Polytrauma with significant bone and volumetric muscle loss presents substantial clinical challenges.Although immune responses significantly influence fracture healing post-polytrauma,the cellular and molecular underp...Polytrauma with significant bone and volumetric muscle loss presents substantial clinical challenges.Although immune responses significantly influence fracture healing post-polytrauma,the cellular and molecular underpinnings of polytrauma-induced immune dysregulation require further investigation.While previous studies examined either injury site tissue or systemic tissue(peripheral blood),our study uniquely investigated both systemic and local immune cells at the same time to better understand polytrauma-induced immune dysregulation and associated impaired bone healing.Using single-cell RNA sequencing(scRNA-seq)in a rat polytrauma model,we analyzed blood,bone marrow,and the local defect soft tissue to identify potential cellular and molecular targets involved in immune dysregulation.We identified a trauma-associated immunosuppressive myeloid(TIM)cell population that drives systemic immune dysregulation,immunosuppression,and potentially impaired bone healing.We found CD1d as a global marker for TIM cells in polytrauma.展开更多
BACKGROUND Hypothermia during laparoscopic surgery in patients with multiple trauma is a significant concern owing to its potential complications.Machine learning models offer a promising approach to predict the occur...BACKGROUND Hypothermia during laparoscopic surgery in patients with multiple trauma is a significant concern owing to its potential complications.Machine learning models offer a promising approach to predict the occurrence of intraoperative hypothermia.AIM To investigate the value of machine learning model to predict hypothermia during laparoscopic surgery in patients with multiple trauma.METHODS This retrospective study enrolled 220 patients who were admitted with multiple injuries between June 2018 and December 2023.Of these,154 patients were allocated to a training set and the remaining 66 were allocated to a validation set in a 7:3 ratio.In the training set,53 cases experienced intraoperative hypothermia and 101 did not.Logistic regression analysis was used to construct a predictive model of intraoperative hypothermia in patients with polytrauma undergoing laparoscopic surgery.The area under the curve(AUC),sensitivity,and specificity were calculated.RESULTS Comparison of the hypothermia and non-hypothermia groups found significant differences in sex,age,baseline temperature,intraoperative temperature,duration of anesthesia,duration of surgery,intraoperative fluid infusion,crystalloid infusion,colloid infusion,and pneumoperitoneum volume(P<0.05).Differences between other characteristics were not significant(P>0.05).The results of the logistic regression analysis showed that age,baseline temperature,intraoperative temperature,duration of anesthesia,and duration of surgery were independent influencing factors for intraoperative hypothermia during laparoscopic surgery(P<0.05).Calibration curve analysis showed good consistency between the predicted occurrence of intraoperative hypothermia and the actual occurrence(P>0.05).The predictive model had AUCs of 0.850 and 0.829 for the training and validation sets,respectively.CONCLUSION Machine learning effectively predicted intraoperative hypothermia in polytrauma patients undergoing laparoscopic surgery,which improved surgical safety and patient recovery.展开更多
This review aims to provide a concise overview of the trauma management evolution in the past decade. 1） Trauma care priorities have incorporated staff protection against infection and early decision making in additi...This review aims to provide a concise overview of the trauma management evolution in the past decade. 1） Trauma care priorities have incorporated staff protection against infection and early decision making in addition to the conventional ABCDE. 2） Five stratified levels for DAM have replaced the non-specific conventional Plans A ＆ B. 3） CT scanning can be the tunnel to death for the hemodynamically unstable patient. 4） DPL has virtually been replaced by the FAST USG. 5） Direct whole-body MDCT provides rapid imaging diagnosis ＆ expedites the definitive treatment but carries high radiation hazards. 6） The dynamic shock assessment by fluid resuscitation response provides more outcome-specific evaluation than the static blood volume loss model. 7） DCR comprising of permissive hypotension, hemostatic resuscitation ＆ DCS aims to overcome the lethal triad of trauma. Early transfusion of blood components of FFP ＆ platelet concentrates improves the outcome in massive blood transfusion. 8） DCS aims to rectify the deranged physiology and not to fully restore the damaged anatomy. 9） A pre-defined protocol for major pelvic fracture can be life-saving and the novel Pre-PPP （pre-peritoneal pelvic packing） may further reduce mortality coupled with the necessary TCAE. 10） Injury prevention is equally important if not more than the trauma resuscitation ＆ operation.展开更多
BACKGROUND:In a tertiary care institute of northern India,the emergency department receives an average of 6-7 patients with poly trauma every day.Of these patients,some come directly and many are referred from other h...BACKGROUND:In a tertiary care institute of northern India,the emergency department receives an average of 6-7 patients with poly trauma every day.Of these patients,some come directly and many are referred from other hospitals from the region.Various problems are faced in the management of patients with poly trauma.This study aimed to elicit various complaints,suggestions and possible solutions in the management of patients with poly trauma.METHODS:A retrospective cross sectional study was done on 210 patients in the emergency OPD for a period of 2 months.All the records of the patients with poly trauma were studied and the problems during their management were measured against 6 predetermined steps(step Ⅰ to step Ⅵ).RESULTS:In the younger generation,males were predominantly the primary victims of poly trauma injury,and road traffic accident was the major etiological factor.Injuries involving more than2 specialties induced many problems during the management of patients with poly trauma.Of 210 patients we studied,32 patients had problems at various steps and maximum problems in step Ⅲ,i.e.co-ordination between various specialties in the management of patients with poly trauma.CONCLUSION:A proper poly trauma management team and a well defined standard operative procedure are the keys to effective management of patients with poly trauma by minimizing the problems encountered.展开更多
