Articles: trauma.
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To determine the percentage of patients with correction of their first international normalized ratio (INR) less than 1.5 after administration of moderate-dose three-factor prothrombin complex concentrate (PCC), 35 IU/kg compared with low-dose PCC, 25 IU/kg. ⋯ Moderately dosed PCC at 35 IU/kg compared with a lower dosage of 25 IU/kg was associated with a higher percentage of INR reversal and more rapid time to INR normalization in patients with TBI. Future randomized controlled studies to further investigate this novel dose and the impact on potential reductions in the use of fresh frozen plasma are warranted.
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Ther Hypothermia Temp Manag · Mar 2014
ReviewTherapeutic Hypothermia in Children and Adults with Severe Traumatic Brain Injury.
Great expectations have been raised about neuroprotection of therapeutic hypothermia in patients with traumatic brain injury (TBI) by analogy with its effects after heart arrest, neonatal asphyxia, and drowning in cold water. The aim of this study is to review our present knowledge of the effect of therapeutic hypothermia on outcome in children and adults with severe TBI. A literature search for relevant articles in English published from year 2000 up to December 2013 found 19 studies. ⋯ The difference between body temperature and temperature set by the biological thermostat may cause stress-induced worsening of the circulation and oxygenation in injured areas of the brain. These mechanisms may counteract neuroprotective effects of therapeutic hypothermia. We conclude that we still lack scientific support as a first-tier therapy for the use of therapeutic hypothermia in TBI patients for both adults and children, but it may still be an option as a second-tier therapy for refractory intracranial hypertension.
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The aim of this study was to describe the evolution and nature of self-destructive metabolic responses observed in critically ill patients, and to analyze therapeutic principles on how best to avoid or diminish these responses. ⋯ Minor surgical trauma is associated with a beneficial adaptive metabolic response. After a severe insult, however, emergence of self-destructive responses will be unavoidable if the patient survives the acute phase. Effective treatment is only possible by an aggressive therapy of underlying pathologies (such as shock, trauma or infection) thereby interrupting secondary metabolic trigger mechanisms at an early stage.
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Pleural Disease/Pneumothorax PostersSESSION TYPE: Poster PresentationsPRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PMPURPOSE: Management of secondary spontaneous pneumothorax (SSP) is more complex than the primary spontaneous pneumothorax (PSP), often requiring multiple interventions. There is paucity of data comparing the efficacy of various treatment strategies in SSP. Current British Thoracic Society guidelines recommend considering needle aspiration (NA) in symptomatic patients with small SSP. We looked at the efficacy of NA versus Intercostal Tube (ICT) drainage as the first intervention; outcomes included immediate successful re-inflation, length of stay (LOS) and recurrence at 1 year. ⋯ The following authors have nothing to disclose: Muhammad Ganaie, Shiva Bikmalla, Masood Khalil, Muhammad Afridi, Mohammed Haris, Imran HussainNo Product/Research Disclosure Information.
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To assess the association between Injury Severity Score (ISS) and subsequent risk of early retirement. ⋯ The risk of early retirement is 2.6 times higher in severely injured patients (ISS 16-75) than the risk in low to moderately injured patients (ISS 1-15) and they have a high absolute 5-year risk as well. Early, targeted interventions to assist with return to work might be able to reduce this risk.