Articles: trauma.
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Transfusion medicine · Jun 2014
Not only in trauma patients: hospital-wide implementation of a massive transfusion protocol.
To review outcomes of massive transfusion protocol (MTP) activation and determine the impact of MTP implementation on blood bank use. ⋯ MTP may be successfully used in trauma and non-trauma settings without significantly impacting overall blood product utilisation. Inclusion of non-trauma patients into prospective studies of resuscitation with blood products is warranted to ensure benefit in these patients.
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Critical care medicine · Jun 2014
Observational StudyMicrocirculatory Alterations in Traumatic Hemorrhagic Shock.
Microcirculatory dysfunction has been well reported in clinical studies in septic shock. However, no clinical studies have investigated microcirculatory blood flow behavior in hemorrhagic shock. The main objective of this study was to assess the time course of sublingual microcirculation in traumatic hemorrhagic shock during the first 4 days after trauma. ⋯ Alterations of microcirculation in traumatic hemorrhagic shock patients result from the interplay among hemorrhage-induced tissue hypoperfusion, trauma injuries, inflammatory response, and subsequent resuscitation interventions. Despite restoration of the macrocirculation, the sublingual microcirculation was impaired for at least 72 hours. The initial proportion of perfused vessels appears to be a good predictor of high Sequential Organ Failure Assessment score at D4. Further studies are required to firmly establish the link between microvascular alterations and organ dysfunction in traumatic hemorrhagic shock patients.
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Chirurgie de la main · Jun 2014
ReviewSurgical management of combat-related upper extremity injuries.
This review presents the current surgical management of combat-related upper extremity injuries during the acute phase. The strategy consists of saving the life, saving the limb and retaining function. ⋯ Features of the definitive management of local casualties in battlefield medical facilities are also discussed. In this situation, reconstructive procedures have to take into account the limited resources and operational constraints.
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Journal of neurosurgery · Jun 2014
Blunt traumatic occlusion of the internal carotid and vertebral arteries.
The stroke rate, management, and outcome after blunt cerebrovascular occlusion (Biffl Grade IV injury) is not well defined, given the rarity of the disease. Both hemodynamic failure and embolic mechanisms have been implicated in the pathophysiology of subsequent stroke after blunt cerebrovascular occlusion. In this study, the authors evaluated their center's experience with Biffl Grade IV injuries, focusing on elucidating the mechanisms of stroke and their optimal management. ⋯ At the authors' institution, traumatic ICA occlusion is rare but associated with a high stroke rate. Robust collateral circulation may mitigate its severity. Embolic monitoring with TCD ultrasonography and prophylactic antiplatelet therapy should be used in all ICA Biffl Grade IV injuries. Unilateral VA Biffl Grade IV injury is the most common type of traumatic occlusion and is associated with significantly less morbidity. Embolic monitoring using TCD and prophylactic antiplatelet therapy do not appear to be beneficial in patients with traumatic VA occlusion.
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Surgery is a posttraumatic immune stimulus which contributes to the systemic inflammatory response syndrome and multiple organ failure (MOF). Serum markers may facilitate post-injury immune monitoring, predict complications and guide the timing of surgery. ⋯ An increase in posttraumatic serum cytokines has been demonstrated after surgery, but without consistent clinical associations. The timing of surgery may modulate this increase. Future research directions include confirmation of findings in larger populations, clarifying clinical associations, and evaluation of other surgical interventions.