Trauma is the leading cause of death in age group less than 45 years. In trauma, time is one of the most crucial factors in predicting prognosis. Outcomes are greatly improved when critical interventions are provided ...Trauma is the leading cause of death in age group less than 45 years. In trauma, time is one of the most crucial factors in predicting prognosis. Outcomes are greatly improved when critical interventions are provided within the golden hour following injury. Whole body multidetector computerised tomography (WBMDCT) can decrease this critical time and increase survival. Emergency CT plays a major role in diagnostic workflow in the evaluation of patients with polytrauma. MDCT scanners are widely used because they rapidly produce high-resolution scans of large areas, offering short examination times for multiple body regions under emergency conditions. Such examinations most often include the head, cervical spine, and thorax to pelvis. Role of MDCT in head trauma remains unparalleled for reasons like its widespread availability and capability to reveal skull fractures, primarily because it is a fast and efficient method to triage the patients with treatable conditions mandating urgent surgical intervention such as extra axial hematomas, mass effect, herniations of brain, hydrocephalus, and midline shift and hence preventing secondary brain injury. MDCT angiography is an important tool to screen patients with suspected vascular injury.展开更多
The aim of this article is to summarize the experience of rehabilitation nursing of one case of severe polytrauma caused by earthquake.The key points of the rehabilitation nursing include body posture nursing,orthoped...The aim of this article is to summarize the experience of rehabilitation nursing of one case of severe polytrauma caused by earthquake.The key points of the rehabilitation nursing include body posture nursing,orthopedic rehabilitation nursing,pulmonary function rehabilitation nursing,bladder rehabilitation nursing,nutritional support,and psychological rehabilitation nursing.Through the comprehensive rehabilitation nursing interventions,satisfactory outcomes were obtained,and the patient was successfully recovered and discharged after 2 months.展开更多
Managing critically injured patients are challenging. Victims of major trauma often present with a host of unknowns including the exact site and nature of injury with a need for urgent diagnosis and resuscitation. It ...Managing critically injured patients are challenging. Victims of major trauma often present with a host of unknowns including the exact site and nature of injury with a need for urgent diagnosis and resuscitation. It takes significant clinical expertise to detect multiple injuries and implement life or limb saving treatment within a short period of time. Conventional radiographs and focused assessment with sonography for trauma (FAST) scans are useful adjuncts to help in initial diagnosis. Conventional computer tomography (CT) investigations have been used for secondary survey in these scenarios. We reviewed the guidelines that regulate the use of CT scans in multiple injured patients in the UK. CT imaging is rapidly emerging as an adjunct to primary survey. It allows quick detection of major organ injury allowing focussed treatment whilst simultaneous initial resuscitation is underway. Availability of adequate resources is needed for widespread adaptation of this technique that involves manpower, relocation and refurbishment of the CT suites. Although it is not yet clear if using CT imaging during primary survey reduces mortality, it surely results in more organised patient care and efficient use of resources in an acute setting.展开更多
Purpose： ＂Polytrauma＂ patients are of a higher risk of complications and death than the summation of expected mortality and morbidity of their individual injuries. The ideal goal in trauma resuscitation care is to ...Purpose： ＂Polytrauma＂ patients are of a higher risk of complications and death than the summation of expected mortality and morbidity of their individual injuries. The ideal goal in trauma resuscitation care is to identify and treat all injuries. With clinical and technological advanced imaging available for diagnosis and treatment of traumatic patients, point of care-rapid ultrasound in shock and hypotension （RUSH） significantly affects modern trauma services and patient outcomes. This study aims to evaluate the accuracy of RUSH and patient outcomes by early detection of the causes of unstable polytrauma. Methods： This cross-sectional, prospective study included 100 unstable polytrauma patients admitted in Suez Canal University Hospital. Clinical exam, RUSH and pan-computed tomography （pan-CT） were conducted. The result of CT was taken as the standard. Patients were managed according to the advanced trauma life support （ATLS） guidelines and treated of life threatening conditions if present. Patients were followed up for 28 days for a short outcome. Results： The most diagnostic causes of unstability in polytrauma patients by RUSH are hypovolemic shock （64%）, followed by obstructive shock （14%）, distributive shock （12%） and cardiogenic shock （10%） respectively. RUSH had 94.2% sensitivity in the diagnosis of unstable polytrauma patients; the accuracy of RUSH in shock patients was 95.2%. Conclusion： RUSH is accurate in the diagnosis of unstable polytrauma patients; and 4% of patients were diagnosed during follow-up after admission by RUSH and pan-CT.展开更多
