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《Medical Journal Armed Forces India》2017,73(4):407-409
Traditionally injury care meant definitive repair following surgical exploration. However the outcome is poor because of deranged physiology in severely injured. Damage control surgery (DCS) is abbreviated initial procedure with subsequent correction of physiological imbalance, followed by definite repair.Tactical abbreviated surgical control (TASC) is application of principles of DCS techniques in the tactical environment. TASC is applied because of patient related factors (classic damage control) and limitations due to tactical reasons. Non-patient related factors only seen in tactical setting are, large numbers of patients arriving in short span, mobility of forward medical units, limitation of resources, and hostile environment. TASC involves only phase one of classical DCS. Complete correction of physiological imbalances and definitive surgery is carried out at a better equipped static hospital. TASC has shown to improve survival, extends benefit to greater number and helps to conserve precious resources. However TASC has its own limitations. 相似文献
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《Injury》2017,48(1):158-164
BackgroundIntra-abdominal packing with laparotomy pads (LP) is a common and rapid method for hemorrhage control in critically injured patients. Combat Gauze™ and Trauma Pads™ ([QC] Z-Medica QuikClot®) are kaolin impregnated hemostatic agents, that in addition to LP, may improve hemorrhage control. While QC packing has been effective in a swine liver injury model, QC remains unstudied for human intra-abdominal use. We hypothesized QC packing during damage control laparotomy (DCL) better controls hemorrhage than standard packing and is safe for intracorporeal use.MethodsA retrospective review (2011–2014) at a Level-I Trauma Center reviewed all patients who underwent DCL with intentionally retained packing. Clinical characteristics, intraoperative and postoperative parameters, and outcomes were compared with respect to packing (LP vs. LP + QC). All complications occurring within the patients’ hospital stays were reviewed. A p ≤ 0.05 was considered significant.Results68 patients underwent DCL with packing; (LP n = 40; LP + QC n = 28). No difference in age, BMI, injury mechanism, ISS, or GCS was detected (Table 1, all p > 0.05). LP + QC patients had a lower systolic blood pressure upon ED presentation and greater blood loss during index laparotomy than LP patients. LP + QC patients received more packed red blood cell and fresh frozen plasma resuscitation during index laparotomy (both p < 0.05). Despite greater physiologic derangement in the LP + QC group, there was no difference in total blood products required after index laparotomy until abdominal closure (LP vs LP + QC; p > 0.05). After a median of 2 days until abdominal closure in both groups, no difference in complications rates attributable to intra-abdominal packing (LP vs LP + QC) was detected.ConclusionWhile the addition of QC to LP packing did not confer additional benefit to standard packing, there was no additional morbidity identified with its use. The surgeons at our institution now select augmented packing with QC for sicker patients, as we believe this may have additional advantage over standard LP packing. A randomized controlled trial is warranted to further evaluate the intra-abdominal use of advanced hemostatic agents, like QC, for both hemostasis and associated morbidity. 相似文献
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Sung H. Yang Josh Gustafson Matt Gangidine David Stepien Rebecca Schuster Timothy A. Pritts Michael D. Goodman Daniel G. Remick Alex B. Lentsch 《The Journal of surgical research》2013
Background
Mild traumatic brain injury (TBI) is a serious public health concern affecting more than 1.7 million people in the United States annually. Mild TBI is difficult to diagnose and is clinically associated with impaired motor coordination and cognition.Methods
We subjected mice to a mild TBI (mTBI-1 or mTBI-2) induced by a weight drop model. We assessed brain injury histologically and biochemically, the latter by serum neuron-specific enolase and glial fibrillary acidic protein. Systemic and brain inflammation were measured by cytokine array. We determined blood–brain barrier integrity by cerebral vascular leakage of micromolecular and macromolecular fluorescent molecules. We evaluated mice using a rotarod device and novel object recognition to measure motor coordination and cognition, respectively.Results
Mice undergoing mTBI-1 or mTBI-2 had significant deficits in motor coordination and cognition for several days after injury compared with controls. Furthermore, both mTBI-1 and mTBI-2 caused micromolecular leakage in the blood–brain barrier, whereas only mTBI-2 caused macromolecular leakage. Serum neuron-specific enolase and glial fibrillary acidic protein were elevated acutely and corresponded to the degree of injury, but returned to baseline within 24 h. Serum cytokines interleukin-6 and keratinocyte-derived chemokine were significantly increased within 90 min of TBI. Interleukin-6 levels correlated with the degree of injury.Conclusions
The current study provides a reproducible model of mild TBI in mice that exhibits pathologic features of mild TBI in humans. Furthermore, our data suggest that serum cytokines, such as IL-6, may be effective biomarkers for severity of head injury. 相似文献9.
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Laurent Mathieu Naklan Ouattara Antoine Poichotte Erwan Saint-Macari Olivier Barbier Fréderic Rongiéras Sylvain Rigal 《International orthopaedics》2014,38(8):1569-1576