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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Observational Study
Trauma induced hypercoagulablity in pediatric patients.
Coagulation changes in pediatric trauma patients are not well defined. To fill this gap, we tested the hypothesis that trauma evokes a hypercoagulable response. ⋯ A hypercoagulable state is associated with minor trauma in children. More work is needed to determine the functional significance of these changes and to establish normal pediatric reference ranges.
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We aimed to determine the association between scalp hematoma characteristics and traumatic brain injuries in young children with blunt head trauma who have no other symptoms or signs suggestive of traumatic brain injuries (defined as "isolated scalp hematomas"). ⋯ In patients younger than 24 months with isolated scalp hematomas, a minority received CTs. Despite the occasional presence of traumatic brain injuries on CT, the prevalence of clinically important traumatic brain injuries was very low, with no patient requiring neurosurgery. Clinicians should use patient age, scalp hematoma location and size, and injury mechanism to help determine which otherwise asymptomatic children should undergo neuroimaging after minor head trauma.