Articles: trauma.
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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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Injury is the second leading cause of death worldwide, and as much as 40% of injury-related mortality is attributed to uncontrollable hemorrhage. This persists despite establishment of regionalized trauma systems and advances in the management of severely injured patients. Trauma-induced coagulopathy has been identified as the most common preventable cause of postinjury mortality. ⋯ Trauma-induced coagulopathy is a complex pathophysiological condition, of which some mechanisms have been characterized, but much remains to be understood in order to translate this knowledge into improved outcomes for the injured patient.
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Traumatic brain injury (TBI) is a significant public health concern. On average, 1.7 million persons sustain a TBI annually, and about 5.3 million Americans are living with a TBI-related disability. As the leading cause of death and disability in persons under 45 years old, there is a need for developing evidence-based interventions to reduce morbidity from this injury. ⋯ The cascade of molecular and cellular changes after TBI involves plasticity in many different neurochemical systems, which represent putative targets for neurotherapeutic interventions. Accordingly, a successful TBI treatment may have to simultaneously attenuate many injury factors. The purpose of this review is to highlight four promising nutritional intervention options that have been identified-omega-3, zinc, vitamin D, and glutamine-and to provide an up-to-date summary regarding their apparent efficacy for affecting TBI.
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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.
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Critical care medicine · May 2014
ReviewRehabilitation Interventions for Postintensive Care Syndrome: A Systematic Review.
An increasing number of ICU patients survive and develop mental, cognitive, or physical impairments. Various interventions support recovery from this postintensive care syndrome. Physicians in charge of post-ICU patients need to know which interventions are effective. ⋯ Interventions which have substantial effects in post-ICU patients are rare. Positive effects were seen for ICU-diary interventions for posttraumatic stress disorder. More interventions for the growing number of ICU survivors are needed.