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Ryan ML Thorson CM Otero CA Vu T Schulman CI Livingstone AS Proctor KG 《The journal of trauma and acute care surgery》2012,72(1):54-9; discussion 59-60
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Barthel ER Pierce JR Goodhue CJ Burke RV Ford HR Upperman JS 《The journal of trauma and acute care surgery》2012,73(4):885-889
ABSTRACT: Recent events including the 2001 terrorist attacks on New York; Hurricane Katrina; the 2010 Haitian and Chilean earthquakes; and the 2011 earthquake, tsunami, and nuclear disaster in Japan have reminded disaster planners and responders of the tremendous scale of mass casualty disasters and their resulting human devastation. Although adult disaster medicine is a well-developed field with roots in wartime medicine, we are increasingly recognizing that children may comprise up to 50% of disaster victims, and response mechanisms are often designed without adequate preparation for the number of pediatric victims that can result. In this short educational review, we explore the differences between the pediatric and adult disaster and trauma populations, the requirements for designation of a site as a pediatric trauma center (PTC), and the magnitude of the problem of pediatric disaster patients as described in the literature, specifically as it pertains to the availability and use of designated PTCs as opposed to trauma centers in general. We also review our own experience in planning and simulating pediatric mass casualty events and suggest strategies for preparedness when there is no PTC available. We aim to demonstrate from this brief survey that the availability of a designated PTC in the setting of a mass casualty disaster event is likely to significantly improve the outcome for the pediatric demographic of the affected population. We conclude that the relative scarcity of disaster data specific to children limits epidemiologic study of the pediatric disaster population and offer suggestions for strategies for future study of our hypothesis. LEVEL OF EVIDENCE: Systematic review, level III. 相似文献
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Millar T Lerpiniere C Walker R Smith C Bell JE 《British journal of nursing (Mark Allen Publishing)》2008,17(10):644-649
Previous research using human brain tissue has increased the understanding of many brain disorders, such as Alzheimer's disease and Creutzfeldt Jakob disease. However, there are other conditions, such as multiple sclerosis, which remain poorly understood and which require further investigation. The ongoing decline in the consented postmortem rate poses a threat to tissue collections and, consequently, future research. In the setting of the new Human Tissue legislation the authors set out to ascertain whether families recently and suddenly bereaved were willing to grant authorization for tissue samples and/or organs to be retained for research purposes at the time of medico-legal postmortem examination in adequate numbers to support the establishment of a brain and tissue bank. During the 2-year pilot phase of the project, 96% of families authorized retention of tissue samples for research and 17% agreed to whole brain donation. Respondents to a short questionnaire indicated that they were not further distressed by the approach and the majority were of the opinion that research donation should be offered to all bereaved families. This research concludes that the overwhelming majority of families who are recently and suddenly bereaved are willing to authorize research use of tissue taken at the time of postmortem examination. 相似文献
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Salim A Kim KA Kimbrell BJ Petrone P Roldán G Asensio JA 《Southern medical journal》2002,95(8):929-931
Klüver-Bucy syndrome (KBS) has been described as a disconnection of the temporal lobes from the remainder of the brain. Its presence in minor head trauma has not been previously reported. We therefore report what we believe to be the first case of KBS due to mild head trauma and unilateral injury to a temporal lobe. 相似文献
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《Journal of Orthopaedic Nursing》2000,4(3):127-129
In recent years the RCN Society of Orthopaedic Nursing has been asked by some of its members to consider including the word ‘trauma’ in its title, thus making it the Society of Orthopaedic and Trauma Nursing. Many members feel the time is right for this to be debated. It raises issues surrounding specialist practice and professional status and growth for the future. This article reflects the thoughts of one individual about several of the issues and draws some of the current evidence together. 相似文献
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Alessandro Protti Davide T Andreis Giacomo E Iapichino Massimo Monti Beatrice Comini Marta Milesi Loredana Zani Stefano Gatti Luciano Lombardi Luciano Gattinoni 《Critical care (London, England)》2013,17(4):R131
Introduction
Healthy piglets ventilated with no positive end-expiratory pressure (PEEP) and with tidal volume (VT) close to inspiratory capacity (IC) develop fatal pulmonary oedema within 36 h. In contrast, those ventilated with high PEEP and low VT, resulting in the same volume of gas inflated (close to IC), do not. If the real threat to the blood-gas barrier is lung overinflation, then a similar damage will occur with the two settings. If PEEP only hydrostatically counteracts fluid filtration, then its removal will lead to oedema formation, thus revealing the deleterious effects of overinflation.Methods
Following baseline lung computed tomography (CT), five healthy piglets were ventilated with high PEEP (volume of gas around 75% of IC) and low VT (25% of IC) for 36 h. PEEP was then suddenly zeroed and low VT was maintained for 18 h. Oedema was diagnosed if final lung weight (measured on a balance following autopsy) exceeded the initial one (CT).Results
Animals were ventilated with PEEP 18 ± 1 cmH2O (volume of gas 875 ± 178 ml, 89 ± 7% of IC) and VT 213 ± 10 ml (22 ± 5% of IC) for the first 36 h, and with no PEEP and VT 213 ± 10 ml for the last 18 h. On average, final lung weight was not higher, and actually it was even lower, than the initial one (284 ± 62 vs. 347 ± 36 g; P = 0.01).Conclusions
High PEEP (and low VT) do not merely impede fluid extravasation but rather preserve the integrity of the blood-gas barrier in healthy lungs. 相似文献17.
