The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Jul 2019
Shock index and pulse pressure as triggers for massive transfusion.
Hemorrhage is the most common cause of preventable death in trauma patients. These mortalities might be prevented with prehospital transfusion. We sought to characterize injured patients requiring massive transfusion to determine the potential impact of a prehospital whole blood transfusion program. The primary goal of this analysis was to determine a method to identify patients at risk of massive transfusion in the prehospital environment. Many of the existing predictive models require laboratory values and/or sonographic evaluation of the patient after arrival at the hospital. Development of an algorithm to predict massive transfusion protocol (MTP) activation could lead to an easy-to-use tool for prehospital personnel to determine when a patient needs blood transfusion. ⋯ Therapeutic/care management, level V.
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J Trauma Acute Care Surg · Jul 2019
Tranexamic acid administration following head trauma in a combat setting: Does tranexamic acid result in improved neurologic outcomes?
Tranexamic acid (TXA) has been shown to decrease mortality and blood product requirements in severely injured patients. Tranexamic acid has also been hypothesized to prevent secondary brain injury in patients with traumatic brain injury. While prior studies have demonstrated improved neurologic outcomes associated with TXA administration in severely injured pediatric patients, no such studies have been performed in adults. ⋯ Therapeutic, level IV.
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J Trauma Acute Care Surg · Jul 2019
From the battlefield to main street: Tourniquet acceptance, use, and translation from the military to civilian settings.
Throughout history, battlefield medicine has led to advancements in civilian trauma care. In the most recent conflicts of Operation Enduring Freedom in Afghanistan/Operation Iraqi Freedom, one of the most important advances is increasing use of point-of-injury hemorrhage control with tourniquets. ⋯ Additionally, bystander educational campaigns such as the Stop the Bleed program is expanding, now with over 125,000 trained on tourniquet placement. Because the medical community and the population at large has broader acceptance and training on the use of tourniquets, there is greater potential for saving lives from preventable hemorrhagic deaths.
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J Trauma Acute Care Surg · Jul 2019
Cold-stored whole blood platelet function is preserved in injured children with hemorrhagic shock.
Recent data demonstrate the safety of uncrossmatched cold-stored whole blood (WB) transfusion in pediatric trauma patients. The hemostatic capabilities of platelets within the cold-stored WB unit have been demonstrated via in vitro studies and animal models. However, platelet function has not been evaluated in pediatric recipients of cold-stored WB transfusions. ⋯ Therapeutic, level IV.
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J Trauma Acute Care Surg · Jul 2019
Automated noninvasive evaluation of blood flow and oxygenation in rats integrated with systemic physiological monitoring.
Many studies evaluating blood flow and oxygen partial pressure (PO2) do not directly measure both parameters, are confined to few locations/microvessels, and depend on investigator's selection of measuring sites. Moreover, clinically/physiologically relevant systemic parameters are not simultaneously recorded. We implemented an automated system for prolonged blood flow/PO2 acquisition in large areas while collecting relevant systemic information. ⋯ Diagnostic test, level V.