目的探讨损伤控制外科(DCS)与早期全面救治(ETC)治疗合并骨盆骨折多发伤的临床疗效。方法计算机检索中国知网、万方及维普数据库、PubMed、Embase、Web of Science、Cochrane Library等中外文数据库,检索时间为自建库至2023年8月。收集...目的探讨损伤控制外科(DCS)与早期全面救治(ETC)治疗合并骨盆骨折多发伤的临床疗效。方法计算机检索中国知网、万方及维普数据库、PubMed、Embase、Web of Science、Cochrane Library等中外文数据库,检索时间为自建库至2023年8月。收集有关DCS与ETC治疗合并骨盆骨折多发伤的临床疗效对比的中英文文献,应用RevMan 5.3软件进行Meta分析。结果共纳入32篇文献,包括12篇随机对照试验和20篇队列研究,共3053例患者。采用DCS治疗的患者共1609例(DCS组),采用ETC治疗的患者共1444例(ETC组)。与ETC组相比,DCS组在救治成功率、失血性休克病死率、多器官功能衰竭病死率、受伤至确定手术时间、手术操作时间、术中输血量、术中出血量、体温恢复时间、活化部分凝血活酶时间(APTT)恢复时间、乳酸清除时间、Matta影像评分优良率、Majeed功能评分、骨折愈合时间、总并发症发生率、总感染发生率、脓毒症、深部感染、浆膜腔积液、腹腔积液、急性呼吸窘迫综合征、神经损伤、下肢深静脉血栓、畸形愈合方面均显著优于ETC组(均P<0.05)。而在严重腹盆腔感染病死率、弥散性血管内凝血病死率、住院时间、浅表感染、胸腔积液、肺部感染、肺栓塞、尿道损伤方面则差异无统计学意义(均P>0.05)。结论在治疗合并骨盆骨折多发伤中,DCS较ETC具有显著优势,DCS的救治成功率更高,且术后并发症更少。展开更多
Purpose： The emergency physicians face significant clinical uncertainty when multiple trauma patients arrive in the emergency department （ED）. The priorities for assessment and treatment of polytrauma patients are ...Purpose： The emergency physicians face significant clinical uncertainty when multiple trauma patients arrive in the emergency department （ED）. The priorities for assessment and treatment of polytrauma patients are established in the primary survey. Focused assessment with sonography for trauma （FAST） is very essential clinical skill during trauma resuscitation. Use of point of care ultrasound among the trauma team working in the primary survey in emergency care settings is lacking in Suez Canal University Hospitals even ultrasound machine not available in ED. This study aims to evaluate the accuracy of FAST in hemodynam- ically unstable polytraumatized patients and to determine its role as an indication of laparotomy. Methods： This study is a cross-sectional study included 150 polytrauma patients with a blunt mechanism admitted in Suez Canal University Hospital. Firstly primary survey by airway check, cervical spine securing with neck collar, maintenance of breathing/circulation and management of life threading conditions if present were conducted accordingly to ATLS （advanced trauma life support） guidelines. The patients were assessed in the primary survey using the FAST as a tool to determine the presence of intra- abdominal collection. Results： A total of 150 patients, and FAST scans were performed in all cases. The sensitivity and specificity were 92.6% and 100%, respectively. The negative predictive value was 92%, while the positive predictive value of FAST was 100%. The accuracy of FAST was 96%. Conclusion： FAST is an important method to detect intra-abdominal fluid in the initial assessment in hemodynamically unstable polytrauma patients with high accuracy.展开更多
Purpose： Host response to polytrauma occasionally has unpredictable outcomes. Immune response is a major factor influencing patient＇s outcome. This study evaluated the interaction of two main cytokines in immune res...Purpose： Host response to polytrauma occasionally has unpredictable outcomes. Immune response is a major factor influencing patient＇s outcome. This study evaluated the interaction of two main cytokines in immune response after major trauma, specifically interleukin-6 （IL-6） and interleukin-10 （IL-10）. Plasma level of these cytokines is determined by mRNA expression of these cytokines genes which may decide the outcome of polytrauma patients. Methods： This prospective multicenter trial held at four trauma centers enrolled 54 polytrauma patients [Injury Severity Score （ISS） ≥ 16]. Plasma levels and mRNA expression of IL-6 and IL-10 were measured for 5 days after trauma. Clinical evaluation was conducted to observe whether patients endured multiple organ dysfunction syndrome （MODS） and death. MODS evaluation was performed using sequential organ failure assessment （SOFA）. Trauma load which in this study is represented with ISS, plasma level, expression of cytokine genes and patient＇s outcome were examined with correlation test and statistical analysis. Results： The elevated IL-6/IL-10 ratio indicated increased activity of systemic inflammation response, especially pro-inflammation response which bears higher probability of progressing to MODS and death. The decline of IL-6/IL-IO ratio with heavy trauma load （1SS 〉 30） showed that compensatory anti- inflammation response syndrome （CARS） state was more dominant than systemic inflammatory response syndrome （SIRS）, indicating that malfunction and failure of immune system eventually lead to MODS and deaths. The statistical significance in plasma level of cytokines was found in the outcome group which was defined as bearing a low trauma load but mortality. Conclusion： The pattern of cytokine levels in inflammation response has great impact on the outcome of polytrauma patients. Further study at the genetic level is needed to investigate inflammation process which may influence patient＇s outcome.展开更多
The past century has seen many changes in the management of the polytraumatized orthopaedic patient.Early recommendations for non-operative treatment have evolved into early total care(ETC)and damage control orthopaed...The past century has seen many changes in the management of the polytraumatized orthopaedic patient.Early recommendations for non-operative treatment have evolved into early total care(ETC)and damage control orthopaedic(DCO)treatment principles.These principles force the treating orthopaedist to take into account multiple patient parameters including hypothermia,coagulopathy and volume status before deciding upon the operative plan.This requires a multidisciplinary approach involving critical care physicians,anesthesiologists and others.展开更多
