Journal of Trauma-Injury Infection and Critical Care最新文献

Background: The pernicious individual and societal effects of exposure to violence highlight the importance of understanding factors related to trauma perpetration. Little research has investigated the phenomenon of accidental perpetration of serious injury and death, or considered the relationship between perpetration and trauma exposure.

Methods: This study uses data from the National Comorbidity Survey-Replication to examine the demographic correlates and characteristics of both intentional and accidental perpetration of trauma, as well as the relationship of these types of perpetration to exposure to traumatic events. Participants were 83 individuals who had accidentally perpetrated trauma and 120 individuals who had intentionally perpetrated trauma.

Results: Findings indicated that men were more likely than women to report having intentionally, compared to accidentally, perpetrated trauma. Intentional and accidental perpetration of trauma were both associated with high levels of psychologic disorders, although those who had intentionally perpetrated trauma were more likely to report symptoms of posttraumatic stress disorder compared with those who had accidentally perpetrated trauma. Intentional perpetrators were more likely to have experienced interpersonal trauma in adulthood and childhood compared to accidental perpetrators. Interpersonal and sexual trauma was likely to precede any kind of trauma perpetration.

Conclusions: Findings suggest that accidental, as well as intentional, perpetration of serious injury or death frequently occurs in the context of trauma and violence. Both types of perpetration are related to psychopathology. Potential mechanisms underlying the relationship between trauma exposure, psychopathology, and perpetration are discussed. Further research is needed to elucidate pathways from trauma exposure to perpetration and mental disorder.

Background: Heat stroke (HS) is a fatal illness characterized by an elevated core body temperature above 40°C and complicated with rhabdomyolysis and acute renal failure. We retrospectively analyzed the effect of continuous veno-venous hemofiltration (CVVH) in patients with HS.

Methods: A total of 16 patients with HS were retrospectively analyzed. All patients were treated by CVVH for at least 96 hours, and CVVH was initiated with replacement fluid between 25°C and 30°C for 2 hours to 2.5 hours, and 36°C thereafter. The vital signs were monitored and blood samples were collected during CVVH to measure serum urea, creatinine, myoglobin, creatine kinase, and total bilirubin.

Results: All patients survived. The core temperature of the patients decreased from 41.3 ± 0.2°C to 38.7 ± 0.1°C after 2 hours and to 36.7 ± 0.1°C after 5 hours during CVVH (p < 0.05). Compared with values before starting CVVH, there were remarkable improvements in mean arterial blood pressure, heart rate, and oxygenation index (p < 0.05). The serum creatinine, urea, myoglobin, and creatine kinase decreased significantly (p < 0.05), while the bilirubinemia had no obvious decline (p > 0.05). The scores of APACHE II and arterial lactate had also obvious decline (p < 0.05). The hemodynamic variables were stabilized during CVVH, and no obvious side effects related to CVVH were found.

Conclusions: CVVH is safe and feasible in the treatment of patients with HS by lowering core temperature, removal of myoglobin, support of multiorgan function, and modulating systemic inflammatory response syndrome (SIRS). The impact of CVVH on patient outcome, however, still needs proof by larger randomized controlled trials.

Background: Hemorrhage from pelvic fracture is common in victims of blunt traumatic injury. In 2001, the Eastern Association for the Surgery of Trauma (EAST) published practice management guidelines for the management of hemorrhage in pelvic trauma. Since that time there have been new practice patterns and larger experiences with older techniques. The Practice Guidelines Committee of EAST decided to replace the 2001 guidelines with an updated guideline and systematic review reflecting current practice.

Methods: Building on the previous systematic literature review in the 2001 EAST guidelines, a systematic literature review was performed to include references from 1999 to 2010. Prospective and retrospective studies were included. Reviews and case reports were excluded. Of the 1,432 articles identified, 50 were selected as meeting criteria. Nine Trauma Surgeons, an Interventional Radiologist, and an Orthopedic Surgeon reviewed the articles. The EAST primer was used to grade the evidence.

Results: Six questions regarding hemorrhage from pelvic fracture were addressed: (1) Which patients with hemodynamically unstable pelvic fractures warrant early external mechanical stabilization? (2) Which patients require emergent angiography? (3) What is the best test to exclude extrapelvic bleeding? (4) Are there radiologic findings which predict hemorrhage? (5) What is the role of noninvasive temporary external fixation devices? and (6) Which patients warrant preperitoneal packing?

Conclusions: Hemorrhage due to pelvic fracture remains a major cause of morbidity and mortality in the trauma patient. Strong recommendations were made regarding questions 1 to 4. Further study is needed to answer questions 5 and 6.

Background: Hypothermia is common during hemorrhagic shock. To warm the victims or not has been controversial. This study aims to investigate the effect of warming during the initial time of hemorrhage on body temperature, blood pressure, and survival in rat hemorrhagic shock models.

Methods: Forty anesthetized rats were divided into control group (n = 20) and warming group (n = 20). The rats of control group were placed on a wooden pad without heating, and the rats of warming group were placed on a heating pad maintained at 37°C ± 0.1°C. Blood withdrawal reached 40% of the total blood volume within 60 minutes. Numbers of survival rats, rectal temperature, and mean arterial pressure (MAP) were recorded when blood loss reached 0 (T0), 20% (T20), 30% (T30), and 40% (T40) of the total blood volume, respectively.

Results: Rectal temperature and MAP decrease gradually in both groups during hemorrhage. Warming continuously makes the rectal temperature of the warming group (36.68°C ± 0.63°C) slightly higher than that of the control group (36.17°C ± 0.69°C) at T0. The rectal temperature and MAP of the warming group are higher than that of the control group at T20, T30, and T40 (p < 0.05). Survival rates of the warming group are higher than that of the control group (p < 0.01).

Conclusions: Warming during hemorrhage may prevent exacerbation of hypothermia and hypotension and therefore improve survival.