International journal of burns and trauma
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Securing the airway is a crucial aspect during reconstructive surgeries of patients with extensive post-burn mentosternal scar contractures; however, the American Society of Anesthesiologists Difficult Airway Management Algorithm recommendation of initial direct laryngoscopy may not be appropriate for these complicated patients. Consequently, there is a significant risk for failure of intubation and airway emergency. ⋯ Many airway techniques have been effectively used in burn patients, but the role of awake blind or fiberoptic bronchoscopy, although well established in the non-burn population, has yet to be evaluated in burn patients. We report a case series of successful management of difficult airways with fiberoptic bronchoscopy in patients with varying degrees of post-burn head and neck scar contractures.
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Coagulopathy can occur after hemorrhage, trauma and resuscitation, and has been associated with dilution of coagulation factors and hypothermia. Recombinant activated Factor VII (rFVIIa) has been used, often as a last resort, to improve hemostasis in trauma/hemorrhage patients with coagulopathy. The aim of this study was to further characterize the effects of rFVIIa on various coagulation parameters and the influence of temperature and hemodilution. ⋯ Theses data show that thrombin generation is affected by hypothermia, but not 40% dilution. TEG is affected by 40% dilution with Hextend, but not by hypothermia. PT and aPTT are significantly affected by both hypothermia and dilution. Recombinant FVIIa caused a greater change in thrombin generation at 34°C as compared to 37°C, and a greater change in PT at 40% dilution, suggesting that the effect of rFVIIa on coagulation is both temperature and dilution dependant.
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Committing Suicide is an awful way to die as well as a historical psycho-social problem of human community worldwide. Suicide is an action deliberately initiated and performed by a person with complete awareness of its fatal outcome, prevalence of which is very rare in developed countries, but it is reported with more frequency in Baltic region, Africa (including Egypt), The Middle East (including Iran), The Far East, particularly India and Vietnam. Its rate has ranged from10 per 100,000 people/year in Egypt, and up to 35 per 100,000 people/year in Baltic region (including Lithuania, Finland, and Russia). ⋯ In this review study, we try to focus on self- inflicted burn or self- immolation as the most dramatic and violent method of suicide. The present review article was aimed to assess the epidemiology of self immolation phenomenon and its associated factors as a worldwide problem, particularly in Iran and other developing communities. The main victims of this awful way of death are women who are considered the most vulnerable group in such societies.
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Small volumes of resuscitation products to sustain survival until definitive care are desired in extreme environments due to limited resources. A severe controlled hemorrhage model in sedated, sexually mature miniature swine has been developed to evaluate these products. Valproic Acid (VPA) and Pentoxifylline (PTX) have been suggested as potential products for small volume resuscitation following hemorrhage predominately in anesthetized small animal models. We evaluated the survival time of VPA and PTX in the swine model. ⋯ In this sedated severe hemorrhage model VPA and PTX were unacceptable as small volume resuscitation products at the concentrations and delivery rates used because of early deaths. Considering that these drugs are FDA approved for other indications at lower doses the present data suggest that further investigation of mechanisms involved are warranted.
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Trauma, often accompanied by hemorrhage, is a leading cause of death worldwide, often leading to inflammation-related late complications that include sepsis and multiple organ failure. These secondary complications are a manifestation of the complexity of biological responses elicited by trauma/hemorrhage, responses that span most, if not all, cell types, tissues, and organ systems. This daunting complexity at the patient level is manifest by the near total dearth of available therapeutics, and we suggest that this dire condition is due in large part to the lack of a rational, systems-oriented framework for drug development, clinical trial design, in-hospital diagnostics, and post-hospital care. ⋯ We propose a rational framework for transitioning through the currently fragmented process from identification of biological networks that are potential therapeutic targets, through clinical trial design, to personalized diagnosis and care. Insights derived from systems and computational biology in trauma and sepsis include the centrality of Damage-Associated Molecular Pattern molecules as drivers of both beneficial and detrimental inflammation, along with a novel view of multiple organ dysfunction as a cascade of containment failures with distinct implications for therapy. Finally, we suggest how these insights might be best implemented to drive transformational change in the fields of trauma and sepsis.