The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Dec 2013
Comparative StudyClinical utility of flat inferior vena cava by axial tomography in severely injured elderly patients.
Flat inferior vena cava (IVC) has been associated with shock and mortality in young trauma patients (age < 55 years). Because of the greater possibility of nonhypovolemic shock in the elderly, we hypothesized that there would be no correlation between IVC ratio and the presence of shock. ⋯ Diagnostic study, level IV.
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J Trauma Acute Care Surg · Dec 2013
Comparative StudyDriving intoxicated: is hospital admission protective against legal ramifications?
According to the US National Highway Traffic Safety Administration, in 2010, 10,228 people were killed in alcohol-impaired driving crashes. Daily, intoxicated drivers are seen in trauma centers across the country. At our trauma center, we sought to determine the number of drivers who had a documented elevation in their blood alcohol content (BAC) and compare this with county police records to evaluate how many charges for driving while intoxicated (DWI) were issued. ⋯ Epidemiologic study, level III.
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J Trauma Acute Care Surg · Dec 2013
Comparative StudyThe International Normalized Ratio overestimates coagulopathy in stable trauma and surgical patients.
The international normalized ratio (INR) was developed to assess adequacy of Coumadin dosing. Its use has been generalized to guide fresh frozen plasma (FFP) therapy in stable patients. Thrombelastography (TEG) is a whole-blood assay measuring the viscoelastic properties of the clot in near real time. This study hypothesized that INR does not reflect coagulopathy and should not be used to guide FFP therapy in stable trauma and surgical patients. ⋯ Diagnostic study, level III.
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J Trauma Acute Care Surg · Dec 2013
Comparative StudyDifferential effects of fresh frozen plasma and normal saline on secondary brain damage in a large animal model of polytrauma, hemorrhage and traumatic brain injury.
We have previously shown that the extent of traumatic brain injury (TBI) in large animal models can be reduced with early infusion of fresh frozen plasma (FFP), but the precise mechanisms remain unclear. In this study, we investigated whether resuscitation with FFP or normal saline differed in their effects on cerebral metabolism and excitotoxic secondary brain injury in a model of polytrauma, TBI, and hemorrhagic shock. ⋯ In this model of TBI, polytrauma, and hemorrhage, FFP resuscitation confers neuroprotection by improving cerebral perfusion, diminishing glutamate-mediated excitotoxic secondary brain injury and reducing mitochondrial dysfunction.
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J Trauma Acute Care Surg · Dec 2013
Comparative StudyThe effects of tranexamic acid and prothrombin complex concentrate on the coagulopathy of trauma: an in vitro analysis of the impact of severe acidosis.
Bleeding is the most frequent cause of preventable death after severe injury. Our purposes were to study the efficacy of tranexamic acid (TXA) and prothrombin complex concentrate (PCC) on a traumatic coagulopathy with a severe native metabolic acidosis and compare the efficacy of PCC versus fresh frozen plasma (FFP) to reverse a dilutional coagulopathy. ⋯ Both TXA and PCC seem to function well in reversing a traumatic coagulopathy in vitro, and TXA seems to have no loss of function in a severe metabolic acidosis. Further investigations are warranted.