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1.
World J Emerg Surg ; 15(1): 33, 2020 05 15.
Artículo en Inglés | MEDLINE | ID: mdl-32414390

RESUMEN

BACKGROUND: A novel coronavirus pneumonia outbreak began in Wuhan, Hubei Province, in December 2019; the outbreak was caused by a novel coronavirus previously never observed in humans. China has imposed the strictest quarantine and closed management measures in history to control the spread of the disease. However, a high level of evidence to support the surgical management of potential trauma patients during the novel coronavirus outbreak is still lacking. To regulate the emergency treatment of trauma patients during the outbreak, we drafted this paper from a trauma surgeon perspective according to practical experience in Wuhan. MAIN BODY: The article illustrates the general principles for the triage and evaluation of trauma patients during the outbreak of COVID-19, indications for emergency surgery, and infection prevention and control for medical personnel, providing a practical algorithm for trauma care providers during the outbreak period. CONCLUSIONS: The measures of emergency trauma care that we have provided can protect the medical personnel involved in emergency care and ensure the timeliness of effective interventions during the outbreak of COVID-19.


Asunto(s)
Infecciones por Coronavirus , Transmisión de Enfermedad Infecciosa/prevención & control , Control de Infecciones/normas , Pandemias , Neumonía Viral , Heridas y Traumatismos/diagnóstico , Heridas y Traumatismos/terapia , Algoritmos , Anestesia/normas , China , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Urgencias Médicas , Unidades Hospitalarias/normas , Humanos , Pandemias/prevención & control , Atención Perioperativa/normas , Equipo de Protección Personal/normas , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , Procedimientos Quirúrgicos Operativos/normas , Tomografía Computarizada por Rayos X/normas , Triaje/normas
2.
Br J Anaesth ; 124(5): 571-578, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32307033

RESUMEN

BACKGROUND: Pre-hospital emergency anaesthesia (PHEA) is frequently required for injured patients. National Institute for Health and Care Excellence (NICE) quality standards state that PHEA should be delivered within 45 min of an emergency call. We investigated whether there is geo-temporal variation in service provision to the UK population. METHODS: We retrospectivly audited the time of day when PHEA is provided by UK Helicopter Emergency Medical Services (HEMS), by recording PHEA provision on a randomly selected week and weekend day in 2018. Pre-hospital emergency anaesthesia in the United Kingdom: an observational cohort study retrospectively assessed the time from emergency call to pre-hospital emergency anaesthesia delivery by HEMS during a 1 yr period from April 2017 to March 2018. The population coverage likely to receive pre-hospital emergency anaesthesia in accord with NICE guidelines was estimated by integrating population data with the median time to PHEA, hours of service provision, geographic location, and transport modality. RESULTS: On a weekday 20 HEMS units (comprising from four to 31 enhanced care teams) were estimated to be able to meet NICE guidelines for delivery of PHEA to a poulation of 6.6-35.2 million individuals (at times of minimum and maximal staffing, respectively). At the weekend, 17 HEMS units (comprising from 5 to 28 enhanced care teams) were estimated to be able to meet NICE guidelines for PHEA deliveryto a population of 6.8-34.1 million individuals (minimum and maximal staffing, respectively). CONCLUSIONS: There is marked geo-temporal variation in the ability of HEMS organisations to deliver pre-hospital emergency anaesthesia in the UK.


Asunto(s)
Ambulancias Aéreas , Anestesia/estadística & datos numéricos , Prestación de Atención de Salud/estadística & datos numéricos , Servicios Médicos de Urgencia/estadística & datos numéricos , Atención Posterior/normas , Atención Posterior/estadística & datos numéricos , Anestesia/normas , Estudios de Cohortes , Prestación de Atención de Salud/normas , Urgencias Médicas , Servicios Médicos de Urgencia/normas , Mapeo Geográfico , Humanos , Auditoría Médica/métodos , Estudios Retrospectivos , Factores de Tiempo , Transporte de Pacientes/estadística & datos numéricos , Reino Unido , Heridas y Traumatismos/terapia
3.
Emerg Med Clin North Am ; 38(2): 383-400, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32336332

RESUMEN

More than half of pediatric malpractice cases arise from emergency departments, primarily due to missed or delayed diagnoses. All providers who take care of children in emergency departments should be aware of this risk and the most common diagnoses associated with medicolegal liability. This article focuses on diagnosis and management of high-risk diagnoses in pediatric patients presenting to emergency departments, including meningitis, pneumonia, appendicitis, testicular torsion, and fracture. It highlights challenges and pitfalls that may increase risk of liability. It concludes with a discussion on recognition and management of abuse in children, including when to report and decisions on disposition.


