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Zhang Y, Jian F, Wang L, Chen H, Wu Z, Zhong S. Navigating the 'Triangle of Death': A Multidisciplinary Approach in Severe Multi-Trauma Management. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2024; 17:11795476241271544. [PMID: 39148708 PMCID: PMC11325324 DOI: 10.1177/11795476241271544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 06/26/2024] [Indexed: 08/17/2024]
Abstract
This case report details the challenging management of a 45-year-old male construction worker who suffered severe multiple injuries after a fall and subsequent collision with cement mixers. The patient presented with extensive injuries, including amputation, fractures and internal bleeding, leading to a state known as the 'triangle of death'. Despite the initial grim prognosis, evidenced by an ISS score of 28 and a mortality risk coefficient of 89.56%, the patient was successfully resuscitated and managed through a multidisciplinary approach. This included damage control resuscitation, emergency vascular interventions and targeted temperature management for brain protection. The patient's recovery highlights the effectiveness of comprehensive trauma management and the critical role of coordinated care in severe multi-trauma cases.
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Affiliation(s)
- Yushan Zhang
- Department of Intensive Care Medicine, Army Medical Center of PLA, Yuzhong District, Chongqing, China
| | - Fuxia Jian
- Department of Intensive Care Medicine, Army Medical Center of PLA, Yuzhong District, Chongqing, China
| | - Liang Wang
- Dermatology, Army Medical Center of PLA, Yuzhong District, Chongqing, China
| | - Hao Chen
- Department of Intensive Care Medicine, Army Medical Center of PLA, Yuzhong District, Chongqing, China
| | - Zhengbin Wu
- Department of Intensive Care Medicine, Army Medical Center of PLA, Yuzhong District, Chongqing, China
| | - Shili Zhong
- Department of Intensive Care Medicine, Army Medical Center of PLA, Yuzhong District, Chongqing, China
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2
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Caruhel JB, Haen P, Pavlychuk T, Kopchak A, Bertolus C, Khonsari RH. Facial surgeons and high-intensity conflict scenarios: Let us be ready to face the challenge. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101978. [PMID: 39047909 DOI: 10.1016/j.jormas.2024.101978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 07/20/2024] [Indexed: 07/27/2024]
Affiliation(s)
| | - Pierre Haen
- Maxillo-Facial Surgery Department, Laveran Military Hospital, Marseille, France
| | - Tetiana Pavlychuk
- Department of Maxillo-Facial Surgery and Innovative Dentistry, Bogomolets National Medical University, Kiev, Ukraine
| | - Andrii Kopchak
- Department of Maxillo-Facial Surgery and Innovative Dentistry, Bogomolets National Medical University, Kiev, Ukraine
| | - Chloé Bertolus
- Maxillo-Facial Surgery Department, Pitié-Salpêtrière Hospital, Paris, France
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Lurin I, Vorovskiy O, Makarov V, Khoroshun E, Nehoduiko V, Ryzhenko A, Chobey S, Gorobeiko M, Dinets A. Management of thoracoabdominal gunshot injuries by using minimally invasive surgery at role 2 deployed field hospitals in Ukraine. BMC Surg 2024; 24:183. [PMID: 38877409 PMCID: PMC11177506 DOI: 10.1186/s12893-024-02475-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 06/06/2024] [Indexed: 06/16/2024] Open
Abstract
The Russia-Ukraine war is associated with critical and severe thoracoabdominal injuries. A more specific approach to treating patients with thoracoabdominal injury should also include minimally invasive technologies. It remains unclear about the utility of using video-assisted thoracoscopic surgery (VATS) and laparoscopy in patients with thoracoabdominal injury. The aim of this study was to investigate and evaluate the utility of video-assisted thoracoscopic surgery, laparoscopy as well as magnetic tool applications for the management of severe thoracoabdominal injury in combat patients injured in the ongoing war in Ukraine and treated in the Role 2 deployed hospital. Patients and methods 36 male combat patients thoracoabdominal injury were identified for the study during the first 100 days from February, 24 2022. These individuals were diagnosed with thoracoabdominal GSW in the Role 2 hospital (i.e. deployed military hospital) of the Armed Forces of Ukraine. Video-assisted thoracoscopy surgery (VATS) and laparoscopy with application of surgical magnetic tools were applied with regards to the damage control resuscitation and damage control surgery. Results In 10 (28%) patients, VATS was applied to remove the metal foreign body fragments. Both thoracotomy and laparotomy were performed in 20 (56%) hemodynamically unstable patients. Of these 20 patients, the suturing of the liver was performed in 8 (22%) patients, whereas peri-hepatic gauze packing in 12 (33%) patients. Massive injury to the liver and PI 2.0-3.0 were diagnosed in 2 (6%) patients. Lethal outcome was in 1 (2.8%) patient. Conclusions Thoracoabdominal gunshot injuries might be managed at Role 2 hospitals by using video-assisted thoracoscopy (VATS) and laparoscopy accompanied by surgical magnetic tools. Damage control surgery and damage control resuscitation must be applied for patients in critical and severe conditions.
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Affiliation(s)
- Igor Lurin
- National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
- State Institution of Science "Research and Practical Center of Preventive and Clinical Medicine", State Administrative Department, Kyiv, Ukraine
| | - Oleh Vorovskiy
- National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | - Vitalii Makarov
- Department of Thoraco-Abdominal Surgery, Military Medical Teaching Center of the Northern Region of Ministry of Defense of Ukraine, Kharkiv, Ukraine
- Department of Surgery #4, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Eduard Khoroshun
- Department of Thoraco-Abdominal Surgery, Military Medical Teaching Center of the Northern Region of Ministry of Defense of Ukraine, Kharkiv, Ukraine
- Department of Surgery #4, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Volodymyr Nehoduiko
- Department of Thoraco-Abdominal Surgery, Military Medical Teaching Center of the Northern Region of Ministry of Defense of Ukraine, Kharkiv, Ukraine
- Department of Surgery #4, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Andrii Ryzhenko
- National Pirogov Memorial Medical University, Vinnytsya, Ukraine
- Military medical clinical center of the central region, Vinnytsya, Ukraine
| | - Stepan Chobey
- Department of Surgery, Uzhgorod National University, Uzhgorod, Ukraine
| | - Maksym Gorobeiko
- National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
- Department of Healthcare, Faculty of Postgraduate Education, Kyiv Agrarian University, Kyiv, Ukraine
- Department of Surgery, Lancet Clinic and Lab, Kyiv, Ukraine
| | - Andrii Dinets
- National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine.
- Department of Healthcare, Faculty of Postgraduate Education, Kyiv Agrarian University, Kyiv, Ukraine.
- Department of Surgery, Verum Expert Clinic, vul. Demiїvska 13, Kyiv, 03039, Ukraine.
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Li R, Han W, Lu J, Sun X, Tang T. The predictive value of four traumatic hemorrhage scores for early massive blood transfusion in trauma patients in the pre-hospital setting. Eur J Trauma Emerg Surg 2024; 50:967-973. [PMID: 38105275 DOI: 10.1007/s00068-023-02412-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/19/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES We aimed to explore the predictive value of four traumatic hemorrhage scores for early massive blood transfusion in trauma patients in the pre-hospital setting. METHODS Trauma patients admitted to Shenzhen University General Hospital from July 2018 to December 2022 were included in this study. They were divided into the massive transfusion group and the non-massive transfusion group according to the blood transfusion volume within 24 h. Basic information about patients was collected. Glasgow Coma Scale (GCS), focused assessment with sonography for trauma (FAST), and injury severity score (ISS) were performed. The receiving operating characteristic (ROC) curve was used to compare the predictive value of four trauma transfusion scores for early massive blood transfusion in the pre-hospital setting. RESULTS A total of 475 patients were enrolled, 43 received massive blood transfusions and 29 died within 24 h. The sensitivity and specificity of the four trauma hemorrhage scores in predicting the need for massive blood transfusions in trauma patients at their recommended cutoff points were all high. Among the four scores, the area under the ROC curve was larger for the assessment of blood consumption (ABC) score (0.864) and smaller for the trauma-induced coagulopathy clinical score (TICCS) score (0.795, p > 0.05). CONCLUSIONS All four pre-hospital trauma hemorrhage scores have a high predictive value in assessing massive blood transfusion in trauma patients.
