Articles: trauma.
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Scand J Trauma Resus · Aug 2014
Resuscitation speed affects brain injury in a large animal model of traumatic brain injury and shock.
Optimal fluid resuscitation strategy following combined traumatic brain injury (TBI) and hemorrhagic shock (HS) remain controversial and the effect of resuscitation infusion speed on outcome is not well known. We have previously reported that bolus infusion of fresh frozen plasma (FFP) protects the brain compared with bolus infusion of 0.9% normal saline (NS). We now hypothesize reducing resuscitation infusion speed through a stepwise infusion speed increment protocol using either FFP or NS would provide neuroprotection compared with a high speed resuscitation protocol. ⋯ In this clinically relevant model of combined TBI and HS, stepwise resuscitation protected the brain compared with bolus resuscitation.
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Scand J Trauma Resus · Aug 2014
Mortality in severely injured elderly patients: a retrospective analysis of a German level 1 trauma center (2002-2011).
Demographic change is expected to result in an increase in cases of severely injured elderly patients. To determine special considerations in treatment and outcome, patients aged 75 years and older were studied. ⋯ The treatment of severely injured elderly patients is challenging. The most common cause of accident is falling from less than 3 m with head injuries being determinant. We identified deranged coagulopathy as an important predictor for mortality, suggesting rapid normalization of coagulation might be a key to reducing mortality.
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World J Crit Care Med · Aug 2014
French pre-hospital trauma triage criteria: Does the "pre-hospital resuscitation" criterion provide additional benefit in triage?
To evaluate the performance of the specific French Vittel "Pre-Hospital (PH) resuscitation" criteria in selecting polytrauma patients during the pre-hospital stage and its potential to increase the positive predictive value (PPV) of pre-hospital trauma triage. ⋯ The criterion of "pre-hospital resuscitation" was statistically significant with the severity of the trauma, but did not increase the PPV. The use of "pre-hospital resuscitation" criterion could be re-considered if these results are confirmed by larger studies.
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In the treatment of severely injured patients, the term 'damage control radiology' has been used to parallel the modern concept of damage control surgery and the allied development of continuous damage control resuscitation from patient retrieval, through all transfers, to appropriate primary treatment. The aims of damage control radiology are (i) rapid identification of life-threatening injuries including bleeding sites, (ii) identification or exclusion of head or spinal injury, and (iii) prompt and accurate triage of patients to the operating theatre for thoracic, abdominal, or both surgeries or the angiography suite for endovascular haemorrhage control. ⋯ The most severely injured patients are those who have the most to benefit from early diagnosis and life-saving therapies. The traditional teaching that these patients should go immediately to surgery is challenged by technological developments in MDCT and recent clinical evidence.
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J Neurosurg Pediatr · Aug 2014
Pediatric skull fractures: the need for surgical intervention, characteristics, complications, and outcomes.
Head trauma is a common cause of morbidity and mortality in the pediatric population and often results in a skull fracture. Pediatric skull fractures are distinct from adult fractures. Pediatric fractures have a greater capacity to remodel, but the pediatric brain and craniofacial skeleton are still developing. Although pediatric head trauma has been extensively studied, there is sparse literature regarding skull fractures. The authors' aim was to investigate the characteristics, injuries, complications, and outcomes of the patients in whom surgical intervention was needed for skull fractures. ⋯ The majority of pediatric skull fractures can be managed conservatively. Of those requiring surgical intervention, fewer than half of the surgeries are performed solely for skull fracture repair only. Patients hit in the head with an object or involved in a motor vehicle crash are more likely to need surgical intervention either to repair the skull fracture or for TBI management, respectively. Frontal bone fractures are more likely to necessitate repair, and those patients treated for TBI have a greater incidence of 2 or 3 bones involved in the fracture. Complications occurred but most were related to underlying trauma, not the surgery. No patients who underwent intervention for repair of their skull fracture only had a worsening of their neurological status.