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1.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4978-4981, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019104

RESUMO

We investigated whether a statistical model could predict mean arterial pressure (MAP) during uncontrolled hemorrhage; such a model could be used for automated decision support, to help clinicians decide when to provide intravascular volume to achieve MAP goals. This was a secondary analysis of adult swine subjects during uncontrolled splenic bleeding. By protocol, after developing severe hypotension (MAP < 60 mmHg), subjects were resuscitated with either saline (NS) or fresh frozen plasma (FFP), determined randomly. Vital signs were documented at quasi-regular time-step intervals, until either subject death or 300 min. Subjects were randomly separated 50%/50% into training/validation sets, and regression models were developed to predict MAP for each subsequent (i.e., future) time-step. Median time-steps for serially recorded vital signs were +15 min. 5 subjects survived the protocol; 17 died after a median time of 87 min (IQR 78 - 134). The final model consisted of: current MAP; heart rate (HR); prior NS; imminent NS; and imminent FFP. The 95% limits-of-agreement between true subsequent MAP vs. predicted subsequent MAP were +10/-11 mmHg for the 79 time-steps in the training set; and +14/-13 for the 64 time-steps in the validation set. A total of 10 sudden death events (i.e., rapid, fatal MAP decrease within one single time-step) were excluded from analysis. In conclusion, for uncontrolled hemorrhage in a swine model, it was possible to estimate the next documented MAP value on the basis of the subject's current documented MAP; HR; prior NS; and the volume of resuscitation about to be administered. However, the model was unable to predict "sudden death" events. The applicability to populations with wider heterogeneity of hemorrhage patterns and with comorbidities requires further investigation.


Assuntos
Choque Hemorrágico , Animais , Modelos Animais de Doenças , Hemodinâmica , Hemorragia/terapia , Ressuscitação , Choque Hemorrágico/terapia , Suínos
2.
Artigo em Alemão | MEDLINE | ID: mdl-33053587

RESUMO

Seriously injured patients represent only a small group of patients in the emergency medical service with 0.5% (ground based) to 5% (HEMS), but they are associated with a high mortality rate. Among people younger than 45, trauma is the most common cause of death, mostly as a result of severe traumatic brain injury (TBI) and/or extreme hemorrhage. As the outcome of severe TBI prehospitally can only be influenced to a very limited extent, a majority of preventable deaths in prehospital setting are caused by "critical" bleeding. The "critical" bleeding is defined by its life-threatening dimension. Anticoagulation medication can have a reinforcing effect. Adequate prehospital therapy strategies exist for external bleeding. In contrast, internal bleeding regularly evades a causal prehospital care, so that in such cases, transport prioritization and rapid definitive surgical intervention remain the only option. In the civilian environment the tested and evaluated "ABCDE" scheme must be preceded by the (for "critical bleeding") in order to react time-critically to compressible external bleeding, possibly even prior to airway management. These findings have found their way into the current version of the S3 guideline on treatment of multi system trauma by the German Society for Trauma Surgery (DGU). According to this "severely bleeding injuries that can impair vital functions should be treated with priority". Thus, this publication focuses on prehospital bleeding control.


Assuntos
Lesões Encefálicas Traumáticas , Serviços Médicos de Emergência , Traumatismo Múltiplo , Manuseio das Vias Aéreas , Hemorragia/terapia , Humanos
3.
Medicine (Baltimore) ; 99(40): e22531, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019457

