International journal of burns and trauma
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Securing the airway is a crucial aspect during reconstructive surgeries of patients with extensive post-burn mentosternal scar contractures; however, the American Society of Anesthesiologists Difficult Airway Management Algorithm recommendation of initial direct laryngoscopy may not be appropriate for these complicated patients. Consequently, there is a significant risk for failure of intubation and airway emergency. ⋯ Many airway techniques have been effectively used in burn patients, but the role of awake blind or fiberoptic bronchoscopy, although well established in the non-burn population, has yet to be evaluated in burn patients. We report a case series of successful management of difficult airways with fiberoptic bronchoscopy in patients with varying degrees of post-burn head and neck scar contractures.
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Trauma, often accompanied by hemorrhage, is a leading cause of death worldwide, often leading to inflammation-related late complications that include sepsis and multiple organ failure. These secondary complications are a manifestation of the complexity of biological responses elicited by trauma/hemorrhage, responses that span most, if not all, cell types, tissues, and organ systems. This daunting complexity at the patient level is manifest by the near total dearth of available therapeutics, and we suggest that this dire condition is due in large part to the lack of a rational, systems-oriented framework for drug development, clinical trial design, in-hospital diagnostics, and post-hospital care. ⋯ We propose a rational framework for transitioning through the currently fragmented process from identification of biological networks that are potential therapeutic targets, through clinical trial design, to personalized diagnosis and care. Insights derived from systems and computational biology in trauma and sepsis include the centrality of Damage-Associated Molecular Pattern molecules as drivers of both beneficial and detrimental inflammation, along with a novel view of multiple organ dysfunction as a cascade of containment failures with distinct implications for therapy. Finally, we suggest how these insights might be best implemented to drive transformational change in the fields of trauma and sepsis.
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The development of acute coagulopathy of trauma (ACoT) is associated with a significant increase in mortality. However, the contributory mechanisms behind ACoT have yet to be clearly defined. The purpose of this study was to evaluate the influence of multiple variables, including base deficit and injury severity, on development of ACoT within a subset of critically ill trauma patients. ⋯ The current study revealed that ACoT is independently associated with both shock (base deficit) and tissue injury. Additionally, tissue injury is a significant contributor to the development of early ACoT regardless of blunt or penetrating mechanism.
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Limb injuries represent a constant and severe problem. Several lower limb injuries are more frequent than upper limb injuries. Over time, in an attempt to quantify the severity of traumas and to establish guidelines for the decision whether to save or amputate a mangled extremity, several scoring systems have been reported. Most refer to bone fractures, soft tissue damage, vascular, nerves and tendon lesions. ⋯ The mangled extremity is a long-lasting, unsolved problem, with much debate and a large number of protocols and scoring systems, but with no unanimously-accepted solution. Many mangled extremities are borderline cases, and the decision to amputate or to salvage a limb must be carefully assessed. With advances in the medical field over the last 15 years, more mangled lower extremities are salvaged, especially in civilian injuries.
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Hemorrhagic shock and trauma are associated with acidosis and altered coagulation. A fall in pH has been reported to attenuate the activity of recombinant activated Factor VII (rFVIIa) in vitro. However, it is not known if acidosis induced by hemorrhagic shock or infusion of HCl attenuates FVIIa activity in vivo. The purpose of this study was to determine if acidosis, induced by two methods, affects recombinant FVIIa (rFVIIa) activity in swine, and if correction of the pH restores rFVIIa activity to normal. ⋯ Acidosis associated with hemorrhagic shock or HCl infusion led to a hypocoagulation that was not corrected with bicarbonate infusion. Furthermore, acidosis did not affect rFVIIa function, and correction of the acidosis with bicarbonate had no effect on rFVIIa function in these models. This suggests that in vivo acidosis did not diminish rFVIIa function.