Portal vein thrombosis(PVT)secondary to blunt abdominal trauma associated with liver injury is extremely rare in healthy individuals as well as in minor liver injury,and it carries a high rate of morbidity and mortali...Portal vein thrombosis(PVT)secondary to blunt abdominal trauma associated with liver injury is extremely rare in healthy individuals as well as in minor liver injury,and it carries a high rate of morbidity and mortality.Moreover,acute asymptomatic PVT is difficult to diagnose.We present a young trauma patient with isolated minor liver injury associated with acute PVT.A 27-year-old man presented to the emergency department after a motor vehicle collision.His primary survey findings were unremarkable.His secondary survey showed a large contusion(7×7 cm2)at the epigastrium with marked tenderness and localized guarding.The CT angiography of the whole abdomen revealed liver injury grade 3 in hepatic segments 2/3 and 4b(according to the American Association for the Surgery of Trauma classification)extending near the porta hepatis with patent hepatic and portal veins and without other solid organ injury.The follow-up CT of the whole abdomen on post-injury day 7 showed a 1.8-cm thrombus in the left portal vein with patent right portal and hepatic veins,and a decreased size of the hepatic lacerations.A liver function test was repeated on post-injury day 4,and it revealed improved transaminitis.The patient received intravenous anticoagulant therapy with low-molecular-weight heparin according to weight-based dosing for treatment.The CT of the whole abdomen performed 2 weeks after anticoagulant therapy showed small residual thrombosis in the left portal vein.The patient received intravenous anticoagulant therapy for a total of 3 months.On the follow-up visits at 1 month,2 months,6 months,and 1 year after the injury,the patients did not have any detectable abnormal symptoms.PVT post-blunt minor liver injury is an extremely rare complication.If the thrombosis is left untreated,serious morbidity and mortality can ensue.However,its diagnosis in asymptomatic patients is still challenging.Periodic imaging is necessary for highly suspected PVT,especially in liver injury with lacerations close to the porta hepatis,even in cases of a minor injury.展开更多
Central venous catheterization is widely used in the emergency setting. This review aims to assess central venous catheterization from the perspectives of types of catheters, sites of insertion, and tech- niques. In e...Central venous catheterization is widely used in the emergency setting. This review aims to assess central venous catheterization from the perspectives of types of catheters, sites of insertion, and tech- niques. In emergency conditions, non-tunneled catheters are preferred because the technique for its insertion is not complicated and less time-consuming. The size of catheter depends on the purpose of catheterization. For example, a large bore catheter is needed for rapid infusion. The ideal catheterization site should bear fewer thromboses, lower infectious rate, and fewer mechanical complications. Thus the femoral vein should be avoided due to a high rate of colonization and thrombosis while the subclavian vein seems to exhibit fewer infectious complications compared with other sites. The ultrasound-guided technique increases the success rate of insertion while decreases the mechanical complications rate,展开更多
Purpose:After damage control surgery,trauma patients are transferred to intensive care units to restore the physiology.During this period,massive transfusion might be required for ongoing bleeding and coagulopathy.Thi...Purpose:After damage control surgery,trauma patients are transferred to intensive care units to restore the physiology.During this period,massive transfusion might be required for ongoing bleeding and coagulopathy.This research aimed to identify predictors of massive blood transfusion in the surgical intensive care units(SICUs).Methods:This is an analysis of the THAI-SICU study which was a prospective cohort that was done in the 9-university-based SICUs in Thailand.The study included only patients admitted due to trauma mechanisms.Massive transfusion was defined as received>10 units of packed red blood cells on the first day of admission.Patient characteristics and physiologic data were analyzed to identify the potential factors.A multivariable regression was then performed to identify the significant model.Results:Three hundred and seventy patients were enrolled.Sixteen patients(5%)received massive transfusion in the SICUs.The factors that significantly predicted massive transfusion were an initial sequential organ failure assessment(SOFA)>9(risk difference(RD)0.13,95%confidence interval(CI):0.03—0.22,p=0.01);intra-operative blood loss>4900 mL(RD 0.33,95%CI:0.04—0.62,p=0.02)and intra-operative blood transfusion>10 units(RD 0.45,95%Cl:0.06 to 0.84,p=0.02).The probability to have massive transfusion was 0.976 in patients who had these 3 factors.Conclusion:Massive blood transfusion in the SICUs occurred in 5%.An initial SOFA>9,intra-operative blood loss>4900 mL,and intra-operative blood transfusion>10 units were the significant factors to predict massive transfusion in the SICUs.展开更多