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Affiliation(s)
- Rui Li
- Emergency Department, Shenzhen University General Hospital, Shenzhen, 518055, China
| | - Wei Han
- Emergency Department, Shenzhen University General Hospital, Shenzhen, 518055, China
| | - Jiafa Lu
- Emergency Department, Shenzhen University General Hospital, Shenzhen, 518055, China
| | - Xuedong Sun
- Emergency Department, Shenzhen University General Hospital, Shenzhen, 518055, China
| | - Tianhong Tang
- Department of Ultrasonography, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, 12 Langshan Road, Nanshan District, Shenzhen, 518057, Guangdong, China.
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Kwon MA, Ji SM. Revolutionizing trauma care: advancing coagulation management and damage control anesthesia. Anesth Pain Med (Seoul) 2024; 19:73-84. [PMID: 38725162 PMCID: PMC11089294 DOI: 10.17085/apm.24038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/15/2024] Open
Abstract
Despite advances in emergency transfer systems and trauma medicine, the incidence of preventable deaths due to massive hemorrhage remains high. Recent immunological research has elucidated key mechanisms underlying trauma-induced coagulopathy in the early stages of trauma, including sympathoadrenal stimulation, shedding of the glycocalyx, and endotheliopathy. Consequently, the condition progresses to fibrinogen depletion, hyperfibrinolysis, and platelet dysfunction. Coexisting factors such as uncorrected acidosis, hypothermia, excessive crystalloid administration, and a history of anticoagulant use exacerbate coagulopathy. This study introduces damage-control anesthetic management based on recent insights into damage-control resuscitation, emphasizing the importance of rapid transport, timely bleeding control, early administration of antifibrinolytics and fibrinogen concentrates, and maintenance of calcium levels and body temperature. Additionally, this study discusses brain-protective strategies for trauma patients with brain injuries and the utilization of cartridge-based viscoelastic assays for goal-directed coagulation management in trauma settings. This comprehensive approach may provide potential insights for anesthetic management in the fast-paced field of trauma medicine.
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Affiliation(s)
- Min A Kwon
- Department of Anesthesiology and Pain Medicine, Dankook University Hospital, Cheonan, Korea
| | - Sung Mi Ji
- Department of Anesthesiology and Pain Medicine, Dankook University Hospital, Cheonan, Korea
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Harada K, Kojima D, Yamana I, Seike H, Fujikawa T. Damage Control Surgery for Duodenal Ulcer Bleeding With Massive Hematoma and Perforation Due to Over-the-Scope Clip (OTSC). Cureus 2024; 16:e56359. [PMID: 38633969 PMCID: PMC11022004 DOI: 10.7759/cureus.56359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Due to the advances in endoscopic technology, surgery for duodenal ulcer (DU) bleeding has decreased, although surgery is still necessary for more complicated cases. The concept of damage control surgery (DCS) has been established in the field of trauma, and a simple surgical approach may be preferable in serious cases such as uncontrolled DU bleeding. We present a successful case of bleeding with massive hematoma and perforation of the duodenum due to an over-the-scope clip that was treated by a less invasive surgical approach with consideration of the DCS.
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Affiliation(s)
- Kei Harada
- Surgery, Kokura Memorial Hospital, Kitakyushu, JPN
| | - Daibo Kojima
- Surgery, Kokura Memorial Hospital, Kitakyushu, JPN
- Gastroenterological Surgery, Fukuoka University, Faculty of Medicine, Fukuoka, JPN
| | - Ippei Yamana
- Surgery, Kokura Memorial Hospital, Kitakyushu, JPN
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Ye H, He S, Du Y, Wang Y, Hu Y, Zhao C, Jin Y, Liu F, Guo Y. Involvement of CD44 and MAPK14-mediated ferroptosis in hemorrhagic shock. Apoptosis 2024; 29:154-168. [PMID: 37751106 DOI: 10.1007/s10495-023-01894-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2023] [Indexed: 09/27/2023]
Abstract
To elucidate the induction of ferroptotic pathways and the transcriptional modulation of pivotal genes in the context of hemorrhagic shock. The R software was used to analyze the GSE64711 dataset, isolating genes relevant to ferroptosis. Enrichment analyses and protein interaction networks were assembled. Using WGCNA hub genes were identified and intersected with ferroptosis-related genes, highlighting hub genes CD44 and MAPK14. In a rat hemorrhagic shock model, cardiac ROS, Fe2+, MDA, and GSH levels were assessed. Key ferroptotic proteins (SLC7A11/GPX4) in myocardial tissues were examined via western blot. Hub genes, CD44 and MAPK14, expressions were confirmed through immunohistochemistry. Analyzing the GSE64711 dataset revealed 337 differentially expressed genes, including 12 linked to ferroptosis. Enrichment analysis highlighted pathways closely related to ferroptosis. Using Genemania, we found these genes mainly affect ROS metabolism and oxidative stress response. WGCNA identified CD44 and MAPK14 as hub genes. Rat myocardial tissue validation showed significant cardiac damage and elevated ROS and MDA levels, and decreased GSH levels in the hemorrhagic shock model. The ferroptotic pathway SLC7A11/GPX4 was activated, and immunohistochemistry showed a significant increase in the expression levels of CD44 and MAPK14 in the hemorrhagic shock rat model. We demonstrated the presence of tissue ferroptosis in hemorrhagic shock by combining bioinformatics analysis with in vivo experimentation. Specifically, we observed the activation of the SLC7A11/GPX4 ferroptotic pathway. Further, CD44 and MAPK14 were identified as hub genes in hemorrhagic shock.
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Affiliation(s)
- Haoran Ye
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
- Beijing Institute of Chinese Medicine, Beijing, China
- Beijing Key Laboratory of Basic Research with Traditional Chinese Medicine on Infectious Diseases, Beijing, China
| | - Shasha He
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
- Beijing Institute of Chinese Medicine, Beijing, China
- Beijing Key Laboratory of Basic Research with Traditional Chinese Medicine on Infectious Diseases, Beijing, China
| | - Yuan Du
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Yuchen Wang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Yahui Hu
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Chunxia Zhao
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
- Beijing Institute of Chinese Medicine, Beijing, China
- Beijing Key Laboratory of Basic Research with Traditional Chinese Medicine on Infectious Diseases, Beijing, China
| | - Yueting Jin
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
- Beijing Institute of Chinese Medicine, Beijing, China
- Beijing Key Laboratory of Basic Research with Traditional Chinese Medicine on Infectious Diseases, Beijing, China
| | - Fangyu Liu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Yuhong Guo
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China.
- Beijing Institute of Chinese Medicine, Beijing, China.
- Beijing Key Laboratory of Basic Research with Traditional Chinese Medicine on Infectious Diseases, Beijing, China.
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Perrin JM, Monchal T, Texier G, Salou-Regis L, Goudard Y. Concordance of CT imaging and surgical lesions in penetrating abdominal trauma. J Visc Surg 2023; 160:407-416. [PMID: 37481414 DOI: 10.1016/j.jviscsurg.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
OBJECTIVE The management of penetrating abdominal wounds has greatly benefited from the development of computed tomography (CT), particularly in stable patients. In this setting, the scanner is the reference examination. Our study aims to evaluate the performance of preoperative CT in the assessment of penetrating abdominal lesions. MATERIAL AND METHODS Between January 1, 2015 and January 1, 2022, 81 patients were hospitalized following penetrating abdominal trauma at the Army Training Hospitals of Sainte-Anne and Laveran. Fifty-one stable patients who had an abdominopelvic CT scan and thereafter underwent abdominal surgery (laparotomy or laparoscopy) were included. Radiological and surgical data were collected from the electronic record and compared by a descriptive analysis (calculation of the sensitivity, specificity, positive and negative predictive value of the CT for the detection of lesions of the various organs) and by a correlation of the CT findings with surgical findings using Kripendorff's alpha coefficient. RESULTS The cohort was largely male (n=45; 88%), with injuries by knife wound in 62.7% of cases (n=32) and gunshot in 35.3% (n=18) of cases. The median age was 36years (25-47). The median index of severity score (ISS) was 17 (10-26). Excellent agreement between predicted and actual findings was obtained for solid organs (α=0.801) with high sensitivity and specificity (81.8% and 96.6%, respectively). The largest discrepancies were observed for the hollow organs (α=26.2%, sensitivity of 53.3% and specificity of 76.2%) and the diaphragm (α=67.3%, sensitivity 75%, specificity 92.3%). Surgical exploration was non-therapeutic for five patients (9.8%). The failure rate for non-operative treatment was 10% (n=1). CONCLUSION CT detection of solid organ lesions in patients with penetrating abdominal wounds is excellent. However, the detection of hollow organ and diaphragmatic wounds remains a challenge with a risk of over- and underdiagnosis. Laparoscopic exploration should be able to fill in the gaps in the CT findings.
