Current Issue : October - December Volume : 2016 Issue Number : 4 Articles : 7 Articles
Objective. The aimof this study was to identify routinely available clinical surrogate markers for potential clotting factor alterations\nfollowing multiple trauma. Methods. In 68 patients admitted directly from the scene of the accident, all soluble clotting factors\nwere analyzed and clinical data was collected prospectively. Ten healthy subjects served as control group. Results. Patients showed\nreduced activities of clotting factors II, V, VII, and X and calcium levels (all P < 0.0001 to 0.01). Levels of hemoglobin and base\ndeficit correlated moderately to highly with the activities of a number of clotting factors. Nonsurvivors and patients who needed\npreclinical intubation or hemostatic therapy showed significantly reduced factor activities at admission. In contrast, factor VIII\nactivity was markedly elevated after injury in general (P < 0.0001), but reduced in nonsurvivors (P < 0.05). Conclusions. Multiple\ntrauma causes an early reduction of the activities of nearly all soluble clotting factors in general. Initial hemoglobin and, with\ncertain qualifications, base deficit levels demonstrated a potential value in detecting those underlying clotting factor deficiencies.\nNevertheless, their role as triggers of a hemostatic therapy as well as the observed response of factor VIII to multiple trauma and\nalso its potential prognostic value needs further evaluation....
Objective: Hyponatremia is the most common electrolyte imbalance. The initial treatment decision\nis based on clinical evaluation of patient volume status but an accurate assessment is\ndifficult, particularly differentiating mild hypovolemia from euvolemia. The aim of this study is to\nexamine if biomarkers are valuable in the early determination of volume status and SIADH\ndiagnosis. Methods: Blood samples were collected from an unselected patient population at entry\nto the Emergency Department. If the plasma sodium level (P-Na) was �125 mmol/L, the sample\nwas frozen for further analysis. Mid-regional pro-atrial natriuretic peptide (MR-proANP), proadrenomedullin\n(MR-proADM), C-terminal prepro-vasopressin (copeptin), pro-endothelin-1\n(proET-1) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were analysed. A\ncomprehensive assessment of volume status and underlying causes was made after discharge\nblinded for biomarker results. Results: A total of 81 patients were included. A well substa ntiated\nvolemic state (hypo/eu/hypervolemia) was established in 72 patients (mean age 76 years, 65%\nwomen, median P-Na 119 mmol/L). A significant association was observed between MR-proANP\nlevels and volemic state (p = 0.0001). Data was specifically analysed with respect to distinguishing\nhypo- from euvolemia (n = 59) using logistic regression. In a crude analysis, MR-proANP was\nsignificantly related to euvolemia (OR: 2.54 per SD of MR-proANP, 95% CI 1.32 - 4.86, p = 0.005)\nand remained so after the multivariate backward elimination model (OR: 2.45 per SD of MRproANP,\n95% CI 1.22 - 4.91, p = 0.012.), whereas the other studied biomarkers were not. Copeptin\nlevels were not associated with a diagnosis of SIADH. Conclusions: MR-proANP may be of value in\nearly determination of volume status in hyponatremic patients....
Medical science has come a long way in terms of development of procedures and technology which has shaped the treatment scenario across the world. There are many challenges in front of healthcare practitioners when it comes to deal with patients, diseases and injuries they come across. One such injury commonly present is Liver trauma. Liver is one of the vital organs of the body, which helps in detoxification of the blood in the body. Over the ages, the mortality rate due to liver trauma has reduced substantially. With the advent of better emergency services, diagnostic techniques and experienced technicians along with on time availability of diagnostic images, the management of liver trauma has enhanced. The present letter to editor is focused on a review of development in liver trauma management and techniques which in the end have helped in reducing the mortalities associated with it thus saving valuable lives....
Background: Bleeding represents the most well-known and the most feared complications caused by the use of\nantithrombotic agents. There is, however, limited documentation whether pre-injury use of antithrombotic agents\naffects outcome after head trauma. The aim of this study was to define the relationship between the use of\npreinjury antithrombotic agents and mortality among elderly people sustaining blunt head trauma.\nMethods: A retrospective cohort analysis was performed on the hospital based trauma registry at Oslo University\nHospital. Patients aged 55 years or older sustaining blunt head trauma between 2004 and 2006 were included.\nMultivariable logistic regression analyses were used to identify independent predictors of 30-day mortality.\nSeparate analyses were performed for warfarin use and platelet inhibitor use.\nResults: Of the 418 patients admitted with a diagnosis of head trauma, 137 (32.8 %) used pre-injury antithrombotic\nagents (53 warfarin, 80 platelet inhibitors, and 4 both). Seventy patients died (16.7 %); 15 (28.3 %) of the warfarin users,\n12 (15.0 %) of the platelet inhibitor users, and two (50 %) with combined use of warfarin and platelet inhibitors,\ncompared to 41 (14.6 %) of the non-users. There was a significant interaction effect between warfarin use and the\nTriage Revised Trauma Score collected upon the patients� arrival at the hospital. After adjusting for potential confounders,\nwarfarin use was associated with increased 30-day mortality among patients with normal physiology (adjusted OR\n8,3; 95 % CI, 2.0 to 34.8) on admission, but not among patients with physiological derangement on admission.\nUse of platelet inhibitors was not associated with increased mortality.\nConclusions: The use of warfarin before trauma was associated with increased 30-day mortality among a subset\nof patients. Use of platelet inhibitors before trauma was not associated with increased mortality. These results indicate\nthat patients on preinjury warfarin may need closer monitoring and follow up after trauma despite normal physiology\non admission to the emergency department....
