The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Sep 2018
Randomized Controlled TrialDo screening and a randomized brief intervention at a Level 1 trauma center impact acute stress reactions to prevent later development of posttraumatic stress disorder?
Approximately 20% to 40% of trauma survivors experience posttraumatic stress disorder (PTSD). The American College of Surgeons Committee on Trauma reports that early screening and referral has the potential to improve outcomes and that further study of screening and intervention for PTSD would be beneficial. This prospective randomized study screened hospitalized patients for traumatic stress reactions and assessed the effect of a brief intervention in reducing later development of PTSD. ⋯ Prospective randomized controlled trial, level II.
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J Trauma Acute Care Surg · Sep 2018
Comparative StudyEndovascular variable aortic control (EVAC) versus resuscitative endovascular balloon occlusion of the aorta (REBOA) in a swine model of hemorrhage and ischemia reperfusion injury.
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is effective at limiting hemorrhage from noncompressible sources and restoring but causes progressive distal ischemia, supraphysiologic pressures, and increased cardiac afterload. Endovascular variable aortic control (EVAC) addresses these limitations, while still controlling hemorrhage. Previous work demonstrated improved outcomes following a 90-minute intervention period in an uncontrolled hemorrhage model. The present study compares automated EVAC to REBOA over an occlusion period reflective of contemporary REBOA usage. ⋯ For short durations of therapy, EVAC produces superior hemodynamics and less ischemic insult than REBOA in this porcine-controlled hemorrhage model, with improved outcomes during critical care. This study suggests EVAC is a viable strategy for in-hospital management of patients with hemorrhagic shock from noncompressible sources. Survival studies are needed to determine if these early differences persist over time.
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J Trauma Acute Care Surg · Sep 2018
Selective nonoperative management of pharyngoesophageal injuries secondary to penetrating neck trauma: A single-center review of 86 cases.
This article describes our experience with penetrating pharyngoesophageal injuries (PEI) in the light of a selective conservative approach, and has the objective to define criteria for nonoperative management (NOM). ⋯ Clinical Management Study, Level V evidence.
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J Trauma Acute Care Surg · Sep 2018
Comparative StudyFacing the facts on prophylactic antibiotics for facial fractures: 1 day or less.
To evaluate the role of initial prophylactic antibiotics on facial fractures, outcomes were compared between a short course (≤24 hours) of antibiotics to those who received an extended course (>24 hours). ⋯ Therapeutic/care management, level IV.
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J Trauma Acute Care Surg · Sep 2018
Early arterial access for resuscitative endovascular balloon occlusion of the aorta is related to survival outcome in trauma.
Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used in refractory hemorrhagic shock patients. Since the optimal timing of arterial access remains unclear, we evaluated the preocclusion status of patients, and elapsed time from the arrival to the hospital is associated with the survival outcomes in the REBOA patients. ⋯ Therapeutic/care management, level V.