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Affiliation(s)
- Jean-Mathieu Perrin
- Visceral Surgery Department, Military Teaching Hospital Laveran, Marseille, France.
| | - Tristan Monchal
- Visceral Surgery Department, Military Teaching Hospital Sainte-Anne, Toulon, France
| | - Gaëtan Texier
- Aix Marseille University, IRD, AP-HM, SSA, VITROME, IHU Méditerrannée Infection, Marseille, France; Centre d'épidémiologie et de Santé Publique des Armées (CESPA), Marseille, France
| | - Laure Salou-Regis
- Visceral Surgery Department, Military Teaching Hospital Laveran, Marseille, France
| | - Yvain Goudard
- Visceral Surgery Department, Military Teaching Hospital Laveran, Marseille, France
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Petitjean M, de La Villéon B, Lefort H, de Martène H, Caubère A. [Caregiving in an exceptional environment: the military operating theater nurse in a tropical zone]. REVUE DE L'INFIRMIERE 2023; 72:35-38. [PMID: 38071016 DOI: 10.1016/j.revinf.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The profession of operating theater nurse in the French Armed Forces Medical Corps is often little-known. Called upon to serve in mainland France, but also deployed on overseas operations, they provide medical and surgical support to the French armed forces. Personal qualities - human, physical and technical - are essential to adapt to the environmental constraints of this isolated post.
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Affiliation(s)
- Mélodie Petitjean
- Service du bloc opératoire, Hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83800 Toulon cedex 9, France
| | - Bruno de La Villéon
- Service de chirurgie viscérale, Hôpital d'instruction des armées Lavéran, 34, boulevard Lavéran, 13013 Marseille, France
| | - Hugues Lefort
- Service de médecine d'accueil et d'urgences, Hôpital d'instruction des armées Lavéran, 34, boulevard Lavéran, 13013 Marseille, France.
| | - Hugues de Martène
- Centre médico-chirurgical interarmées, Forces françaises stationnées à Djibouti, Base aérienne 188, Djibouti
| | - Alexandre Caubère
- Service de chirurgie orthopédique et traumatologie, Hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83800 Toulon cedex 9, France
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Martinet C, Gevaudan A, Antoine S, Scotti M, Lefort H. [Ballistic wound in the pre-hospital and emergency room: Damage Control Resuscitation]. REVUE DE L'INFIRMIERE 2023; 72:19-21. [PMID: 37952988 DOI: 10.1016/j.revinf.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Damage Control Resuscitation (DCR) is a strategy designed to prioritize hemostasis procedures, from the point of injury to surgical management, whether faced with an influx of bleeding casualties or a single casualty with severe hemodynamic instability. Widely disseminated, it provides clear objectives for prioritizing physiological restoration to the anatomy required for short-term survival. Initially applied to surgery, DCR has now been extended to the entire upstream care chain, including first aid and emergency medicine.
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Affiliation(s)
- Camille Martinet
- Hôpital d'instruction des armées Laveran, Structure des urgences, 34, boulevard Laveran, 13013 Marseille, France.
| | - Aurélie Gevaudan
- Hôpital d'instruction des armées Laveran, Structure des urgences, 34, boulevard Laveran, 13013 Marseille, France
| | - Sandrine Antoine
- Hôpital d'instruction des armées Laveran, Structure des urgences, 34, boulevard Laveran, 13013 Marseille, France
| | - Marina Scotti
- Hôpital d'instruction des armées Laveran, Structure des urgences, 34, boulevard Laveran, 13013 Marseille, France
| | - Hugues Lefort
- Hôpital d'instruction des armées Laveran, Structure des urgences, 34, boulevard Laveran, 13013 Marseille, France
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11
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Blanchard M, Ancellin M, Didelot M, Lefort H, Thomas-Pohl M. [Ballistic injury, decaying wounds: the nurse at the heart of the long rehabilitation process]. REVUE DE L'INFIRMIERE 2023; 72:29-31. [PMID: 37952991 DOI: 10.1016/j.revinf.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Ballistic injuries are disabling. Its functional impact is determined by its trajectory. Whether the injury affects a limb that could jeopardize its preservation, visceral lesions or craniocerebral and vertebro-medullary wounds, the nurse is at the heart of multidisciplinary care to limit and compensate for the after-effects. Directed healing, appropriate analgesia, settling in, technical training for this new, modified body (stoma, self-catheterization, appliances, etc.) and support in accepting the injury are all part of the nurse's role in helping the injured person rebuild his or her life.
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Affiliation(s)
- Mélody Blanchard
- Service de médecine physique et de réadaptation, Hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart cedex, France
| | - Marianne Ancellin
- Service de médecine physique et de réadaptation, Hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart cedex, France
| | - Maud Didelot
- Service de médecine physique et de réadaptation, Hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart cedex, France
| | - Hugues Lefort
- Structure des urgences, Hôpital d'instruction des armées Laveran, 34, boulevard Laveran, 13013 Marseille, France
| | - Marie Thomas-Pohl
- Service de médecine physique et de réadaptation, Hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart cedex, France.
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12
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Manet R, Joubert C, Balanca B, Taverna XJ, Monneuse O, David JS, Dagain A. Neuro damage control: current concept and civilian applications. Neurochirurgie 2023; 69:101505. [PMID: 37806039 DOI: 10.1016/j.neuchi.2023.101505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/26/2023] [Accepted: 09/26/2023] [Indexed: 10/10/2023]
Abstract
Damage control (DC) initially referred to abbreviated (<1 h) surgical procedures to control abdominal hemorrhage in severe trauma patients, to avoid the 'bloody vicious circle' of hypothermia-coagulopathy-acidosis-hypocalcemia. Progressively, the concept was extended to pre-hospital and peri-operative surgical and non-surgical trauma care. The DC strategy can be applied either in a single severe trauma patient at risk of progression toward the bloody vicious circle or in case of limited or overwhelmed health resources (deprived environment, mass casualties, etc.). DC strategies in neurological casualties have improved over the last decade in military neurosurgeons, but remain poorly codified in civilian settings. In this comprehensive review, we summarize the current concept of neuro-DC, which includes surgical and medical care for neurological injuries as part of a DC strategy. Neuro-DC basically consists in: (i) preventing secondary brain injury; (ii) controlling intracranial bleeding; (iii) controlling intracranial pressure; (iv) limiting contamination of compound wounds; and (v) achieving secondary anatomical restoration.
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Affiliation(s)
- Romain Manet
- Service de Neurochirurgie B, Hôpital Neurologique Wertheimer, Hospices Civils de Lyon, Lyon, France.
| | - Christophe Joubert
- Service de Neurochirurgie, Hôpital d'Instruction des Armées St Anne, Toulon, France
| | - Baptiste Balanca
- Service de Neuro-Réanimation, Hôpital Neurologique Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Xavier-Jean Taverna
- Service de Réanimation Chirurgicale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Olivier Monneuse
- Service de Chirurgie d'Urgence, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Jean-Stéphane David
- Service de Réanimation, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Arnaud Dagain
- Service de Neurochirurgie, Hôpital d'Instruction des Armées St Anne, Toulon, France
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Ye H, Du Y, Jin Y, Liu F, He S, Guo Y. Articles on hemorrhagic shock published between 2000 and 2021: A CiteSpace-Based bibliometric analysis. Heliyon 2023; 9:e18840. [PMID: 37636355 PMCID: PMC10450864 DOI: 10.1016/j.heliyon.2023.e18840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/29/2023] Open
Abstract
Objective To conduct a bibliometric analysis of literature on hemorrhagic shock published between 2000 and 2021 with the help of Citespace to explore the current status, hotspots and research trends in this regard, with the results presented in a visualized manner. Methods The data over the past 22 years were retrieved from the Web of Science (WOS) Core Collection database and downloaded as the "Full Record and Cited References". Cooperative analysis, cluster analysis, co-citation analysis, and burst analysis were performed based on the data on countries/regions, institutions, journals, authors, and keywords through Citespace. Results A total of 2027 articles were retrieved. The number of annual publications fluctuated but was generally on an upward trend. The United States stands out as the most productive country (989 articles), the University of Pittsburgh the most productive publishing institution (109 articles), SHOCK the most cited journal (1486 articles), TAO LI the most productive author (40 articles), DEITCH EA the most cited author (261 times of citation), hemorrhagic shock the most frequent keyword (725 times of occurrence), and "traumatic brain injury" the most covered article in keyword clustering (29 articles). The burst analysis revealed Harvard University as the institution with the highest strength value and the Journal of Trauma and Acute Care Surgery the most important journal. It was also concluded that HASAN B ALAM, AARON M WILLIAMS, and LIMIN ZHANG may continue to publish high-quality articles in the future. In the meanwhile, both "protect" and "transfusion" were considered the hotspots and trends in current research. Conclusions The United States has been a major contributor to the publication of the articles over the past 22 years, with the most productive publishing institution, the most cited journal, and the most cited author all coming from the US. Hemorrhagic shock, injury, resuscitation, trauma, models, activation, expression, fluid resuscitation, rats, and nitric oxide are hot topics in relevant research. According to the keyword burst analysis, the areas related to "protect" and "transfusion" may rise as the research directions in the future. However, since the hotspots in the research of hemorrhagic shock are short-lived and fast-changing, the researchers should pay more attention to the development trend in this field.