RESUMO

RATIONALE: Although surgery has been the standard treatment for pancreaticoduodenal trauma because of the complex anatomical relation of the affect organs, transcatheter arterial embolization (TAE) has recently been introduced as a safe and effective treatment. However, TAE for pancreaticoduodenal arterial hemorrhage (PDAH) can be challenging because it is difficult to localize the involved artery and to embolize the bleeding completely due to the abundant collateral channels of the pancreaticoduodenal artery (PDA). PATIENT CONCERNS: Herein, we report 2 cases of PDAH that occurred after falling down in case 1 and a pedestrian traffic accident in case 2. DIAGNOSES: Multidetector computed tomography scan revealed massive retroperitoneal hematoma with active extravasation of contrast media from the PDA without any duodenal perforation or advanced pancreatic injury in both patients. INTERVENTIONS: All patients were successfully treated using only TAE with a combination of microcoils and n-butyl cyanoacrylate (NBCA) in case 1, and only NBCA in case 2. OUTCOMES: There was no complication such as duodenal ischemia or pancreatitis. Laparotomy was not needed after TAE. LESSONS: In selective PDAH cases, TAE may be a reasonable alternative to emergency laparotomy. It is expected that a careful and repetitive approach, based on complete angiography and embolization with a permanent liquid embolic agent such as NBCA could increase the success rate of TAE.


Assuntos
Traumatismos Abdominais/complicações , Embolização Terapêutica/métodos , Hemorragia/etiologia , Hemorragia/terapia , Ferimentos não Penetrantes/complicações , Duodeno/lesões , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/lesões
4.
Can J Surg ; 63(5): E422-E430, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33009903

RESUMO

BACKGROUND: Failure to rapidly identify bleeding in trauma patients leads to substantial morbidity and mortality. We aimed to develop and validate a simple bedside score for identifying bleeding patients requiring escalation of care beyond initial resuscitation. METHODS: We included patients with major blunt or penetrating trauma, defined as those with an Injury Severity Score greater than 12 or requiring trauma team activation, at The Ottawa Hospital from September 2014 to September 2017. We used logistic regression for derivation. The primary outcome was a composite of the need for massive transfusion, embolization or surgery for hemostasis. We prespecified clinical, laboratory and imaging predictors using findings from our prior systematic review and survey of Canadian traumatologists. We used an AIC-based stepdown procedure based on the Akaike information criterion and regression coefficients to create a 5-variable score for bedside application. We used bootstrap internal validation to assess optimism-corrected performance. RESULTS: We included 890 patients, of whom 133 required a major intervention. The main model comprised systolic blood pressure, clinical examination findings suggestive of hemorrhage, lactate level, focused assessment with sonography in trauma (FAST) and computed tomographic imaging. The C statistic was 0.95, optimism-corrected to 0.94. A simplified Canadian Bleeding (CAN-BLEED) score was devised. A score cut-off of 2 points yielded sensitivity of 97.7% (95% confidence interval [CI] 93.6 to 99.5) and specificity 73.2% (95% CI 69.9 to 76.3). An alternative version that included mechanism of injury rather than CT had lower discriminative ability (C statistic = 0.89). CONCLUSION: A simple yet promising bleeding score is proposed to identify highrisk patients in need of major intervention for traumatic bleeding and determine the appropriateness of early transfer to specialized trauma centres. Further research is needed to evaluate the performance of the score in other settings, define interrater reliability and evaluate the potential for reduction of time to intervention.


Assuntos
Hemorragia/diagnóstico , Modelos Biológicos , Triagem/métodos , Ferimentos não Penetrantes/complicações , Ferimentos Penetrantes/complicações , Adulto , Transfusão de Sangue/estatística & dados numéricos , Canadá/epidemiologia , Tomada de Decisão Clínica , Embolização Terapêutica/estatística & dados numéricos , Feminino , Hemorragia/epidemiologia , Hemorragia/etiologia , Hemorragia/terapia , Hemostasia Cirúrgica/estatística & dados numéricos , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Transferência de Pacientes/estatística & dados numéricos , Estudos Prospectivos , Reprodutibilidade dos Testes , Medição de Risco/métodos , Centros de Traumatologia/estatística & dados numéricos , Ferimentos não Penetrantes/terapia , Ferimentos Penetrantes/terapia
5.
Einstein (Sao Paulo) ; 18: eAO5032, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32876090

