J Trauma
-
Comparative Study
Intracorporeal use of advanced local hemostatics in a damage control swine model of grade IV liver injury.
The purpose of this study was to evaluate the efficacy of zeolite- and chitosan-based local hemostatic agents for the control of intracorporeal bleeding in a damage control swine model of grade IV liver injury. ⋯ Celox and QuikClot ACS(+) are effective adjuncts to standard intracavitary damage control packing for the control of bleeding. Celox provided durable control allowing packing removal at the time of take-back laparotomy. Further evaluation of their long-term effects is warranted.
-
This retrospective cohort study aims to investigate the impact of regular pre- and postoperative geriatric input into the management of geriatric patients with hip fracture, with specific interests in morbidity and mortality. ⋯ In addition to existing evidence that postoperative orthogeriatric collaboration improves mortality and functional outcomes in older patients with hip fractures, this study suggests that allowing preoperative geriatric input in this model of care can produce even more superior results.
-
Comparative Study
Repair of blunt thoracic outlet arterial injuries: an evolution from open to endovascular approach.
Thoracic outlet artery injuries due to blunt trauma are uncommon. Exposure of these arteries is associated with significant morbidity and mortality. An endovascular approach is a less invasive alternative approach for these technically challenging injuries. ⋯ Covered stents are a feasible alternative to open repair in the multiply injured blunt trauma patients with thoracic outlet arterial injuries. This can be used in the damage control setting as it offers shorter operative time, less blood loss, and overall less morbidity to the patient. Long-term follow-up is needed.
-
The purpose of this study was to document the surgical experience of the Role 3 Multinational Medical Unit (R3MMU) at Kandahar Airfield Base while Canada was the lead nation for the facility. This study will help inform on future staffing, training, and deployment issues of field hospitals on military missions. ⋯ Our operative data were slightly different from historical controls. Hopefully, this data will help with planning for future deployments of field hospitals on military missions.
-
Comparative Study Clinical Trial
Clotting factor deficiency in early trauma-associated coagulopathy.
Coagulopathic bleeding is a leading cause of in-hospital death after injury. A recently proposed transfusion strategy calls for early and aggressive frozen plasma transfusion to bleeding trauma patients, thus addressing trauma-associated coagulopathy (TAC) by transfusing clotting factors (CFs). This strategy may dramatically improve survival of bleeding trauma patients. However, other studies suggest that early TAC occurs by protein C activation and is independent of CF deficiency. This study investigated whether CF deficiency is associated with early TAC. ⋯ Twenty percent of all severely injured patients had critical CF deficiency on admission, particularly of factor V. The observed factor V deficit aligns with current understanding of the mechanisms underlying early TAC. Critical deficiency of factor V impairs thrombin generation and profoundly affects hemostasis.