J Trauma
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Traumatic brain injury (TBI) remains an exclusionary criterion in nearly every clinical trial involving hemoglobin-based oxygen carriers (HBOCs) for traumatic hemorrhage. Furthermore, most HBOCs are vasoactive, and use of pressors in the setting of hemorrhagic shock is generally contraindicated. The purpose of this investigation was to test the hypothesis that low-volume resuscitation with a vasoactive HBOC (hemoglobin glutamer-200 [bovine], HBOC-301; Oxyglobin, BioPure, Inc., Cambridge, MA) would improve outcomes after severe TBI and hemorrhagic shock. ⋯ The use of HBOC-301 supplemented by a crystalloid bolus was clearly superior to the standard of care (LR + MAN + RBCs) after TBI. This may represent a new indication for HBOCs. Use of HBOC eliminated the need for RBC transfusions and mannitol. The inherent vasopressor effect of HBOCs, especially when used alone, may misguide initial resuscitation, leading to transient poor global tissue perfusion despite restoration of MAP and HR. This suggests that MAP and HR are inadequate endpoints with HBOC resuscitation. HBOC use alone after TBI permitted early extubation and excellent 72-hour outcomes.
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A variety of policy groups recommend that screening and brief intervention (SBI) programs for alcohol-use disorders be widely implemented in health care settings. This article reports the extent to which trauma surgeons support SBI programs and the feasibility of implementing these programs in trauma centers. ⋯ Most trauma surgeons supported alcohol screening and interventions. Preliminary data showed that one half-time research assistant at each facility could successfully screen most injured patients and implement brief interventions. An alcohol screening and brief intervention program seems feasible in any trauma center committed to implementation.
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Comparative Study Clinical Trial
Use of a single question to screen trauma patients for alcohol dependence.
Alcohol-dependent trauma patients are known to be at future risk for both recidivism and mortality. Psychological tools exist to screen for alcohol-dependent disorders, and among patients with alcohol-dependent disorders, a brief intervention has been shown to modify behavior. However, the training involved and time required to administer these tools may decrease their utility. We explored the possibility that yet simpler screening tools could be used. ⋯ It may be reasonable to substitute a single question for the entire AUDIT screening instrument to screen for those at risk for alcohol misuse. If so, this single question could easily be incorporated into the history taken among patients admitted to a trauma service. Confirmation with a larger study is recommended.
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Comparative Study
Screening for blunt cerebrovascular injury: evaluating the accuracy of multidetector computed tomographic angiography.
Digital subtraction angiography (DSA) has been widely considered the "gold standard" for diagnosing blunt cerebral vascular injury, but recent advances in multidetector computed tomographic angiography (CTA) may have led to improved accuracy compared with DSA. ⋯ The sensitivity of CTA for carotid artery injury at our center was higher than in previous studies. This might be attributable to the superior quality of multidetector CTA images. Our conclusions on CTA accuracy in the vertebral artery are limited by the small number of injuries.
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Comparative Study
A rational approach to formulating public policy on substance abuse.
Unlike alcohol, which is legal and regulated, current public policy makes drugs such as heroin, cocaine, methamphetamines, and marijuana illegal. This article summarizes the history of drug and alcohol use in the United States, compares our public policies on alcohol to those on drugs, and shows the direct link between alcohol or drug use and crime, corruption, violence, and health problems in other countries and in our own. A rational approach to formulating a workable public policy is presented.