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Affiliation(s)
- Haoran Ye
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
- Beijing Institute of Traditional Chinese Medicine, Beijing, China
- Beijing Key Laboratory of Basic Research with Traditional Chinese Medicine on Infectious Diseases, Beijing, China
| | - Yuan Du
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Yueting Jin
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
- Beijing Institute of Traditional Chinese Medicine, Beijing, China
- Beijing Key Laboratory of Basic Research with Traditional Chinese Medicine on Infectious Diseases, Beijing, China
| | - Fangyu Liu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Shasha He
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
- Beijing Institute of Traditional Chinese Medicine, Beijing, China
- Beijing Key Laboratory of Basic Research with Traditional Chinese Medicine on Infectious Diseases, Beijing, China
| | - Yuhong Guo
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
- Beijing Institute of Traditional Chinese Medicine, Beijing, China
- Beijing Key Laboratory of Basic Research with Traditional Chinese Medicine on Infectious Diseases, Beijing, China
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Omar A, Winkelmann M, Liodakis E, Clausen JD, Graulich T, Omar M, Krettek C, Macke C. Applicability of Anatomic and Physiologic Scoring Systems for the Prediction of Outcome in Polytraumatized Patients with Blunt Aortic Injuries. Diagnostics (Basel) 2021; 11:diagnostics11112156. [PMID: 34829503 PMCID: PMC8617692 DOI: 10.3390/diagnostics11112156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Most patients with blunt aortic injuries, who arrive alive in a clinic, suffer from traumatic pseudoaneurysms. Due to modern treatments, the perioperative mortality has significantly decreased. Therefore, it is unclear how exact the prediction of commonly used scoring systems of the outcome is. Methods: We analyzed data on 65 polytraumatized patients with blunt aortic injuries. The following scores were calculated: injury severity score (ISS), new injury severity score (NISS), trauma and injury severity score (TRISS), revised trauma score coded (RTSc) and acute physiology and chronic health evaluation II (APACHE II). Subsequently, their predictive value was evaluated using Spearman´s and Kendall´s correlation analysis, logistic regression and receiver operating characteristics (ROC) curves. Results: A proportion of 83% of the patients suffered from a thoracic aortic rupture or rupture with concomitant aortic wall dissection (54/65). The overall mortality was 24.6% (16/65). The sensitivity and specificity were calculated as the area under the receiver operating curves (AUC): NISS 0.812, ISS 0.791, APACHE II 0.884, RTSc 0.679 and TRISS 0.761. Logistic regression showed a slightly higher specificity to anatomical scoring systems (ISS 0.959, NISS 0.980, TRISS 0.957, APACHE II 0.938). The sensitivity was highest in the APACHE II with 0.545. Sensitivity and specificity for the RTSc were not significant. Conclusion: The predictive abilities of all scoring systems were very limited. All scoring systems, except the RTSc, had a high specificity but a low sensitivity. In our study population, the RTSc was not applicable. The APACHE II was the most sensitive score for mortality. Anatomical scoring systems showed a positive correlation with the amount of transfused blood products.
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Affiliation(s)
- Alexander Omar
- Trauma Department, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (M.W.); (E.L.); (J.-D.C.); (T.G.); (M.O.); (C.K.)
- Bundeswehr Joint Medical Service, 26384 Wilhelmshaven, Germany
| | - Marcel Winkelmann
- Trauma Department, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (M.W.); (E.L.); (J.-D.C.); (T.G.); (M.O.); (C.K.)
| | - Emmanouil Liodakis
- Trauma Department, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (M.W.); (E.L.); (J.-D.C.); (T.G.); (M.O.); (C.K.)
| | - Jan-Dierk Clausen
- Trauma Department, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (M.W.); (E.L.); (J.-D.C.); (T.G.); (M.O.); (C.K.)
| | - Tilman Graulich
- Trauma Department, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (M.W.); (E.L.); (J.-D.C.); (T.G.); (M.O.); (C.K.)
| | - Mohamed Omar
- Trauma Department, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (M.W.); (E.L.); (J.-D.C.); (T.G.); (M.O.); (C.K.)
| | - Christian Krettek
- Trauma Department, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (M.W.); (E.L.); (J.-D.C.); (T.G.); (M.O.); (C.K.)
| | - Christian Macke
- Trauma Department, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (M.W.); (E.L.); (J.-D.C.); (T.G.); (M.O.); (C.K.)
- Correspondence:
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15
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Wei Z, Zhu J, Lin T, Cai H, Fang X, Zhu Y, Yang X, Cheng J. Application of damage control surgery in patients with sacrococcygeal deep decubitus ulcers complicated by sepsis. J Int Med Res 2021; 49:3000605211049876. [PMID: 34719986 PMCID: PMC8562640 DOI: 10.1177/03000605211049876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate the clinical application of damage control surgery (DCS) in patients with sacrococcygeal deep decubitus ulcers complicated by sepsis. Methods We conducted a 3-year retrospective clinical study of 32 patients with deep sacrococcygeal bedsores and sepsis admitted from January 2018 to January 2021. According to the concept of DCS, the wound was temporarily closed with vacuum sealing drainage after primary debridement, and a local rhomboid flap was designed to repair the wound in the second stage. Finally, the clinical therapeutic effect was observed. Results Twenty-nine patients were treated with skin flap translocation and were cured clinically. Specifically, the skin flap survived in 27 of the 29 patients after the first translocation attempt (success rate of 93.1%). One patient developed incisional dehiscence, and one patient developed a hydrocele under the skin flap. Conclusions Application of DCS in patients with sacrococcygeal deep decubitus ulcers complicated by sepsis improves the therapeutic success rate and reduces the risks of the operation and complication rate. It has unique advantages and is worthy of clinical promotion.