The critically ill polytrauma patient presents with a series of associated pathophysiologies secondary to the traumatic injuries. The most important include systemic inflammatory response syndrome (SIRS), sepsis, oxid...The critically ill polytrauma patient presents with a series of associated pathophysiologies secondary to the traumatic injuries. The most important include systemic inflammatory response syndrome (SIRS), sepsis, oxidative stress (OS), metabolic disorders, and finally multiple organ dysfunction syndrome (MODS) and death. The poor outcome of these patients is related to the association of the aforementioned pathologies. The nutrition of the critically ill polytrauma patient is a distinct challenge because of the rapid changes in terms of energetic needs associated with hypermetabolism, sepsis, SIRS, and OS. Moreover, it has been proven that inadequate nutrition can prolong the time spent on a mechanical ventilator and the length of stay in an intensive care unit (ICU). A series of mathematical equations can predict the energy expenditure (EE), but they have disadvantages, such as the fact that they cannot predict the EE accurately in the case of patients with hypermetabolism. Indirect calorimetry (IC) is another method used for evaluating and monitoring the energy status of critically ill patients. In this update paper, we present a series of pathophysiological aspects associated with the metabolic disaster affecting the critically ill polytrauma patient. Furthermore, we present different non-invasive monitoring methods that could help the intensive care physician in the adequate management of this type of patient.展开更多
Objective： To provide clinicians with data supporting three different clearance techniques in the obtunded patients after severe polytrauma. Methods： This study gave an overview of the available and pertinent liter...Objective： To provide clinicians with data supporting three different clearance techniques in the obtunded patients after severe polytrauma. Methods： This study gave an overview of the available and pertinent literature regarding cervical spine clearance in obtunded patients after severe polytrauma. Results： Currently, there were three accepted techniques for clearance of the cervical spine in obtunded patients after severe polytrauma. Each of these methods has advantages and disadvantages to both of the patients and the clinicians, Conclusions： There are continuous improvements in both computed tomography （CT） and magnetic resonance imaging （MRI） techniques that increase their sensitivities. The continued use of plain radiographs is called into question with respect to cost and time requirements. An algorithmic approach to the evaluation of the cervical spine in the obtunded patients will lead to fewer missed injuries.展开更多
Background:Severe trauma is associated with systemic inflammation and organ dysfunction.Preclinical rodent trauma models are the mainstay of postinjury research but have been criticized for not fully replicating sever...Background:Severe trauma is associated with systemic inflammation and organ dysfunction.Preclinical rodent trauma models are the mainstay of postinjury research but have been criticized for not fully replicating severe human trauma.The aim of this study was to create a rat model of multicompartmental injury which recreates profound traumatic injury.Methods:Male Sprague-Dawley rats were subjected to unilateral lung contusion and hemorrhagic shock(LCHS),multicompartmental polytrauma(PT)(unilateral lung contusion,hemorrhagic shock,cecectomy,bifemoral pseudofracture),or na?ve controls.Weight,plasma toll-l ike receptor 4(TLR4),hemoglobin,spleen to body weight ratio,bone marrow(BM)erythroid progenitor(CFU-GEMM,BFU-E,and CFU-E)growth,plasma granulocyte colony-stimulating factor(G-CSF)and right lung histologic injury were assessed on day 7,with significance defined as p values<0.05(*).Results:Polytrauma resulted in markedly more profound inhibition of weight gain compared to LCHS(p=0.0002)along with elevated plasma TLR4(p<0.0001),lower hemoglobin(p<0.0001),and enlarged spleen to body weight ratios(p=0.004).Both LCHS and PT demonstrated suppression of CFU-E and BFU-E growth compared to naive(p<0.03,p<0.01).Plasma G-CSF was elevated in PT compared to both na?ve and LCHS(p<0.0001,p=0.02).LCHS and PT demonstrated significant histologic right lung injury with poor alveolar wall integrity and interstitial edema.Conclusions:Multicompartmental injury as described here establishes a reproducible model of multicompartmental injury with worsened anemia,splenic tissue enlargement,weight loss,and increased inflammatory activity compared to a less severe model.This may serve as a more effective model to recreate profound traumatic injury to replicate the human inflammatory response postinjury.展开更多
BACKGROUND Pelvic fractures(PF)with concomitant injuries are on the rise due to an increase of high-energy trauma.Increase of the elderly population with age related comorbidities further complicates the management.Ab...BACKGROUND Pelvic fractures(PF)with concomitant injuries are on the rise due to an increase of high-energy trauma.Increase of the elderly population with age related comorbidities further complicates the management.Abdominal organ injuries are kindred with PF due to the proximity to pelvic bones.Presence of contrast blush(CB)on computed tomography in patients with PF is considered a sign of active bleeding,however,its clinical significance and association with outcomes is debatable.AIM To analyze polytrauma patients with PF with a focus on the geriatric population,co-injuries and the value of contrast blush.METHODS This retrospective cohort study included 558 patients with PF admitted to level 1 trauma center(01/2017-01/2023).Analyzed variables included:Age,sex,mechanism of injury(MOI),injury