Paul Blankman Djo Hasan Groot Jebbink Erik Diederik Gommers 《Critical care (London, England)》2014,18(3):R95
Introduction
This study compares different parameters derived from electrical impedance tomography (EIT) data to define ‘best’ positive end-expiratory pressure (PEEP) during a decremental PEEP trial in mechanically-ventilated patients. ‘Best’ PEEP is regarded as minimal lung collapse and overdistention in order to prevent ventilator-induced lung injury.Methods
A decremental PEEP trial (from 15 to 0 cm H2O PEEP in 4 steps) was performed in 12 post-cardiac surgery patients on the ICU. At each PEEP step, EIT measurements were performed and from this data the following were calculated: tidal impedance variation (TIV), regional compliance, ventilation surface area (VSA), center of ventilation (COV), regional ventilation delay (RVD index), global inhomogeneity (GI index), and intratidal gas distribution. From the latter parameter we developed the ITV index as a new homogeneity parameter. The EIT parameters were compared with dynamic compliance and the PaO2/FiO2 ratio.Results
Dynamic compliance and the PaO2/FiO2 ratio had the highest value at 10 and 15 cm H2O PEEP, respectively. TIV, regional compliance and VSA had a maximum value at 5 cm H2O PEEP for the non-dependent lung region and a maximal value at 15 cm H2O PEEP for the dependent lung region. GI index showed the lowest value at 10 cm H2O PEEP, whereas for COV and the RVD index this was at 15 cm H2O PEEP. The intratidal gas distribution showed an equal contribution of both lung regions at a specific PEEP level in each patient.Conclusion
In post-cardiac surgery patients, the ITV index was comparable with dynamic compliance to indicate ‘best’ PEEP. The ITV index can visualize the PEEP level at which ventilation of the non-dependent region is diminished, indicating overdistention. Additional studies should test whether application of this specific PEEP level leads to better outcome and also confirm these results in patients with acute respiratory distress syndrome. 相似文献18.
Kerner T Ahlers O Spielmann S Keh D Bührer C Gerlach M Höfler S Gerlach H 《European journal of clinical investigation》1999,29(12):1077-1086
BACKGROUND: Systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) are important factors affecting morbidity and mortality after trauma. Adhesion molecules, e.g. L-selectin (CD62 L), play crucial roles in both conditions. PATIENTS AND METHODS: In 51 multiple trauma patients, CD62 L surface expression on granulocytes, monocytes, lymphocytes, as well as sCD62 L plasma concentrations were determined during the first 6 days after trauma, starting at the site of accident. Clinical parameters were severity of injury scores (ISS, APACHE II), requirement of red blood cell transfusion, acute lung or liver failure, development of MODS or SIRS, early (< or = 6 d) or late (> 6 d), and outcome. RESULTS: CD62 L expression was reversibly elevated on granulocytes, T cells and monocytes in comparison with initial values. sCD62 L plasma concentrations did not show temporal variations but were depressed throughout observation period, in comparison with healthy controls. Lung failure within the first 6 days was associated with increased CD62 L expression on monocytes and B cells on admission and increased sCD62 L concentrations after 12 and 24 h. Patients with more severe injuries (APACHE II > 20 points) had higher sCD62 L concentrations after 24 h. Non-survivors had decreased sCD62 L (on admission) and T-cell CD62 L expression (after 4 h). Patients with early MODS or SIRS showed increased monocyte CD62 L expression after 6 days. CONCLUSIONS: In multiple trauma patients, severe organ dysfunction is associated with altered CD62 L expression on leukocytes and circulating sCD62 L plasma concentrations. However, the obvious complexity of the pattern currently restricts use of CD62 L quantitation for clinical purposes. 相似文献
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A 48‐year‐old man presented with headaches and confusion. Imaging demonstrated a right frontal glioblastoma multiforme (GBM), twenty years after a nail gun injury to the same region. GBM in the same location as a previous injury points toward possible causation from the trauma in the development of a high‐grade glioma. 相似文献
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Purpose:?To describe, by use of a phenomenological approach, how relatively young trans-femoral amputees experienced their amputation and their coping strategies in the acute phase and over time.Method:?Eleven trans-femoral amputees, median age 33.5 years, were interviewed. The amputation was caused by tumour, motorcycle accidents or work-related traumas. Amputation was made in median 7.5 years before the interview. The informants were community dwelling and managed well indoors. One had a half disablement pension and all the others were working or studying full time. The interviews were tape-recorded and transcribed verbatim.Results:?Two themes emerged. In the first theme ‘Experiences of the amputation’ denial and avoidance were the coping strategies mainly used. In the second theme ‘Coping strategies to relate to a new norm’ the informants used downward comparison, positive comparison and repression. Only one informant indicated a full acceptance of his situation.Conclusion:?Relatively young, trans-femoral amputees within this sample, have not reached the acceptance level, though a long time has passed since the amputation. They might have benefited from professional support and guidance during the rehabilitation process in order to improve coping strategies to relate to a new norm. 相似文献