Journal of emergencies, trauma, and shock
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J Emerg Trauma Shock · Oct 2012
Therapeutic hypothermia for out-of-hospital cardiac arrest: An analysis comparing cooled and not cooled groups at a Canadian center.
Out of hospital cardiac arrest is a devastating event and is associated with poor outcomes; however, therapeutic hypothermia (TH) is a novel treatment which may improve neurological outcome and decrease mortality. Despite this, TH is not uniformly implemented across Coronary Care and Intensive Care Units in Canada. ⋯ In our center, the use of TH in out-of-hospital cardiac arrest survivors was associated with improved neurological outcome.
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J Emerg Trauma Shock · Oct 2012
Significance of the carboxyhemoglobin level for out-of-hospital cardiopulmonary arrest.
At low concentrations, carbon monoxide (CO) can confer cyto and tissue-protective effects, such as endogenous Heme oxygenase 1 expression, which has antioxidative, anti-inflammatory, antiproliferative, and antiapoptotic effects. The level of carboxyhemoglobin in the blood is an indicator of the endogenous production of CO and inhaled CO. ⋯ There appeared to be an association between higher carboxyhemoglobin levels and survival in comparison with non-survival patients.
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J Emerg Trauma Shock · Oct 2012
A retrospective clinical audit of 696 central venous catheterizations at a tertiary care teaching hospital in India.
Malpositions after central venous cannulation are frequently encountered and may need a change in catheter. The incidence of malpositions are varied according to various studies and depend on the experience of the operator performing the cannulation. ⋯ Incidence of malpositions was low. We conclude that experience of operator improves successful catheterization with lesser number of complications.
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J Emerg Trauma Shock · Oct 2012
Maximum surgical blood ordering schedule in a tertiary trauma center in northern India: A proposal.
Over ordering of blood is a common practice in elective surgical practice. Considerable time and effort is spent on cross-matching for each patient undergoing a surgical procedure. ⋯ In this study 40% and 22% of cross-matched blood was being utilized for elective general surgery and neurosurgical procedures, respectively. The calculated required blood units for all elective Trauma surgery procedures were more than 2 units. The calculated required blood units were less than 0.5 units in four of the 11 neurosurgical procedures, and hence only one unit should be arranged for them. It is crucial for every institutional blood bank to formulate a blood ordering schedule. Regular auditing and periodic feedbacks are also vital to improve the blood utilization practices.
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A shift of approach from 'clinics trying to fit physiology' to the one of 'physiology to clinics', with interpretation of the clinical phenomena from their physiological bases to the tip of the clinical iceberg, and a management exclusively based on modulation of physiology, is finally surging as the safest and most efficacious philosophy in hemorrhagic shock. ATLS(®) classification and recommendations on hemorrhagic shock are not helpful because antiphysiological and potentially misleading. Hemorrhagic shock needs to be reclassified in the direction of usefulness and timing of intervention: in particular its assessment and management need to be tailored to physiology.