Articles: trauma.
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Eur J Trauma Emerg Surg · Feb 2025
Effect of pre-existing psychiatric treatment in suicidal jumpers on the need for in-hospital treatment following injury.
To study the effect of pre-existing psychiatric disorders on outcome following suicidal jump from a height. ⋯ Patients with pre-existing psychiatric disorder reaching hospital alive have higher pre- and post-injury requirements for in-hospital treatment than patients without a pre-existing psychiatric disorder. Although pre-existing psychiatric disorder does not affect early mortality, long-term mortality is increased by 14%.
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Curr Opin Anaesthesiol · Feb 2025
Restoring hemostasis with prothrombin complex concentrate: benefits and risks in trauma-induced coagulopathy.
To provide evidence for the use of prothrombin complex concentrate (PCC) as a potential hemostatic treatment for trauma-induced coagulopathy with and without anticoagulants. ⋯ PCC is a valuable option for managing coagulopathy in specific settings, especially VKA and DOAC reversal. Based on current evidence, we caution against the use of PCC as a versatile hemostatic agent suitable for indications involving multiple clotting factor deficiencies for uncontrolled coagulopathic bleeding in trauma or other clinical settings outside anticoagulation reversal. The risk vs. benefit profile should be carefully examined, similar to any other agent.
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Thoracic injuries are directly responsible for 20-30% of deaths in severe trauma patients and represent one of the main regions involved in preventable or potentially preventable deaths. Controlling bleeding in thoracic trauma is a major challenge because intrathoracic hemorrhagic lesions can lead to hemodynamic instability and respiratory failure. ⋯ Thoracic bleeding can result from the diaphragm, intrathoracic vessels (aorta, but also inferior or superior vena cava, and suprahepatic veins), lung, cardiac, or chest wall injuries. Depending on thoracic lesions (such as hemothorax or hemopericardium), hemodynamic instability, and respiratory failure, a pericardial window approach, sternotomy, thoracotomy, or emergency resuscitation thoracotomy may be considered after discussion with the surgeon. Alongside treatment of injuries, managing oxygenation, ventilation, hemodynamic, and coagulopathy are essential for the patient's outcome.
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This review aims to summarize recent developments for the management of severe traumatic brain injury (TBI) in the ICU. Recent advancements in TBI ICU management emphasize a progression toward more multimodal approaches and mitigating secondary brain injury by increased focus on careful systemic management. ⋯ ICP monitoring remains a key component of severe TBI management in ICU. Emerging evidence is slowly changing and improving intensive care and patient outcomes and include both brain-targeted therapies and careful systemic intensive care management.
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Over the past two decades, the epidemiology of trauma has shifted significantly, driven primarily by demographic changes. Aim of our study was to illustrate the changing landscape of trauma mortality rates and compare them with other leading causes of death. ⋯ Level III retrospective study.