The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Jul 2012
Randomized Controlled TrialKetamine/propofol admixture (ketofol) is associated with improved hemodynamics as an induction agent: a randomized, controlled trial.
Critically ill patients may require emergent intubations, and the use of some induction agents can lead to undesirable effects on hemodynamics. The use of "ketofol" (ketamine/propofol admixture) may allow for improved hemodynamic control. The primary aim of this study was to assess the hemodynamic effects of "ketofol" in a fixed-dose combination during induction of general anesthesia in a controlled environment. ⋯ "Ketofol" is associated with improved hemodynamic stability during the first 10 minutes after induction. Further study is needed to assess the efficacy of "ketofol" in critically ill patients and those with significant comorbidities. This combination has the potential to be used as an alternative agent for emergency induction during which time stable hemodynamics are desirable.
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The increased morbidity and mortality associated with coagulopathy and thrombocytopenia after trauma are well described. However, few studies have assessed platelet function after injury. ⋯ In this prognostic study, we identify clinically significant platelet dysfunction after trauma in the presence of an otherwise reassuring platelet count and standard clotting studies, with profound implications for mortality. Multiple electrode impedance aggregometry reliably identifies this dysfunction in injured patients, and admission AA and collagen responsiveness are sensitive and specific independent predictors of both early and late mortality.
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J Trauma Acute Care Surg · Jul 2012
Impact of operative intervention delay on pediatric trauma outcomes.
Establishing quality indicators is an essential step in improving mortality and disability among pediatric patients with trauma. We hypothesized that timing of craniotomy, intracranial pressure (ICP) monitoring for traumatic brain injury, and abdominal operation for solid organ injury correlates with a reduced risk of death, shorter stay, and reduced risk of requiring assistance at discharge. ⋯ Therapeutic study, level III.
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J Trauma Acute Care Surg · Jul 2012
Clinical TrialIntensive exercise after thermal injury improves physical, functional, and psychological outcomes.
Although exercise programs after burns are considered a standard of care, there is limited evidence for efficacy in adult patients. This study aimed to investigate the effects of an exercise program on physical, functional, and quality of life measures. ⋯ Therapeutic study, level III.
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J Trauma Acute Care Surg · Jul 2012
Predicting outcomes after traumatic brain injury: the development and validation of prognostic models based on admission characteristics.
Early estimation of prognosis for the patient with traumatic brain injury is an important factor in making treatment decisions, resource allocation, classify patients, or communicating with family. We aimed to develop and validate practical prognostic models for mortality at 30 days and for 6 months unfavorable outcome after moderate and severe traumatic brain injury. ⋯ Our validated prognostic models have good performance and are generalizable to be used to predict outcome of new patients. We recommend the use of prognostic models to complement clinical decision making.