J Trauma
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Randomized Controlled Trial
Propranolol does not increase inflammation, sepsis, or infectious episodes in severely burned children.
Propranolol, a nonselective beta1-2 antagonist, attenuates hypermetabolism and catabolism in severely burned patients. However, recent data suggest that propranolol impairs immune function and enhances inflammation. The purpose of the present study was to determine the effect of propranolol administration on infection, sepsis, and inflammation in severely burned pediatric patients. ⋯ Propranolol treatment attenuates hypermetabolism and does not cause increased incidence of infection and sepsis.
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The incidence of venous thromboembolism (VTE) without prophylaxis is as high as 80% after major trauma. Initiation of prophylaxis is often delayed because of concerns of injury-associated bleeding. As the effect of delays in the initiation of prophylaxis on VTE rates is unknown, we set out to evaluate the relationship between late initiation of prophylaxis and VTE. ⋯ Clinicians are reticent to begin timely VTE prophylaxis in critically injured patients. Patients are without VTE prophylaxis for half of all days within the first week of admission and this delay in the initiation of prophylaxis is associated with a threefold greater risk of VTE. The relative risks and benefits of early VTE prophylaxis need to be defined to better direct practice in this high-risk population.
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Comparative Study
Lactated Ringer's is superior to normal saline in the resuscitation of uncontrolled hemorrhagic shock.
Normal saline (NS) and lactated Ringer's solution (LR) continue to be used interchangeably for the resuscitation of hemorrhagic shock in some institutions. We hypothesized that, aside from hyperchloremic acidosis, NS resuscitation would be similar to that of LR in a swine model of uncontrolled hemorrhage. ⋯ Resuscitation of uncontrolled hemorrhagic shock with NS requires significantly greater volume and is associated with greater urine output, hyperchloremic acidosis, and dilutional coagulopathy as compared with LR. Resuscitation with LR results in an elevation of the lactate level that is not associated with acidosis. Lactated Ringer's solution is superior to NS for the resuscitation of uncontrolled hemorrhagic shock in swine.
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Suicide is an important public health concern. Firearms are the most common mechanism of suicide death. This study describes the epidemiology of fatal and nonfatal firearm suicide injuries (FSI) in one metropolitan area from 2002 through 2004 using a firearm injury surveillance system. ⋯ Community level firearm injury surveillance effectively identifies local trends that may differ from national statistics. Collaboration among various groups is used to support injury prevention programs. These data can both complement and contribute to national statistics.
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Postconcussion symptoms (PCS) (such as dizziness, headache, irritability, fatigue, and impaired memory) are common in patients who sustain a mild traumatic brain injury (mTBI). However, few studies have systematically investigated the association between PCS and clinical outcomes in mTBI patients. Therefore, the present study attempted to examine PCS during the disease course and to determine whether PCS adversely affect outcome. ⋯ The results show that PCS during the disease course and the relationship between PCS and clinical outcome can be systematically evaluated. In fact, different postconcussion symptom domains should be monitored while the disease is progressing.