Articles: trauma.
-
AJR Am J Roentgenol · Aug 2014
Radiologic features of injuries from the Boston Marathon bombing at three hospitals.
The aim of this study is to describe the radiologic imaging findings of primary, secondary, tertiary, and quaternary blast injuries in patients injured in the Boston Marathon bombing on April 15, 2013. ⋯ Injuries from the Boston Marathon bombing were predominantly from the secondary blast wave and resulted in traumatic injuries predominantly of the lower extremities. The most common shrapnel found on radiologic evaluation was the ball bearing.
-
Trauma and penetrating injury, mostly in the form of assault and self-inflicted gunshot and stab wounds, is a major contributor to mortality and morbidity in the modern world, specifically among younger populations. While the prevalence of this form of injury is drastically lower in the UK and Europe in comparison with the USA, it is still common enough to necessitate practising anaesthetists to have a good understanding and working knowledge of the principles in treating victims with penetrating injury. This review article aims to cover basic principles of attending to penetrating trauma victims starting at the pre-hospital level and continuing into the emergency department (ED) and the operating theatre. ⋯ We also suggest a work flow for treating life-threatening penetrating injury and review the major controversies in this field. Our perspective is based on the experience and procedures used at the University of Washington's Harborview Medical Center, the only level 1 trauma centre covering the states of Washington, Alaska, Montana, Idaho, and Wyoming in the USA. This region contains almost 11 000 000 persons over a surface area of more than 2 700 000 km(2).
-
Significant progress has been made recently in the recognition, screening, diagnosis, and treatment of blunt cerebrovascular vascular injury (BCVI). Although controversy still exists as to optimal screening algorithms and best diagnostic modality, the vital and growing role of noninvasive imaging in identifying patients at high risk for BCVI and in characterizing the injury itself has been clearly established. There has been promising early work in stratifying BCVI patients into risk categories by initially evaluating them with high-resolution head, maxillofacial, and cervical computed tomographic examinations with the ultimate goal of maximizing diagnostic yield and enabling prompt initiation of therapy.
-
Coagulopathy is the inability of blood to coagulate normally; in trauma patients, it is a multifactorial and complex process. Seriously injured trauma patients experience coagulopathies during the acute injury phase. Risk factors for trauma-induced coagulopathy include hypothermia, metabolic acidosis, hypoperfusion, hemodilution, and fluid replacement. ⋯ Therefore, medication-induced coagulopathy also is a concern. Traditional laboratory-based methods of assessing coagulation are being supported or even replaced by point-of-care tests. The evidence-based management of trauma-induced coagulopathy should address hypothermia, fluid resuscitation, blood components administration, and, if needed, medications to reverse identified coagulation disorders.
-
Journal of critical care · Aug 2014
ReviewFrom data patterns to mechanistic models in acute critical illness.
The complexity of the physiologic and inflammatory response in acute critical illness has stymied the accurate diagnosis and development of therapies. The Society for Complex Acute Illness was formed a decade ago with the goal of leveraging multiple complex systems approaches to address this unmet need. ⋯ We suggest that the next decade holds the potential to merge these approaches, connecting patient diagnosis to treatment via mechanism-based dynamical system modeling and feedback control and allowing extrapolation from physiologic signals to biomarkers to novel drug candidates. As a predicate example, we focus on the role of data-driven and mechanistic models in neuroscience and the impact that merging these modeling approaches can have on general anesthesia.