The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Sep 2020
Use of bilobed partial resuscitative endovascular balloon occlusion of the aorta is logistically superior in prolonged management of a highly lethal aortic injury.
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a viable technique for management of noncompressible torso hemorrhage. The major limitation of the current unilobed fully occlusive REBOA catheters is below-the-balloon ischemia-reperfusion complications. We hypothesized that partial aortic occlusion with a novel bilobed partial (p)REBOA-PRO would result in the need for less intraaortic balloon adjustments to maintain a distal goal perfusion pressure as compared with currently available unilobed ER-REBOA. ⋯ In this highly lethal aortic injury model, use of bilobed pREBOA-PRO for a 4-hour partial aortic occlusion was logistically superior to unilobed ER-REBOA. It required less intraaortic balloon adjustments to maintain target MAP and resulted in less inflammation.
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J Trauma Acute Care Surg · Aug 2020
OPEN TRACHEOSTOMY FOR COVID19 POSITIVE PATIENTS: A METHOD TO MINIMIZE AEROSOLIZATION AND REDUCE RISK OF EXPOSURE.
The COVID-19 virus is highly contagious, and thus there is a potential of infecting operating staff when operating on these patients. This case series describes a method of performing open tracheostomy for COVID-19 patients while minimizing potential aerosolization of the virus using typically available equipment and supplies. ⋯ Therapeutic/care management, Level V.
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J Trauma Acute Care Surg · Aug 2020
Complications and outcome after rib fracture fixation: A systematic review.
In recent years, there has been a growing interest in operative treatment for multiple rib fractures and flail chest. However, to date, there is no comprehensive study that extensively focused on the incidence of complications associated with rib fracture fixation. Furthermore, there is insufficient knowledge about the short- and long-term outcomes after rib fracture fixation. ⋯ Systematic Review, level III.
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J Trauma Acute Care Surg · Aug 2020
High crystalloid volumes negate benefit of hemostatic resuscitation in pediatric wartime trauma casualties.
Recent data for adult trauma patients suggest improved survival when using hemostatic resuscitation, which includes limiting crystalloids and using closer to 1:1 ratios for both fresh frozen plasma (FFP) and platelets (PLTs) relative to packed red blood cells (PRBCs). Pediatric studies have shown similar but mixed results and often lack measuring crystalloids. We seek to evaluate in-hospital survival based on crystalloid administration and different blood product ratios in pediatric casualties during the recent conflicts. ⋯ Retrospective, comparative, level III.
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J Trauma Acute Care Surg · Aug 2020
Is magnetic resonance imaging becoming the new computed tomography for cervical spine clearance? Trends in magnetic resonance imaging utilization at a Level I trauma center.
Increasing evidence supports the limited use of magnetic resonance imaging (MRI) for cervical spine (C-spine) clearance following blunt trauma. We sought to characterize the utilization of MRI of the C-spine at a Level I trauma center. ⋯ Therapeutic/Care Management Study, Level III or IV. Diagnostic test, level IV.