J Trauma
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In field situations, patient triage may require early determination of patients progressing to irreversible shock. We investigated the utility of near-infrared spectroscopy (NIRS) in early detection of irreversible hemorrhagic shock. ⋯ Non-invasive NIRS monitoring of leg and stomach StO2 differentiates resuscitatable from unresuscitatable animals after the initial resuscitative bolus. Use of this non-invasive tool may guide appropriate use of resuscitative fluids and has possible point-of-care applications.
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We sought to evaluate the effect on short-term outcomes of normothermic, extracorporeal perfusion (ECMO) for donation of abdominal organs for transplantation after cardiac death (DCD). Study parameters included increase in number of donors and organs, types of organs procured, and viability of kidneys transplanted. ⋯ The implementation of a DCD protocol using extracorporeal perfusion increased the potential organ donor pool at our institution by 33%. This was accomplished without short term adverse effect on organ function compared with kidneys transplanted from DBD donors.
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Comparative Study
The high morbidity associated with handlebar injuries in children.
Although injury prevention strategies for bicyclists have focused on legislation requiring helmet use to prevent head trauma, direct impact handlebar injuries account for a significant proportion of bicycle-related injuries. Little attention, however, has been paid to strategies that prevent direct impact handlebar injuries. We reviewed our experience with bicycle-related injuries and compared outcome for children who flipped over the handlebars to those for children who sustained direct impact from the handlebars. ⋯ Children who suffer from direct impact of the handlebars are more likely to require operative intervention and have a longer LOS than those who flip over the handlebars. While helmet utilization by bicyclists may have reduced the number of serious head injuries, direct impact from the handlebars remains a major source of bicycle-related morbidity since nearly one third of these patients required surgery. Future injury prevention strategies for bicyclists should be aimed at reducing the incidence of direct impact handlebar-related injuries.
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According to the National Institute of Justice (NIJ) Standard 0101.04, the maximum deformation a soft armor vest can undergo without penetration is 44 mm. However, this does not take into account the effect of the pressure wave or energy transferred to the organs within the torso due to behind armor blunt trauma (BABT). Therefore, a study was undertaken to develop a finite element model (FEM) to study these effects. ⋯ The resulting pressure profiles and kinetic energy exhibited by the respective organs indicate this model may be useful in identifying mechanisms of injury as well as organs at an elevated injury risk as a result of BABT.
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No objective criteria have been described to help selecting patients with major blunt aortic injury (BAI) for postponed surgical repair. The efficacy of conservative management of minor BAI needs further evaluation. ⋯ Conservative management of minor BAI with serial follow-up appears to be appropriate. In patients with a grade 2 BAI and small false aneurysm formation and hemomediastinum, postponed surgical repair appears to be safe. However, these TEE criteria remain to be tested prospectively.