Asunto(s)
Urgencias Médicas , Mala Praxis , Gestión de Riesgos , Adolescente , Factores de Edad , Apendicitis/diagnóstico , Apendicitis/terapia , Niño , Maltrato a los Niños/diagnóstico , Maltrato a los Niños/terapia , Preescolar , Medicina de Emergencia/legislación & jurisprudencia , Medicina de Emergencia/métodos , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Meningitis/diagnóstico , Meningitis/terapia , Neumonía/diagnóstico , Neumonía/terapia , Torsión del Cordón Espermático/diagnóstico , Torsión del Cordón Espermático/terapia , Heridas y Traumatismos/diagnóstico , Heridas y Traumatismos/terapia
5.
Rev Fac Cien Med Univ Nac Cordoba ; 77(1): 10-14, 2020 03 12.
Artículo en Español | MEDLINE | ID: mdl-32238252

RESUMEN

Introduction: Presidential medical units are intended to protect the dignitary's health in multiple aspects and work in close relationship with security. There are three central areas of coverage: myocardial infarction, stroke and trauma. By 2016 we had not found information about the resources on medical centers in Argentina and their integration into healthcare networks. Objective: Describe the relevant medical centers and their available resources for the medical coverage areas mentioned. Methods: It is a descriptive, cross-sectional study between 12/2016 and 8/2019. The sampling was not probabilistic and for convenience. Variables were reported as proportions and comparisons were made using the chi-square test or Fischer. Results: 232 centers were entered, 66.8% in capital cities and 67% in the public sector. Capitals were associated with a greater presence of resources: category 3 centers (OR 7.85; 95% CI 3.66-16.84; p <0.000001), angiography (OR 5.94; 95% CI 3.24-10.28; p <0.000001 ), tomography (OR 3.41; 95% CI 1.51-7.69; p=0.002), thrombolytics (OR 3.24; 95% CI 1.37-7.76; p=0.005); except trauma surgery (OR 1.83; 95% CI 0.75-4.46; p=0.17). Private centers were associated with greater resources for reperfusion; and public centers for trauma treatment. Conclusions: There is an unbalanced distribution of key resources between capital and non-capital cities in large geographical areas that makes it impossible to develop an adequate network for the treatment of heart attack, stroke and trauma. The best quality of care requires combining public and private networks.


Asunto(s)
Infarto Cerebral/terapia , Instituciones de Salud/estadística & datos numéricos , Infarto del Miocardio/terapia , Asignación de Recursos/estadística & datos numéricos , Heridas y Traumatismos/terapia , Argentina , Estudios Transversales , Geografía , Encuestas de Atención de la Salud , Humanos , Sector Privado , Estudios Prospectivos , Sector Público
6.
PLoS One ; 15(3): e0226452, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32196498

RESUMEN

OBJECTIVE: Primary motor (M1) cortical excitability alterations are involved in the development and maintenance of chronic pain. Less is known about M1-cortical excitability implications in the acute phase of an orthopedic trauma. This study aims to assess acute M1-cortical excitability in patients with an isolated upper limb fracture (IULF) in relation to pain intensity. METHODS: Eighty-four (56 IULF patients <14 days post-trauma and 28 healthy controls). IULF patients were divided into two subgroups according to pain intensity (mild versus moderate to severe pain). A single transcranial magnetic stimulation (TMS) session was performed over M1 to compare groups on resting motor threshold (rMT), short-intracortical inhibition (SICI), intracortical facilitation (ICF), and long-interval cortical inhibition (LICI). RESULTS: Reduced SICI and ICF were found in IULF patients with moderate to severe pain, whereas mild pain was not associated with M1 alterations. Age, sex, and time since the accident had no influence on TMS measures. DISCUSSION: These findings show altered M1 in the context of acute moderate to severe pain, suggesting early signs of altered GABAergic inhibitory and glutamatergic facilitatory activities.


