Articles: trauma.
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Electrical burns are classified as either high voltage (1000 volts and higher) or low voltage (<1000 volts). The typical injury with a high-voltage electrical contact is one where subcutaneous fat, muscles, and even bones are injured. Lower voltages may have lesser injuries. ⋯ A full neurologic examination must be performed on admission, documenting initial presentation and at any change in symptoms. Electrical injuries can have devastating consequences. Prevention of electrical injuries is clearly the preferable strategy for treatment.
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Frontiers in neuroscience · Jan 2014
ReviewCerebral metabolism following traumatic brain injury: new discoveries with implications for treatment.
Because it is the product of glycolysis and main substrate for mitochondrial respiration, lactate is the central metabolic intermediate in cerebral energy substrate delivery. Our recent studies on healthy controls and patients following traumatic brain injury (TBI) using [6,6-(2)H2]glucose and [3-(13)C]lactate, along with cerebral blood flow (CBF) and arterial-venous (jugular bulb) difference measurements for oxygen, metabolite levels, isotopic enrichments and (13)CO2 show a massive and previously unrecognized mobilization of lactate from corporeal (muscle, skin, and other) glycogen reserves in TBI patients who were studied 5.7 ± 2.2 days after injury at which time brain oxygen consumption and glucose uptake (CMRO2 and CMRgluc, respectively) were depressed. By tracking the incorporation of the (13)C from lactate tracer we found that gluconeogenesis (GNG) from lactate accounted for 67.1 ± 6.9%, of whole-body glucose appearance rate (Ra) in TBI, which was compared to 15.2 ± 2.8% (mean ± SD, respectively) in healthy, well-nourished controls. ⋯ Use of a diagnostic to monitor BES to provide health care professionals with actionable data in providing nutritive formulations to fuel the body and brain and achieve exquisite glycemic control are discussed. In particular, the advantages of using inorganic and organic lactate salts, esters and other compounds are examined. To date, several investigations on brain-injured patients with intact hepatic and renal functions show that compared to dextrose + insulin treatment, exogenous lactate infusion results in normal glycemia.
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Missed injuries sustain an important issue concerning patient safety and quality of care. The purpose of this study is to examine the effect of surgeon commitment to trauma care on missed injuries. We hypothesised that surgeons committed to the trauma service has less missed injuries than surgeons not committed to the trauma service would have. ⋯ Physicians will perform better when they are trained and interested in a specific area than those not trained, or even not having any particular interest in that specific area. Surgeons committed to the trauma service had less missed injuries in severely injured patients, and it is vital to improve patient safety and quality of care for trauma patients. Staff training and education for assessing severely injured patients and creating an open culture with detection and reduction of the potential for error are important and effective strategies in decreasing missed injuries and improving patient safety.
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The best marker for the monitoring of immune alterations in critically ill patients (sepsis, trauma, pancreatitis, surgery, burns) so far remains decreased HLA-DR expression on monocytes measured by flow cytometry as it regularly provides valuable information in terms of mortality prediction or evaluation of risk for secondary infections. As shown by Cajander and colleagues in a recent issue of Critical Care, some promising tools-based molecular biology may circumvent some drawbacks related to flow cytometry. Herein, issues and perspectives about this alternative are discussed.
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Former studies have demonstrated that health-related quality of life is decreased in severely injured patients. However, in those studies patients were asked about their functioning and not about their (dis)contentment concerning their functioning. Little is known about how severely injured patients experience their quality of life (QOL). The objective of this cross-sectional study was to measure this subjective QOL of severely injured patients after their rehabilitation phase and to examine which accident- and patient-related factors affect the QOL of these patients. ⋯ The experience of impaired QOL appears to depend on living alone, inability to return to work and pre-accidental comorbidity rather than on the injured body area or the severity of the injury. Duration of hospital or ICU stay is important to subsequent QOL, even if ISS or body region is not.