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Affiliation(s)
- Zhiyi Wei
- Department of Burn Intensive Care Unit, Quanzhou First Hospital, Quanzhou City, Fujian Province, P.R. China
| | - Jingfa Zhu
- Department of Emergency, Quanzhou First Hospital, Quanzhou City, Fujian Province, P.R. China
| | - Tianlai Lin
- Department of Intensive Care Unit, Quanzhou First Hospital, Quanzhou City, Fujian Province, P.R. China
| | - Hehui Cai
- Department of Medical Laboratory, Quanzhou First Hospital, Quanzhou City, Fujian Province, P.R. China
| | - Xiangjian Fang
- Department of Burn Intensive Care Unit, Quanzhou First Hospital, Quanzhou City, Fujian Province, P.R. China
| | - Yixin Zhu
- Department of Burn Intensive Care Unit, Quanzhou First Hospital, Quanzhou City, Fujian Province, P.R. China
| | - Xiaolan Yang
- Department of Burn Intensive Care Unit, Quanzhou First Hospital, Quanzhou City, Fujian Province, P.R. China
| | - Juntao Cheng
- Department of Burn Intensive Care Unit, Quanzhou First Hospital, Quanzhou City, Fujian Province, P.R. China
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Qiao J, Ray B, Wians F, Abadie J. Transfusion management of trauma from the 2019 El Paso mass shooting incident. Vox Sang 2021; 117:299-312. [PMID: 34558091 DOI: 10.1111/vox.13206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/31/2021] [Accepted: 09/06/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Mortality rates, transfusion ratios, trauma management logistics, and assault characteristics from the El Paso mass shooting incident (MSI) are evaluated in comparison to other MSIs. In 2019, El Paso, TX experienced the eighth-deadliest MSIs in modern US history. In this 21st mass killing in the United States of 2019, 19 people died immediately, and four of 27 injured, later died from ballistic injuries. MATERIALS AND METHODS We examined the victims' injuries, pre-hospital treatments, transfusions, rotational thromboelastometry (ROTEM) interpretation, tranexamic acid (TXA) use, and compared El Paso's outcomes with other MSIs. RESULTS Fifteen casualties were treated for bullet injuries at University Medical Center (UMC). Three were in critical condition; one died during surgery. Of the remaining victims, two were guarded, and the remaining ten in stable condition. Anatomic trauma locations included chest, abdomen, hip, breast, thigh and arm. Haemostatic agents and TXA were administered to arriving patients. Seven casualties receiving blood products were administered 95 units at UMC (45 red blood cells [RBC], 38 fresh frozen plasma [FFP], 8 platelets and 4 cryoprecipitate). ROTEM guided mass transfusion decisions in three patients. Out of seven MSIs reviewed, El Paso had the highest mortality rate (50.0%) and lowest RBC:FFP:admission ratio (1.18 at UMC). CONCLUSION We report the greatest proportion of transfusions per admission for an MSI and are first to discuss ROTEM roles to guide transfusion and manage coagulopathy during an MSI. This case highlights the severity and impact of MSIs on victims and requirements to follow established transfusion protocols with adjunct use of ROTEM, TXA and haemostatic agents.
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Affiliation(s)
- Jesse Qiao
- Department of Pathology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Bradford Ray
- Patient Blood Management and Research, University Medical Center, El Paso, TX, USA
| | - Frank Wians
- Department of Pathology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Jude Abadie
- Department of Pathology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
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17
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[Dealing with the bleeding patient, being effective with (almost) nothing]. REVUE DE L'INFIRMIÈRE 2021; 70:19-20. [PMID: 34446228 DOI: 10.1016/j.revinf.2021.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The practice of pre-hospital care, whether you are a professional rescuer, a nurse, a doctor or a simple citizen, sometimes exposes you to the management of a patient who presents an acute hemorrhage. The prognosis is quickly life-threatening if the safety, assessment, life-saving gestures and activation of the rescue chain are not carried out. A basic, inexpensive first aid kit can further reduce morbidity and mortality. Training first responders in life-saving techniques is a public health issue.
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18
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Choufani C, de Saint Roman C, Bianchin D, Tricoteaux G, Lefort H. [Bleeding management in the operating theatre]. REVUE DE L'INFIRMIÈRE 2021; 70:31-33. [PMID: 34446232 DOI: 10.1016/j.revinf.2021.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Despite all the measures taken preoperatively, bleeding may persist and require surgical control. Before considering treatment, it is necessary to establish the diagnosis with the origin of the bleeding. The surgical procedure depends on the aetiology. There are many surgical options and adjuvant measures to consider. They should be known by the operating theatre nurse, who is a major player in surgical management. Successful control of bleeding requires quality multidisciplinary collaboration.
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Affiliation(s)
- Camille Choufani
- Service de chirurgie orthopédique, hôpital d'instruction des armées Sainte-Anne, 2 boulevard Sainte-Anne, 83800 Toulon, France.
| | - Charlotte de Saint Roman
- Service de chirurgie viscérale, hôpital d'instruction des armées Legouest, rue des Frères-Lacretelle, 57070 Metz, France
| | - David Bianchin
- Service du bloc opératoire, centre hospitalier Édouard-Herriot, 5 place d'Arsonval, 69003 Lyon, France
| | - Gérald Tricoteaux
- Service du bloc opératoire, hôpital d'instruction des armées Legouest, rue des Frères-Lacretelle, 57070 Metz, France
| | - Hugues Lefort
- Structure des urgences, hôpital d'instruction des armées Legouest, rue des Frères-Lacretelle, 57000 Metz, France; Structure des urgences, hôpital d'instruction des armées Lavéran, 34 boulevard Lavéran, 13384 Marseille, France
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19
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Borowko R, Vignon PO, Lutz N, Maillot A, Lefort H. [The lethal triad of hemorrhage]. REVUE DE L'INFIRMIÈRE 2021; 70:16-18. [PMID: 34446227 DOI: 10.1016/j.revinf.2021.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Coagulopathy, acidosis and hypothermia form the lethal triad in trauma patients with acute hemorrhage. The prevention of this chain reaction relies on an adapted management from the first care in pre-hospital situation: rapid arrest of bleeding, fight against hypothermia, limited vascular filling with an early recourse to vasoactive amines. Pre-hospital transfusion is still rare, whereas in the hospital, an adapted transfusion strategy can wait for or support a surgical or radiological hemostasis procedure.
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Affiliation(s)
- Rachel Borowko
- Structure des urgences, hôpital d'instruction des armées Legouest, rue des Frères-Lacretelle, 57000 Metz, France
| | - Pierre-Olivier Vignon
- Structure des urgences, hôpital d'instruction des armées Legouest, rue des Frères-Lacretelle, 57000 Metz, France
| | - Noémie Lutz
- Structure des urgences, hôpital d'instruction des armées Legouest, rue des Frères-Lacretelle, 57000 Metz, France
| | - Aline Maillot
- Structure des urgences, hôpital d'instruction des armées Legouest, rue des Frères-Lacretelle, 57000 Metz, France
| | - Hugues Lefort
- Structure des urgences, hôpital d'instruction des armées Legouest, rue des Frères-Lacretelle, 57000 Metz, France; Structure des urgences, hôpital d'instruction des armées Lavéran, 34 boulevard Lavéran, 13384 Marseille, France.
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20
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Lutz N, Labrousse T, Borowko R, Lecurou A, Lefort H. [The ABC's of the tactical tourniquet]. REVUE DE L'INFIRMIERE 2021; 70:21-22. [PMID: 34446229 DOI: 10.1016/j.revinf.2021.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Uncontrolled bleeding is the leading cause of preventable death. After rapid diagnosis of the injury, early stoppage of the bleeding and maintenance of effective coagulation are, in the pre-hospital setting, the two mainstays of treatment of hemorrhagic shock. The latter requires a trained and experienced medical and paramedical team to prevent patient morbidity and mortality.
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Affiliation(s)
- Noémie Lutz
- Structure des urgences, hôpital d'instruction des armées Legouest, rue des Frères-Lacretelle, 57000 Metz, France
| | - Thomas Labrousse
- Structure des urgences, hôpital d'instruction des armées Legouest, rue des Frères-Lacretelle, 57000 Metz, France
| | - Rachel Borowko
- Structure des urgences, hôpital d'instruction des armées Legouest, rue des Frères-Lacretelle, 57000 Metz, France
| | - Aurélie Lecurou
- Structure des urgences, hôpital d'instruction des armées Legouest, rue des Frères-Lacretelle, 57000 Metz, France
| | - Hugues Lefort
- Structure des urgences, hôpital d'instruction des armées Legouest, rue des Frères-Lacretelle, 57000 Metz, France; Structure des urgences, hôpital d'instruction des armées Lavéran, 34 boulevard Lavéran, 13384 Marseille, France.
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21
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Abstract
Traumatic injury remains the leading cause of death among individuals younger than age 45 years. Hemorrhage is the primary preventable cause of death in trauma patients. Management of hemorrhage focuses on rapidly controlling bleeding and addressing the lethal triad of hypothermia, acidosis, and coagulopathy. The principles of damage control surgery are rapid control of hemorrhage, temporary control of contamination, resuscitation in the intensive care unit to restore normal physiology, and a planned, delayed definitive operative procedure. Damage control resuscitation focuses on 3 key components: fluid restriction, permissive hypotension, and fixed-ratio transfusion. Rapid recognition and control of hemorrhage and implementation of resuscitation strategies to control damage have significantly improved mortality and morbidity rates. In addition to describing the basic principles of damage control surgery and damage control resuscitation, this article explains specific management considerations for and potential complications in patients undergoing damage control interventions in an intensive care unit.
