J Trauma
-
Comparative Study
Hemostatic resuscitation during surgery improves survival in patients with traumatic-induced coagulopathy.
Although hemostatic resuscitation with a 1:1 ratio of fresh-frozen plasma (FFP) to packed red blood cells (PRBC) after severe hemorrhage has been shown to improve survival, its benefit in patients with traumatic-induced coagulopathy (TIC) after >10 units of PRBC during operation has not been elucidated. We hypothesized that a survival benefit would occur when early hemostatic resuscitation was used intraoperatively after injury in patients with TIC. ⋯ TIC is common after severe injury and is associated with a high mortality in patients transfused with >10 units of PRBC during surgery. Early hemostatic resuscitation during first hours after injury improves survival with shorter TICU LOS in patients with TIC.
-
Comparative Study
Mortality in severe traumatic brain injury: a multivariated analysis of 748 Brazilian patients from Florianópolis City.
Traumatic brain injury (TBI) is a major cause of incapacity and mortality worldwide, with most of the burden occurring in low-income and middle-income countries. A number of clinical, demographic, and neurosurgical variables of patients with TBI were associated with their outcome. ⋯ Age, CT findings, Glasgow coma scale, pupil examination, and the presence of thoracic trauma at admission were independently associated with mortality at the time of discharge in Brazilian patients with severe TBI.
-
Hemorrhagic shock has been reported to elevate the concentration of ammonia in the blood of animals. However, only one clinical study, of a few surgical patients, found a similar effect. This investigation sought to determine whether ammonia is elevated in the plasma of trauma patients with hemorrhage and whether it could be used to predict serious hemorrhage. ⋯ Elevated plasma ammonia concentration at admission can be a clinically significant indicator for traumatic hemorrhage that requires treatment.
-
Case Reports
Treatment of chest wall implosion injuries without thoracotomy: technique and clinical outcomes.
Chest wall implosion injuries secondary to side impact are unusual but devastating injuries. The purpose of this series is to describe the clinical entity, present a surgical technique to reduce and repair the thoracic cage deformity without thoracotomy, and report outcomes in nine patients. ⋯ Chest wall implosion injuries with fixed deformities of the thoracic cage, multiple segmental rib fractures, and clavicular injury are a distinct clinical entity, which can be effectively managed with a posterior paramidline approach without thoracotomy. Reduction of the deformity and repair of the rib fractures led to a dramatic reduction in time to extubation, ICU LOS, and in-hospital complications including pneumonia and sepsis. Repair of the clavicular fracture appeared to be beneficial.
-
Obesity is an independent predictor of increased morbidity and mortality in critically injured trauma patients. We hypothesized that obese patients in need of damage control laparotomy (DCL) will encounter an increase incidence of postsurgical complications with a concomitant increase mortality when compared with a cohort of nonobese patients. ⋯ Severe obesity was significantly associated with adverse outcomes and increased resource utilization in trauma patients treated with DCL. Measures to improve outcomes in this vulnerable patient population must be directed at multiple levels of health care.