J Trauma
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Comparative Study
Intracorporeal use of advanced local hemostatics in a damage control swine model of grade IV liver injury.
The purpose of this study was to evaluate the efficacy of zeolite- and chitosan-based local hemostatic agents for the control of intracorporeal bleeding in a damage control swine model of grade IV liver injury. ⋯ Celox and QuikClot ACS(+) are effective adjuncts to standard intracavitary damage control packing for the control of bleeding. Celox provided durable control allowing packing removal at the time of take-back laparotomy. Further evaluation of their long-term effects is warranted.
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Limited transthoracic echocardiogram (LTTE) represents an attractive alternative to formal transthoracic echocardiogram (TTE), because it does not require an echocardiogram machine. Our hypothesis is that trauma attendings can learn LTTE effectively with minimal training. ⋯ Trauma attendings can successfully learn LTTE with minimal training and use the technique as a resuscitation tool in the hypotensive patient.
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Hemorrhage is a leading cause of death in trauma patients and coagulopathy is a significant contributor. Although the exact mechanisms of trauma-associated coagulopathy (TAC) are incompletely understood, hemostatic resuscitation strategies have been developed to treat TAC. Our study sought to identify which trauma patients develop TAC and the factors associated with its development, to describe the natural history of TAC, and to identify patients with TAC who may not require hemostatic resuscitation. ⋯ TAC may appear in an early or delayed form and its presence and progression are associated with a number of identifiable factors. Although TAC commonly progresses, it also resolves spontaneously in many patients. Further research is required to identify which patients with TAC require hemostatic treatment, although those with intracranial hemorrhages seem to warrant aggressive therapy.
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Comparative Study
The use of the radiographic appearance of the azygos vein to assess volume status in trauma patients.
The assessment of hypovolemia in victims of trauma is a critical aspect of resuscitation and care in the initial presentation of a patient. This study attempted to validate the use of the appearance of the azygos vein (AV) on initial chest radiographs as a parameter that may add to this initial assessment. ⋯ When a small AV can be seen by the TTL, it may be a useful adjunct to the assessment of volume status.
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Fractures of the lateral clavicle result in a high rate of nonunion compared with midshaft fractures. Many operative treatment methods of unstable lateral clavicle fractures have been described, but no single method has become generally accepted. This study reports our experience treating unstable lateral clavicle fractures with coracoclavicular ligament rupture. ⋯ This study shows that treatment of unstable lateral clavicular fractures with an angular stable locking plate together with a polydioxanone cord ligament augmentation leads to excellent results with a 95% union rate. Additional coracoclavicular augmentation next to plate fixation of the clavicle may partially solve the problem of uncertain plate fixation if the lateral fragment is small and multifragmented, as often observed.