European journal of trauma and emergency surgery : official publication of the European Trauma Society
-
Eur J Trauma Emerg Surg · Apr 2014
The effect of evolving trauma care on the development of multiple organ dysfunction syndrome.
Multiple organ dysfunction syndrome (MODS) is still a major threat to polytrauma patients, since sepsis-related organ failure is the most common cause of late mortality in these patients. In this article, the development of trauma surgery and evolution of trauma care from early total care to damage control surgery is discussed. Increasing knowledge of the pathophysiology of trauma has enabled us to identify the inflammatory response induced by trauma. By understanding the pathophysiology, we may be able to fully comprehend the origin of multiple organ dysfunction related sepsis. Further, it is important to appreciate the influence of surgery on the inflammatory response induced by trauma, and subsequently on the development of inflammatory complications. It is crucial to offer the polytrauma patient the appropriate type of surgery at the right time to prevent further deterioration. ⋯ MODS is still highly lethal, and once it has developed it is difficult to treat, so it is vital to be able to predict its occurrence. If we knew how to predict MODS, we might be able to develop strategies to prevent this syndrome.
-
Traumatic injury is the leading cause of death worldwide. The rapid evaluation and correction of injuries in these patients is paramount to preventing uncontrolled decompensation and death. Damage control strategies are a compendium of techniques refined over decades of surgical care that focus on the rapid correction of deranged physiology, control of contamination and blood loss, and resuscitation of critical patients. ⋯ Pelvic packing, an adjunct to DCR, provides a means to control hemorrhage from severe pelvic fractures. Temporary vascular shunts restore perfusion, while resuscitation and reconstruction are ongoing. Taken together, these strategies provide the trauma surgeon with a powerful arsenal to preserve life in the transition from injury to the shock trauma room to the intensive care unit.
-
β-hemolytic streptococci (βHS) causes a diverse array of human infections. The molecular epidemiology of β-hemolytic streptococcal infections in trauma patients has not been studied. This study reports the molecular and clinical epidemiology of β-hemolytic streptococcal infections at a level 1 trauma centre of India. ⋯ β-hemolytic streptococcal infections in Indian trauma patients are caused by GAS and non-GAS strains alike. A high diversity of emm types was seen in GAS isolates, with high macrolide and tetracycline resistance. SpeA was less commonly seen in Indian GAS isolates. There was no association between disease severity and exotoxin gene production.
-
Eur J Trauma Emerg Surg · Apr 2014
Dalteparin versus Enoxaparin for the prevention of venous thromboembolic events in trauma patients.
The use of low-molecular-weight heparin (LMWH) for the chemoprophylaxis of venous thromboembolism (VTE) in trauma patients is supported by Level-1 evidence. Because Enoxaparin was the agent used in the majority of studies for establishing the efficacy of LMWH in VTE, it remains unclear if Dalteparin provides an equivalent effect. ⋯ Dalteparin is equivalent to Enoxaparin in terms of VTE in trauma patients and can be safely used in this population, with no increase in complications and significant cost savings.
-
Eur J Trauma Emerg Surg · Apr 2014
Planned re-laparotomy and the need for optimization of physiology and immunology.
Planned re-laparotomy or damage control laparotomy (DCL), first described by Dr. Harlan Stone in 1983, has become a widely utilized technique in a broad range of patients and operative situations. ⋯ The immunology of DCL patients is not well described in humans, but promising animal studies suggest a benefit from the open abdomen (OA) and several human trials on this subject are currently underway. Optimal critical care of patients with OA's, including sedation, paralysis, nutrition, antimicrobial and fluid management strategies have been associated with improved closure rates and recovery.