Articles: trauma.
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Background : New strategies are needed to mitigate further tissue injury during traumatic limb ischemia in cases requiring damage control resuscitation (DCR). Little is known about the pathophysiology and injury course in acute limb ischemia (ALI) with DCR in polytraumatized casualties. We therefore investigated the effects of therapeutic limb hypothermia in a swine model of ALI and DCR. ⋯ Mean nerve histology scores did not differ between the 5°C and paired control limbs, or between the mean muscle and nerve histology scores of the 15°C and paired control limbs. Conclusion : Cooling to 15°C significantly reduced local tissue metabolites compared to paired controls, while producing no significant increase in histologic damage, whereas cooling to 5°C increased histologic muscle damage. These results suggest an approach to prevention of ischemic injury through local hypothermia but warrant further functional testing.
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Efficient resuscitation after trauma and shorter time to definitive hemorrhage control help improve trauma outcomes. We aimed to improve the speed and efficiency of resuscitation for critically ill trauma patients in the emergency department by involving interventional radiology and a second surgeon. ⋯ The Double 90 rule is effective for expediting trauma care starting in the emergency department, shortening the times to computed tomography, hemorrhage control intervention, and decreasing packed red blood cell transfusion.
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The Extended Focused Assessment with Sonography for Trauma (E-FAST) is a diagnostic ultrasound technique used in hospital and pre-hospital settings for patients with torso trauma. While E-FAST is common in emergency departments, its pre-hospital use is less routine. This study aims to establish a set of variables for designing studies on pre-hospital E-FAST through a Delphi consensus process involving international experts. ⋯ This Delphi consensus study presents a list of 32 variables for future research studies concerning the use of E-FAST ultrasound in pre-hospital settings. The results of this study are significant as they provide a standardized set of variables that will facilitate the comparison of data obtained from various studies. This will ultimately contribute to the advancement of pre-hospital E-FAST research and practice.
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Mice used in biomedical research are typically housed at ambient temperatures (22°C-24°C) below thermoneutrality (26°C-31°C). This chronic cold stress triggers a hypermetabolic response that may limit the utility of mice in modeling hypermetabolism in response to burns. To evaluate the effect of housing temperature on burn-induced hypermetabolism, mice were randomly assigned to receive sham, small, or large scald burns. ⋯ Locomotion was significantly reduced in mice with large burns compared to sham and small burn groups, irrespective of sex or housing temperature ( P < 0.05). Housing at 30°C revealed sexual dimorphism in terms of the impact of burns on body mass and composition, where males with large burns displayed marked cachexia, whereas females did not. Collectively, this study demonstrates a sex-dependent role for housing temperature in influencing energetics and body composition in a rodent model of burn trauma.