RESUMO

Objective To describe the implementation of a care protocol based on rapid response teams, for management and resolution of bleeding. Methods A hospital protocol called Hemorrhage Code (Code H) was devised and developed. In a flow line, a multidisciplinary team provides comprehensive, fast and effective care to the patient with a severe hemorrhagic condition. In another flow line, professionals based at the hospital pharmacy focus on identifying patients at risk of bleeding, to avoid this event. Several hospital professionals and sectors were trained, each with specific roles, ensuring full support to the medical and nursing staffs. Results After implementing this protocol, we were able to significantly reduce the number of catastrophic events related to failure in bleeding management. Conclusion Code H is an example of a value-based medicine and precision medicine project by delivering comprehensive and multidisciplinary care, in addition to point-of-care testing introduced in clinical practice, optimizing patient safety and care practices at the hospital. Furthermore, it will be possible to minimize the risk of lawsuits for the hospital and physicians, as well as rationalizing resources with benefits for administrators and payers.


Assuntos
Transtornos da Coagulação Sanguínea/terapia , Transfusão de Sangue , Hemorragia/terapia , Assistência ao Paciente/normas , Segurança do Paciente , Guias de Prática Clínica como Assunto , Choque Hemorrágico/terapia , Brasil , Hemorragia/prevenção & controle , Humanos , Estudos Retrospectivos
6.
Crit Care ; 24(1): 561, 2020 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-32948243

RESUMO

BACKGROUND: Optimal prophylactic and therapeutic management of thromboembolic disease in patients with COVID-19 remains a major challenge for clinicians. The aim of this study was to define the incidence of thrombotic and haemorrhagic complications in critically ill patients with COVID-19. In addition, we sought to characterise coagulation profiles using thromboelastography and explore possible biological differences between patients with and without thrombotic complications. METHODS: We conducted a multicentre retrospective observational study evaluating all the COVID-19 patients received in four intensive care units (ICUs) of four tertiary hospitals in the UK between March 15, 2020, and May 05, 2020. Clinical characteristics, laboratory data, thromboelastography profiles and clinical outcome data were evaluated between patients with and without thrombotic complications. RESULTS: A total of 187 patients were included. Their median (interquartile (IQR)) age was 57 (49-64) years and 124 (66.3%) patients were male. Eighty-one (43.3%) patients experienced one or more clinically relevant thrombotic complications, which were mainly pulmonary emboli (n = 42 (22.5%)). Arterial embolic complications were reported in 25 (13.3%) patients. ICU length of stay was longer in patients with thrombotic complications when compared with those without. Fifteen (8.0%) patients experienced haemorrhagic complications, of which nine (4.8%) were classified as major bleeding. Thromboelastography demonstrated a hypercoagulable profile in patients tested but lacked discriminatory value between those with and without thrombotic complications. Patients who experienced thrombotic complications had higher D-dimer, ferritin, troponin and white cell count levels at ICU admission compared with those that did not. CONCLUSION: Critically ill patients with COVID-19 experience high rates of venous and arterial thrombotic complications. The rates of bleeding may be higher than previously reported and re-iterate the need for randomised trials to better understand the risk-benefit ratio of different anticoagulation strategies.


Assuntos
Infecções por Coronavirus/complicações , Estado Terminal , Hemorragia/etiologia , Pneumonia Viral/complicações , Trombose/etiologia , Betacoronavirus , Infecções por Coronavirus/terapia , Feminino , Hemorragia/terapia , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/terapia , Estudos Retrospectivos , Tromboelastografia , Trombose/terapia , Reino Unido
7.
Orv Hetil ; 161(37): 1579-1587, 2020 09.
Artigo em Húngaro | MEDLINE | ID: mdl-32894738

RESUMO

The accessibility to blood products is increasingly limited worldwide. Approximately half of the blood products is utilized in cardiovascular surgery. The rational use of the available blood products has therefore paramount importance in everyday practice. In the present publication, the possible methods of blood-product sparing in cardiac surgery are summarized. We have emphasized the principles of the treatment and the prevention of severe peri-operative bleeding. Orv Hetil. 2020; 161(37): 1579-1587.


