Articles: trauma.
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To investigate the prevalence and influencing factors of acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) in trauma patients, and to explore the predictive effect of ASD on PTSD. ⋯ Both trauma conditions and clinical features may affect the occurrence of ASD and PTSD in trauma patients. If ASD in trauma patients is identified early and targeted interventions, it may reduce the occurrence and development of PTSD.
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Crystalloid administration during early resuscitation of bleeding trauma patients is recommended by current guidelines, yet evidence supporting this practice is limited. We aimed to evaluate the trends in the utilization of crystalloids during the last decade and to determine the threshold crystalloid volume independently associated with mortality risk in trauma patients at risk of or experiencing shock. ⋯ The administration of ≥2 liters of crystalloids during the initial phase of care was independently associated with increased mortality in hemodynamically compromised trauma patients. These findings support the judicious and goal-directed use of crystalloids in the resuscitation of trauma patients.
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Nearly 30 million, mostly rurally located Americans lack timely access to level I or II trauma center care, resulting in inefficient resource use and potentially preventable death. Although significant progress has been made in the care of the injured patient during the last few decades, rural trauma patients continue to face significant challenges in accessing high-quality trauma care with resultant outcomes disparities and increased expenditures associated with potentially avoidable interfacility transfers. ⋯ Although telehealth has been used in trauma with some success, it remains underused. Members of a 2023 American College of Surgeons Committee on Trauma Spotlight Session on the role of teletrauma present an introduction to the applications, potential benefits, and future directions for telehealth use in trauma care.
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Background: Mechanical ventilation (MV) is a clinically important measure for respiratory support in critically ill patients. Although moderate tidal volume MV does not cause lung injury, it can further exacerbate lung injury in a pathological state such as sepsis. This pathological process is known as the "two-hit" theory, whereby an initial lung injury (e.g., infection, trauma, or sepsis) triggers an inflammatory response that activates immune cells, presenting the lung tissue in a fragile state and rendering it more susceptible to subsequent injury. ⋯ Different species of HMGB1 knockout mice have different lung-protective mechanisms in the two-hit model, and location is the key to function. Specifically, LysM HMGB1 -/- mice due to the deletion of HMGB1 in myeloid cells resulted in a pulmonary-protective mechanism that was associated with a downregulation of the inflammatory response. EC-HMGB1 -/- mice are deficient in HMGB1 owing to endothelial cells, resulting in a distinct pulmonary-protective mechanism independent of the inflammatory response and more relevant to the improvement of alveolar-capillary permeability. iHMGB1 -/- mice, which are systemically HMGB1-deficient, share both of these lung-protective mechanisms.