J Trauma
-
Hemorrhage remains a leading cause of early death in injured patients, and definitive control of bleeding remains a fundamental principle of trauma management. Therapeutic interventional radiology (IR) procedures have increasingly become essential in the acute management of traumatic injury. The importance of time to control of hemorrhage for therapeutic IR procedures has not been adequately characterized. ⋯ In hemodynamically unstable trauma patients undergoing therapeutic catheter-based IR procedures, delay to IR was independently associated with more than a twofold higher risk of mortality. These results suggest that therapeutic IR procedures should be performed as expeditiously as possible and held to the same dogma as applied to definitive operative control of hemorrhage.
-
Single, isolated hypotensive blood pressure (BP) measurements frequently are ignored or considered "erroneous." Although their clinical significance remains unknown, we hypothesized that single, isolated hypotensive BP readings during trauma resuscitations signify the presence of severe injuries that often warrant immediate intervention. ⋯ Single, isolated hypotensive BP measurements during trauma resuscitations should not be ignored or dismissed. Instead, our results suggest that a single SBP reading <105 mm Hg is associated with severe injuries that often require immediate operative or endovascular treatment and surgical intensive care unit admission.
-
Continuous renal replacement therapy (CRRT) is the preferred mode of renal replacement therapy in patients with acute brain injury (ABI). There are limited data available describing the effects of CRRT on intracranial pressure (ICP). This study aims to evaluate changes in ICP during CRRT in patients after ABI. ⋯ CRRT may have beneficial effects in patients with RIH. Given the high mortality rate and poor neurological outcome associated with RIH, further research may be warranted.
-
Because of an increasing life expectancy of patients and the rising number of joint replacements, peri- and interprosthetic femoral fractures are a common occurrence in most trauma centers. This study was designed to answer two primary questions. First, whether the fracture risk increases with two intramedullary implants in one femur; and second, whether a compression plate osteosynthesis is sufficient for stabilizing an interprosthetic fracture. ⋯ Two intramedullary implants reduce the fracture strength significantly. If an interprosthetic fracture occurs, sufficient stability can be achieved by a lateral compression plate. Because two intramedullary implants in the femur may decrease the fracture strength, the treatment of supracondylar femoral fractures with a retrograde nail in cases with preexisting ipsilateral hip prosthesis should be reconsidered.
-
The purpose of this study was to determine whether trauma patients who are intubated because of combativeness, and not because of medical necessity, have more complications resulting in longer lengths of stay. ⋯ The results from this study indicate that trauma patients who are intubated because of combativeness, and not because of medical necessity, have longer lengths of stay, increased incidence of pneumonia, and poorer discharge status when compared with matched controls. The outcomes of this group are similar to that of patients who are intubated because of medical necessity.