The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Jul 2019
Automatic proximal airway volume segmentation using optical coherence tomography for assessment of inhalation injury.
Acute respiratory distress syndrome (ARDS) is a severe form of acute lung injury with a mortality rate of up to 40%. Early management of ARDS has been difficult due to the lack of sensitive imaging tools and robust analysis software. We previously designed an optical coherence tomography (OCT) system to evaluate mucosa thickness (MT) after smoke inhalation, but the analysis relied on manual segmentation. The aim of this study is to assess in vivo proximal airway volume (PAV) after inhalation injury using automated OCT segmentation and correlate the PAV to lung function for rapid indication of ARDS. ⋯ Prognostic, level III.
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J Trauma Acute Care Surg · Jul 2019
Practice GuidelineManagement of acute appendicitis in adults: A practice management guideline from the Eastern Association for the Surgery of Trauma.
Acute appendicitis (AA) has been considered one of the most common acute surgical conditions in the world. Recent studies, however, have suggested that nonoperative management (NOM) with a course of antibiotics (ABX) may be as effective as surgery in treating appendicitis. As there are evolving perspectives regarding the optimal therapy for appendicitis, we sought to provide recommendations regarding the role of NOM with the administration of antibiotics (antibiotics-first approach) in uncomplicated AA as well as the need for routine interval appendectomy (RIA) in those presenting with appendiceal abscess or phlegmon (AAP) initially managed without appendectomy. ⋯ Systematic review, level II.
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J Trauma Acute Care Surg · Jul 2019
Case ReportsUltrasound in trauma resuscitation and critical care with hemodynamic transesophageal echocardiography guidance.
Volume replacement strategies and resuscitation endpoints of therapy in the critical ill or injured patient continues to be a heavily debated topic despite decades of research and the ever evolving technologies that provide for alternate methods of monitoring. Hemodynamic transesophageal echocardiography (hTEE), refined for the use in the intensive care unit (ICU), allows for direct visualization of cardiac filling and function, enabling real-time guidance in the resuscitation of critically ill patients. The disposable, 17F hTEE probe can remain indwelling for up to 72 hours, providing continuous, unobstructed assessments of cardiac activity via the transgastric short axis, midesophageal four chamber, and superior vena cava views. With such, preload and contractility, ventricular size and function, and volume responsiveness can be accurately evaluated and trended for change over time. Hemodynamic transesophageal echocardiography as a monitoring modality is becoming more pervasive in ICUs on a worldwide scale, allowing for real-time visualization of resuscitation and its therapeutic effects, a better understanding of resuscitation effects on individual patients, a more rapid conclusion to patient's resuscitation needs and provides the physician more confidence and patience in guiding complex volume resuscitations. ⋯ Procedures and techniques, level IV.
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J Trauma Acute Care Surg · Jul 2019
Prehospital trauma experience of the Israel defense forces on the Syrian border 2013-2017.
The Israeli Defense Force Medical Corps (IDF-MC) is routinely collecting prehospital data to establish a prehospital registry. Since February 2013, Israel has been providing medical care to Syrian refugees. This unique humanitarian aid begins in prehospital settings and typically culminates in Israeli civilian hospitals. This report describes the accumulated experience of the IDF-MC to provide Syrian refugees with prehospital treatment. ⋯ Therapeutic, level III.
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Fresh whole blood is the optimal resuscitation fluid for casualties in hemorrhagic shock according to the Committee on Tactical Combat Casualty Care and has demonstrated to improve outcomes in severely wounded patients. Like all medical interventions, fresh whole blood transfusions are not without risks, but similarly can be mitigated through increased training to develop provider knowledge and proficiency. ⋯ This article provides a structured foundation to establish a standardized fresh whole blood transfusion training program to increase skill and preparedness for fresh whole blood protocol implementation. Using these techniques in a training environment, providers will be able to provide optimal resuscitation in hemorrhagic shock in austere environments.