J Trauma
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Displaced distal radial fractures treated using volar locking plates: maintenance of normal anatomy.
The objective is to assess the ability of volar locking plates to maintain fracture reduction when used to treat dorsally displaced extra- and intra-articular distal radial fractures. ⋯ In the hands of general trauma surgeons, the volar approach combined with the application of a suitable volar locking plate is a good treatment for restoring and maintaining the anatomy of dorsally displaced intra- and extra-articular distal radial fractures.
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The HemCon (HC) bandage and QuickClot have been used over the past 6 years for treating external compressible hemorrhage in combat casualties. Previously, we tested three new hemostatic agents in granular/powder forms that were superior to these products. In this study, four new dressings (preselected) that are more suitable for battlefield application were evaluated. The efficacy and acute safety of the dressings were tested in our standard arterial hemorrhage model. ⋯ CG was the most effective dressing tested in this arterial hemorrhage model. The hemostatic property of CG is attributed to its raw material (nonwoven Rayon and polyester blend), kaolin coating, and the large surface area (3 inch x 4 yd) of this absorbent sponge. CG is now recommended as the first line of treatment for life-threatening hemorrhage on the battlefield, replacing HC.
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Multicenter Study
Preinjury statin use is associated with a higher risk of multiple organ failure after injury: a propensity score adjusted analysis.
Recent studies suggest that statin use may improve outcome in critically ill patients. This has been attributed to the pleiomorphic effect and modulation of inflammatory mediators that occurs with statin use. We sought to determine whether preinjury statin (PIS) use was associated with improved outcome in severely injured blunt trauma patients. ⋯ PIS use was independently associated with a higher risk of MOF postinjury. These results are contrary to previous analyses. The protective effect of statins may be lost in the severely injured, and modulation of the inflammatory response may result in higher morbidity. Further studies are required to better understand the impact and potential therapeutic utility of this commonly prescribed medication both before and after injury.
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A tissue hemoglobin oxygen saturation (STO2) monitor was created to assess the perfusion status of a peripheral muscle bed using near infrared light to directly measure oxygen saturation in the microcirculation. Hypoperfusion has been noted when the STO2 is <75%. The use of this technology has not been tested in the prehospital setting. This pilot study was performed to assess the technology's ease of use in the field and to correlate STO2 readings with patient outcomes. ⋯ The STO2 monitor can easily be used in the prehospital environment. In addition, initial recordings were significantly different between survivors and nonsurvivors with every 10% decrease in STO2 increasing mortality threefold. This monitor seems to give the prehospital provider a noninvasive tool for assessment of hypoperfusion in the field and may allow for earlier resuscitative efforts to commence.