Sepsis biomarkers in polytrauma patients

Despite continual advances in medical care and injury prevention efforts, traumatic injury remains a leading cause of death of Americans with these deaths occurring in a tri-modal pattern. The early phases of this pattern are characterized by immune activation whereas the last phase is marked by profound immune dysfunction. It is during this last phase that many trauma patients die of septic complications pointing to a dire need for a specific biomarker for post-traumatic infection. This article discusses several biomarkers, including emerging ones, for infection and sepsis following trauma including inflammatory cytokines, intracellular proteins, and cellular biomarkers.     

Geriatric trauma

Elderly trauma patients present unique challenges and face more significant obstacles to recovery than younger patients. Despite overall higher mortality, longer length of stay, increased resource use, and higher rates of discharge to rehabilitation, most elderly trauma patients return to independent or preinjury functional status. Critical to improving these outcomes is an understanding that although similar trauma principles apply to the elderly, these patients require more aggressive evaluation and resuscitation. This article reviews the recent developments in the literature regarding care of the elderly trauma patient.     

Geriatric rehabilitation

Elderly people experience motor, sensory and cognitive losses that affect their mobility and their ability to perform activities of daily living. There is often gradual loss of function, which requires recognition and correction. Sudden events, such as stroke, amputation or trauma, may occur in an environment of diminished function and reserve. Rehabilitation measures must be directed toward prevention of dysmobility, correction of functional losses and provision for continuing aftercare.     

Geriatric depression

Depression in later life can present unique clinical and therapeutic challenges. Phenomenology is often atypical and the concurrence of physical illness can confound both diagnosis and treatment. A review of current knowledge about epidemiology, pathogenesis, clinical features, and therapeutic issues is presented.