J Trauma
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Digital subtraction angiography is frequently required in the initial evaluation of trauma patients. We hypothesized that mobile digital subtraction angiography technology directly into the trauma resuscitation area would save time in restoring metabolic derangements for patients with on-going hemorrhage. ⋯ The introduction of mobile angiography into the trauma resuscitation room and the immediate availability of trained trauma surgeons to perform diagnostic and therapeutic angiographic procedures shortened the time required to restore normal physiology.
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Alcohol (EtOH) use may potentiate acute lung injury and development of acute respiratory distress syndrome in patients with shock or sepsis. Gut ischemia/reperfusion (I/R) episodes are common in these settings and may have systemic effects. Human pulmonary microvascular endothelial cells (HMVEC) and Caco-2 intestinal epithelial cells were used to study gut-lung interactions after EtOH exposure in vitro. ⋯ Gut-lung interactions after EtOH exposure and ischemia/reperfusion insults lead to lung injury and may potentiate the clinical evolution of acute respiratory distress syndrome. These in vitro findings confirm clinical experience and provide a model to further elucidate the pathogenic mechanisms.
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Over the past 20 years, the rate of suicide in rural communities has surpassed those of urban areas. The number of rural trauma patients who attempt suicide, are treated and survive at a trauma center, but ultimately reattempt suicide and succeed (suicide recidivists) is unknown. We have characterized all adult suicide deaths seen at a rural Level I trauma center and identified predictors of a successful suicide. We hypothesized that rural adult trauma patients exhibit a high rate of suicide recidivism. ⋯ The overwhelming majority (94%) of suicide deaths in our rural state were never seen by the trauma center, and only 1.1% were recidivists. Previous admissions for self-inflicted injuries or penetrating injuries were significant predictors of future suicide attempt and should trigger select interventions. Other factors that can to lead a suicidal tendency include a previous mental health history (depression), poly-substance abuse, and chronic pain history. In our small sample, suicidal tendencies could persist for a prolonged period of time.
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Multicenter Study
Fresh frozen plasma is independently associated with a higher risk of multiple organ failure and acute respiratory distress syndrome.
Blood transfusion is known to be an independent risk factor for mortality, multiple organ failure (MOF), acute respiratory distress syndrome (ARDS), and nosocomial infection after injury. Less is known about the independent risks associated with plasma-rich transfusion components including fresh frozen plasma (FFP), platelets (PLTS), and cryoprecipitate (CRYO) after injury. We hypothesized that plasma-rich transfusion components would be independently associated with a lower risk of mortality but result in a greater risk of morbid complications. ⋯ In patients who survive their initial injury, FFP was independently associated with a greater risk of developing MOF and ARDS, whereas CRYO was associated with a lower risk of MOF. Further investigation into the mechanisms by which these plasma-rich component transfusions are associated with these effects are required.