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Affiliation(s)
- Shannon Gaasch
- Shannon Gaasch is Senior Nurse Practitioner II, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201 (Shannon. )
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22
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de Lesquen H, Bergez M, Vuong A, Boufime-Jonqheere A, de l'Escalopier N. Adding the Capacity for an Intensive Care Unit Dedicated to COVID 19, Preserving the Operational Capability of a French Golden Hour Offset Surgical Team in Sahel. Mil Med 2020; 186:e30-e33. [PMID: 33169148 PMCID: PMC7717289 DOI: 10.1093/milmed/usaa273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/19/2020] [Accepted: 08/05/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction In April 2020, the military medical planning needs to be recalibrated to support the COVID-19 crisis during a large-scale combat operation carried out by the French army in Sahel. Material and Methods Since 2019, proper positioning of Forward Surgical Teams (FSTs) has been imperative in peer-to-near-peer conflict and led to the development of a far-forward surgical asset: The Golden Hour Offset Surgical Team (GHOST). Dedicated to damage control surgery close to combat, GHOST made the FST aero-mobile again, with a light logistical footprint and a fast setting. On 19 and 25 March 2020, Niger and Mali confirmed their first COVID-19 cases, respectively. The pandemic was ongoing in Sahel, where 5,100 French soldiers were deployed in the Barkhane Operation. Results For the first time, the FST had to provide, continuously, both COVID critical care and surgical support to the ongoing operation in Liptako. Its deployment on a Main Operating Base had to be rethought on Niamey, to face the COVID crisis and support ongoing operations. This far-forward surgical asset, embedded with a doctrinal Role-1, sat up a 4-bed COVID intensive care unit while maintaining a casualty surgical care capacity. A COVID training package has been developed to prepare the FST for this innovative employment. This far-forward surgical asset was designed to support a COVID-19 intensive care unit before evacuation, preserving forward surgical capability for battalion combat teams. Conclusion Far-forward surgical assets like GHOST have demonstrated their mobility and effectiveness in a casualty care system and could be adapted as critical care facilities to respond to the COVID crisis in wartime.
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Affiliation(s)
- Henri de Lesquen
- 4th Forward Surgical Team, French Military Health Service, France.,Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, 8300, Toulon, France
| | - Marie Bergez
- 4th Forward Surgical Team, French Military Health Service, France.,Département d'Anésthésie-Réanimation, Etablissement Hospitalier Civilo Militaire de Metz., 57070 Metz, France
| | - Antoine Vuong
- 183ème Antenne Medical de Mont de Marsan, 12ème Centre Médical des Armées de Bordeaux, 4000 Mont de Marsan, France
| | | | - Nicolas de l'Escalopier
- 4th Forward Surgical Team, French Military Health Service, France.,Department of Orthopedic, Traumatology and Reconstructive Surgery, PERCY Military Teaching Hospital, 92140, Clamart, France
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Cornero SG, Maegele M, Lefering R, Abbati C, Gupta S, Sammartano F, Cimbanassi S, Chiara O. Predictive Factors for Massive Transfusion in Trauma: A Novel Clinical Score from an Italian Trauma Center and German Trauma Registry. J Clin Med 2020; 9:jcm9103235. [PMID: 33050378 PMCID: PMC7601146 DOI: 10.3390/jcm9103235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/29/2020] [Accepted: 10/02/2020] [Indexed: 11/17/2022] Open
Abstract
Early management of critical bleeding and coagulopathy can improve patient survival. The aim of our study was to identify independent predictors of critical bleeding and to build a clinical score for early risk stratification. A prospective analysis was performed on a cohort of trauma patients with at least one hypotensive episode during pre-hospital (PH) care or in the Emergency Department (ED). Patients who received massive transfusion (MT+) (≥4 blood units during the first hour) were compared to those who did not (MT−). Hemodynamics, Glagow Coma Score (GCS), diagnostics and blood tests were evaluated. Using multivariate analysis, we created and validated a predictive score for MT+ patients. The predictive score was validated on a matched cohort of patients of the German Trauma Registry TR-DGU. One hundred thirty-nine patients were included. Independent predictors of MT+ included a prehospital (PH) GCS of 3, PH administration of tranexamic acid, hypotension and tachycardia upon admission, coagulopathy and injuries with significant bleeding such as limb amputation, hemoperitoneum, pelvic fracture, massive hemothorax. The derived predictive score revealed an area under the curve (AUC) of 0.854. Massive transfusion is essential to damage control resuscitation. Altered GCS, unstable hemodynamics, coagulopathy and bleeding injuries can allow early identification of patients at risk for critical hemorrhage.
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Affiliation(s)
- Sara Giulia Cornero
- Trauma Team and General Surgery ASST Niguarda Milano, Department of Pathophysiology and Transplantation, University of Milano, 20125 Milano, Italy; (S.G.C.); (C.A.); (F.S.); (S.C.)
| | - Marc Maegele
- Cologne-Merheim Medical Center, Department for Trauma and Orthopedic Surgery, Institute for Research in Operative Medicine, University Witten/Herdecke, 51109 Köln, Germany; (M.M.); (R.L.)
| | - Rolf Lefering
- Cologne-Merheim Medical Center, Department for Trauma and Orthopedic Surgery, Institute for Research in Operative Medicine, University Witten/Herdecke, 51109 Köln, Germany; (M.M.); (R.L.)
| | - Claudia Abbati
- Trauma Team and General Surgery ASST Niguarda Milano, Department of Pathophysiology and Transplantation, University of Milano, 20125 Milano, Italy; (S.G.C.); (C.A.); (F.S.); (S.C.)
| | - Shailvi Gupta
- R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD 21201, USA;
| | - Fabrizio Sammartano
- Trauma Team and General Surgery ASST Niguarda Milano, Department of Pathophysiology and Transplantation, University of Milano, 20125 Milano, Italy; (S.G.C.); (C.A.); (F.S.); (S.C.)
| | - Stefania Cimbanassi
- Trauma Team and General Surgery ASST Niguarda Milano, Department of Pathophysiology and Transplantation, University of Milano, 20125 Milano, Italy; (S.G.C.); (C.A.); (F.S.); (S.C.)
| | - Osvaldo Chiara
- Trauma Team and General Surgery ASST Niguarda Milano, Department of Pathophysiology and Transplantation, University of Milano, 20125 Milano, Italy; (S.G.C.); (C.A.); (F.S.); (S.C.)
- Correspondence:
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Ahmed O, Walsh TN. Surgical Trainee Experience with Open Cholecystectomy and the Dunning-Kruger Effect. JOURNAL OF SURGICAL EDUCATION 2020; 77:1076-1081. [PMID: 32362558 DOI: 10.1016/j.jsurg.2020.03.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/27/2020] [Accepted: 03/29/2020] [Indexed: 05/05/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy has become the standard approach to gallbladder surgery, but open cholecystectomy retains a role in complex cases. AIMS The aim of this study was to evaluate exposure of senior trainees in general surgery to open cholecystectomy and their experience and confidence in independent performance. METHODS General surgical trainees on a higher surgical training programme from surgical training years 5 (ST 5) to 8 (ST8) were invited to partake in an online anonymous survey. Data pertaining to case numbers, whether supervised or independently performed and level of comfort were collated and analyzed. RESULTS Twenty-six of 40 trainees responded (65%). Twenty-one (81%) had performed over 40 laparoscopic cholecystectomies with their trainer either scrubbed or un-scrubbed in theatre. As to open cholecystectomy experience, 12 trainees had assisted in 5 or fewer cases and only 3 assisted in over 20; 17 (65%) had performed 2 or fewer cases whilst assisted by their trainer while 24 of 26 trainees (92%) had no independent experience of open cholecystectomy. However, 16 felt they would be "somewhat comfortable" and 2 reported feeling "very comfortable" while only 8 reported they were "not comfortable" converting to open cholecystectomy. CONCLUSIONS This study confirms a steep decline in training opportunities in open cholecystectomy, but also raises concern about a Dunning-Kruger effect as, despite this lack of experience, the majority felt "somewhat comfortable" or "very comfortable" in converting to open surgery. Trainees need first to be familiar with safer alternatives to conversion. Surgical trainers need to consider the assessment of confidence as well as competence as an endpoint of trainee evaluation.