severity score(ISS),Glasgow coma scale(GCS),abbreviated injury scale(AIS),co-injuries,transfusion requirements,pelvic angiography,embolization,laparotomy,orthopedic pelvic surgery,intensive care unit and hospital lengths of stay,discharge disposition and mortality.The study compared geriatric and non-geriatric patients,patients with and without CB and abdominal co-injuries.Propensity score matching was implemented in comparison groups.RESULTS PF comprised 4%of all trauma admissions.89 patients had CB.286(52%)patients had concomitant injuries including 93(17%)patients with abdominal co-injuries.Geriatric patients compared to non-geriatric had more falls as MOI,lower ISS and AIS pelvis,higher GCS,less abdominal co-injuries,similar CB and angio-embolization rates,less orthopedic pelvic surgeries,shorter lengths of stay and higher mortality.After propensity matching,orthopedic pelvic surgery rates remained lower(8%vs 19%,P<0.001),hospital length of stay shorter,and mortality higher(13%vs 4%,P<0.001)in geriatric patients.Out of 89 patients with CB,45(51%)were embolized.After propensity matching,patients with CB compared to without CB had more pelvic angiography(71%vs 12%,P<0.001),higher embolization rates(64%vs 22%,P=0.02)and comparable mortality.CONCLUSION Half of the patients with PF had concomitant co-injuries,including abdominal co-injuries in 17%.Similarly injured geriatric patients had higher mortality.Half of the patients with CB required an embolization.展开更多
文摘Polytrauma with significant bone and volumetric muscle loss presents substantial clinical challenges.Although immune responses significantly influence fracture healing post-polytrauma,the cellular and molecular underpinnings of polytrauma-induced immune dysregulation require further investigation.While previous studies examined either injury site tissue or systemic tissue(peripheral blood),our study uniquely investigated both systemic and local immune cells at the same time to better understand polytrauma-induced immune dysregulation and associated impaired bone healing.Using single-cell RNA sequencing(scRNA-seq)in a rat polytrauma model,we analyzed blood,bone marrow,and the local defect soft tissue to identify potential cellular and molecular targets involved in immune dysregulation.We identified a trauma-associated immunosuppressive myeloid(TIM)cell population that drives systemic immune dysregulation,immunosuppression,and potentially impaired bone healing.We found CD1d as a global marker for TIM cells in polytrauma.
文摘BACKGROUND Hypothermia during laparoscopic surgery in patients with multiple trauma is a significant concern owing to its potential complications.Machine learning models offer a promising approach to predict the occurrence of intraoperative hypothermia.AIM To investigate the value of machine learning model to predict hypothermia during laparoscopic surgery in patients with multiple trauma.METHODS This retrospective study enrolled 220 patients who were admitted with multiple injuries between June 2018 and December 2023.Of these,154 patients were allocated to a training set and the remaining 66 were allocated to a validation set in a 7:3 ratio.In the training set,53 cases experienced intraoperative hypothermia and 101 did not.Logistic regression analysis was used to construct a predictive model of intraoperative hypothermia in patients with polytrauma undergoing laparoscopic surgery.The area under the curve(AUC),sensitivity,and specificity were calculated.RESULTS Comparison of the hypothermia and non-hypothermia groups found significant differences in sex,age,baseline temperature,intraoperative temperature,duration of anesthesia,duration of surgery,intraoperative fluid infusion,crystalloid infusion,colloid infusion,and pneumoperitoneum volume(P<0.05).Differences between other characteristics were not significant(P>0.05).The results of the logistic regression analysis showed that age,baseline temperature,intraoperative temperature,duration of anesthesia,and duration of surgery were independent influencing factors for intraoperative hypothermia during laparoscopic surgery(P<0.05).Calibration curve analysis showed good consistency between the predicted occurrence of intraoperative hypothermia and the actual occurrence(P>0.05).The predictive model had AUCs of 0.850 and 0.829 for the training and validation sets,respectively.CONCLUSION Machine learning effectively predicted intraoperative hypothermia in polytrauma patients undergoing laparoscopic surgery,which improved surgical safety and patient recovery.
文摘This review aims to provide a concise overview of the trauma management evolution in the past decade. 1） Trauma care priorities have incorporated staff protection against infection and early decision making in addition to the conventional ABCDE. 2） Five stratified levels for DAM have replaced the non-specific conventional Plans A ＆ B. 3） CT scanning can be the tunnel to death for the hemodynamically unstable patient. 4） DPL has virtually been replaced by the FAST USG. 5） Direct whole-body MDCT provides rapid imaging diagnosis ＆ expedites the definitive treatment but carries high radiation hazards. 6） The dynamic shock assessment by fluid resuscitation response provides more outcome-specific evaluation than the static blood volume loss model. 7） DCR comprising of permissive hypotension, hemostatic resuscitation ＆ DCS aims to overcome the lethal triad of trauma. Early transfusion of blood components of FFP ＆ platelet concentrates improves the outcome in massive blood transfusion. 8） DCS aims to rectify the deranged physiology and not to fully restore the damaged anatomy. 9） A pre-defined protocol for major pelvic fracture can be life-saving and the novel Pre-PPP （pre-peritoneal pelvic packing） may further reduce mortality coupled with the necessary TCAE. 10） Injury prevention is equally important if not more than the trauma resuscitation ＆ operation.
