The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Aug 2012
A novel sponge-based wound stasis dressing to treat lethal noncompressible hemorrhage.
Noncompressible hemorrhage is the leading cause of preventable death caused by hemorrhage on the battlefield. Currently, there are no hemostatic agents with the ability to control noncompressible hemorrhage. A wound stasis dressing based upon rapidly expanding cellulose minisponges (MS) was developed and tested in a lethal noncompressible model in swine, by fully transecting subclavian artery and vein. MS were compared with conventional hemostasis dressings, Combat Gauze (CG), in a randomized comparison. ⋯ The use of MS is a novel approach for the rapid, simple treatment of severe noncompressible hemorrhage, which provided statistically significant improvement in hemostasis and survival 60 minutes after injury and a large reduction in blood loss, resuscitation fluid requirement, and medic treatment time compared with conventional hemorrhage control dressings in a swine model.
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J Trauma Acute Care Surg · Aug 2012
Comparative StudyThe utility of procalcitonin in critically ill trauma patients.
Procalcitonin (PCT), the prohormone of calcitonin, has an early and highly specific increase in response to systemic bacterial infection. The objectives of this study were to determine the natural history of PCT for patients with critical illness and trauma, the utility of PCT as a marker of sepsis versus systemic inflammatory response syndrome (SIRS), and the association of PCT level with mortality. ⋯ PCT levels are significantly higher in ICU patients with trauma and sepsis and may help differentiate sepsis from SIRS in critical illness. An elevated PCT level was associated with increased mortality.
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J Trauma Acute Care Surg · Aug 2012
Comparative StudyScreening for traumatic stress among survivors of urban trauma.
This study piloted the use of the Primary Care PTSD (PC-PTSD) screening tool in an outpatient setting to determine its utility for broader use and to gather data on traumatic stress symptoms among direct (patients) and indirect (families) survivors of traumatic injuries. ⋯ The PC-PTSD was an easy to administer screening tool. Patients reported PTSD symptoms at higher rates than previous studies. Patients with gunshot wounds and those injured greater than 30 days from the time of the screen were more likely to report PTSD symptoms. Although males represented 82% of positive screens, there was no statistical difference in PTSD symptoms between male and female participants because of the small number of females represented. Families also reported significant levels of PTSD. Both patients and families may benefit from additional screening and intervention in the early posttrauma period.
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J Trauma Acute Care Surg · Aug 2012
Continuous measurement of cerebral oxygen saturation (rSO₂) for assessment of cardiovascular status during hemorrhagic shock in a swine model.
Early trauma care is dependent on subjective assessments and sporadic vital sign assessments. We hypothesized that near-infrared spectroscopy-measured cerebral oxygenation (regional oxygen saturation [rSO₂]) would provide a tool to detect cardiovascular compromise during active hemorrhage. We compared rSO₂ with invasively measured mixed venous oxygen saturation (SvO₂), mean arterial pressure (MAP), cardiac output, heart rate, and calculated pulse pressure. ⋯ Near-infrared spectroscopy-measured rSO₂ provided reproducible decreases during hemorrhage that were similar in time course to invasively measured cardiac output and SvO₂ but delayed 5 to 9 minutes compared with MAP and pulse pressure. rSO₂ may provide an earlier warning of worsening hemorrhagic shock for prompt interventions in patients with trauma when continuous arterial BP measurements are unavailable.
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J Trauma Acute Care Surg · Aug 2012
Comparative StudyThe influence of unit-based nurse practitioners on hospital outcomes and readmission rates for patients with trauma.
With the increased restrictions on resident work hours, hospitals increasingly are relying on advance practice nurses and physician assistants to help meet the patient care demand. We have created a workflow model wherein unit-based nurse practitioners (UBNPs) provide the minute-to-minute care for patients with trauma in one specific unit in our hospital, with supervision by the attending surgeons. Patients with trauma may also be admitted to other units, where the care model is a traditional resident-run (RR) service, again with supervision by the attending staff. Our aim was to determine if there were differences between the care provided by UBNPs and residents. ⋯ Care provided by UBNPs is equivalent to that provided by residents. With the restriction on resident work hours and greater reliance on nurse practitioners, patient care does not suffer. Moreover, a difference of 0.5 days in mean length of stay for the UBNP patients equates with more than 1,300 fewer patient care days. This difference, although not statistically significant, may be clinically relevant to physicians and administrators and may offset the cost of hiring UBNPs to help meet the patient care demand.