The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Jun 2012
Evaluating the use and utility of noninvasive angiography in diagnosing traumatic blunt cerebrovascular injury.
Digital subtraction angiography (DSA) is the gold standard for radiographic diagnosis of blunt cerebrovascular injury (BCVI), but use of computed tomography angiography (CTA) and magnetic resonance angiography (MRA) has increased dramatically in BCVI screening. This study explores the utility, effectiveness, and cost of noninvasive CTA and MRA screening for BCVI. ⋯ Diagnostic study, level III; economic analysis, level IV.
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J Trauma Acute Care Surg · Jun 2012
Steady-state and time-dependent thermodynamic modeling of the effect of intravenous infusion of warm and cold fluids.
Hypothermia results in vital sign lability, coagulopathy, wound infections, and other sequelae. Normothermia can be restored by several modalities, including passive blanket heating, warm forced-air devices, and active fluid warming (AFW). In AFW, intravenously administered fluids are heated to 40 to 45 °C to minimize net thermal losses and to raise body temperature. Clinical studies have demonstrated the efficacy of AFW as part of a strategy encompassing several methods, but the isolated contribution of AFW to warming has not been theoretically examined in detail. ⋯ Our calculations reveal that AFW has a larger measurable beneficial effect for patients with more severe hypothermia, but true rewarming of the patient with AFW alone would require prohibitively large fluid volumes (more than 10 L of 40 °C fluid) or dangerously hot fluid (20 mL/kg of 80 °C fluid for a 1 °C increase). The major beneficial effect of AFW is the prevention of further net heat loss.
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J Trauma Acute Care Surg · Jun 2012
Distraction lengthening by callotasis of traumatically shortened bones of the hand.
Callotasis of the hand has several advantages: it is less invasive than other techniques as bone grafting is unnecessary, gradual distraction is possible, joint mobilization can be performed during treatment, and sensation is maintained. Disadvantages include longer period of treatment and perhaps the need for complicated and bulky instrumentation. ⋯ Therapeutic study, level V.
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J Trauma Acute Care Surg · Jun 2012
The Fort Hood Massacre: Lessons learned from a high profile mass casualty.
On November 5, 2009, an army psychiatrist at Fort Hood in Killeen, TX, allegedly opened fire at the largest US military base in the world, killing 13 and wounding 32. ⋯ Prognostic study, level V.
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J Trauma Acute Care Surg · Jun 2012
Comparative StudyVagal nerve stimulation decreases blood-brain barrier disruption after traumatic brain injury.
Traumatic brain injury (TBI) may alter sympathetic tone causing autonomic abnormalities and organ dysfunction. Vagal nerve stimulation (VNS) has been shown to decrease inflammation and distant organ injury after TBI. It is unknown whether VNS may reduce blood-brain barrier (BBB) dysfunction after TBI.We hypothesize that VNS prevents TBI-induced breakdown of the BBB, subsequent brain edema, and neuronal injury. ⋯ VNS attenuates cerebral vascular permeability and decreases the up-regulation of AQP-4 after TBI. Future studies are needed to assess the mechanisms by which VNS maintains the BBB.