J Trauma
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Bleeding is the most frequent cause of preventable death after severe injury. Coagulopathy associated with severe injury complicates the control of bleeding and is associated with increased morbidity and mortality in trauma patients. The causes and mechanisms are multiple and yet to be clearly defined. ⋯ There is limited understanding of the mechanisms by which tissue trauma, shock, and inflammation initiate trauma coagulopathy. Acute Coagulopathy of Trauma-Shock should be considered distinct from disseminated intravascular coagulation as described in other conditions. Rapid diagnosis and directed interventions are important areas for future research.
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More than 1% of closed fractures of lower limbs and 6% of orthopedic implants are complicated by inflammation caused by infection despite of all precautionary methods taken. The question arises whether this clinical complication is not caused by bacteria dwelling in limb tissues. ⋯ The colonizing bacterial cells and their DNA were detected in fracture callus but not in other deep tissues. Contamination was precluded by lack of isolates in disinfected cutis, subcutis, muscles, and materials used for sampling cultured after surgery. We suggest that certain strains of bacteria dwell in normal tissues of lower limbs and may cause inflammation upon stimulation by trauma. Their source may be tissue fluid, superficial and deep lymphatics, and lymph serving the physiologic transport to the regional lymph nodes of microorganisms penetrating foot skin during microinjuries.
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Beside the often discussed topics of consumption and dilution coagulopathy, additional perioperative impairments of coagulation are caused by acidosis, hypocalcemia, anemia, hypothermia, and combinations. ⋯ The prevention and timely correction, especially of the combination acidosis plus hypothermia, is crucial for the treatment of hemorrhagic coagulopathy.
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Comparative Study
Automatically-computed prehospital severity scores are equivalent to scores based on medic documentation.
Prehospital severity scores can be used in routine prehospital care, mass casualty care, and military triage. If computers could reliably calculate clinical scores, new clinical and research methodologies would be possible. One obstacle is that vital signs measured automatically can be unreliable. We hypothesized that Signal Quality Indices (SQI's), computer algorithms that differentiate between reliable and unreliable monitored physiologic data, could improve the predictive power of computer-calculated scores. ⋯ SQI algorithms improve automatically-computed severity scores, and automatically-computed scores using SQI's are equivalent to medic-based scores.
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The open abdomen after severe intra-abdominal trauma and emergency surgery is a major operative challenge. It is associated with high morbidity and prolonged hospital stays. Several management strategies have been developed to assist with fascial closure but no single method has emerged as the best. The Wittmann Patch (Starsurgical, Burlington, WI) is a unique device which uses velcro to permit progressive abdominal closure without necessitating serial operations. The purpose of this study was to determine the fascial closure rate using the Wittmann patch. We hypothesized that use of the patch would result in a high closure rate. ⋯ Use of the Wittmann Patch can achieve a high rate of delayed fascial closure in severe trauma and critically ill emergency surgery patients with open abdomens. Most of the complications associated with use of the patch were wound infections after fascial closure and closure of the skin.