Articles: trauma.
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This study evaluated noninvasively determined muscle pH (pHm) and muscle oxygen saturation (SmO2) in a swine shock model that used uncontrolled hemorrhage and restricted volume resuscitation. Anesthetized 40-kg female swine underwent hemorrhage until 24 mL/kg of blood was removed (n = 26), followed by transection of the spleen, causing uncontrolled hemorrhage throughout the remainder of the protocol. After 15 min, 15 mL/kg of resuscitation fluid (Hextend, fresh-frozen plasma or platelets) was given for 30 min. ⋯ It was shown that, for both pH and SO2, venous and muscle values were similar to each other at the end of the resuscitation period and at the end of the study for both surviving and nonsurviving animals. pH and SO2, venous and muscle, significantly declined as a result of bleeding, but lactate and base excess did not show significant changes during this period. Noninvasive pHm and SmO2 tracked the adequacy of resuscitation in real time, indicating at the time all of the fluid was delivered, which animals would live and which would die. The results of this swine study indicate that further evaluation on trauma patients is warranted.
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We aimed to evaluate whether hepatic transaminase levels could predict the presence and severity of liver injury following abdominal trauma. ⋯ In patients with abdominal trauma, abnormal hepatic transaminase and LDH levels are associated with liver injury. Alanine aminotransferase ≤76 U/L, aspartate aminotransferase <130 U/L, and LDH ≤410 U/L are predictive of low-grade liver injury, and patients with serum liver levels below these levels can be managed conservatively.
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Comparative Study
Risk Factors for Hypothermia in EMS-treated Burn Patients.
Hypothermia has been associated with increased mortality in burn patients. We sought to characterize the body temperature of burn patients transported directly to a burn center by emergency medical services (EMS) personnel and identify the factors independently associated with hypothermia. ⋯ A substantial proportion of burn patients demonstrate hypothermia at hospital arrival. Risk factors for hypothermia are readily identifiable by prehospital providers. Maintenance of normothermia should be stressed during prehospital care.
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The majority of research on terrorism-exposed youth has examined large-scale terrorism with mass casualties. Limited research has examined children's reactions to terrorism of the scope of the Boston Marathon bombing. Furthermore, the extraordinary postattack interagency manhunt and shelter-in-place warning made for a truly unprecedented experience in its own right for families. Understanding the psychological adjustment of Boston-area youth in the aftermath of these events is critical for informing clinical efforts. ⋯ Clinical efforts must maintain a broadened focus beyond simply youth present at the blasts and must also include youth highly exposed to the intense interagency pursuit and manhunt. Continued research is needed to understand the adjustment of youth after mass traumas and large-scale manhunts in residential communities.
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J Neurosurg Anesthesiol · Jul 2014
Anesthetic Management of Neurosurgical Procedures During Pregnancy: A Case Series.
Neurosurgical disorders are rare during pregnancy and challenge the anesthesiologist with conflicting anesthetic considerations and little evidence to guide decision-making. Our objective was to review the anesthetic management of pregnant patients undergoing intracranial neurosurgery at our institution and to describe the perioperative complications and outcomes. ⋯ Pregnant patients undergoing neurosurgery experience a high rate of morbidity and mortality. There were no adverse outcomes directly attributed to the use of osmotic diuretics and hyperventilation in our series.