AANA journal
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Trauma is a leading cause of morbidity and mortality. Uncontrolled hemorrhage related to the traumatic event is often the major cause of complications and death. The use of hemostatic agents may be one of the easiest and most effective methods of treating hemorrhage. ⋯ The evidence does not describe serious side effects, exothermic reaction, and thromboemboli formation associated with other hemostatic agents. Further investigation to determine the effectiveness of hemostatic agents, specifically QuikClot Combat Gauze, in the management of trauma casualties in the prehospital setting is required. These should include large-scale, multicenter, prehospital randomized controlled trials.
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Hypothermia in the perioperative setting can have serious consequences, including increased risk of infection or adverse cardiac events. Forced-air warming units commonly are used to prevent hypothermia. This study examined the impact of adding preoperative warming (Bair Paws, 3M) to conventional intraoperative forced-air warming modalities. ⋯ However, no statistically significant differences in temperature were demonstrated between groups over time. ASA status and type of procedure (laparoscopic vs open) also had no impact on results. These results suggest that preoperative warming with the Bair Paws gown offers no benefit over conventional therapy in maintaining normothermia in the perioperative period.
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The primary aim of this study was to investigate emergence delirium (ED) in service members, through the perceptions of active duty US Army anesthesia providers. The following perceptions were examined: (1) the extent and seriousness of ED in service members, (2) effects of ED on the safety of service members and operating room/postanesthesia care unit personnel, and (3) behaviors relevant to ED in service members. The study also explored the relationships between the perceived seriousness of ED, reported case experiences, and behaviors and consequences relevant to ED. ⋯ Approximately 38% of the respondents believed that ED was a moderate problem. There was a statistically significant association between perceived severity of ED and the ED case experience. The behaviors and consequences that were often or always seen included hyperactive motor behavior, pulling at the monitoring equipment, and making disruptive movements.
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Malignant hyperthermia (MH) is a rare pathologic hypermetabolic pharmacogenetic disorder of skeletal muscle calcium regulation following exposure to depolarizing muscle relaxants and/or volatile anesthetics. Although its pathogenesis is relatively well understood, there is wide variability in both the time of onset and the presentation of clinical signs and symptoms. ⋯ Differential diagnosis of an MH crisis can be particularly challenging in a trauma patient, especially in an austere environment. This case report describes the presentation and management of a suspected case of MH in an Afghan national who underwent surgery following lower extremity trauma resulting from an improvised explosive device.