J Trauma
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Time to revascularization is speculated to be a major determinant of limb salvage for traumatic popliteal injuries. The purpose of this study was to determine whether location of diagnostic arteriography affected outcome. ⋯ For popliteal artery injuries, diagnostic arteriography in the operating room reduces the likelihood of amputation by decreasing time to initiating repair and thereby limiting limb ischemia. Salvage is possible in the most severely injured extremities with rapid transport to the operating room.
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Trauma centers successfully save lives of severely injured patients who would have formerly died. However, survivors often have multiple complications and morbidities associated with prolonged intensive care unit (ICU) stays. Because the reintegration of patients into the society to lead an active and a productive life is the ultimate goal of trauma center care, we questioned whether our "success" may condemn these patients to a fate worse than death? ⋯ These data demonstrate that ICU survivors >3 years after severe injury have significant impairments including inability to return to work or regain previous levels of activity and that the goal of reintegrating patients back into the society is not being met. Further studies better defining the limitations and barriers to improved quality of life are necessary. Survival, although important, is no longer a sufficient outcome to measure trauma center success.
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Acute renal failure (ARF) in trauma patients is associated with high mortality rates. There is currently no consensus definition for renal failure, however, the American College of Surgeons' Committee on Trauma (ACSCOT) defines ARF as a serum creatinine > or =3.5, blood urea nitrogen > 100, or renal replacement therapy. We hypothesize that by using the Acute Kidney Injury Network (AKIN) staging system we would identify smaller changes in renal function that may impact outcome, and may serve as a marker for mortality and other organ dysfunction. ⋯ Stratification using the AKIN criteria for acute kidney injury identifies an increased number of patients with renal dysfunction compared with the current ACSCOT criteria. Importantly, these patients have an increased risk of multiple organ failure and death. Inclusion into the AKIN criteria may be a marker for later morbidity and mortality.
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Comparative Study
Thromboelastography as a better indicator of hypercoagulable state after injury than prothrombin time or activated partial thromboplastin time.
To investigate the hemostatic status of critically ill, nonbleeding trauma patients. We hypothesized that a hypercoagulable state exists in patients early after severe injury and that the pattern of clotting and fibrinolysis are similar between burned and nonburn trauma patients. ⋯ Thromboelastography analysis of whole blood showed that patients were in a hypercoagulable state; this was not detected by plasma PT or aPTT. The high incidence of pulmonary embolism indicated that our current prophylaxis regimen could be improved.
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Oncotic agents are a therapeutic mainstay for the management of intracranial hypertension. Both mannitol and varied concentrations of hypertonic saline (HTS) have been shown to be effective at reducing elevated intracranial pressure (ICP). We compared the safety and efficacy of 23.4% HTS to mannitol for acute management of elevated ICP after traumatic brain injury (TBI). ⋯ Based on this retrospective analysis, 23.4% HTS is more efficacious than mannitol in reducing ICP. If these results are confirmed in a prospective, randomized study, 23.4% HTS may become the agent of choice for the management of elevated ICP after TBI.