Articles: trauma.
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Retrospective cohort study. ⋯ Our study suggests racial disparities in outcomes and discharge disposition for acute cSCI patients.
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Trauma remains a significant cause of mortality and morbidity. Non-compressible torso haemorrhage is one of the key drives of these mortality data. Our contemporary management has focused on damage control resuscitation, with a focus on haemorrhage control, haemostatic resuscitation and permissive hypotension. ⋯ In this paper, we suggest that perhaps more consideration should be given to the diastolic blood pressure in bleeding trauma patients. The diastolic blood pressure is critical for coronary perfusion, and in turn the cardiac output responsible for cerebral blood flow. We suggest that a move to reframing resuscitation in terms of physiology may change the way that we resuscitate these patients and allow for more nuanced treatment strategies.
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Department of Veterans Affairs disability benefits for post-traumatic stress disorder (PTSD), also known as "service connection," have been shown to reduce homelessness and poverty, increase mental health engagement, and improve clinical outcomes. However, gender and race disparities in PTSD service connection have been described in Vietnam and post-Vietnam era Veterans. ⋯ Women were less likely to receive PTSD service connection compared to men; this difference was nearly completely mediated by gender differences in combat exposure. Black women were less likely than non-Black women to receive PTSD service connection, but we could not identify a plausible mechanism to explain this finding. On net, the base compensation package was lower for Veterans denied PTSD service connection than for those receiving PTSD service connection.
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Unstable posterior pelvic-ring fractures are rare and difficult to manage. There are many injury patterns, they are associated with high morbidity and mortality, and optimal surgical management remains contentions. This study aims to compare outcomes and complications for different surgical management of these injuries. ⋯ This study highlight bilateral posterior-pelvic ring injuries as a greater management challenge than unilateral injuries. It supports the use of percutaneous fixation with closed-reduction, decreased infection risk and decreased length-of-stay. It challenges the use of external fixators and supports less restrictive post-operative restrictions. This study also serves as a descriptive analysis for the current management of pelvic fractures in an Australian setting, shedding light on complication rates and profiles.
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Hemorrhage and subsequent development of therapy refractory shock are the major cause of death in potentially salvageable trauma victims. Recent scientific work recognizes that there is an urgent need to develop new life-support strategies. From a variety of interventions and drugs with the potential to prolong the compensation phase or to reverse the decompensation phase of shock, arginine vasopressin (AVP) is one of the most promising and best evaluated drugs. Nonetheless, the efficacy of AVP administration in hemorrhagic shock is still to be proven. Thus, this umbrella review summarizes the current evidence of AVP in hemorrhagic shock. ⋯ In uncontrolled hemorrhagic shock, arginine vasopressin might be considered as a therapy of last resort in shock patients not responding to conventional therapy. Further research is needed to determine the potential benefits and optimal dosage/timing of vasopressin use in hemorrhagic shock.