The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Sep 2020
Multicenter StudyInto the wild and on to the table: A Western Trauma Association multicenter analysis and comparison of wilderness falls in rock climbers and nonclimbers.
Wilderness activities expose outdoor enthusiasts to austere environments with injury potential, including falls from height. The majority of published data on falls while climbing or hiking are from emergency departments. We sought to more accurately describe the injury pattern of wilderness falls that lead to serious injury requiring trauma center evaluation and to further distinguish climbing as a unique pattern of injury. ⋯ Epidemiological, Level IV.
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J Trauma Acute Care Surg · Sep 2020
Case ReportsRescue therapy for severe COVID-19-associated acute respiratory distress syndrome with tissue plasminogen activator: A case series.
The coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented stresses on modern medical systems, overwhelming the resource infrastructure in numerous countries while presenting a unique series of pathophysiologic clinical findings. Thrombotic coagulopathy is common in critically ill patients suffering from COVID-19, with associated high rates of respiratory failure requiring prolonged periods of mechanical ventilation. ⋯ All five patients appeared to have an improved respiratory status following tPA administration: one patient had an initial marked improvement that partially regressed after several hours, one patient had transient improvements that were not sustained, and three patients had sustained clinical improvements following tPA administration. LEVEL OF EVIDENCE: Therapeutic, Level V.
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J Trauma Acute Care Surg · Sep 2020
Diaphragm pacing improves respiratory mechanics in acute cervical spinal cord injury.
Cervical spinal cord injury (CSCI) is devastating with ventilator-associated pneumonia being a main driver of morbidity and mortality. Laparoscopic diaphragm pacing implantation (DPS) has been used for earlier liberation from mechanical ventilation. We hypothesized that DPS would improve respiratory mechanics and facilitate liberation. ⋯ Therapeutic IV.
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J Trauma Acute Care Surg · Sep 2020
Case ReportsEarly outcomes with utilization of tissue plasminogen activator in COVID-19-associated respiratory distress: A series of five cases.
Coronavirus patients demonstrate varying degrees of respiratory insufficiency; many will progress to respiratory failure with a severe version of acute respiratory distress syndrome refractory to traditional supportive strategies. Providers must consider alternative therapies to deter or prevent the cascade of decompensation to fulminant respiratory failure. ⋯ Case series of therapeutic effect, Level V.
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J Trauma Acute Care Surg · Sep 2020
Radiologic predictors of in-hospital mortality after traumatic craniocervical dissociation.
Traumatic craniocervical dissociation (CCD) is the forcible dislocation of the skull from the vertebral column. Because most CCD patients die on scene, prognostication for those who arrive alive to hospital is challenging. The study objective was to determine if greater dissociation, based on radiologic measurements of CCD, is predictive of in-hospital mortality among patients surviving to the emergency department. ⋯ Prognostic and Epidemiological, Level III.