Survey on worldwide trauma team activation requirement Waydhas, Christian; Trentzsch, Heiko; Hardcastle, Timothy C. ...
European journal of trauma and emergency surgery,
10/2021, Letnik:
47, Številka:
5
Journal Article
Recenzirano
Odprti dostop
Purpose
Trauma team activation (TTA) is thought to be essential for advanced and specialized care of very severely injured patients. However, non-specific TTA criteria may result in overtriage that ...consumes valuable resources or endanger patients in need of TTA secondary to undertriage. Consequently, criterion standard definitions to calculate the accuracy of the various TTA protocols are required for research and quality assurance purposes. Recently, several groups suggested a list of conditions when a trauma team is considered to be essential in the initial care in the emergency room. The objective of the survey was to post hoc identify trauma-related conditions that are thought to require a specialized trauma team that may be widely accepted, independent from the country’s income level.
Methods
A set of questions was developed, centered around the level of agreement with the proposed post hoc criteria to define adequate trauma team activation. The participants gave feedback before they answered the survey to improve the quality of the questions. The finalized survey was conducted using an online tool and a word form. The income per capita of a country was rated according to the World Bank Country and Lending groups.
Results
The return rate was 76% with a total of 37 countries participating. The agreement with the proposed criteria to define post hoc correct requirements for trauma team activation was more than 75% for 12 of the 20 criteria. The rate of disagreement was low and varied between zero and 13%. The level of agreement was independent from the country’s level of income.
Conclusions
The agreement on criteria to post hoc define correct requirements for trauma team activation appears high and it may be concluded that the proposed criteria could be useful for most countries, independent from their level of income. Nevertheless, more discussions on an international level appear to be warranted to achieve a full consensus to define a universal set of criteria that will allow for quality assessment of over- and undertriage of trauma team activation as well as for the validation of field triage criteria for the most severely injured patients worldwide.
The mechanisms by which pH influences vascular tone are not entirely understood, but evidence suggests that the endothelium is involved. Here, we aimed to study the in vitro vascular responses ...induced by extracellular hypercapnic acidification (HA), as well as the endothelium-dependent mechanisms that are involved in the responses. We bubbled a mixture of CO2 (40%)/O2 (60%) in an organ bath; we constructed a pH-response curve (pH range 7.4–6.6) and registered isometric force simultaneously. Aortic rings from rats were pre-contracted with phenylephrine (10−6 M) and incubated for 30 min in the presence of different chemicals. The relaxations induced by HA occurred in rings with endothelium were: 1) Partially inhibited by indomethacin (10−5 M) (PGI2 pathway inhibitor); 2) Strongly inhibited by NO pathways: L-NAME (10−4 M) and L-NMMA (10−4 M) (no specific NO synthase inhibitors); L-Nil (10−3 M) (specific iNOS inhibitor); ODQ (10−4 M) (specific guanylate cyclase inhibitor), and; 4) Inhibit by tetraethylammonium (10−3 M) (non-specific potassium channel inhibitor), glibenclamide (10−5 M) (specific KATP inhibitor), aminopyridine (10−3 M) (specific Kv inhibitor) and apamin (10−6 M) (specific SKCa inhibitor). In conclusion: 1) HA causes endothelium-dependent relaxation; 2) Indomethacin failed in blocking this relaxation, but the method limitation does not allow ruling out some prostanoid role; 3) The HA vessel relaxation is mediated via cGMP/NO, and; 4) The hyperpolarization occurs by the action of potassium SKCa, KATP and Kv channels without relying on BKCa channels.
Display omitted
•A mixture of CO2 (40%)/O2 (60%) bubbled in organ baths was adequate for producing extracellular acidification.•Extracellular acidification in arteries pre-contracted with Phe (10−6 M) caused endothelium-dependent relaxation in the pH range from 7.5 to 6.8.•The relaxation induced by acidification involved the three pathways of signal transduction for endothelium-dependent vasodilation: cGMP/NO, cAMP/PGI2, and hyperpolarization at potassium channels.