Assuntos
Anestesia em Procedimentos Cardíacos , Procedimentos Cirúrgicos Cardíacos , Hemorragia , Cirurgia Torácica , Transfusão de Sangue , Hemorragia/terapia , Humanos
8.
Orv Hetil ; 161(37): 1599-1605, 2020 09.
Artigo em Húngaro | MEDLINE | ID: mdl-32894740

RESUMO

Major trauma is a frequent cause of death, and is the leading cause of death in the younger agegroups. Severe bleeding is often responsible for early mortality. The background of the latter is the trauma-induced coagulopathy (TIC), which - often very early - develops after the onset of bleeding. The high amount of blood products, i.e., massive transfusion administered during the management of traumatic bleeding can result in severe, even fatal complications. Modern, aggressive management of masssive traumatic bleeding is effective in reducing exsanguination and mortality or late complications. This method also fits into the concept of Patient Blood Management. This review deals with the up-to-date, goal-directed, preventive management of traumatic bleeding and coagulopathy, with emphasis on theoretical grounds. The aim is to present the essence of this management method also to those who are not directly involved in this activity. Orv Hetil. 2020; 161(37): 1599-1605.


Assuntos
Transtornos da Coagulação Sanguínea , Hemorragia , Ferimentos e Lesões , Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/terapia , Transfusão de Sangue , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Ferimentos e Lesões/complicações
9.
Tex Med ; 116(7): 42-45, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32872701

RESUMO

The need for improved training on hemorrhage control in emergencies has been building for decades. Physicians say it's just as important to reach out to the community to promote hemorrhage control in the same way CPR and other life-saving methods are promoted.


Assuntos
Educação Médica Continuada , Serviços Médicos de Emergência/métodos , Medicina de Emergência/educação , Hemorragia/terapia , Médicos , Torniquetes , Hemorragia/prevenção & controle , Humanos
10.
J Spec Oper Med ; 20(3): 44-51, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32969003

RESUMO

BACKGROUND: Given little data to assess guidelines, we sought a way to exchange one type of intervention, field tourniquet use, for another, use of a pressure dressing. The study purpose was to test performance of controlling simulated bleeding with a stepwise procedure of tourniquet conversion. METHODS: An experiment was designed to assess 15 tests of a caregiver making tourniquet-dressing conversions. Tests were divided into trials: tourniquet use and its conversion. In laboratory conditions, the tourniquet trial was care under gunfire; then, the conversion trial was emergency healthcare. A HapMed Leg Tourniquet Trainer simulated a limb amputation. An investigator provided healthcare. RESULTS: Mean (± standard deviation [SD]) test time and blood loss were 9 ± 3.6 minutes and 334 ± 353.9mL, respectively. The first test took 17 minutes. By test number, times decreased; the last six took ≤7 minutes. All tourniquet trials controlled bleeding. Mean (±SD) tourniquet pressure and blood loss were 222 ± 18.0mmHg and 146 ± 40.9mL, respectively. Bleeding remained uncontrolled in one conversion. Initial attempts to wrap a dressing were effective in 73% of tries (n = 11 of 15). Four of 15 wrap attempts (27%) were repeated to troubleshoot bleeding recurrence, and the first three tests required a repetition. Mean (±SD) dressing pressures and blood losses were 141 ± 17.6mmHg and 188 ± 327.4mL, respectively. Unsatisfactory conversion trials had a dressing pressure <137mmHg. Dressings and wraps hid the wound to impair assessment of bleeding. CONCLUSIONS: In testing a method of converting a limb tourniquet to a pressure dressing, the caregiver performed faster with experience accrual. The tourniquet results were uniformly good, but conversion results were worse and more varied. Simulating conversion was disappointing on a manikin and indicated that its redesign might be needed to suit this method. The procedural method constituted a start for further development.


