J Trauma
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Comparative Study
Talk and die revisited: bifrontal contusions and late deterioration.
Severe bifrontal contusions in an awake traumatic brain injury (TBI) patient is a challenging clinical picture, as they are prone to late deterioration. We evaluated our series of patients with severe bifrontal contusions, characterizing their clinical course and suggestions for management. ⋯ Awake patients with bifrontal contusions represent a unique cohort of TBI patients who are prone to rapid deterioration late in their clinical course. They have extensive frontal edema and mass effect, yet we were unable to find a correlation between edema volumes and incidence of deterioration. Based on this series and our experience in other TBI patients, we no longer utilize prophylactic infusions of hypertonic saline in the setting of TBI. We recommend managing these patients with intensive care unit admission and early intracranial pressure monitoring. If they do deteriorate despite these measures, rapid bifrontal decompression can lead to good functional outcomes.
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Clinical training in operative technique is important to boost self-confidence in residents in all surgical fields but particularly in trauma surgery. The fully trained trauma surgeon must be able to provide operative intervention for any injury encountered in practice. In this report, we describe a novel training model using a human cadaver in which circulation in the major vessels can be simulated to mimic traumatic injuries seen in clinical practice. ⋯ In this report, we describe a novel training model that simulates the life-threatening injuries that confront trauma surgeons. An alternative to living laboratory animals, this inexpensive and readily available model offers good educational value for the acquisition and refinement of surgical skills that are specific to trauma surgery.
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Comparative Study
Enoxaparin dose adjustment is associated with low incidence of venous thromboembolic events in acute burn patients.
Inadequate antifactor Xa levels have been documented in critically ill patients given prophylactic enoxaparin and may result in increased risk of venous thromboembolic (VTE) events. The objective of this study was to examine the impact of dose adjustment of enoxaparin and associated incidence of VTE in acute burn patients. ⋯ Frequent occurrence of low antifactor Xa levels observed in this study demonstrated the inadequacy of standard dosing of enoxaparin for VTE prophylaxis in many patients with acute burns. Enoxaparin dose adjustment was associated with a low incidence of VTE events and no bleeding complications.
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Comparative Study
Association of interleukin 4 -589T/C polymorphism with T(H)1 and T(H)2 bias and sepsis in Chinese major trauma patients.
Interleukin (IL)-4 is a pleiotropic cytokine, severed as an important component of the adaptive immune system, and implicated in the pathophysiology of sepsis. Data from other studies show that the -589T/C polymorphism in IL-4 promoter may alter IL-4 expression and susceptibility of inflammatory or autoimmune diseases. Whether this genetic variation is associated with sepsis susceptibility is unknown. The aim of this study was to search for the association of IL-4 -589T/C with the susceptibility to sepsis. ⋯ These results suggest that the IL-4 -589T/C polymorphism might affect T(H)1/T(H)2 balance and predispose trauma patients to susceptibility sepsis.
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Evidence suggests that there may be an association between transfer status (direct admission or interhospital transfer) and outcomes in trauma patients. The purpose of this study was to systematically review the current evidence of the association between transfer status and outcomes for patients. ⋯ Available evidence suggests there is no difference in mortality between transfer and direct admissions. However, the significant heterogeneity across studies precludes deriving any definitive conclusions regarding the impact of interhospital transfer on mortality after major trauma. Moreover, most studies excluded patients dying at outlying hospitals, which may underestimate the association of transfer status with mortality. Prospective studies that address the limitations of the current evidence, including use of population-based trauma registries, are warranted to establish whether the process of interhospital transfer to higher level care when compared with direct admission to a trauma center negatively impacts clinical outcomes for trauma patients.