Este trabalho apresenta uma revisão da literatura, baseada em artigos publicados no período de julho de 2002 a maio de 2007. Procuramos analisar questões referentes a diversos tipos de traumas e suas ...relações com os programas de reabilitação e qualidade de vida. A revisão foi realizada a partir da consulta às bases de dados internacionais Medline, Scielo e Lilacs e os artigos selecionados foram divididos em quatro categorias, dentro de dois eixos de análise, baseados na Classificação Internacional de Funcionalidade . 1. estruturas e funções do corpo, (aspectos clínico-cirúrgicos e funcionais e validação de protocolos) e 2. atividades e participação social (aspectos psicossociais). Por fim, diante das mudanças decorrentes do trauma e baseados nos resultados e discussões que os artigos apresentam, enfatizamos a importância do trabalho multidisciplinar da equipe de reabilitação, em particular a contribuição da Terapia Ocupacional, e a necessidade de promoção da qualidade de vida destas populações, tanto nos aspectos físicos, como emocionais e sócio-familiar.
The mechanisms by which pH influences vascular tone are not entirely understood, but evidence suggests that the endothelium is involved. Here, we aimed to study the in vitro vascular responses ...induced by extracellular hypercapnic acidification (HA), as well as the endothelium-dependent mechanisms that are involved in the responses. We bubbled a mixture of CO
(40%)/O
(60%) in an organ bath; we constructed a pH-response curve (pH range 7.4-6.6) and registered isometric force simultaneously. Aortic rings from rats were pre-contracted with phenylephrine (10
M) and incubated for 30 min in the presence of different chemicals. The relaxations induced by HA occurred in rings with endothelium were: 1) Partially inhibited by indomethacin (10
M) (PGI
pathway inhibitor); 2) Strongly inhibited by NO pathways: L-NAME (10
M) and L-NMMA (10
M) (no specific NO synthase inhibitors); L-Nil (10
M) (specific iNOS inhibitor); ODQ (10
M) (specific guanylate cyclase inhibitor), and; 4) Inhibit by tetraethylammonium (10
M) (non-specific potassium channel inhibitor), glibenclamide (10
M) (specific K
P inhibitor), aminopyridine (10
M) (specific Kv inhibitor) and apamin (10
M) (specific SKCa inhibitor).
1) HA causes endothelium-dependent relaxation; 2) Indomethacin failed in blocking this relaxation, but the method limitation does not allow ruling out some prostanoid role; 3) The HA vessel relaxation is mediated via cGMP/NO, and; 4) The hyperpolarization occurs by the action of potassium SK
, K
and K
channels without relying on BK
channels.
Swelling is inexorably linked to shock and resuscitation in trauma. In many forms, swelling complicates and interacts with traumatic injury to raise pressures in the abdomen, resulting in ...intraabdominal hypertension, which may overtly manifest as abdominal compartment syndrome (ACS) driving multiple organ failure. Despite renewed clinical interest in posttraumatic intraabdominal pressure, there remains a chiasm between knowledge of the risks and clinical interventions to mitigate them. This review provides a concise overview of definitions, risk factors, diagnosis and management using an illustrative trauma case.
Intraabdominal pressure commonly increases following trauma, wherein ACS may manifest earlier than generally appreciated and complicate other insults such as shock and hemorrhage. Contemporary resuscitation strategies may exacerbate intraabdominal hypertension, particularly massive crystalloid resuscitation. Although unproven, the recent transition to crystalloid restriction and high plasma resuscitation strategies may influence the prevalence of ACS. Nonetheless, aggressive intraabdominal pressure monitoring should be mandatory in the critically ill. Despite potential nonoperative options, decompressive laparotomy remains the only definitive but often morbid treatment.
ACS results from many dysfunctions acting in concert with each other in self-propagating vicious cycles. Starting with greater awareness, it is imperative that the growing knowledge should be translated into clinical practice.
BACKGROUND:Hemorrhage is a leading cause of death in trauma patients and coagulopathy is a significant contributor. Although the exact mechanisms of trauma-associated coagulopathy (TAC) are ...incompletely understood, hemostatic resuscitation strategies have been developed to treat TAC. Our study sought to identify which trauma patients develop TAC and the factors associated with its development, to describe the natural history of TAC, and to identify patients with TAC who may not require hemostatic resuscitation.
METHODS:Patients with early coagulopathy (International Normalized Ratio >1.3) who were admitted directly from the scene within 1 hour of injury were identified in our institutional trauma registry. We analyzed these data for the presence of TAC, predictors of early and delayed TAC, and evolution of TAC during the first 24 hours of admission.