Asunto(s)
Dolor Agudo , Excitabilidad Cortical , Corteza Motora/fisiopatología , Inhibición Neural , Estimulación Magnética Transcraneal , Heridas y Traumatismos , Dolor Agudo/fisiopatología , Dolor Agudo/terapia , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Heridas y Traumatismos/fisiopatología , Heridas y Traumatismos/terapia
7.
Br J Anaesth ; 124(5): 579-584, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32200992

RESUMEN

BACKGROUND: Up to one in eight trauma patients arrive at a hospital with a partially or completely obstructed airway. The UK National Institute for health and Care Excellence (NICE) practice guidelines recommend that trauma patients requiring anaesthesia for definitive airway management receive this care within 45 min of an emergency call, preferably at the incident scene. How frequently this target is achieved remains unclear. We assessed the recorded time to pre-hospital emergency anaesthesia after trauma across UK helicopter emergency medical service (HEMS) units. METHODS: We retrospectively recorded time to pre-hospital emergency anaesthesia across all 20 eligible UK HEMS units (comprising 52 enhanced care teams) from April 1, 2017 to March 31, 2018. Times recorded for emergency notification, dispatch, arrival, and neuromuscular blocking agent administration were analysed. RESULTS: HEMS undertook 1755 pre-hospital emergency anaesthetics for trauma across the UK during the study period. There were 1176/1755 (67%) episodes undertaken by helicopter response teams during daylight hours. The median time to pre-hospital emergency anaesthesia was 55 min (inter-quartile range: 45-70); anaesthesia within 45 min of the initial emergency call was achieved in 25% cases. Delayed dispatch time (>9 min) was associated with fewer patients receiving pre-hospital anaesthesia within 45 min (odds ratio: 7.7 [95% confidence intervals: 5.8-10.1]; P<0.0001). CONCLUSIONS: The time to achieve pre-hospital emergency anaesthesia by UK HEMS frequently exceeds the recommended 45 min target. Reducing the time to dispatch of emergency medical teams may impact on the delivery of pre-hospital emergency anaesthesia.


Asunto(s)
Anestesia/estadística & datos numéricos , Servicios Médicos de Urgencia/estadística & datos numéricos , Ambulancias Aéreas , Manejo de la Vía Aérea/métodos , Manejo de la Vía Aérea/normas , Manejo de la Vía Aérea/estadística & datos numéricos , Anestesia/normas , Estudios de Cohortes , Prestación de Atención de Salud/normas , Prestación de Atención de Salud/estadística & datos numéricos , Urgencias Médicas , Servicios Médicos de Urgencia/normas , Humanos , Estudios Retrospectivos , Factores de Tiempo , Transporte de Pacientes/métodos , Transporte de Pacientes/estadística & datos numéricos , Reino Unido , Heridas y Traumatismos/terapia
8.
Br J Nurs ; 29(5): S28-S35, 2020 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-32167812

RESUMEN

BACKGROUND: Surgical and wound site infections (SWSIs) are the second most frequent type of healthcare-associated Infection. One way of preventing SWSIs is by adhering to the principles of asepsis. However, many nurses struggle to apply the principles of aseptic non-touch technique (ANTT) during wound management. AIM: To identify the barriers and enablers that influence nurses' adherence to the principles of ANTT during wound care. METHOD: A literature search using a systematic approach was carried out. Four databases were searched to identify relevant studies published between January 1993 and December 2018. Titles and abstracts were reviewed. Studies that met the inclusion criteria were reviewed for quality. The extracted data were then synthesised. FINDINGS: A total of seven studies fulfilled the requirements for inclusion. Three themes emerged and were found to be the most dominant factors influencing adherence to the principles of ANTT: material and resources, nurse education, and nurses' behaviour. CONCLUSION: Nurses' compliance with aseptic practice is directly influenced by environmental and psychological factors. Ensuring compliance to ANTT may require an integrated approach involving local, national and worldwide organisations, in collaboration with higher education institutions that teach nurses and similar healthcare professionals.