Purpose： Exsanguination is the most common leading cause of death in trauma patients. The massive transfusion （MT） protocol may influence therapeutic strategies and help provide blood components in timely manner. T...Purpose： Exsanguination is the most common leading cause of death in trauma patients. The massive transfusion （MT） protocol may influence therapeutic strategies and help provide blood components in timely manner. The assessment of blood consumption （ABC） score is a popular MT protocol but has low predictability. The lactate level is a good parameter to reflect poor tissue perfusion or shock states that can guide the management. This study aimed to modify the ABC scoring system by adding the lactate level for better prediction of MTo Methods： The data were retrospectively collected from 165 trauma patients following the trauma acti- vated criteria at Songklanagarind Hospital from January 2014 to December 2014. The ABC scoring system was applied in all patients. The patients who had an ABC score 〉2 as the cut point for MT were defined as the ABC group. All patients who had a score 〉2 with a lactate level 〉4 mmol/dL were defined as the ABC plus lactate level （ABC ＋ L） group. The prediction for the requirement of massive blood transfusion was compared between the ABC and ABC ＋ L groups. The ability of ABC and ABC ＋ L groups to predict MT was estimated by the area under the receiver operating characteristic curve （AUROC）. Results： Among 165 patients, 15 patients （9%） required massive blood transfusion. There were no sig- nificant differences in age, gender, mechanism of injury or initial vital signs bet^teen the MT group and the non-MT group. The group that required MT had a higher Injury Severity Score and mortality. The sensitivity and specificity of the ABC scoring system in our institution were low （81%, 34%, AUC 0.573）. The sensitivity and specificity were significantly better in the ABC ＋ L group （92%, 42%, AUC = 0.745）. Conclusion： The ABC scoring system plus lactate increased the sensitivity and specificity compared with the ABC scoring system alone.展开更多
文摘Portal vein thrombosis(PVT)secondary to blunt abdominal trauma associated with liver injury is extremely rare in healthy individuals as well as in minor liver injury,and it carries a high rate of morbidity and mortality.Moreover,acute asymptomatic PVT is difficult to diagnose.We present a young trauma patient with isolated minor liver injury associated with acute PVT.A 27-year-old man presented to the emergency department after a motor vehicle collision.His primary survey findings were unremarkable.His secondary survey showed a large contusion(7×7 cm2)at the epigastrium with marked tenderness and localized guarding.The CT angiography of the whole abdomen revealed liver injury grade 3 in hepatic segments 2/3 and 4b(according to the American Association for the Surgery of Trauma classification)extending near the porta hepatis with patent hepatic and portal veins and without other solid organ injury.The follow-up CT of the whole abdomen on post-injury day 7 showed a 1.8-cm thrombus in the left portal vein with patent right portal and hepatic veins,and a decreased size of the hepatic lacerations.A liver function test was repeated on post-injury day 4,and it revealed improved transaminitis.The patient received intravenous anticoagulant therapy with low-molecular-weight heparin according to weight-based dosing for treatment.The CT of the whole abdomen performed 2 weeks after anticoagulant therapy showed small residual thrombosis in the left portal vein.The patient received intravenous anticoagulant therapy for a total of 3 months.On the follow-up visits at 1 month,2 months,6 months,and 1 year after the injury,the patients did not have any detectable abnormal symptoms.PVT post-blunt minor liver injury is an extremely rare complication.If the thrombosis is left untreated,serious morbidity and mortality can ensue.However,its diagnosis in asymptomatic patients is still challenging.Periodic imaging is necessary for highly suspected PVT,especially in liver injury with lacerations close to the porta hepatis,even in cases of a minor injury.