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Affiliation(s)
- Ola Ahmed
- Department of General and Upper Gastrointestinal Surgery, Connolly Hospital, Blanchardstown, Dublin, Ireland
| | - Thomas Noel Walsh
- Department of General and Upper Gastrointestinal Surgery, Connolly Hospital, Blanchardstown, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland.
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25
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Gupta AK, Edwards B, Vega JA. The Tumbling Bullet: Subacute Intestinal Obstruction due to a Retained Bullet. Cureus 2020; 12:e9844. [PMID: 32953351 PMCID: PMC7497767 DOI: 10.7759/cureus.9844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/18/2020] [Indexed: 12/19/2022] Open
Abstract
A 29-year-old female presented with multiple gunshot wounds to the back and bilateral lower extremities. The patient underwent an exploratory laparotomy with small-bowel resection of two segments with primary stapled anastomosis and partial nephrectomy. The postoperative course showed prolonged intermittent bowel obstruction secondary to the bullet, which lodged in the distal ileum. The patient eventually passed the bullet; it, however, led to a delay in recovery.
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Affiliation(s)
- Anupam K Gupta
- Minimally Invasive Surgery, University of Miami Hospital, Miami, USA
| | - Blake Edwards
- General Surgery, Boca Raton Regional Hospital, Florida Atlantic University, Boca Raton, USA
| | - Jorge A Vega
- Trauma and Acute Care Surgery, St. Mary's Medical Center, Florida Atlantic University, West Palm Beach, USA
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26
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Alexander LF, Hanna TN, LeGout JD, Roda MS, Cernigliaro JG, Mittal PK, Harri PA. Multidetector CT Findings in the Abdomen and Pelvis after Damage Control Surgery for Acute Traumatic Injuries. Radiographics 2020; 39:1183-1202. [PMID: 31283454 DOI: 10.1148/rg.2019180153] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
After experiencing blunt or penetrating trauma, patients in unstable condition who are more likely to die of uncorrected shock than of incomplete injury repairs undergo emergency limited exploratory laparotomy, which is also known as damage control surgery (DCS). This surgery is part of a series of resuscitation steps, with the goal of stabilizing the patient's condition, with rapid surgical control of hemorrhage followed by supportive measures in the intensive care unit before definitive repair of injuries. These patients often are imaged with multidetector CT within 24-48 hours of the initial surgery. Knowledge of this treatment plan is critical to CT interpretation, because there are anatomic derangements and foreign bodies that would not be present in patients undergoing surgery for other reasons. Patients may have injuries beyond the surgical field that are only identified at imaging, which can alter the care plan. Abnormalities related to the resuscitation period such as the CT hypoperfusion complex and ongoing hemorrhage can be recognized at CT. Familiarity with these imaging and clinical findings is important, because they can be seen not only in trauma patients after DCS but also in other patients in the critical care setting. The interpretation of imaging studies can be helped by an understanding of the diagnostic challenges of grading organ injuries with surgical materials in place and the awareness of potential artifacts on images in these patients. Online supplemental material is available for this article. ©RSNA, 2019 See discussion on this article by LeBedis .
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Affiliation(s)
- Lauren F Alexander
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (L.F.A., J.D.L., J.G.C.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.N.H., P.A.H.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (M.S.R.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.)
| | - Tarek N Hanna
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (L.F.A., J.D.L., J.G.C.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.N.H., P.A.H.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (M.S.R.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.)
| | - Jordan D LeGout
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (L.F.A., J.D.L., J.G.C.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.N.H., P.A.H.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (M.S.R.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.)
| | - Manohar S Roda
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (L.F.A., J.D.L., J.G.C.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.N.H., P.A.H.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (M.S.R.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.)
| | - Joseph G Cernigliaro
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (L.F.A., J.D.L., J.G.C.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.N.H., P.A.H.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (M.S.R.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.)
| | - Pardeep K Mittal
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (L.F.A., J.D.L., J.G.C.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.N.H., P.A.H.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (M.S.R.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.)
| | - Peter A Harri
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (L.F.A., J.D.L., J.G.C.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.N.H., P.A.H.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (M.S.R.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.)
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27
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Carvajal JA, Ramos I, Kusanovic JP, Escobar MF. Damage-control resuscitation in obstetrics. J Matern Fetal Neonatal Med 2020; 35:785-798. [PMID: 32102586 DOI: 10.1080/14767058.2020.1730800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Severe obstetric hemorrhage is a catastrophic event and represents the main cause of maternal morbidity and mortality worldwide. The elevated mortality rate due to hemorrhage is associated with metabolic complications and organ hypoperfusion that may trigger a state of irreversible coagulopathy. Thus, the use of conventional measures to control bleeding frequently generates a vicious cycle in which the patient continues bleeding (prolonging surgical times). Damage-control surgery has proven to be feasible and effective in the context of obstetric hemorrhage. It combines surgical and resuscitative measures that generate successful results in the control of refractory bleeding, ultimately decreasing mortality in patients being in critical condition.
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Affiliation(s)
- Javier A Carvajal
- High Complexity Obstetric Unit, Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cali, Colombia
| | - Isabella Ramos
- Faculty of Health Sciences, ICESI University, Cali, Colombia
| | - Juan P Kusanovic
- Center for Research and Innovation in Maternal-Fetal Medicine (CIMAF), Department of Obstetrics and Gynecology, Hospital Sótero del Río, Santiago, Chile.,Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - María F Escobar
- High Complexity Obstetric Unit, Department of Obstetrics and Gynecology, Fundación Valle del Lili, Cali, Colombia
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Derkenne C, Le Corfec T, Labrousse T, Lefort H, Prunet B. [Pre-hospital treatment of the seriously burned person]. REVUE DE L'INFIRMIERE 2019; 68:18-20. [PMID: 31870471 DOI: 10.1016/j.revinf.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Pre-hospital management of a severe burn begins with an early assessment of the burn (burned skin surface, depth, location) and the concerned patient (age, comorbidities, injury associations). The immediate vital prognosis is more often due to associated injuries (trauma or poisoning) rather than burns. The patient must be referred by medical regulation to a burn treatment centre.
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Affiliation(s)
- Clément Derkenne
- Service médical d'urgence, brigade de sapeurs-pompiers de Paris, 1 place Jules-Renard, 75017 Paris, France.
| | - Thibaut Le Corfec
- Service médical d'urgence, brigade de sapeurs-pompiers de Paris, 1 place Jules-Renard, 75017 Paris, France
| | - Thomas Labrousse
- Structure des urgences, hôpital d'instruction des armées Legouest, 27 avenue de Plantieres 57077 Metz, France
| | - Hugues Lefort
- Structure des urgences, hôpital d'instruction des armées Legouest, 27 avenue de Plantieres 57077 Metz, France
| | - Bertrand Prunet
- Service médical d'urgence, brigade de sapeurs-pompiers de Paris, 1 place Jules-Renard, 75017 Paris, France
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29
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Lozada MJ, Goyal V, Levin D, Walden RL, Osmundson SS, Pacheco LD, Malbrain MLNG. Management of peripartum intra-abdominal hypertension and abdominal compartment syndrome. Acta Obstet Gynecol Scand 2019; 98:1386-1397. [PMID: 31070780 PMCID: PMC7313226 DOI: 10.1111/aogs.13638] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 04/09/2019] [Accepted: 05/02/2019] [Indexed: 12/24/2022]
Abstract
Normal pregnancy leads to a state of chronically increased intra-abdominal pressure. Obstetric and non-obstetric conditions may increase intra-abdominal pressure further, causing intra-abdominal hypertension and abdominal compartment syndrome, which leads to maternal organ dysfunction and a compromised fetal state. Limited medical literature exists to guide treatment of pregnant women with these conditions. In this state-of-the-art review, we propose a diagnostic and treatment algorithm for the management of peripartum intra-abdominal hypertension and abdominal compartment syndrome, informed by newly available studies.
