Articles: trauma.
-
Data suggest that treatment of critical illness-related corticosteroid insufficiency after traumatic brain injury (TBI) with a stress dose of hydrocortisone may improve the neurological outcome and the mortality rate. The mineralocorticoid properties of hydrocortisone may reduce the rate of hyponatremia and of brain swelling. ⋯ Considering side effects, corticosteroids are not equal; when a high dose of synthetic corticosteroids seems detrimental, a strategy using a stress dose of hydrocortisone seems attractive. Finally, results from a large multicenter study are needed to close the debate regarding the use of hydrocortisone in TBI patients.
-
Scand J Trauma Resus · Jan 2013
Comparative StudySuperimposed traumatic brain injury modulates vasomotor responses in third-order vessels after hemorrhagic shock.
Traumatic brain injury (TBI) and hemorrhagic shock (HS) are the leading causes of death in trauma. Recent studies suggest that TBI may influence physiological responses to acute blood loss. This study was designed to assess to what extent superimposed TBI may modulate physiologic vasomotor responses in third-order blood vessels in the context of HS. ⋯ Superimposed TBI modulated arteriolar and venular responses to HS in third-order vessels in a spinotrapezius muscle preparation. Further research is necessary to precisely define the role of TBI on the microcirculation in tissues vulnerable to HS.
-
Front Bioeng Biotechnol · Jan 2013
ReviewA Systems Engineering Perspective on Homeostasis and Disease.
Engineered systems are coupled networks of interacting sub-systems, whose dynamics are constrained to requirements of robustness and flexibility. They have evolved by design to optimize function in a changing environment and maintain responses within ranges. Analysis, synthesis, and design of complex supply chains aim to identify and explore the laws governing optimally integrated systems. ⋯ Our increasing understanding of life's multi-scale architecture suggests that living systems share similar characteristics with much to be learned about biological complexity from engineered systems. If health reflects a dynamically stable integration of molecules, cell, tissues, and organs; disease indicates displacement compensated for and corrected by activation and combination of feedback mechanisms through interconnected networks. In this article, we draw analogies between concepts in systems engineering and conceptual models of health and disease; establish connections between these concepts and physiologic modeling; and describe how these mirror onto the physiological counterparts of engineered systems.
-
Int J Surg Case Rep · Jan 2013
Paediatric case of a large gastric rupture after a blunt abdominal trauma: Report of a case in a District General Hospital.
Isolated gastric rupture after blunt abdominal trauma is rare. In current literature gastric rupture from blunt abdominal trauma ranges between 0.02% and 1.7%. This document reports the first non-motor-vehicle case of an isolated gastric rapture after blunt abdominal injury, which repaired after early diagnosis and aggressive surgical treatment. ⋯ We present this case report focusing on the paediatric patient to illustrate isolated gastric injury in terms of mechanism of injury, clinical presentation, and immediate surgical management.
-
This editorial aims to refine the severe polytrauma management principles. While keeping ABCDE priorities, the termination of futile resuscitation and the early use of tourniquet to stop exsanguinating limb bleeding are crucial. Difficult-airway-management (DAM) is by a structured 5-level approach. ⋯ DCS attains rapid correction of the deranged physiology. Mortality reduction in major pelvic disruption requires a multi-disciplinary protocol, the novel pre-peritoneal pelvic packing and the angio-embolization. When operation is the definitive treatment for injury, prevention is best therapy.