J Trauma
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Case Reports Randomized Controlled Trial Comparative Study Clinical Trial
Randomized trial of hydroxyethyl starch versus gelatine for trauma resuscitation.
Previous studies have demonstrated the rapid increase in systemic capillary permeability after blunt trauma and its association with poor outcome. There are theoretical advantages in resuscitation with colloid fluids, which are well retained in the vascular compartment during times of capillary leak. The aim of this study was to compare the effects of posttrauma resuscitation with hydroxyethyl starch (HES) (molecular mass, 250 kDa) or gelatine (molecular mass, 30 kDa), the hypothesis being that HES would reduce capillary leak. ⋯ The results suggest that compared with gelatine, resuscitation with HES reduces posttrauma capillary leak.
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Abdominal compartment syndrome (ACS) has multiple well-described etiologies, but almost no attention has focused on ACS in the absence of abdominal injury. This study describes a secondary ACS that occurs after severe hemorrhagic shock with no evidence of abdominal injury. ⋯ ACS can occur with no abdominal injury; The incidence of secondary ACS was 0.5% in this cohort trauma intensive care unit patients, so it probably occurs more frequently than is currently appreciated. Because survivors were decompressed 20 hours before nonsurvivors, early recognition might improve outcomes. On the basis of these observations, we recommend that bladder pressures should be routinely checked and acted on appropriately when resuscitation volumes approach 10 liters of crystalloid or 10 units of packed red cells.
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As a method of crime reduction among teenagers, several cities, counties, and states across the country have enacted, or attempted to enact, curfew laws. A curfew law was successfully implemented in Dade County, Florida, in January of 1996. Although its efficacy for crime reduction has been questioned, its benefit for trauma prevention may be real. ⋯ Although the overall trauma admissions and juvenile trauma admissions during the noncurfew hours remained relatively stable, juvenile trauma admissions during curfew hours dropped significantly in the 2 years after enforcement of the curfew law compared with the 2 years before the curfew law. This finding suggests that attempts to prevent late-night nonproductive street presence among teens can decrease the incidence of trauma occurrences.
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Comparative Study
Comparison of clinical, radiologic, and serum marker as prognostic factors after severe head injury.
S-1OOB, a protein of astroglial cells, is described as a marker for neuronal damage. Reliable outcome prediction from severe head injury is still unresolved. Clinical scores such as the Glasgow Coma Scale score (GCS) and diagnostic scores such as the Marshall Computed Tomographic Classification are well established and investigated, but there are still some concerns about these tools. The aim of this study was to investigate the predictive value of the initial serum level of S-100B compared with the predictive value of the GCS score and the Marshall Computed Tomographic Classification to outcome after severe head injury. ⋯ The serum level of S-100B calculated within 1 to 6 hours of a severe head injury is a useful additional outcome predictor.
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Comparative Study
Hypothermic aortic arch flush for preservation during exsanguination cardiac arrest of 15 minutes in dogs.
Trauma victims rarely survive cardiac arrest from exsanguination. Survivors may suffer neurologic damage. Our hypothesis was that a hypothermic aortic arch flush of 500 mL of isotonic saline solution at 4 degrees C, compared with 24 degrees C (room temperature), administered at the start of prolonged exsanguination cardiac arrest (CA) would improve functional neurologic outcome in dogs. ⋯ At the start of 15 minutes of exsanguination cardiac arrest in dogs, hypothermic aortic arch flush allows resuscitation to survival with normal neurologic function and histologically almost clean brains.