The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Nov 2016
Evaluation of respiratory volume monitoring (RVM) to detect respiratory compromise in advance of pulse oximetry and help minimize false desaturation alarms.
Monitoring respiratory function is important. By continuously monitoring respiratory volumes, respiratory depression could be identified before hypoxemia and drive earlier intervention. Here, we evaluate the temporal relationship of respiratory volume monitoring (providing real-time minute ventilation [MV], tidal volume, and respiratory rate in nonintubated patients) to hypoxemic episodes and its potential to help classify true vs false desaturations (related to patient movement/probe dislodgement). ⋯ Diagnostic study, level II.
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J Trauma Acute Care Surg · Nov 2016
Identifying potential utility of resuscitative endovascular balloon occlusion of the aorta: An autopsy study.
Resuscitative thoracotomy (RT) has been the standard therapy in patients with acute arrest due to hemorrhagic shock. However, with the development of resuscitative endovascular balloon occlusion of the aorta (REBOA), its role as a potential adjunct to a highly morbid intervention such as RT is being discussed. The aim of this study was to identify patients who most likely would have potentially benefited from REBOA use based on autopsy findings. ⋯ Therapeutic study, level V.
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J Trauma Acute Care Surg · Nov 2016
Comparative StudyComparison of NIRS, serum biomarkers, and muscle damage in a porcine balloon compression model of acute compartment syndrome.
Near-infrared spectroscopy (NIRS) has been shown to aid in the diagnosis of extremity acute compartment syndrome (ACS), offering continuous real-time capability to monitor perfusion in extremities. Porcine models of ACS have been developed to attempt to aid in the understanding of the development of ACS and provide better methods of diagnosing ACS. The objective of the present study was to assess and correlate NIRS, tibial intracompartmental pressure (TICP), tibial intracompartmental perfusion pressure (TIPP), serum markers of inflammation and muscle injury in a balloon compression model of ACS. ⋯ Near-infrared spectroscopy of the compartment provided a reliable, sensitive measure of both an increase and decrease in TICP and TIPP in this porcine balloon model of ACS. Creatine kinase and myoglobin significantly increased following balloon removal. Significant correlations between muscle degeneration, edema, hemorrhage, and NIRS were found.
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J Trauma Acute Care Surg · Nov 2016
Neurochemical changes following combined hypoxemia and hemorrhagic shock in a rat model of penetrating ballistic-like brain injury: A microdialysis study.
Energy metabolic dysfunction is a key determinant of cellular damage following traumatic brain injury and may be worsened by additional insults. This study evaluated the acute/subacute effects of combined hypoxemia (HX) and hemorrhagic shock (HS) on cerebral interstitial levels of glucose, lactate, and pyruvate in a rat model of penetrating ballistic-like brain injury (PBBI). ⋯ This study identified the temporal profile of energy-related neurochemical dysregulation induced by PBBI and combined injury in the perilesional region. Furthermore, combined HX and HS further reduced the pyruvate level and increased the lactate-to-pyruvate ratio following PBBI, indicating the exacerbation of posttraumatic metabolic perturbation.
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No guidelines exist for the evaluation of patients after near hanging. Most patients receive a comprehensive workup, regardless of examination. We hypothesize that patients with a normal neurologic examination, without major signs or symptoms suggestive of injury, require no additional workup. ⋯ Therapeutic/care management study, level V.