The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Sep 2019
ReviewWound ballistics of military rifle bullets: An update on controversial issues and associated misconceptions.
The wound ballistics literature contains several misconceptions about the physical effects of penetrating projectiles in tissue and tissue simulants. These can adversely affect the proper management of gunshot injuries, particularly in view of the ongoing threat of terrorist and criminal acts using assault rifles against civilians. The understanding of the wounding effects by military rifle bullets can be founded on the concept of energy transfer to the wound as applied to high-energy missile trauma. ⋯ The interaction between the projectile and tissue can lead to tumbling and possibly to deformation and fragmentation of the bullet, all of which strongly influence the energy transfer characteristics affecting both the temporary cavitation and the size of the permanent wound channel. Awareness of these effects can enhance perception of clinical and radiological findings suggestive of the wounding mechanism by various projectiles. LEVEL OF EVIDENCE: Review/therapeutic, level V.
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J Trauma Acute Care Surg · Sep 2019
Variability in international normalized ratio and activated partial thromboplastin time after injury are not explained by coagulation factor deficits.
Conventional coagulation assays (CCAs), prothrombin time (PT)/international normalized ratio (INR) and activated partial thromboplastin time (aPTT), detect clotting factor (CF) deficiencies in hematologic disorders. However, there is controversy about how these CCAs should be used to diagnose, treat, and monitor trauma-induced coagulopathy. Study objectives were to determine whether CCA abnormalities are reflective of deficiencies of coagulation factor activity in the setting of severe injury. ⋯ Prognostic, level III.
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J Trauma Acute Care Surg · Sep 2019
Observational StudyPreinjury Palliative Performance Scale predicts functional outcomes at 6 months in older trauma patients.
Older trauma patients have increased risk of adverse in-hospital outcomes. We previously demonstrated that low preinjury Palliative Performance Scale (PPS) independently predicted poor discharge outcomes. We hypothesized that low PPS would predict long-term outcomes in older trauma patients. ⋯ Prognostic study, Therapeutic level IV.
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J Trauma Acute Care Surg · Sep 2019
Surgery for adhesive small-bowel obstruction is associated with improved long-term survival mediated through recurrence prevention: A population-based, propensity-matched analysis.
Adhesive small-bowel obstruction (aSBO) is among the most common reasons for admission to a surgical service. While operative intervention for aSBO is associated with a lower risk of recurrence, current guidelines continue to advocate a trial of nonoperative management. The impact of the increased risk for recurrence on long-term survival is unknown. We sought to explore the potential for improved survival with operative management through the prevention of admissions for recurrence of aSBO and the associated risks. ⋯ Therapeutic study, Level II.
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J Trauma Acute Care Surg · Sep 2019
Adenosine, lidocaine, and Mg2+ fluid therapy leads to 72-hour survival after hemorrhagic shock: A model for studying differential gene expression and extending biological time.
Noncompressible torso hemorrhage is a leading cause of traumatic death. Our aim was to examine survival time and the expression of key master genes of cellular metabolism after 3% NaCl adenosine, lidocaine, and Mg (ALM) bolus and 4 hours 0.9% NaCl/ALM "drip" in a rat model of uncontrolled hemorrhagic shock. ⋯ Small-volume ALM therapy led to 3.3-times longer survival time compared with saline controls after hemorrhagic shock. A hallmark of the ALM-survival phenotype in heart and brain was an upregulation of amp-k, PGC-1α, sirt-1, and mtCO3 to presumably "boost" mitochondrial function and ATP production, and a contrasting downregulation in liver. These central-peripheral differences in gene expression require further investigation.