Articles: trauma.
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Neurocritical patients have a metabolic condition that makes them particularly sensitive to protein-caloric malnutrition in a short period of time. Due to this, it is essential nutritional support treatment. But the neurocritical patient has physiological connotations that makes it difficult to be able to establish an early nutrition: persistent gastroparesis for days and exacerbated metabolic response with hyperglycemia is a challenge to the therapist. This review intends to respond to nutritional difficulties in neurocritical patients and also review pharmaco-nutritients that may be helpful for the subsequent clinical course.
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Critical care clinics · Jan 2014
Review Case ReportsThe FAST and E-FAST in 2013: Trauma Ultrasonography: Overview, Practical Techniques, Controversies, and New Frontiers.
This article reviews important literature on the FAST and E-FAST examinations in adults. It also reviews key pitfalls, limitations, and controversies. A practical "how-to" guide is presented. Lastly, new frontiers are explored.
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The aim of this paper was to identify factors associated with self-efficacy for managing recovery in the trauma intensive care population. ⋯ Significant factors associated with self-efficacy for managing recovery at 6 months included 1 month self-efficacy, illness perception and psychological distress. To promote patient recovery, screening patients at 1 month in order to commence relevant interventions could be beneficial.
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The management of acute traumatic pain is a crucial component of prehospital care and yet the assessment and administration of analgesia is highly variable, frequently suboptimal, and often determined by consensus-based regional protocols. ⋯ GRADE methodology was used to develop an evidence-based guideline for prehospital analgesia in trauma. The panel issued four strong recommendations regarding patient assessment and narcotic medication dosing. Future research should define optimal approaches for implementation of the guideline as well as the impact of the protocol on safety and effectiveness metrics.
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Fibrinogen plays an essential role in clot formation and stability. Importantly it seems to be the most vulnerable coagulation factor, reaching critical levels earlier than the others during the course of severe injury. A variety of causes of fibrinogen depletion in major trauma have been identified, such as blood loss, dilution, consumption, hyperfibrinolysis, hypothermia and acidosis. ⋯ Therefore, repeated measurements of plasma fibrinogen concentration are strongly recommended in trauma patients with major bleeding. Recent guidelines recommend maintaining plasma fibrinogen concentration at 1.5-2 g/l in coagulopathic patients. It has been shown that early fibrinogen substitution is associated with improved outcome.