International journal of critical illness and injury science
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Int J Crit Illn Inj Sci · Jan 2017
Prognostication of traumatic brain injury outcomes in older trauma patients: A novel risk assessment tool based on initial cranial CT findings.
Advanced age has been traditionally associated with worse traumatic brain injury (TBI) outcomes. Although prompt neurosurgical intervention (NSI, craniotomy or craniectomy) may be life-saving in the older trauma patient, it does not guarantee survival and/or return to preinjury functional status. The aim of this study was to determine whether a simple score, based entirely on the initial cranial computed tomography (CCT) is predictive of the need for NSI and key outcome measures (e.g., morbidity and mortality) in the older (age 45+ years) TBI patient subset. We hypothesized that increasing number of categorical CCT findings is independently associated with NSI, morbidity, and mortality in older patients with severe TBI. ⋯ This study found that the number of discrete findings on CCT is independently associated with major TBI outcome measures, including 30-day mortality, in-hospital morbidity, and NSI. Of note, multivariate models with best predictive characteristics incorporate both CCTST and GCS. CCTST is easy to calculate, and this preliminary investigation of its predictive utility in older patients with TBI warrants further validation, focusing on exploring prognostic synergies between CCTST, GCS, and AISh. If independently confirmed to be predictive of clinical outcomes and the need for NSI, the approach described herein could lead to a shift in both operative and nonoperative management of patients with TBI.
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Int J Crit Illn Inj Sci · Oct 2016
Usefulness of full outline of unresponsiveness score to predict extubation failure in intubated critically-ill patients: A pilot study.
To assess the usefulness of the full outline of unresponsiveness (FOUR) score in predicting extubation failure in critically ill intubated patients admitted with disturbed level of conscious in comparison with the Glasgow coma scale (GCS). ⋯ The FOUR score is superior to the GCS for the prediction of successful extubation of intubated critically ill patients.
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Int J Crit Illn Inj Sci · Oct 2016
A profile of metabolic acidosis in patients with sepsis in an Intensive Care Unit setting.
Metabolic acidosis is frequently found in patients with severe sepsis. An understanding of types of acidosis in sepsis and their evolution over the course of treatment may give us insight into the behavior of acid-base balance in these patients. ⋯ In patients with sepsis and septic shock, high anion gap metabolic acidosis is the dominant blood gas anomaly. Fall in lactate levels over the first 5 days of admission is a good prognostic marker of survival. Evolution of the blood gas profile over time suggests that a fall in lactate levels and a rise in bicarbonate levels correlate with a better outcome. The role of the anion gap as a prognostic marker holds promise and further studies are needed in this regard.
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Int J Crit Illn Inj Sci · Oct 2016
Effect of training problem-solving skill on decision-making and critical thinking of personnel at medical emergencies.
The aim of this study was to determine the effect of problem-solving training on decision-making skill and critical thinking in emergency medical personnel. ⋯ Therefore, this kind of education on problem-solving in various emergency medicine domains such as education, research, and management, is recommended.
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Int J Crit Illn Inj Sci · Jul 2016
Clinical and functional outcomes of acute lower extremity compartment syndrome at a Major Trauma Hospital.
Acute lower extremity compartment syndrome (CS) is a condition that untreated causes irreversible nerve and muscle ischemia. Treatment by decompression fasciotomy without delay prevents permanent disability. The use of intracompartmental pressure (iCP) measurement in uncertain situations aids in diagnosis of severe leg pain. As an infrequent complication of lower extremity trauma, consequences of CS include chronic pain, nerve injury, and contractures. The purpose of this study was to observe the clinical and functional outcomes for patients with lower extremity CS after fasciotomy. ⋯ Escalation in leg pain and changes in sensation are the cardinal signs for CS rather than reliance on assessing for firm compartments and pressures. The severity of nerve injury worsens with the delay in performing fasciotomy. Standardized diagnostic protocols and wound treatment strategies will result in improved outcomes from this complication.