The American surgeon
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The American surgeon · Feb 2011
Does splenic embolization and grade of splenic injury impact nonoperative management in patients sustaining blunt splenic trauma?
Nonoperative management (NOM) for blunt splenic trauma (BST) is an established practice. The impact of splenic embolization (SE) in the algorithm for NOM has not been well studied. This study evaluates the role of SE and spleen injury grade on failure of NOM. ⋯ SE was protective against splenectomy (Hazard Ratio (HR) 0.18, 95% confidence interval: 0.06-0.55, P = 0.004), whereas splenic injury grades III or higher was associated with increased risk of splenectomy (grade III: HR 5.26, P = 0.003; grade IV: HR 6.84, P = 0.002; grade V: HR 9.81, P = 0.002) compared with those with splenic injury grade I. Splenic embolization is a protective measure to reduce the failure of NOM. Spleen injury grade III and higher was significantly associated with NOM failure and would require a 5-day inpatient observation.
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The American surgeon · Feb 2011
Damage control resuscitation: from emergency department to the operating room.
Damage control surgery emphasizes limited operations with control of bleeding and contamination. Traditional management centered upon correction of acidosis and hypotension with crystalloids. Damage control resuscitation (DCR) is permissive hypotension and early hemostatic resuscitation combined identified and corrects coagulopathy with fresh-frozen plasma (FFP), restricting use of crystalloids. ⋯ NonDCR group had 13.2 days longer hospital length of stay. Damage control resuscitation, beginning in the ED, used more packed red blood cells and FFP minimizing crystalloids. DCR was associated with a survival advantage and shorter length of stay in patients with severe hemorrhage.
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The American surgeon · Feb 2011
Prospective identification of patients at risk for massive transfusion: an imprecise endeavor.
Most retrospective studies evaluating fresh-frozen plasma:packed red blood cell ratios in trauma patients requiring massive transfusion (MT) are limited by survival bias. As prospective resource-intensive studies are being designed to better evaluate resuscitation strategies, it is imperative that patients with a high likelihood of MT are identified early. The objective of this study was to develop a predictive model for MT in civilian trauma patients. ⋯ All combinations or clinical measures alone yielded lower predictive probability. Using these emergency department clinical measures, a predictive model to successfully identify civilian trauma patients at risk for MT was not able to be constructed. Given prospective identification of patients at risk for MT remains an imprecise undertaking, appropriate resources to support these efforts will need to be allocated for the completion of these studies.
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The American surgeon · Feb 2011
Hemostatic dressings reduce tourniquet time while maintaining hemorrhage control.
Tourniquet application has become first-line treatment for extremity hemorrhage on the battlefield and has seen increased use in the civilian arena. We hypothesized that an effective windlass tourniquet could be removed after application of a hemostatic dressing in a swine model of peripheral vascular injury. A tourniquet was placed proximally in 50 forelimb-injured swine after 30 seconds of hemorrhage with cessation of hemorrhage in all cases. ⋯ ActCel maintained hemostasis in nine (90%) subjects, whereas HemCon was successful in all instances (100%). All four hemostatic dressings were superior to gauze in maintaining hemostasis after removal of an effective tourniquet. Use of hemostatic dressings in conjunction with a tourniquet may reduce tourniquet times and improve outcomes in peripheral vascular injury and warrants further study.