文摘BACKGROUND:In a tertiary care institute of northern India,the emergency department receives an average of 6-7 patients with poly trauma every day.Of these patients,some come directly and many are referred from other hospitals from the region.Various problems are faced in the management of patients with poly trauma.This study aimed to elicit various complaints,suggestions and possible solutions in the management of patients with poly trauma.METHODS:A retrospective cross sectional study was done on 210 patients in the emergency OPD for a period of 2 months.All the records of the patients with poly trauma were studied and the problems during their management were measured against 6 predetermined steps(step Ⅰ to step Ⅵ).RESULTS:In the younger generation,males were predominantly the primary victims of poly trauma injury,and road traffic accident was the major etiological factor.Injuries involving more than2 specialties induced many problems during the management of patients with poly trauma.Of 210 patients we studied,32 patients had problems at various steps and maximum problems in step Ⅲ,i.e.co-ordination between various specialties in the management of patients with poly trauma.CONCLUSION:A proper poly trauma management team and a well defined standard operative procedure are the keys to effective management of patients with poly trauma by minimizing the problems encountered.
文摘Trauma is the leading cause of death in age group less than 45 years. In trauma, time is one of the most crucial factors in predicting prognosis. Outcomes are greatly improved when critical interventions are provided within the golden hour following injury. Whole body multidetector computerised tomography (WBMDCT) can decrease this critical time and increase survival. Emergency CT plays a major role in diagnostic workflow in the evaluation of patients with polytrauma. MDCT scanners are widely used because they rapidly produce high-resolution scans of large areas, offering short examination times for multiple body regions under emergency conditions. Such examinations most often include the head, cervical spine, and thorax to pelvis. Role of MDCT in head trauma remains unparalleled for reasons like its widespread availability and capability to reveal skull fractures, primarily because it is a fast and efficient method to triage the patients with treatable conditions mandating urgent surgical intervention such as extra axial hematomas, mass effect, herniations of brain, hydrocephalus, and midline shift and hence preventing secondary brain injury. MDCT angiography is an important tool to screen patients with suspected vascular injury.
文摘The aim of this article is to summarize the experience of rehabilitation nursing of one case of severe polytrauma caused by earthquake.The key points of the rehabilitation nursing include body posture nursing,orthopedic rehabilitation nursing,pulmonary function rehabilitation nursing,bladder rehabilitation nursing,nutritional support,and psychological rehabilitation nursing.Through the comprehensive rehabilitation nursing interventions,satisfactory outcomes were obtained,and the patient was successfully recovered and discharged after 2 months.
文摘Managing critically injured patients are challenging. Victims of major trauma often present with a host of unknowns including the exact site and nature of injury with a need for urgent diagnosis and resuscitation. It takes significant clinical expertise to detect multiple injuries and implement life or limb saving treatment within a short period of time. Conventional radiographs and focused assessment with sonography for trauma (FAST) scans are useful adjuncts to help in initial diagnosis. Conventional computer tomography (CT) investigations have been used for secondary survey in these scenarios. We reviewed the guidelines that regulate the use of CT scans in multiple injured patients in the UK. CT imaging is rapidly emerging as an adjunct to primary survey. It allows quick detection of major organ injury allowing focussed treatment whilst simultaneous initial resuscitation is underway. Availability of adequate resources is needed for widespread adaptation of this technique that involves manpower, relocation and refurbishment of the CT suites. Although it is not yet clear if using CT imaging during primary survey reduces mortality, it surely results in more organised patient care and efficient use of resources in an acute setting.
文摘Purpose： ＂Polytrauma＂ patients are of a higher risk of complications and death than the summation of expected mortality and morbidity of their individual injuries. The ideal goal in trauma resuscitation care is to identify and treat all injuries. With clinical and technological advanced imaging available for diagnosis and treatment of traumatic patients, point of care-rapid ultrasound in shock and hypotension （RUSH） significantly affects modern trauma services and patient outcomes. This study aims to evaluate the accuracy of RUSH and patient outcomes by early detection of the causes of unstable polytrauma. Methods： This cross-sectional, prospective study included 100 unstable polytrauma patients admitted in Suez Canal University Hospital. Clinical exam, RUSH and pan-computed tomography （pan-CT） were conducted. The result of CT was taken as the standard. Patients were managed according to the advanced trauma life support （ATLS） guidelines and treated of life threatening conditions if present. Patients were followed up for 28 days for a short outcome. Results： The most diagnostic causes of unstability in polytrauma patients by RUSH are hypovolemic shock （64%）, followed by obstructive shock （14%）, distributive shock （12%） and cardiogenic shock （10%） respectively. RUSH had 94.2% sensitivity in the diagnosis of unstable polytrauma patients; the accuracy of RUSH in shock patients was 95.2%. Conclusion： RUSH is accurate in the diagnosis of unstable polytrauma patients; and 4% of patients were diagnosed during follow-up after admission by RUSH and pan-CT.