RESULTS:Of 2,473 patients, 290 (12%) had early TAC (International Normalized Ratio >1.3) and 271 (11%) developed delayed TAC. Multivariate analysis identified female gender (odds ratio OR 1.25 1.11–1.41), lower pH (OR 0.08 0.015–0.47), lower hemoglobin (OR 0.96 0.95–0.97), lower temperature (OR 0.82 0.70–0.95), and blunt mechanism (OR 0.49 0.33–0.71) as factors significantly associated with development of early TAC. Progression of early TAC occurred in 64%, and these patients had more severe abdominal injury and received more emergency room crystalloid. Of patients with early TAC who did not receive fresh frozen plasma, only 49% developed worsening coagulopathy. Patients with isolated intracranial hemorrhage had higher rates of bleeding progression (75% vs. 20%, p < 0.005) in the presence of early TAC.
CONCLUSIONS:TAC may appear in an early or delayed form and its presence and progression are associated with a number of identifiable factors. Although TAC commonly progresses, it also resolves spontaneously in many patients. Further research is required to identify which patients with TAC require hemostatic treatment, although those with intracranial hemorrhages seem to warrant aggressive therapy.
To report on our clinical experience with and the success rate and safety of percutaneous transcatheter embolization with N-butyl cyanoacrylate (NBCA) as the lone primary embolic agent used for ...arterial embolization of hemorrhagic liver lesions.
This retrospective study enrolled all patients who presented to the emergency room with hemorrhagic liver lesions during a two-year period and were treated by percutaneous transcatheter embolization with NBCA.
Eight consecutive patients were evaluated, and 13 lesions were embolized exclusively with NBCA: eight pseudoaneurysms and five active bleeds. All patients were treated successfully using percutaneous transcatheter embolization with NBCA without re-bleedings or major complications.
Percutaneous transcatheter embolization with NBCA is a safe and effective method for treating hemorrhagic lesions.
To analyze the characteristics of visits resulting from land transport injuries.
A total of 5,934 visits in four hospital emergency departments (ED) were analyzed, in the state of São Paulo, in 2005. ...A questionnaire based on the following three models was used to collect data: World Health Organization (WHO), Center for Disease Control and Prevention (CDC), and Pan American Health Organization (PAHO). Variables analyzed were as follows: type of road user (vehicle occupant, pedestrian, motorcyclist, and cyclist), sex, age group, and type of injury suffered. Logistic regression analysis was employed to test associations between variables. Odds ratios with their respective 95% confidence intervals were calculated.
The majority of victims were males (74.2%) in the 20-to-29-year age group (35.0%). Vulnerable road users totaled 72.4% of all cases (29.8% were motorcyclists, 24.1% pedestrians, and 18.5% cyclists). Victims aged between zero and 14 years who had suffered injuries were mostly pedestrians and cyclists; motorcyclists predominated among those aged between 15 and 39 years; and pedestrians among those aged over 50 years. About half of the cases suffered minor injuries (strains, dislocations, contusions and cuts), while the other half was comprised by fractures, traumatic brain injuries and internal injuries. Extremities were the most affected body parts, particularly among motorcyclists. The majority of victims were discharged at triage (87.6%). Compared to women, men were 1.5 times more likely to be admitted or transferred, or to die. Pedestrians, vehicle occupants and motorcyclists were, respectively, 2.7, 2.4 and 1.9 times more likely to be admitted or transferred, or to die than cyclists.
Measures aimed to protect vulnerable road users should be among the priorities to reduce land transport-related injuries.
Hepatic trauma occurs in approximately 5% of all admissions in emergency rooms. The anatomic location and the size of the liver make the organ even more susceptible to trauma and frequently in ...penetrating injuries. The American Association for the Surgery of Trauma established a detailed classification system that provides for uniform comparisons of hepatic injury. Diagnosis of hepatic injury can be sometimes easy; however the use diagnostic modalities as diagnostic peritoneal lavage, ultrasound and computed tomography allow faster and more accurate diagnosis. Nonoperative management of the hemodynamically stable patient with blunt injury has become the standard of care in most trauma centers. Few penetrating abdominal lesions allow conservative management; exceptions can be some penetrating wounds to right upper abdominal quadrant. Operative treatment of minor liver injuries requires no fixation or can only be managed with eletrocautery or little sutures. Major liver injuries continue, despite technical advances, a challenge to surgeons. Many procedures can be done as direct repair, debridement associated to resections, or even in more severe lesions, packing. This constitutes a damage control which can allow time to recovery of patient and decreasing mortality shortly after trauma.
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