Scand J Trauma Resus
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Scand J Trauma Resus · Oct 2016
Observational StudyElevations in growth hormone and glucagon-like peptide-2 levels on admission are associated with increased mortality in trauma patients.
Burn and trauma patients present a clinical challenge due to metabolic derangements and hypermetabolism that result in a prolonged catabolic state with impaired healing and secondary complications, including ventilator dependence. Previous work has shown that circulating levels of growth hormone (GH) are predictive of mortality in critically ill adults, but few studies have examined the prognostic potential of GH levels in adult trauma patients. ⋯ GH and GLP-2 may have clinical utility for outcome prediction in adult trauma patients.
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Scand J Trauma Resus · Oct 2016
Observational StudyHyperchloremia is associated with 30-day mortality in major trauma patients: a retrospective observational study.
Chloride is important for maintaining acid-base balance, muscular activity, osmosis and immunomodulation. In patients with major trauma, chloride levels increase after fluid therapy; this is associated with poor clinical outcomes. The purpose of this study was to determine whether hyperchloremia was associated with increased mortality in patients who had sustained major trauma. ⋯ Hyperchloremia 48-h post-admission and Δchloride was associated with 30-day mortality in major trauma patients. These indices may be useful prognostic markers.
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Scand J Trauma Resus · Oct 2016
Are ethical norms and current policies still relevant in face of the recent mass terror events?
The widespread utilization of social media in recent terror attacks in major European cities should raise a "red flag" for the emergency medical response teams. The question arises as to the impact of social media during terror events on the healthcare system. Information was published well before any emergency authority received a distress call or was requested to respond. ⋯ Technological advancements of recent years decrease and remove barriers that enable the public to use them as they see fit. These attacks raise ethical considerations for the patients and their rights as they were outsourced from the medical community, into the hands of the public. The healthcare system should leverage social media and its advantages in designing response to terror, but this requires a re-evaluation and introspection into the current emergency response models.
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Scand J Trauma Resus · Oct 2016
ReviewA systematic review on the rotational thrombelastometry (ROTEM®) values for the diagnosis of coagulopathy, prediction and guidance of blood transfusion and prediction of mortality in trauma patients.
Viscoelastic assays have been promoted as an improvement over traditional coagulation tests in the management of trauma patients. Rotational thromboelastometry (ROTEM®) has been used to diagnose coagulopathy and guide hemostatic therapy in trauma. This systematic review of clinical studies in trauma investigates the ROTEM® parameters thresholds used for the diagnosing coagulopathy, predicting and guiding transfusion and predicting mortality. ⋯ Most of the evidence indicates that abnormal EXTEM and FIBTEM clot amplitude (CA5, CA10) or maximal clot firmness (MCF) diagnose coagulopathy, and predict blood transfusion and mortality. The presence of fibrinolysis (abnormal lysis index [LI30] or maximum lysis [ML]) was also associated with mortality. ROTEM® thus, may be of value in the early management of trauma patients.
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Scand J Trauma Resus · Sep 2016
Epidemiology, prehospital care and outcomes of patients arriving by ambulance with dyspnoea: an observational study.
This study aimed to determine epidemiology and outcome for patients presenting to emergency departments (ED) with shortness of breath who were transported by ambulance. ⋯ This study shows that patients transported to hospital by ambulance with shortness of breath are a complex and seriously ill group with a broad range of diagnoses. Understanding the characteristics of these patients, the range of diagnoses and their outcome can help inform training and planning of services.