Assuntos
Bandagens , Torniquetes , Primeiros Socorros , Hemorragia/terapia , Humanos , Manequins
11.
Am J Nurs ; 120(9): 36-43, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32858696

RESUMO

Optimal management of trauma-related hemorrhagic shock begins at the point of injury and continues throughout all hospital settings. Several procedures developed on the battlefield to treat this condition have been adopted by civilian health care systems and are now used in a number of nonmilitary hospitals. Despite the important role nurses play in caring for patients with trauma-related hemorrhagic shock, much of the literature on this condition is directed toward paramedics and physicians. This article discusses the general principles underlying the pathophysiology and clinical management of trauma-related hemorrhagic shock and updates readers on nursing practices used in its management.


Assuntos
Serviços Médicos de Emergência/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Choque Hemorrágico/terapia , Centros de Traumatologia/organização & administração , Hemorragia/terapia , Hemostáticos/uso terapêutico , Humanos , Traumatismo Múltiplo/complicações , Choque Hemorrágico/enfermagem , Gestão da Qualidade Total
13.
Wilderness Environ Med ; 31(3): 337-343, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32830028

RESUMO

The objective of this case series was to describe 2 patients presenting with subarachnoid hemorrhage with hydrocephalus and hemoventricle after a snakebite caused by presumed Bothrops ssp. Both cases occurred in the municipality of Guajará (Amazonas state), Western Brazilian Amazon. Both cases featured delay in administration of serum therapy, which may have contributed to the emergence of complications such as stroke. Patient 1 was admitted to hospital 16 h after the snakebite occurred. Before receiving antivenom, testing showed the patient as having unclottable blood. She developed hemorrhagic stroke (a subarachnoid hemorrhage with hydrocephalus and hemoventricle). On the seventh day, she was discharged from hospital. Patient 2 arrived at the hospital 3 d after the snakebite occurred and presented with unclottable blood. He had a stroke (right frontoparietal hemorrhage, intraparenchymal hemorrhage already open to the ventricle) and died on the eighth day after the snakebite. Delay in seeking health care after snake envenomation can result in worse outcome.


Assuntos
Bothrops , Mordeduras de Serpentes/complicações , Acidente Vascular Cerebral/terapia , Idoso , Animais , Antivenenos/administração & dosagem , Brasil , Diagnóstico Tardio , Evolução Fatal , Feminino , Hemorragia/diagnóstico , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Masculino , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento , Adulto Jovem
14.
Am Surg ; 86(6): 685-689, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32683955

RESUMO

BACKGROUND: Postoperative hemorrhage has been described at rates of 14% in kidney transplant (KT) literature. The preferred management of postoperative hemorrhage in this population is not well described. We hypothesized a difference in outcomes with operative versus nonoperative management of hemorrhage after kidney transplantation. METHODS: We conducted a retrospective cohort study of consecutive KTs from 2012 to 2019 (living and deceased donors). We defined hemorrhage based on the objective finding of hematoma on either ultrasound or CT scan. Management was defined as operative (surgical intervention with or without transfusion) or nonoperative (with or without transfusion). RESULTS: We performed 1758 KTs of which 135 (8%) demonstrated hematoma on ultrasound or CT scan (66 operative vs 69 nonoperative management). The clinical signs and symptoms of low urine output (P = .044), drop in hemoglobin (P < .001), abdominal pain (P = .005), and MAP < 70 mm Hg (P = .034) were 92.5% predictive of postoperative hemorrhage in our KT patients. There were no differences between groups based on medical history, preop anticoagulation, anastomosis type, cold ischemic time, lowest hemoglobin, delayed graft function, or complications. Patients with nonoperative treatment of postoperative hemorrhage had shorter lengths of stay (P = .003), better graft survival (P = .01), and better patient survival (P = .01). DISCUSSION: We found better outcomes of graft and patient survival with shorter lengths of stay when we utilized nonoperative management of postoperative hemorrhage in KT patients. Our findings suggest a role for conservative nonoperative management in select patients. Ultimately, it is the surgeon's choice on how best to manage postoperative hemorrhage.


