AANA journal
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Trauma is a leading cause of morbidity and mortality. Uncontrolled hemorrhage related to the traumatic event is often the major cause of complications and death. The use of hemostatic agents may be one of the easiest and most effective methods of treating hemorrhage. ⋯ The evidence does not describe serious side effects, exothermic reaction, and thromboemboli formation associated with other hemostatic agents. Further investigation to determine the effectiveness of hemostatic agents, specifically QuikClot Combat Gauze, in the management of trauma casualties in the prehospital setting is required. These should include large-scale, multicenter, prehospital randomized controlled trials.
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The primary aim of this study was to investigate emergence delirium (ED) in service members, through the perceptions of active duty US Army anesthesia providers. The following perceptions were examined: (1) the extent and seriousness of ED in service members, (2) effects of ED on the safety of service members and operating room/postanesthesia care unit personnel, and (3) behaviors relevant to ED in service members. The study also explored the relationships between the perceived seriousness of ED, reported case experiences, and behaviors and consequences relevant to ED. ⋯ Approximately 38% of the respondents believed that ED was a moderate problem. There was a statistically significant association between perceived severity of ED and the ED case experience. The behaviors and consequences that were often or always seen included hyperactive motor behavior, pulling at the monitoring equipment, and making disruptive movements.
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Malignant hyperthermia (MH) is a rare pathologic hypermetabolic pharmacogenetic disorder of skeletal muscle calcium regulation following exposure to depolarizing muscle relaxants and/or volatile anesthetics. Although its pathogenesis is relatively well understood, there is wide variability in both the time of onset and the presentation of clinical signs and symptoms. ⋯ Differential diagnosis of an MH crisis can be particularly challenging in a trauma patient, especially in an austere environment. This case report describes the presentation and management of a suspected case of MH in an Afghan national who underwent surgery following lower extremity trauma resulting from an improvised explosive device.
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Review
A review of the evidence for active preoperative warming of adults undergoing general anesthesia.
Inadvertent perioperative hypothermia, a common occurrence in the operating suite, is associated with many adverse outcomes. It is the nurse anesthetist's goal to attenuate the incidence of this problem. Although active intraoperative warming is a widely accepted practice, active preoperative warming may be a less explored option for temperature maintenance. ⋯ Most of the studies support the implementation of active preoperative warming by demonstrating that subjects were warmer during the perioperative period. Overall, these differences were statistically significant and likely clinically significant. Future clinical trials should examine shorter warming times and lower warming unit settings, should include appropriate sample sizes, and should consistently employ trained staff using calibrated biometric instruments to measure temperature.