Articles: trauma.
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This study aimed to identify the incidence and outcomes of patients with trauma related acute kidney injury (AKI), as defined by RIFLE criteria, at a single level I trauma centre and trauma ICU. ⋯ AKI in critically ill trauma patients is an independent risk factor for mortality and is independently associated with increasing age and low BE. Renal replacement therapy utilisation is high in this group and represents a significant health care cost burden.
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Scand J Trauma Resus · Jan 2014
Multicenter StudyHigher mortality rates among the elderly with mild traumatic brain injury: a nationwide cohort study.
It is known that the risk of death in elderly patients with moderate to severe traumatic brain injury is increased. However, the relationship between mild traumatic brain injury and death has never been established. We investigated the mortality rates of older patients with mild traumatic brain injury in Taiwan to evaluate if there is a higher risk of death compared with the general population. ⋯ Mild traumatic brain injury is an independent significant risk factor for death in the elderly.
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Scand J Trauma Resus · Jan 2014
Observational StudyAnaerobic metabolism associated with traumatic hemorrhagic shock monitored by microdialysis of muscle tissue is dependent on the levels of hemoglobin and central venous oxygen saturation: a prospective, observational study.
Traumatic hemorrhagic shock resulting in tissue hypoxia is a significant cause of morbidity and mortality in polytraumatized patients. Early identification of tissue hypoxia is possible with microdialysis. The aim of this study was to determine the correlation between a marker of tissue hypoxia (L/P; lactate to pyruvate ratio) and selected parameters of systemic oxygen delivery (Hb; hemoglobin) and oxygen extraction (ScvO2; central venous oxygen saturation). We also investigated the severity of tissue hypoxia over the course of care. ⋯ The L/P ratio is useful to identify tissue ischemia and can estimate the effectiveness of fluid resuscitation. An increase in the L/P ratio is an early warning sign of inadequate tissue oxygenation and should lead to more detailed hemodynamic and laboratory monitoring. This information cannot usually be obtained from global markers.
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Cumulating evidence indicated that nerve injury-associated cellular and molecular changes play an essential role in contributing to the development of pathological pain, and more recent findings implicated the critical role of epigenetic mechanisms in pain-related sensitization in the DRG subsequent to nerve injury. In this part of the dyad review (Part II), we reviewed and paid special attention on the etiological contribution of DGR gene expression modulated by epigenetic mechanisms of CRPS. As essential effectors to different molecular activation, we first discussed the activation of various signaling pathways that subsequently from nerve injury, and in further illustrated the fundamental and functional underpinnings of nerve injury-induced pain, in which we argued for the potential epigenetic mechanisms in response to sensitizing stimuli or injury. Therefore, understanding the specific mediating factors that influence individual epigenetic differences contributing to pain sensitivity and responsiveness to analgesics possesses crucial clinical implications.
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The management of acute traumatic pain is a crucial component of prehospital care and yet the assessment and administration of analgesia is highly variable, frequently suboptimal, and often determined by consensus-based regional protocols. ⋯ GRADE methodology was used to develop an evidence-based guideline for prehospital analgesia in trauma. The panel issued four strong recommendations regarding patient assessment and narcotic medication dosing. Future research should define optimal approaches for implementation of the guideline as well as the impact of the protocol on safety and effectiveness metrics.