The journal of trauma and acute care surgery
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Neck injury represents 11% of battle injuries in UK forces in comparison with 2% to 5% in US forces. The aim of this study was to determine the causes of death and long-term morbidity from combat neck injury in an attempt to recommend new methods of protecting the neck. ⋯ Nape protectors, that cover zone III of the neck posteriorly, would only have potentially prevented 3% of injuries and therefore this study does not support their use. Current UK OSPREY neck collars potentially protect against the majority of explosive fragments to zones I and II and had these collars been worn potentially 16 deaths may have been prevented. Reasons for their lack of uptake by UK servicemen is therefore being evaluated. Surface wound mapping of penetrating explosive fragments in our series has been used to validate the area of coverage required for future designs of neck protection.
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J Trauma Acute Care Surg · Apr 2012
Fresh frozen plasma/red blood cell resuscitation regimen that restores procoagulants without causing adult respiratory distress syndrome.
Controversy exists about the ideal fresh frozen plasma/red blood cell (FFP/RBC) ratio for resuscitation of patients requiring massive transfusion (MT). This study correlates the FFP/RBC with clotting time (CT), prothrombin time (PT), partial thromboplastin time (PTT), and thrombin time (TT); with procoagulants (fibrinogen [FI], factor 5 [FV], and factor 8 [FVIII]); and with adult respiratory distress syndrome (pO2/FIO2). ⋯ These data show that an FFP/RBC ratio above 0.31:1 in injured patients requiring MT restores CTs and procoagulant to clinically effective levels while not causing adult respiratory distress syndrome. Future studies on defining the ideal FFP/RBC ratio for MT should monitor CTs, procoagulants, and organ function.
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The association between admission heart rate (AHR) and mortality after trauma can assist initial emergency department triage and resuscitation. In addition, increased AHR is often associated with sympathetic hyperactivity which may require targeted treatment. We determined whether AHR was a predictor for mortality in trauma patients. ⋯ Mortality after trauma increases outside the AHR range of 70 to 89 beats per minute. AHR ranges previously considered "normal" were associated with significantly increased mortality. Prospective research is required to evaluate if resuscitation goals should target heart rate at the 70 to 89 range.
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J Trauma Acute Care Surg · Apr 2012
Anticoagulation management around percutaneous bedside procedures: is adjustment required?
Percutaneous endoscopic gastrostomy (PEG) and percutaneous dilatational tracheostomy (PDT) are frequently performed bedside in the intensive care unit. Critically ill patients frequently require anticoagulant (AC) and antiplatelet (AP) therapies for myriad indications. There are no societal guidelines proffering strategies to manage AC/AP therapies periprocedurally for bedside PEG or PDT. The aim of this study is to evaluate the management of AC/AP therapies around PEG/PDT, assess periprocedural bleeding complications, and identify risk factors associated with bleeding. ⋯ We found that while practice patterns were quite consistent in regard to the management of prophylactic anticoagulation, it varied widely in patients receiving therapeutic anticoagulation. It seems that prophylactic anticoagulation use did not affect bleed risk with PEG/PDT.
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J Trauma Acute Care Surg · Apr 2012
Level of agreement between patient and proxy responses to the EQ-5D health questionnaire 12 months after injury.
Health-related quality of life represents a patient's experiences and expectations and should be collected from the patient. In trauma, collection of information from the patient can be challenging, particularly for subgroups where cognitive impairment is prevalent, increasing reliance on proxy reporting. This study assessed the agreement between patient and proxy reporting of health-related quality of life 12 months after injury. ⋯ Although proxy and patient responses for the EQ-5D VAS may differ, the differences show random variability rather than systematic bias. Group comparisons using proxy responses are unlikely to be biased, but proxy responses should be used with caution when assessing individual patient recovery.