J Trauma
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Randomized Controlled Trial Multicenter Study Clinical Trial
Recombinant factor VIIa as adjunctive therapy for bleeding control in severely injured trauma patients: two parallel randomized, placebo-controlled, double-blind clinical trials.
Uncontrolled bleeding is a leading cause of death in trauma. Two randomized, placebo-controlled, double-blind trials (one in blunt trauma and one in penetrating trauma) were conducted simultaneously to evaluate the efficacy and safety of recombinant factor VIIa (rFVIIa) as adjunctive therapy for control of bleeding in patients with severe blunt or penetrating trauma. ⋯ Recombinant FVIIa resulted in a significant reduction in RBC transfusion in severe blunt trauma. Similar trends were observed in penetrating trauma. The safety of rFVIIa was established in these trauma populations within the investigated dose range.
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Blunt injury of the pericardium with strangulation of the heart is a rare clinical injury. ⋯ Pericardial lacerations are common findings at autopsy. Clinically, those that survive to the hospital have a confusing presentation. They are often diagnosed during emergent thoracotomy for hemodynamic instability. Hemodynamic deterioration associated with change in patient position may be a clue to cardiac strangulation.
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Multicenter Study Comparative Study
Trauma base knowledge and the effect of the trauma evaluation and management program among senior medical students in seven countries.
We compared base trauma knowledge and the impact of the Trauma Evaluation and Management (TEAM) program among senior medical students in seven countries. ⋯ Base trauma knowledge in these students, though variable, was generally very low and improved with TEAM. Our data suggest a need for greater undergraduate emphasis in trauma education.
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Trauma patients with surgical procedures, acute lung injury (ALI), systemic inflammatory response syndrome (SIRS), and longer exposure to invasive devices may be at increased risk for hospital-associated infection (HAI). HAIs have been shown to affect outcome measures, but the extent is not well studied. ⋯ In this study of trauma patients, ISS had the greatest effect on LOS, but increased age and presence of HAI did increase LOS and cost of care. HAI increased LOS more in the less severely injured patients.