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Affiliation(s)
- M. James Lozada
- Division of Obstetric Anesthesiology, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Varun Goyal
- Department of Anesthesiology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Danielle Levin
- Department of Anesthesiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Sarah S. Osmundson
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Luis D. Pacheco
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Manu L. N. G. Malbrain
- Intensive Care Unit, University Hospital Brussels, Jette, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
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Malgras B, Aoun O, Pauleau G, Boddaert G, Hornez E, Dulou R, Delmas JM, Haen P, Laversanne S, Crambert A, Balandraud P. Deployment of the Surgical Life-saving Module (SLM) in 2017: Lessons learned in setting up and training operational surgical units. Injury 2019; 50:1133-1137. [PMID: 30851979 DOI: 10.1016/j.injury.2019.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/13/2019] [Accepted: 03/02/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The military operations carried out by the French armed forces, occasionally require the use of the Surgical Life-saving Module (SLM), to ensure the surgical support of its soldiers. Due to its extreme mobility and capacity of fast deployment, SLM is particularly useful in small-scale military operations, such as Special Forces missions. In 2017, the French SLM was for the first time used to ensure surgical support of allied forces, which were lacking forward surgical capabilities. MATERIALS AND METHODS the SLM is a mobile, heliborne, airborne, surgical structure with parachuting capability onto land or sea, therefore essentially focused on life-saving procedures, also known as "damage control" surgery. Due to the need for mobility and rapid implementation, the SLM is limited to a maximum of 5 interventions or, in terms of injuries, to 1 or 2 seriously injured patients. RESULTS Over a period of 2 months, 5 medical teams were successively deployed with the SLM. A total of 157 casualties were treated. The most common injuries were caused by shrapnel 561%), followed by firearms (36%), and blunt trauma (2.5%). Injuries included the limbs (56%), thorax (18%), abdomen (13%), head (11%), and neck (2%). The average ISS was 8.5 (1-25) with 26 patients presenting with an ISS greater than or equal to 15. The average NISS was 10.8 (1-75) with 34 casualties having an NISS equal to or greater than 15. The surgical procedures were broken down as follows: 126 dressings, 16 laparotomies, 7 thoracotomies, 12 isolated thoracic drains (without thoracotomy), 1 cervicotomy, 12 amputations, 7 limb splints, 2 limb fasciotomies, 2 external fixators and 1 femoral fracture traction. CONCLUSIONS The numerous SLM deployments in larger operations highlighted its ability to adapt both in terms of equipment and personnel. Continuous management of equipment logistics, robust personnel training, and appropriate organization of the evacuation procedures, were the key elements for optimizing combat casualty care. As a consequence, the SLM appears to be an operational surgical unit of choice during deployments.
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Affiliation(s)
- Brice Malgras
- Department of Digestive Surgery, Begin Military Teaching Hospital, Saint Mandé, France.
| | - Olivier Aoun
- 5th Armed Forces Medical Center, Strasbourg, France
| | - Ghislain Pauleau
- Department of Gastrointestinal Surgery, Laveran Military Teaching Hospital, Marseille, France
| | - Guillaume Boddaert
- Department of Gastrointestinal, Thoracic and Vascular Surgery, Percy Military Teaching Hospital, Clamart, France
| | - Emmanuel Hornez
- Department of Gastrointestinal, Thoracic and Vascular Surgery, Percy Military Teaching Hospital, Clamart, France
| | - Renaud Dulou
- Department of Neurosurgery, Percy Military Teaching Hospital, Clamart, France
| | - Jean-Marc Delmas
- Department of Neurosurgery, Percy Military Teaching Hospital, Clamart, France
| | - Pierre Haen
- Departmet of Maxillofacial Surgery, Laveran Military Teaching Hospital, Marseille, France
| | - Sophie Laversanne
- Departmet of Maxillofacial Surgery, Laveran Military Teaching Hospital, Marseille, France
| | - Anna Crambert
- Department of Otorhinolaryngology, Percy Military Teaching Hospital, Clamart, France
| | - Paul Balandraud
- Department of Gastrointestinal Surgery, Saint-Anne Military Teaching Hospital, Toulon, France
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31
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González Posada MA, Biarnés Suñe A, Naya Sieiro JM, Salvadores de Arzuaga CI, Colomina Soler MJ. Damage Control Resuscitation in polytrauma patient. ACTA ACUST UNITED AC 2019; 66:394-404. [PMID: 31031044 DOI: 10.1016/j.redar.2019.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/13/2019] [Accepted: 03/18/2019] [Indexed: 11/30/2022]
Abstract
Haemorrhagic shock is one of the main causes of mortality in severe polytrauma patients. To increase the survival rates, a combined strategy of treatment known as Damage Control has been developed. The aims of this article are to analyse the actual concept of Damage Control Resuscitation and its three treatment levels, describe the best transfusion strategy, and approach the acute coagulopathy of the traumatic patient as an entity. The potential changes of this therapeutic strategy over the coming years are also described.
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Affiliation(s)
- M A González Posada
- Servicio de Anestesiología y Reanimación, Hospital Universitario Vall d'Hebron, Barcelona, España; Universidad Autónoma de Barcelona, Barcelona, España.
| | - A Biarnés Suñe
- Servicio de Anestesiología y Reanimación, Hospital Universitario Vall d'Hebron, Barcelona, España; Universidad Autónoma de Barcelona, Barcelona, España
| | - J M Naya Sieiro
- Servicio de Anestesiología y Reanimación, Hospital Universitario Vall d'Hebron, Barcelona, España
| | | | - M J Colomina Soler
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Bellvitge, l'Hospitalet de Llobregat, Barcelona, España; Universidad Barcelona, Barcelona, España
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Cesareo E, Raux M, Soulat L, Huot-Marchand F, Voiglio E, Puidupin A, Claret PG, Desclef JP, Douay B, Duchenne J, Gloaguen A, Lefort H, Rerbal D, Zanker C, Cook F, Pelée de Saint Maurice G, Lachenaud L, Gabilly L, Prieto N, Levraut J, Gueugniaud PY. Recommandations de bonne pratique clinique concernant la prise en charge médicale des victimes d’une « tuerie de masse ». ANNALES FRANCAISES DE MEDECINE D URGENCE 2018. [DOI: 10.3166/afmu-2018-0103] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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The evolution and impact of the "damage control orthopedics" paradigm in combat surgery: a review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:501-508. [PMID: 30317470 DOI: 10.1007/s00590-018-2320-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/07/2018] [Indexed: 12/16/2022]
Abstract
The idea of damage control (DC) is grounded on a sequential therapeutic strategy that supports physiological restoration over anatomic repair in critically injured patients. This concept is firstly described as damage control surgery (DCS) for war-wounded patients with abdominal exsanguinating trauma. The goal was to avoid prolonged operative times and prevent the outset of the lethal cycle of hypothermia, acidosis and coagulopathy. Damage control orthopedics (DCO) is also based on this concept and it is applied in the treatment of some polytrauma patients with pelvic and long bones fractures as to avoid the "second hit" of a lengthy definitive operation and eliminate initial morbidity and mortality. It is in favor of primary fracture stabilization utilizing provisional external fixation. When the patient is in stable condition, conversion to definitive open reduction and intramedullary nailing can be done. This stepwise approach should be considered as a part of the resuscitation process, and it follows the saying "do no further harm".
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Hugenschmitt D, Cesareo É, Claret PG, Lefort H. [Not Available]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2018; 63:59-61. [PMID: 30366707 DOI: 10.1016/j.soin.2018.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Delphine Hugenschmitt
- Samu-Smur 69, CHU Édouard-Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France
| | - Éric Cesareo
- Pôle anesthésie-réanimation douleur urgences, CHU de Nîmes, F-30000 Nîmes, France
| | - Pierre-Géraud Claret
- Structure des urgences, Hôpital d'instruction des armées Legouest, 27, avenue de Plantières, 57000 Metz, France
| | - Hugues Lefort
- Structure des urgences, Hôpital d'instruction des armées Legouest, 27, avenue de Plantières, 57000 Metz, France.
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Nacimento M, Mounier C, Masson Y, Donat N, Lefort H. [Not Available]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2018; 63:59-61. [PMID: 30213321 DOI: 10.1016/j.soin.2018.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Mélanie Nacimento
- Centre de traitement des brûlés, Hôpital Percy, 1, rue du Lieutenant-Batany, 92140 Clamart, France.
| | - Charlen Mounier
- Centre de traitement des brûlés, Hôpital Percy, 1, rue du Lieutenant-Batany, 92140 Clamart, France
| | - Yannick Masson
- Centre de traitement des brûlés, Hôpital Percy, 1, rue du Lieutenant-Batany, 92140 Clamart, France
| | - Nicolas Donat
- Centre de traitement des brûlés, Hôpital Percy, 1, rue du Lieutenant-Batany, 92140 Clamart, France
| | - Hugues Lefort
- Structure des urgences, hôpital d'instruction des armées Legouest, 27, rue Plantière, 57000 Metz, France
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