J Trauma
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Published experience of hypertonic saline (HTS) use in resuscitation has described the use of commercially unavailable 7.5% solutions. The purpose of this study was to compare our experience with the administration of commercially available 5% HTS solution with that of well-matched controls who did not receive HTS. ⋯ Although serum sodium remained increased for several days after HTS administration, no adverse sequelae as a result of hypernatremia resulted. Commercially available 5% HTS solution is safe for use in the resuscitation of trauma patients and may improve outcomes in a selected subset of patients with head injury.
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Comparative Study
Damage control techniques for common and external iliac artery injuries: have temporary intravascular shunts replaced the need for ligation?
Trauma to the common or external iliac arteries has a mortality rate of 24% to 60%. "Damage control" options for these severely injured vessels are either ligation or temporary intravascular shunts (TIVSs). Complications of ligation include a 50% amputation rate and up to 90% mortality. The primary goal of this study was to identify the consequences of using ligation versus TIVS for common or external iliac artery injuries in damage control scenarios. ⋯ TIVSs have replaced ligation as the primary damage control procedure for injuries to common and external iliac arteries. As a result, the high incidence of subsequent amputation has been virtually eliminated. With increased TIVS experience, an improvement in survival is likely.
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We have previously demonstrated that induction of profound hypothermia improves long-term survival in animal models of complex injuries/lethal hemorrhage. However, the precise mechanisms have not been well defined. The aim of this high-throughput study was to investigate the impact of profound hypothermia on gene expression profiles. ⋯ Profound hypothermia increases survival in a rodent model of hemorrhagic shock. In addition to decreasing tissue oxygen consumption, induction of hypothermia directly alters the expression profiles of key genes, with an overall up-regulation of pro-survival pathways and a down- regulation of metabolic pathways.
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It is unknown whether pelvic ring fracture is an independent predictor of death after blunt trauma. Few previous studies have attempted to analyze whether the high death rate observed in association with pelvic ring injury is secondary to the pelvic ring injury or merely related to many other injuries that typically are sustained in such cases. Our hypothesis was that pelvic ring fracture is an independent risk factor for death, even after accounting for the risk of death from other associated injuries. ⋯ The presence of pelvic ring fracture seems to represent a clinically significant independent risk factor for mortality, even after accounting for the association with potentially severe additional body system injuries.