The journal of trauma and acute care surgery
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Point-of-care ultrasound often includes cardiac ultrasound. It is commonly used to evaluate cardiac function in critically ill patients but lacks the specific quantitative anatomic assessment afforded by standard transthoracic echocardiography (TTE). We developed the Focused Rapid Echocardiographic Examination (FREE), a hybrid between a cardiac ultrasound and TTE that places an emphasis on cardiac function rather than anatomy. We hypothesized that data obtained from FREE correlate well with TTE while providing actionable information for clinical decision making. ⋯ Diagnostic test, level III.
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J Trauma Acute Care Surg · Nov 2016
ReviewPain management for blunt thoracic trauma: A joint practice management guideline from the Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society.
Thoracic trauma is the second most prevalent nonintentional injury in the United States and is associated with significant morbidity. Analgesia for blunt thoracic trauma was first addressed by the Eastern Association for the Surgery of Trauma (EAST) with a practice management guideline published in 2005. Since that time, it was hypothesized that there have been advances in the analgesic management for blunt thoracic trauma. As a result, updated guidelines for this topic using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) framework recently adopted by EAST are presented. ⋯ We propose two evidence-based recommendations regarding analgesia for patients with blunt thoracic trauma. The overall risk of bias for all studies was high. The limitations with the available literature precluded the formulation of strong recommendations by our panel. We conditionally recommend epidural analgesia and multimodal analgesia as options for patients with blunt thoracic trauma, but the overall quality of evidence supporting these modalities is low in trauma patients. These recommendations are based on very low-quality evidence but place a high value on patient preferences for analgesia. These recommendations are in contradistinction to the previously published Practice Management Guideline published by EAST.
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J Trauma Acute Care Surg · Nov 2016
The prognostic value of neutrophil-to-lymphocyte ratio on mortality in critically ill trauma patients.
Recent studies suggest that the neutrophil-lymphocyte ratio (NLR) as a marker of inflammation is associated with mortality in surgical patients. The aim of this study was to determine the prognostic impact of NLR in critically ill trauma patients. ⋯ Prognostic study, level III.
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J Trauma Acute Care Surg · Nov 2016
ReviewMachine learning and new vital signs monitoring in civilian en route care: A systematic review of the literature and future implications for the military.
Although air transport medical services are today an integral part of trauma systems in most developed countries, to date, there are no reviews on recent innovations in civilian en route care. The purpose of this systematic review was to identify potential machine learning and new vital signs monitoring technologies in civilian en route care that could help close civilian and military capability gaps in monitoring and the early detection and treatment of various trauma injuries. ⋯ Systematic review, level V.
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J Trauma Acute Care Surg · Nov 2016
Comparative StudyClassification of soft-tissue injuries in open femur fractures: Relevant for systemic complications?
A broad range of systemic complications has been described to occur in patients with open major fractures. Various causes have been claimed to play a role. We therefore surveyed a nationwide trauma registry to assess risk factors associated with closed and various types of open femur fractures. ⋯ Epidemiologic/prognostic study, level II.