文摘目的探讨损伤控制外科(DCS)与早期全面救治(ETC)治疗合并骨盆骨折多发伤的临床疗效。方法计算机检索中国知网、万方及维普数据库、PubMed、Embase、Web of Science、Cochrane Library等中外文数据库,检索时间为自建库至2023年8月。收集有关DCS与ETC治疗合并骨盆骨折多发伤的临床疗效对比的中英文文献,应用RevMan 5.3软件进行Meta分析。结果共纳入32篇文献,包括12篇随机对照试验和20篇队列研究,共3053例患者。采用DCS治疗的患者共1609例(DCS组),采用ETC治疗的患者共1444例(ETC组)。与ETC组相比,DCS组在救治成功率、失血性休克病死率、多器官功能衰竭病死率、受伤至确定手术时间、手术操作时间、术中输血量、术中出血量、体温恢复时间、活化部分凝血活酶时间(APTT)恢复时间、乳酸清除时间、Matta影像评分优良率、Majeed功能评分、骨折愈合时间、总并发症发生率、总感染发生率、脓毒症、深部感染、浆膜腔积液、腹腔积液、急性呼吸窘迫综合征、神经损伤、下肢深静脉血栓、畸形愈合方面均显著优于ETC组(均P<0.05)。而在严重腹盆腔感染病死率、弥散性血管内凝血病死率、住院时间、浅表感染、胸腔积液、肺部感染、肺栓塞、尿道损伤方面则差异无统计学意义(均P>0.05)。结论在治疗合并骨盆骨折多发伤中,DCS较ETC具有显著优势,DCS的救治成功率更高,且术后并发症更少。
文摘Purpose： The emergency physicians face significant clinical uncertainty when multiple trauma patients arrive in the emergency department （ED）. The priorities for assessment and treatment of polytrauma patients are established in the primary survey. Focused assessment with sonography for trauma （FAST） is very essential clinical skill during trauma resuscitation. Use of point of care ultrasound among the trauma team working in the primary survey in emergency care settings is lacking in Suez Canal University Hospitals even ultrasound machine not available in ED. This study aims to evaluate the accuracy of FAST in hemodynam- ically unstable polytraumatized patients and to determine its role as an indication of laparotomy. Methods： This study is a cross-sectional study included 150 polytrauma patients with a blunt mechanism admitted in Suez Canal University Hospital. Firstly primary survey by airway check, cervical spine securing with neck collar, maintenance of breathing/circulation and management of life threading conditions if present were conducted accordingly to ATLS （advanced trauma life support） guidelines. The patients were assessed in the primary survey using the FAST as a tool to determine the presence of intra- abdominal collection. Results： A total of 150 patients, and FAST scans were performed in all cases. The sensitivity and specificity were 92.6% and 100%, respectively. The negative predictive value was 92%, while the positive predictive value of FAST was 100%. The accuracy of FAST was 96%. Conclusion： FAST is an important method to detect intra-abdominal fluid in the initial assessment in hemodynamically unstable polytrauma patients with high accuracy.
文摘Purpose： Host response to polytrauma occasionally has unpredictable outcomes. Immune response is a major factor influencing patient＇s outcome. This study evaluated the interaction of two main cytokines in immune response after major trauma, specifically interleukin-6 （IL-6） and interleukin-10 （IL-10）. Plasma level of these cytokines is determined by mRNA expression of these cytokines genes which may decide the outcome of polytrauma patients. Methods： This prospective multicenter trial held at four trauma centers enrolled 54 polytrauma patients [Injury Severity Score （ISS） ≥ 16]. Plasma levels and mRNA expression of IL-6 and IL-10 were measured for 5 days after trauma. Clinical evaluation was conducted to observe whether patients endured multiple organ dysfunction syndrome （MODS） and death. MODS evaluation was performed using sequential organ failure assessment （SOFA）. Trauma load which in this study is represented with ISS, plasma level, expression of cytokine genes and patient＇s outcome were examined with correlation test and statistical analysis. Results： The elevated IL-6/IL-10 ratio indicated increased activity of systemic inflammation response, especially pro-inflammation response which bears higher probability of progressing to MODS and death. The decline of IL-6/IL-IO ratio with heavy trauma load （1SS 〉 30） showed that compensatory anti- inflammation response syndrome （CARS） state was more dominant than systemic inflammatory response syndrome （SIRS）, indicating that malfunction and failure of immune system eventually lead to MODS and deaths. The statistical significance in plasma level of cytokines was found in the outcome group which was defined as bearing a low trauma load but mortality. Conclusion： The pattern of cytokine levels in inflammation response has great impact on the outcome of polytrauma patients. Further study at the genetic level is needed to investigate inflammation process which may influence patient＇s outcome.
文摘The past century has seen many changes in the management of the polytraumatized orthopaedic patient.Early recommendations for non-operative treatment have evolved into early total care(ETC)and damage control orthopaedic(DCO)treatment principles.These principles force the treating orthopaedist to take into account multiple patient parameters including hypothermia,coagulopathy and volume status before deciding upon the operative plan.This requires a multidisciplinary approach involving critical care physicians,anesthesiologists and others.
文摘The critically ill polytrauma patient presents with a series of associated pathophysiologies secondary to the traumatic injuries. The most important include systemic inflammatory response syndrome (SIRS), sepsis, oxidative stress (OS), metabolic disorders, and finally multiple organ dysfunction syndrome (MODS) and death. The poor outcome of these patients is related to the association of the aforementioned pathologies. The nutrition of the critically ill polytrauma patient is a distinct challenge because of the rapid changes in terms of energetic needs associated with hypermetabolism, sepsis, SIRS, and OS. Moreover, it has been proven that inadequate nutrition can prolong the time spent on a mechanical ventilator and the length of stay in an intensive care unit (ICU). A series of mathematical equations can predict the energy expenditure (EE), but they have disadvantages, such as the fact that they cannot predict the EE accurately in the case of patients with hypermetabolism. Indirect calorimetry (IC) is another method used for evaluating and monitoring the energy status of critically ill patients. In this update paper, we present a series of pathophysiological aspects associated with the metabolic disaster affecting the critically ill polytrauma patient. Furthermore, we present different non-invasive monitoring methods that could help the intensive care physician in the adequate management of this type of patient.
