J Trauma
-
The aim of this modeling study was to examine how casualty load affects the level of trauma care in multiple casualty incidents and to define the surge capacity of the hospital trauma assets. ⋯ This model defines the quantitative relationship between an increasing casualty load and gradual degradation of the level of trauma care in multiple casualty incidents, and defines the surge capacity of the hospital trauma assets as a rate of casualty arrival rather than a number of beds. The study demonstrates the value of dynamic computer modeling as an important tool in disaster planning.
-
The management of patients with hemodynamic instability related to pelvic fracture is a major challenge, with high morbidity and mortality. Evidence-based institutional practice guidelines (PG) were developed as a strategy to optimize the care of these patients. The aims of this study were to evaluate the adherence to the new PG and compare the outcomes before and after their implementation. ⋯ The adherence to the PG as a reflection of optimal management was significantly improved. PG focusing particular on timely hemorrhage control reduced the 24-hour transfusion requirements and the mortality rate in the post-PG group.
-
Major pelvic venous injuries secondary to blunt trauma can be a difficult problem in diagnosis and management. This study aimed to elucidate the clinical significance of iliac vein injuries demonstrated by venography in patients with blunt pelvic injuries who remained unstable even after transcatheter arterial embolization (TAE). ⋯ The iliac vein injury is the principal cause of hemorrhagic shock in some patients with unstable pelvic fractures after blunt trauma. Venography is useful for identifying iliac vein injuries.
-
Over the past 30 years, efforts have been made to identify therapeutic targets in the host response to infection. ⋯ Trials of agents directed at altering the host's response during sepsis have had variable results, and it appears that several different factors may alter the efficacy of these agents.
-
Clinically relevant osmolar stress inhibits priming-induced PMN NADPH oxidase subunit translocation.
The plasma membrane NADPH oxidase is responsible for the external generation of superoxide by neutrophils (polymorphonucleocytes [PMNs]). The oxidase is a multicomponent enzyme, active only when all subunits are translocated to and assembled at the membrane. We have recently demonstrated that platelet-activating factor (PAF) priming of PMNs translocates the cytosolic p67 subunit to the membrane position. Osmolar stress attenuates PAF priming of the oxidase. Consequently, we hypothesized that clinically relevant osmolar stress inhibits PAF priming-induced p67 translocation. ⋯ PAF priming of the PMN oxidase involves translocation of p67 to the plasma membrane. Clinically relevant osmolar stress with hypertonic saline prevents this PAF-induced translocation of the p67 oxidase subunit. This finding provides new insight into the mechanisms responsible for osmolar control of PMN functional responses.