文摘Central venous catheterization is widely used in the emergency setting. This review aims to assess central venous catheterization from the perspectives of types of catheters, sites of insertion, and tech- niques. In emergency conditions, non-tunneled catheters are preferred because the technique for its insertion is not complicated and less time-consuming. The size of catheter depends on the purpose of catheterization. For example, a large bore catheter is needed for rapid infusion. The ideal catheterization site should bear fewer thromboses, lower infectious rate, and fewer mechanical complications. Thus the femoral vein should be avoided due to a high rate of colonization and thrombosis while the subclavian vein seems to exhibit fewer infectious complications compared with other sites. The ultrasound-guided technique increases the success rate of insertion while decreases the mechanical complications rate,
文摘Purpose:After damage control surgery,trauma patients are transferred to intensive care units to restore the physiology.During this period,massive transfusion might be required for ongoing bleeding and coagulopathy.This research aimed to identify predictors of massive blood transfusion in the surgical intensive care units(SICUs).Methods:This is an analysis of the THAI-SICU study which was a prospective cohort that was done in the 9-university-based SICUs in Thailand.The study included only patients admitted due to trauma mechanisms.Massive transfusion was defined as received>10 units of packed red blood cells on the first day of admission.Patient characteristics and physiologic data were analyzed to identify the potential factors.A multivariable regression was then performed to identify the significant model.Results:Three hundred and seventy patients were enrolled.Sixteen patients(5%)received massive transfusion in the SICUs.The factors that significantly predicted massive transfusion were an initial sequential organ failure assessment(SOFA)>9(risk difference(RD)0.13,95%confidence interval(CI):0.03—0.22,p=0.01);intra-operative blood loss>4900 mL(RD 0.33,95%CI:0.04—0.62,p=0.02)and intra-operative blood transfusion>10 units(RD 0.45,95%Cl:0.06 to 0.84,p=0.02).The probability to have massive transfusion was 0.976 in patients who had these 3 factors.Conclusion:Massive blood transfusion in the SICUs occurred in 5%.An initial SOFA>9,intra-operative blood loss>4900 mL,and intra-operative blood transfusion>10 units were the significant factors to predict massive transfusion in the SICUs.
文摘Purpose： Exsanguination is the most common leading cause of death in trauma patients. The massive transfusion （MT） protocol may influence therapeutic strategies and help provide blood components in timely manner. The assessment of blood consumption （ABC） score is a popular MT protocol but has low predictability. The lactate level is a good parameter to reflect poor tissue perfusion or shock states that can guide the management. This study aimed to modify the ABC scoring system by adding the lactate level for better prediction of MTo Methods： The data were retrospectively collected from 165 trauma patients following the trauma acti- vated criteria at Songklanagarind Hospital from January 2014 to December 2014. The ABC scoring system was applied in all patients. The patients who had an ABC score 〉2 as the cut point for MT were defined as the ABC group. All patients who had a score 〉2 with a lactate level 〉4 mmol/dL were defined as the ABC plus lactate level （ABC ＋ L） group. The prediction for the requirement of massive blood transfusion was compared between the ABC and ABC ＋ L groups. The ability of ABC and ABC ＋ L groups to predict MT was estimated by the area under the receiver operating characteristic curve （AUROC）. Results： Among 165 patients, 15 patients （9%） required massive blood transfusion. There were no sig- nificant differences in age, gender, mechanism of injury or initial vital signs bet^teen the MT group and the non-MT group. The group that required MT had a higher Injury Severity Score and mortality. The sensitivity and specificity of the ABC scoring system in our institution were low （81%, 34%, AUC 0.573）. The sensitivity and specificity were significantly better in the ABC ＋ L group （92%, 42%, AUC = 0.745）. Conclusion： The ABC scoring system plus lactate increased the sensitivity and specificity compared with the ABC scoring system alone.