Background: Older people frequently attend the emergency department (ED) and have a high risk of poor outcome\nas compared to their younger counterparts. Our aim was to study routinely collected clinical parameters as predictors\nof 90-day mortality in older patients attending our ED.\nMethods: We conducted a retrospective follow-up study at the Leiden University Medical Center (The Netherlands)\namong patients aged 70 years or older attending the ED in 2012. Predictors were age, gender, time and way of arrival,\npresenting complaint, consulting medical specialty, vital signs, pain score and laboratory testing. Cox regression\nanalyses were performed to analyse the association between these predictors and 90-day mortality.\nResults: Three thousand two hundred one unique patients were eligible for inclusion. Ninety-day mortality was 10.5 % for\nthe total group. Independent predictors of mortality were age (hazard ratio [HR] 1.06, 95 % confidence interval [95 % CI] 1.\n04-1.08), referral from another hospital (HR 2.74, 95 % CI 1.22-6.11), allocation to a non-surgical specialty (HR: 1.55, 95 % CI 1.\n13-2.14), increased respiration rate (HR up to 2.21, 95 % CI 1.25-3.92), low oxygen saturation (HR up to 1.96, 95 % CI 1.\n19-3.23), hypothermia (HR 2.27, 95 % CI 1.28-4.01), fever (HR 0.43, 95 % CI 0.24-0.75), high pain score (HR 1.55,\n95 % CI 1.03-2.32) and the indication to perform laboratory testing (HR 3.44, 95 % CI 2.13-5.56).\nConclusions: Routinely collected parameters at the ED can predict 90-day mortality in older patients presenting\nto the ED. This study forms the first step towards creating a new and simple screening tool to predict and\nimprove health outcome in acutely presenting older patients...
Managing severe burns remains problematic due to the lack of specialized units, but\nalso because of the delay in implementing emergency care. The aim is to show that an\nadapted strategy, can lead to satisfying management of chemical burns. The authors\nreport retrospectively the case of a patient admitted for chemical burns, and treated\nin a non-specialized intensive care unit; a 38 years old male, referred for burns by\nsulfuric acid at his workplace. On admission to H15, the clinic did not reveal any vital\norgans failure. Burns were localized on two legs and soles of the two feet (18%\nTBSA). Treatment combined daily dressings with silver sulfadiazine. On day 14, the\nwound healing associated occlusive gauze dressing, iodine cream application, and\nmechanical debridement. On day 47, a 5% dermal autograft performed on right foot\nfavored with good attachment grafts. On day 58, the patient was released after complete\nskin recovery. Then, in a non-specialized burn unit and without early surgery\naccess, our wound healing adapted strategy was successful. In Senegal, chemical\nburns represent about 2.5% of burn cases. They are often from accidents on occupation\njob, while generally in Africa chemical burns result from criminal attacks. Patients\nwith severe lesions are admitted in non-specialized environments after an extended\ntime of transfer, and don�t have efficient initial care. This may explain the\nhigh morbidity and mortality after burns in our country. The lack of surgical facilities\nsuch as skin substitutes, in non-specialized unit on low or median income countries\n(LMICs), explains this long period of wound healing. The treatment of severe burn in\nLMICs is hazardous....
The Paediatric Observation Priority Score (POPS) is a bespoke assessment tool for use in Paediatric\nEmergency Departments incorporating traditional physiological parameters alongside more\nsubjective observational criteria. Initial performance characteristics of POPS were analysed in a\nconvenience sample of 936 presentations to ED. Triage on the basis of gut instinct parameters\nidentified an additional 261 patients deemed of lowest acuity compared to analysis by physiology\nscores. Resource consumption increased with increasing acuity on presentation. POPS shows\npromise in assisting in the assessment process of children presenting to Emergency Departments.\nInclusion of subjective triage criteria helps contextualise the physiological parameter scoring by\nusing the experience of staff conducting triage. Initial interpretation of presenting physiology\ngives a more informed assessment of initial acuity, and thus is better able to identify a child who\ncan be safely managed in the community. The system also allows for rapid detection of those most\nunwell....
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