Asunto(s)
Infección Hospitalaria/prevención & control , Cicatrización de Heridas , Heridas y Traumatismos/enfermería , Heridas y Traumatismos/terapia , Humanos
9.
Curr Opin Anaesthesiol ; 33(2): 220-226, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32004168

RESUMEN

PURPOSE OF REVIEW: Red cell transfusions are commonly used in management of hemorrhage in trauma patients. The appropriate indications and criteria for transfusion are still debated. Here, we summarize the recent findings on the use of red cell transfusion in trauma setting. RECENT FINDINGS: Recent evidence continues to support the long-established link between allogeneic transfusion and worse clinical outcomes, reinstating the importance of more judicious use of allogeneic blood and careful consideration of benefits versus risks when making transfusion decisions. Studies support restrictive transfusion strategies (often based on hemoglobin thresholds of 7-8 g/dl) in most patient populations, although some argue more caution in specific populations (e.g. patients with traumatic brain injury) and more studies are needed to determine if these patients benefit from less restrictive transfusion strategies. It should be remembered that anemia remains an independent risk factor for worse outcomes and red cell transfusion does not constitute a lasting treatment. Anemia should be properly assessed and managed based on the cause and using hematinic medications as indicated. SUMMARY: Although the debate on hemoglobin thresholds for transfusion continues, clinicians should not overlook proper management of the underlying issue (anemia).


Asunto(s)
Transfusión de Eritrocitos , Hemorragia/terapia , Heridas y Traumatismos/terapia , Anemia/diagnóstico , Anemia/terapia , Hemoglobinas/análisis , Humanos
10.
Curr Opin Anaesthesiol ; 33(2): 246-252, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32022729

RESUMEN

PURPOSE OF REVIEW: Trauma-associated bleeding and coagulopathy require timely identification, prevention, and effective treatment. The present review summarizes the recent literature around point-of-care (POC) coagulation tests, their usefulness in the management of trauma-induced coagulopathy (TIC), their impact on trauma patient outcomes, and the requirement of quality assurance. RECENT FINDINGS: Best practice algorithms to manage TIC have been compiled in the 2019 European Guideline on the management of major bleeding and coagulopathy after trauma. Evidence supports the use of goal-directed approaches to manage TIC. POC coagulation tests can accelerate and tailor individualized therapies. Recent findings emphasize: the time sparing of POC tests in prehospital settings and the validity of POC measurements in extreme environments; the potential scalability of POC-guided TIC algorithms in burn injuries and the pediatric population; the need for careful considerations of strategies to monitor and reverse the effects of direct oral anticoagulants in major trauma. SUMMARY: In contrast to an abundance of reviews and practical approaches to POC coagulation management in trauma patients, there is a scarcity of research in the field and large-scale clinical trials are urgently needed. The paneuropean multicenter trial Implementing Treatment Algorithms for the Correction of Trauma Induced Coagulopathy (iTACTIC) will inform on the potential of viscoelastic tests to augment transfusion protocols for better patient outcomes.


Asunto(s)
Trastornos de la Coagulación Sanguínea/diagnóstico , Transfusión Sanguínea , Hemorragia/terapia , Sistemas de Atención de Punto , Heridas y Traumatismos/terapia , Humanos , Estudios Multicéntricos como Asunto
11.
Curr Opin Anaesthesiol ; 33(2): 259-267, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32049883

RESUMEN

PURPOSE OF REVIEW: Research studies pertaining to the management of pediatric non-red cell blood product transfusion is limited. Clinical practices vary within disciplines and regions. Anesthesiologists need evidence-based guidelines to make appropriate and safe decisions regarding transfusion of the 'yellow' blood products for pediatric patients. RECENT FINDINGS: This review outlines clinical indications for transfusion of fresh frozen plasma, cryoprecipitate, platelets, and fibrinogen concentrate in pediatrics. Recent studies of non-red blood cell transfusions in critical, but stable situations are highlighted. Recommendations to guide transfusion of the 'yellow' blood products in operative and non-operative settings are summarized. Special attention is drawn to guidelines in massive hemorrhage and trauma situations. SUMMARY: Evidence-based guidelines and expert consensus recommendations exist to guide the transfusion of pediatric non-red blood products and should be followed when transfusing the 'yellow' blood components. As high-quality studies in neonates, infants and children are limited, future research should broaden our knowledge in this direction with the goal to use restrictive strategies to improve patient outcomes.


