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By MD Aware Emergency Medicine
Philbert Y Van, John B Holcomb, Martin A Schreiber
PURPOSE OF REVIEW: Traumatic injuries are a major cause of mortality worldwide. Damage control resuscitation or balanced transfusion of plasma, platelets, and red blood cells for the management of exsanguinating hemorrhage after trauma has become the standard of care. We review the literature regarding the use of alternatives to achieve the desired 1 : 1:1 ratio as availability of plasma and platelets can be problematic in some environments. RECENT FINDINGS: Liquid and freeze dried plasma (FDP) are logistically easier to use and may be superior to fresh frozen plasma...
December 2017: Current Opinion in Critical Care
Christoph Kolja Boese, Michael Hackl, Lars Peter Müller, Steffen Ruchholtz, Michael Frink, Philipp Lechler
BACKGROUND: Nonoperative management (NOM) has become the standard treatment in hemodynamically stable patients with blunt hepatic injuries. While the reported overall success rates of NOM are excellent, there is a lack of consensus regarding the risk factors predicting the failure of NOM. The aim of this systematic review was to identify the incidence and prognostic factors for failure of NOM in adult patients with blunt hepatic trauma. METHODS: Prospective studies reporting prognostic factors for the failure of nonoperative treatment of blunt liver injuries were identified by searching MEDLINE and the Cochrane Central Register of Controlled Trials...
October 2015: Journal of Trauma and Acute Care Surgery
Dan Azagury, Rockson C Liu, Ashley Morgan, David A Spain
The initial goal of evaluating a patient with SBO is to immediately identify strangulation and need for urgent operative intervention, concurrent with rapid resuscitation. This relies on a combination of traditional clinical signs and CT findings. In patients without signs of strangulation, a protocol for administration of Gastrografin immediately in the emergency department efficiently sorts patients into those who will resolve their obstructions and those who will fail nonoperative management.Furthermore, because of the unique ability of Gastrografin to draw water into the bowel lumen, it expedites resolution of partial obstructions, shortening time to removal of nasogastric tube liberalization of diet, and discharge from the hospital...
October 2015: Journal of Trauma and Acute Care Surgery
Laura J Moore, Megan Brenner, Rosemary A Kozar, Jason Pasley, Charles E Wade, Mary S Baraniuk, Thomas Scalea, John B Holcomb
BACKGROUND: Hemorrhage remains the leading cause of death in trauma patients. Proximal aortic occlusion, usually performed by direct aortic cross-clamping via thoracotomy, can provide temporary hemodynamic stability, permitting definitive injury repair. Resuscitative endovascular balloon occlusion of the aorta (REBOA) uses a minimally invasive, transfemoral balloon catheter, which is rapidly inserted retrograde and inflated for aortic occlusion, and may control inflow and allow time for hemostasis...
October 2015: Journal of Trauma and Acute Care Surgery
Thomas L Holland, Christopher Arnold, Vance G Fowler
IMPORTANCE: Several management strategies may improve outcomes in patients with Staphylococcus aureus bacteremia. OBJECTIVES: To review evidence of management strategies for S. aureus bacteremia to determine whether transesophageal echocardiography is necessary in all adult cases and what is the optimal antibiotic therapy for methicillin-resistant S. aureus (MRSA) bacteremia. EVIDENCE REVIEW: A PubMed search from inception through May 2014 was performed to identify studies addressing the role of transesophageal echocardiography in S...
October 1, 2014: JAMA: the Journal of the American Medical Association
Mark H Ebell, JoAnna Shinholser
STUDY OBJECTIVE: The objective of this study is to systematically review the accuracy of the Alvarado score and Pediatric Appendicitis Score and to identify optimal cutoffs for low- and high-risk populations. METHODS: We performed a systematic review of the literature and identified 26 studies of the accuracy of the Alvarado score and Pediatric Appendicitis Score. Data were abstracted in parallel, and only prospective, cohort studies that avoided verification bias were included...
October 2014: Annals of Emergency Medicine
Chia-Jung Yang, Kuang-Yu Hsiao, I-Chun Su, I-Chuan Chen
BACKGROUND: Anemia is a common medical problem for critically ill patients. Blood transfusion to augment oxygen delivery for these patients has been a traditional therapy. However, few studies have identified the impact of anemia on individuals suffering from severe traumatic brain injury (TBI). Hence, this study aims to evaluate the effects of initial anemia on patients with severe TBI admitted to the Emergency Unit. METHODS: We reviewed the medical records of patients with isolated severe TBI admitted to the Emergency Unit of a university hospital from July 2003 to June 2008...
December 2011: Journal of Trauma
James N Bogert, John A Harvin, Bryan A Cotton
Resuscitation of the hemorrhaging patient has undergone significant changes in the last decade resulting in the concept of damage control resuscitation (DCR). Hemostatic resuscitation aims to address the physiologic derangements found in the hemorrhaging patient, namely coagulopathy, acidosis, and hypothermia. Strategies to achieve this are permissive hypotension, high ratio of plasma and platelet transfusion to packed red blood cell transfusion, and limitation of crystalloid administration. Damage control surgery aims for early hemorrhage control and minimizing operative time by delaying definitive repair until the patient's physiologic status has normalized...
March 2016: Journal of Intensive Care Medicine
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