The journal of trauma and acute care surgery
-
J Trauma Acute Care Surg · Nov 2019
Protective effects of plasma products on the endothelial-glycocalyx barrier following trauma-hemorrhagic shock: Is sphingosine-1 phosphate responsible?
Plasma is an important component of resuscitation after trauma and hemorrhagic shock (T/HS). The specific plasma proteins and the impact of storage conditions are uncertain. Utilizing a microfluidic device system, we studied the effect of various types of plasma on the endothelial barrier function following T/HS. ⋯ A biomimetic model of the microcirculation following T/HS demonstrated endothelial glycocalyx and endothelial cellular injury/activation as well as a profibrinolytic phenotype. These effects were abrogated by all plasma products except the 5-day thawed plasma. Plasma thawed longer than 5 days had diminished S1-P concentrations. Our data suggest that S1-P protein is critical to the protective effect of plasma products on the endothelial-glycocalyx barrier following T/HS.
-
J Trauma Acute Care Surg · Nov 2019
Critical call for hospital-based domestic violence intervention: The Davis Challenge.
Fifty percent of women killed in intimate partner violence (IPV) were seen by a health care provider within a year of their death. As guest speaker to Virginia Commonwealth University Trauma Center (VCU-TC), Dr. James Davis (Western Trauma Association past president) challenged VCU-TC to develop a hospital-based IPV program. This research examines the development and impact of an integrated hospital/VCU-TC-based IPV program. ⋯ Therapeutic, level I.
-
J Trauma Acute Care Surg · Nov 2019
Randomized Controlled Trial Multicenter StudyImplementation of a prehospital air medical thawed plasma program: Is it even feasible?
The Prehospital Air Medical Plasma (PAMPer) trial demonstrated a 30-day survival benefit among hypotensive trauma patients treated with prehospital plasma during air medical transport. We characterized resources, costs and feasibility of air medical prehospital plasma program implementation. ⋯ Therapeutic, level III.
-
J Trauma Acute Care Surg · Nov 2019
Randomized Controlled TrialKetamine infusion for pain control in elderly patients with multiple rib fractures: Results of a randomized controlled trial.
Rib fractures are associated with increased mortality, particularly in the elderly. While opiate-based pain regimens remain the cornerstone of rib fracture management, issues related to opioids have driven research into alternative analgesics. Adjunctive ketamine use in lieu of opioids continues to increase but little evidence exists to support its efficacy or safety within the elderly trauma population. ⋯ Therapeutic, level I.
-
J Trauma Acute Care Surg · Nov 2019
Randomized Controlled TrialMissing expectations: Windlass tourniquet use without formal training yields poor results.
Despite significant attempts to educate civilians in hemorrhage control, the majority remain untrained. We sought to determine if laypersons can successfully apply one of three commercially available tourniquets; including those endorsed by the United States Military and the American College of Surgeons. ⋯ No one should die of extremity hemorrhage, and civilians are our first line of defense. We demonstrate that when an untrained layperson is handed a commonly accepted tourniquet, failure is unacceptably high. Current devices are not intuitive and require training beyond the enclosed instructions. Plans to further evaluate this cohort after formal "Stop the Bleed" training are underway.