Asunto(s)
Transfusión de Componentes Sanguíneos/métodos , Pediatría , Niño , Hemorragia/terapia , Humanos , Lactante , Recién Nacido , Guías de Práctica Clínica como Asunto , Heridas y Traumatismos/terapia
12.
Curr Opin Anaesthesiol ; 33(2): 253-258, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32049884

RESUMEN

PURPOSE OF REVIEW: Trauma patients are considered a complex population of patients in emergency medicine and need extensive, specialized therapy. One major part is the prevention and treatment of the inflammatory response, which occurs in patients after severe injury resulting in complications like endotheliopathy. Likely as a consequence, coagulopathy occurs. Sterile inflammation is hard to address, especially because of the lack of a single activator. Moreover, it is a complex composition of factors that lead to a pathologic immune response. Our understanding of these patterns is increasing, but the complete pathophysiologic changes have yet to be investigated. Therefore, there is no specific target to treat inflammatory response in trauma patients at the moment. RECENT FINDINGS: There is increasing knowledge of the pathways and mediators that are responsible for the inflammatory response in patients after severe trauma. The endothelial glycocalyx has been identified to be an integral part of these mechanisms. There have been several new therapeutic approaches to diminish the inflammatory response. SUMMARY: Our increasing understanding of the immune system have led to new potential therapeutic perspectives. All of these approaches need further research to be validated. As the current therapies are based on empirical strategies and have not changed much over the years, new treatment options would be an important progress.


Asunto(s)
Inflamación/prevención & control , Heridas y Traumatismos/complicaciones , Humanos , Inflamación/etiología , Heridas y Traumatismos/terapia
15.
Am Fam Physician ; 101(3): 159-166, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-32003952

RESUMEN

Chronic wounds are those that do not progress through a normal, orderly, and timely sequence of repair. They are common and are often incorrectly treated. The morbidity and associated costs of chronic wounds highlight the need to implement wound prevention and treatment guidelines. Common lower extremity wounds include arterial, diabetic, pressure, and venous ulcers. Physical examination alone can often guide the diagnosis. All patients with a nonhealing lower extremity ulcer should have a vascular assessment, including documentation of wound location, size, depth, drainage, and tissue type; palpation of pedal pulses; and measurement of the ankle-brachial index. Atypical nonhealing wounds should be biopsied. The mainstay of treatment is the TIME principle: tissue debridement, infection control, moisture balance, and edges of the wound. After these general measures have been addressed, treatment is specific to the ulcer type. Patients with arterial ulcers should be immediately referred to a vascular surgeon for appropriate intervention. Treatment of venous ulcers involves compression and elevation of the lower extremities, plus exercise if tolerated. Diabetic foot ulcers are managed by offloading the foot and, if necessary, treating the underlying peripheral arterial disease. Pressure ulcers are managed by offloading the affected area.


Asunto(s)
Cicatrización de Heridas/fisiología , Heridas y Traumatismos/terapia , Enfermedad Crónica/terapia , Pie Diabético/fisiopatología , Pie Diabético/terapia , Humanos , Úlcera por Presión/fisiopatología , Úlcera por Presión/terapia , Úlcera Varicosa/fisiopatología , Úlcera Varicosa/terapia , Heridas y Traumatismos/prevención & control
16.
Isr Med Assoc J ; 22(2): 83-88, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32043324

RESUMEN

BACKGROUND: Rapid and selective bromelain-based enzymatic debridement provides a non-surgical alternative for the eschar removal in deep burns, which allows for early debridement of large surface areas, accurate evaluation of burn and wound depth, and the need for skin grafting. OBJECTIVES: To evaluate the efficacy of application of a bromelain-based selective enzymatic debridement (Nexobrid®) beyond the manufacturer's guidelines for use in burns > 48 hours as well as chemical, electrical, and pediatric burns, and chronic wounds. METHODS: This retrospective review included records collected between January 2017 and April 2019, from male and female patients aged 8 months to 99 years with deep burns or wounds treated with bromelain-based selective enzymatic debridement. RESULTS: Of the 33 patients who received the bromelain-based selective enzymatic debridement agent beyond the manufacturer's guidelines, 25 (76%) were observed to have successful debridement of the eschar, 8 (24%) were observed to have little effect on the burn eschar. Sixteen required further surgery after debridement. Clinical data on the use of bromelain-based selective enzymatic debridement agents are limited, but these results suggest the capacity to effectively debride burns > 48 hours (late presentation burns), use for pediatrics and for chemical and electrical burns, and apply to hard to heal full thickness chronic wounds. CONCLUSIONS: Bromelain-based selective enzymatic debridement was found to be an effective treatment modality beyond the recommended guidelines including late presentation burns and chronic wounds. This debridement method warrants further consideration when making clinical decisions concerning burn and wound care.


