emergency Medicine (EM) rather than Anesthesiology. ⋯ EM residents and staff can safely manage the airway of trauma patients. There is no statistically significant difference in peri-intubation complications. The complication rate for EDI (33%) and ANI (38%) is higher than reported in the literature, although the populations are not entirely comparable.