文摘Objective： To provide clinicians with data supporting three different clearance techniques in the obtunded patients after severe polytrauma. Methods： This study gave an overview of the available and pertinent literature regarding cervical spine clearance in obtunded patients after severe polytrauma. Results： Currently, there were three accepted techniques for clearance of the cervical spine in obtunded patients after severe polytrauma. Each of these methods has advantages and disadvantages to both of the patients and the clinicians, Conclusions： There are continuous improvements in both computed tomography （CT） and magnetic resonance imaging （MRI） techniques that increase their sensitivities. The continued use of plain radiographs is called into question with respect to cost and time requirements. An algorithmic approach to the evaluation of the cervical spine in the obtunded patients will lead to fewer missed injuries.
基金supported by the National Institutes of Healthsupported by NIH NIGMS R01 GM105893+2 种基金supported by postgraduate training grant NIH NIGMS T32 GM-008721 in burnstraumaand perioperative injury。
文摘Background:Severe trauma is associated with systemic inflammation and organ dysfunction.Preclinical rodent trauma models are the mainstay of postinjury research but have been criticized for not fully replicating severe human trauma.The aim of this study was to create a rat model of multicompartmental injury which recreates profound traumatic injury.Methods:Male Sprague-Dawley rats were subjected to unilateral lung contusion and hemorrhagic shock(LCHS),multicompartmental polytrauma(PT)(unilateral lung contusion,hemorrhagic shock,cecectomy,bifemoral pseudofracture),or na?ve controls.Weight,plasma toll-l ike receptor 4(TLR4),hemoglobin,spleen to body weight ratio,bone marrow(BM)erythroid progenitor(CFU-GEMM,BFU-E,and CFU-E)growth,plasma granulocyte colony-stimulating factor(G-CSF)and right lung histologic injury were assessed on day 7,with significance defined as p values<0.05(*).Results:Polytrauma resulted in markedly more profound inhibition of weight gain compared to LCHS(p=0.0002)along with elevated plasma TLR4(p<0.0001),lower hemoglobin(p<0.0001),and enlarged spleen to body weight ratios(p=0.004).Both LCHS and PT demonstrated suppression of CFU-E and BFU-E growth compared to naive(p<0.03,p<0.01).Plasma G-CSF was elevated in PT compared to both na?ve and LCHS(p<0.0001,p=0.02).LCHS and PT demonstrated significant histologic right lung injury with poor alveolar wall integrity and interstitial edema.Conclusions:Multicompartmental injury as described here establishes a reproducible model of multicompartmental injury with worsened anemia,splenic tissue enlargement,weight loss,and increased inflammatory activity compared to a less severe model.This may serve as a more effective model to recreate profound traumatic injury to replicate the human inflammatory response postinjury.
文摘BACKGROUND Pelvic fractures(PF)with concomitant injuries are on the rise due to an increase of high-energy trauma.Increase of the elderly population with age related comorbidities further complicates the management.Abdominal organ injuries are kindred with PF due to the proximity to pelvic bones.Presence of contrast blush(CB)on computed tomography in patients with PF is considered a sign of active bleeding,however,its clinical significance and association with outcomes is debatable.AIM To analyze polytrauma patients with PF with a focus on the geriatric population,co-injuries and the value of contrast blush.METHODS This retrospective cohort study included 558 patients with PF admitted to level 1 trauma center(01/2017-01/2023).Analyzed variables included:Age,sex,mechanism of injury(MOI),injury severity score(ISS),Glasgow coma scale(GCS),abbreviated injury scale(AIS),co-injuries,transfusion requirements,pelvic angiography,embolization,laparotomy,orthopedic pelvic surgery,intensive care unit and hospital lengths of stay,discharge disposition and mortality.The study compared geriatric and non-geriatric patients,patients with and without CB and abdominal co-injuries.Propensity score matching was implemented in comparison groups.RESULTS PF comprised 4%of all trauma admissions.89 patients had CB.286(52%)patients had concomitant injuries including 93(17%)patients with abdominal co-injuries.Geriatric patients compared to non-geriatric had more falls as MOI,lower ISS and AIS pelvis,higher GCS,less abdominal co-injuries,similar CB and angio-embolization rates,less orthopedic pelvic surgeries,shorter lengths of stay and higher mortality.After propensity matching,orthopedic pelvic surgery rates remained lower(8%vs 19%,P<0.001),hospital length of stay shorter,and mortality higher(13%vs 4%,P<0.001)in geriatric patients.Out of 89 patients with CB,45(51%)were embolized.After propensity matching,patients with CB compared to without CB had more pelvic angiography(71%vs 12%,P<0.001),higher embolization rates(64%vs 22%,P=0.02)and comparable mortality.CONCLUSION Half of the patients with PF had concomitant co-injuries,including abdominal co-injuries in 17%.Similarly injured geriatric patients had higher mortality.Half of the patients with CB required an embolization.