Asunto(s)
Bromelaínas/administración & dosificación , Quemaduras , Terapia Enzimática/métodos , Cicatrización de Heridas/efectos de los fármacos , Heridas y Traumatismos , Administración Tópica , Adulto , Quemaduras/diagnóstico , Quemaduras/terapia , Monitoreo de Drogas/métodos , Femenino , Humanos , Masculino , Estudios Retrospectivos , Tiempo de Tratamiento , Índices de Gravedad del Trauma , Resultado del Tratamiento , Heridas y Traumatismos/diagnóstico , Heridas y Traumatismos/terapia
17.
Medicine (Baltimore) ; 99(6): e19027, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32028413

RESUMEN

To evaluate disparities in the National Institute of Health (NIH) trauma research funding.Traumatic injury has increased in both prevalence and cost over the last decade. In the event of a traumatic injury, patients in the United States (US) rely on the trauma system to provide high-quality care. The current trauma research funding is not commensurate with the extent of the burden of trauma on the US population.In this qualitative study, the National Institutes of Health's Estimates of Funding for Various Research, Condition, and Disease Categories (RCDC) data were reviewed. The burden of traumatic injury on the US and the NIH trauma research funding was examined and compared with other diseases.In 2018, the NIH funded an estimated $639 million to traumatic injury research projects, <2% of the NIH budget. Comparatively, the NIH funded an estimated $6.3 billion towards cancer research in 2018. Cancer research receives extensively more funding than trauma research despite that trauma accounts for 24.1% of all years of potential life lost (YPLL) before age 75 compared with 21.3% for cancer.In the event of traumatic injury, trauma systems in the US should be able to provide high-quality care to patients yet cannot do so without adequate research funding. The federal funding contributed towards trauma research deserves a re-evaluation.


Asunto(s)
Investigación Biomédica/economía , National Institutes of Health (U.S.) , Heridas y Traumatismos/terapia , Investigación Biomédica/estadística & datos numéricos , Humanos , National Institutes of Health (U.S.)/economía , National Institutes of Health (U.S.)/estadística & datos numéricos , Apoyo a la Investigación como Asunto , Estados Unidos/epidemiología , Heridas y Traumatismos/economía , Heridas y Traumatismos/epidemiología
18.
Plast Reconstr Surg ; 145(2): 348e-359e, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31985636

RESUMEN

BACKGROUND: The authors developed a noncontact low-frequency ultrasound device that delivers high-intensity mechanical force based on phased-array technology. It may aid wound healing because it is likely to be associated with lower risks of infection and heat-induced pain compared with conventional ultrasound methods. The authors hypothesized that the microdeformation it induces accelerates wound epithelialization. Its effects on key wound-healing processes (angiogenesis, collagen accumulation, and angiogenesis-related gene transcription) were also examined. METHODS: Immediately after wounding, bilateral acute wounds in C57BL/6J mice were noncontact low-frequency ultrasound- and sham-stimulated for 1 hour/day for 3 consecutive days (10 Hz/90.6 Pa). Wound closure (epithelialization) was recorded every 2 days as the percentage change in wound area relative to baseline. Wound tissue was procured on days 2, 5, 7, and 14 (five to six per time point) and subjected to histopathology with hematoxylin and eosin and Masson trichrome staining, CD31 immunohistochemistry, and quantitative polymerase-chain reaction analysis. RESULTS: Compared to sham-treated wounds, ultrasound/phased-array-treated wounds exhibited significantly accelerated epithelialization (65 ± 27 percent versus 30 ± 33 percent closure), angiogenesis (4.6 ± 1.7 percent versus 2.2 ± 1.0 percent CD31 area), and collagen deposition (44 ± 14 percent versus 28 ± 13 percent collagen density) on days 5, 2, and 5, respectively (all p < 0.05). The expression of Notch ligand delta-like 1 protein (Dll1) and Notch1, which participate in angiogenesis, was transiently enhanced by treatment on days 2 and 5, respectively. CONCLUSIONS: The authors' noncontact low-frequency ultrasound phased-array device improved the wound-healing rate. It was associated with increased early neovascularization that was followed by high levels of collagen-matrix production and epithelialization. The device may expand the mechanotherapeutic proangiogenesis field, thereby helping stimulate a revolution in infected wound care.


