J Trauma
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Patients with traumatic brain injury (TBI) and traumatic intracranial hemorrhage are frequently admitted to the intensive care unit (ICU) but never require critical care interventions. Improved ICU triage in this patient population can improve resource utilization and decrease health care costs. We sought to identify a low-risk group of patients with TBI who do not require admission to an ICU. ⋯ Patients with TBI without a critical care intervention before admission are at low risk for requiring future critical care interventions. Future studies are required to validate if this low-risk criteria can serve as a safe, cost-effective triage tool for ICU admission.
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This prospective study explores the incidence of preoperative deep venous thrombosis (DVT) in a group of patients with hip and femur fracture who for various reasons experienced a delay of >24 hours from the time of injury until time of surgery. We also evaluated the results of preoperative treatment with inferior vena cava (IVC) filter. ⋯ In this prospective study, we observed that patients experiencing a delay in surgical care for an acute hip or femur fracture are at a relatively high risk for development of thromboembolic disease despite prophylactic anticoagulation. There was a direct correlation between the period of delay and the incidence of thromboembolism. Clinical examination in this setting is unreliable as none of these patients had signs or symptoms suggestive of DVT. We suggest that all patients with delayed (>24 hours) surgical intervention undergo preoperative Doppler ultrasound to rule out DVT. Appropriate measures such as placement of an IVC filter and aggressive postoperative anticoagulation should then be implemented for those with DVT and/or pulmonary embolus.
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Advanced hemostatic dressings perform superior to standard gauze (SG) in animal hemorrhage models but require 2 minutes to 5 minutes application time, which is not feasible on the battlefield. ⋯ Advanced hemostatic dressings do not perform better than conventional gauze in an injury and application model similar to a care under fire scenario.
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Comparative Study Controlled Clinical Trial
Mortality and regional oxygen saturation index in septic shock patients: a pilot study.
Peripheral muscle tissue oxygenation determined noninvasively using near-infrared spectroscopy may help to identify tissue hypoperfusion in septic patients. The aim of this study was to investigate regional oxygen saturation index (rSO2) in the brachioradialis (forearm) muscle by comparing measurements in healthy subjects and in intensive care unit (ICU) septic shock patients, and determine whether brachioradialis muscle rSO2 is associated with poor outcome in ICU septic shock patients. ⋯ We observed that septic shock patients with forearm skeletal muscle rSO2≤60% throughout first 24 hours after ICU admission had significantly greater mortality rate than patients with forearm skeletal muscle rSO2>60% throughout this critical time.