J Trauma
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Low-molecular-weight heparin is effective for prevention of venous thromboembolism. The efficacy of daily dosing in critically ill patients is unknown. ⋯ Daily dosing of enoxaparin is inadequate for critically ill patients and should be abandoned. Further studies using twice daily dosing are needed. Patients with renal insufficiency may require an increased interval of administration (daily dosing). Anti-Xa levels may not correlate with the risk of thromboembolic complications. Patients with renal insufficiency and morbid obesity may require alternative dosing and monitoring of anti-Xa levels.
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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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This study was undertaken to examine the distribution of entry wounds resulting from firearms and shrapnel in soldiers wearing military personal armor systems (MPAS) in low-intensity urban combat conditions. ⋯ The use of MPAS turned the face-neck region into the most vulnerable body part, as shown by its prominent density rate, especially in the shrapnel group. MPAS designed for urban setting warfare should provide maximal shielding both to the anterior and posterior chest regions. The diameter of entrance wounds in the covered versus the uncovered areas was not statistically significant, suggesting that only a minor deformation of the bullet takes place while traversing the Kevlar vest.