Asunto(s)
Piel/lesiones , Terapia por Ultrasonido/métodos , Cicatrización de Heridas/fisiología , Heridas y Traumatismos/terapia , Animales , Colágeno/metabolismo , Masculino , Ratones , Ratones Endogámicos C57BL , Neovascularización Fisiológica/fisiología , Piel/metabolismo , Heridas y Traumatismos/metabolismo , Heridas y Traumatismos/patología
19.
BMC Health Serv Res ; 20(1): 18, 2020 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-31906941

RESUMEN

BACKGROUND: Trauma registries are essential to trauma systems, to enable collection of the data needed to enhance clinical knowledge and monitor system performance. The King Saud Medical City (KSMC) in Riyadh, Kingdom of Saudi Arabia (KSA) is aiming to become a Level 1 Trauma Centre, and required a trauma registry in order to do so. Our objective was to establish the Saudi TraumA Registry (STAR) at the (KSMC) and ready it for national deployment. The challenge was that no formal trauma data collection had occurred previously and clinicians had no prior experience of trauma registries. METHODS: To develop the registry, a novel 12 step implementation plan was created and followed at the KSMC. Registry criteria and a Minimum Dataset were selected; training was delivered; database specifications were written; operating procedures were developed and regular reporting was initiated. RESULTS: Data collection commenced on August 1st 2017. The registry was fully operational by April 2018, eight months ahead of schedule. During the first year of data collection an average of 216 records per month were entered into the database. An inaugural report was presented at the Saudi Trauma Conference in February 2019. CONCLUSIONS: The strategy deployed at the KSMC has successfully established the STAR. In the short term, process indicators will track the development of the hospital into a Level 1 Trauma Centre. In the medium to long term the STAR will be rolled out nationally to capture the impact of public health initiatives aimed at reducing injury in the KSA. The effect of the STAR will be that the country is better equipped to deliver continuous improvements in trauma systems and quality of care.


Asunto(s)
Sistema de Registros , Heridas y Traumatismos , Recolección de Datos , Bases de Datos Factuales , Humanos , Arabia Saudita , Centros Traumatológicos , Heridas y Traumatismos/terapia
20.
Curr Opin Anaesthesiol ; 33(2): 227-233, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31895124

RESUMEN

PURPOSE OF REVIEW: Traumatic injury has been described as a growing pandemic which has significant implications for global health. In the trauma setting, anemia is a common occurrence and is frequently inadequately addressed. It is associated with significant morbidity and incurs great cost - both to the patient and to the health system. The cause is multifactorial, and the pathophysiology is incompletely understood. Appropriate care of the trauma patient is a multidisciplinary responsibility and a focused approach to anemia is vital. The recommendation for restrictive transfusion strategies and the potential benefit of intravenous iron (IVI) in the perioperative setting, make the intervention an attractive proposition in the anemic trauma patient. RECENT FINDINGS: In an era where the importance of patient blood management is recognized, there is significant attention being given to both the implications and the appropriate management of anemia, in various settings. Advances have been made in the understanding of the mechanisms underlying the anemia associated with traumatic injury and the efficacy of current interventions is being explored. This increased understanding of the pathophysiology behind the condition has also facilitated the postulation of potential therapeutic targets for the future. SUMMARY: Suboptimally managed anemia impacts on clinical outcome and contributes to the burden of costs associated with trauma. The cause of the anemia associated with trauma is multifactorial and should be addressed at several levels. The role of IVI in this setting is yet to be clearly defined.


Asunto(s)
Hierro/administración & dosificación , Heridas y Traumatismos/terapia , Administración Intravenosa , Anemia/terapia , Humanos
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