Assuntos
Hemorragia/terapia , Transplante de Rim/efeitos adversos , Hemorragia Pós-Operatória/terapia , Adulto , Isquemia Fria/estatística & dados numéricos , Feminino , Sobrevivência de Enxerto , Hemorragia/etiologia , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
15.
Wiad Lek ; 73(6): 1149-1153, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32723943

RESUMO

OBJECTIVE: The aim: Improve the results of the treatment of patients with pulmonary bleeding. PATIENTS AND METHODS: Materials and methods: We examined 57patients with lung bleeding different etiology, who were hospitalized in the department of Thoraco-Abdominal Surgery. All patients were divided into two groups - of the main group 27patients and the comparison group 30 patients, depend of ages, sex, nosological form, level of lung bleeding. Patients aged from 27 to 78 years, including 34 men (62,5%) and 23 women (37,5%.). The test diseases includes: bronchiectasis disease - in 21 (37,1 %), pulmonary fibrosis with malformation BA - in 14 (24,7 %), abscess of the lung - in 9 (15,9 %), polycystic lung disease - in 6 (12,7 %), chronic obstructive pulmonary disease - in 5 (9,6 %). RESULTS: Results: As a result of complete physical examination of patients with LB, it has been established that hemorrhage was the result of obstructive bronchitis in 14 patients (42%), there was chronic obstructive pulmonary disease in 7 (21%) and bronchiectasis was diagnosed in 6 (18%) patients. In 2 (6%) patients pulmonary hemorrhage was caused by community-acquired pneumonia. Central lung cancer was detected in 4 (12%) patients. CONCLUSION: Conclusions: Bronchial artery angiography gives high efficiency in solving the problem of hemostasis in oncological and nonspecific lung diseases. Endovascular occlusion of bronchial arteries permits: to elaborate diagnosis because of the presence of specific angiographic signs of malignant tumor; to perform effective endovascular hemostasis.


Assuntos
Embolização Terapêutica , Pneumopatias/terapia , Adulto , Idoso , Artérias Brônquicas , Feminino , Hemoptise/terapia , Hemorragia/terapia , Humanos , Masculino , Pessoa de Meia-Idade
17.
Vasc Endovascular Surg ; 54(8): 665-669, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32720585

RESUMO

PURPOSE: To evaluate the efficacy, safety, and feasibility of transradial approach (TRA) for endovascular management of traumatic bleeding. MATERIALS AND METHODS: A retrospective review was performed at a single level 1 trauma institution from August 2018 to July 2019. Patients presented to the interventional radiology department who were intended to be treating using TRA for the management of trauma-induced bleeding were selected. Demographics, indication for embolization, embolization site, preprocedural labs, hemodynamic stability, technical success, and complications were recorded. RESULTS: Transradial approach was attempted in 29 (74.4%) of the 39 patients identified by operators who prefer TRA. Four patients received treatment using TRA on 2 separate occasions, for a total of 33 procedures completed with a technical success of 97% (32/33). Transradial approach was safely completed in 9 patients (27.3%) with preprocedural hemodynamically unstable status. For the 10 patients who received treatment via a transfemoral approach (TFA), traumatic disfiguration of the left upper extremity, preexisting arterial lines placed by the trauma team, and external iliac artery injuries requiring covered stent placement were the most common indications for TFA over TRA. There were no procedural or access site-related complications. CONCLUSION: Transradial approach for the endovascular management of bleeding in a trauma setting is safe and effective with a high technical success rate and no complications.


Assuntos
Cateterismo Periférico , Embolização Terapêutica , Procedimentos Endovasculares , Hemorragia/terapia , Artéria Radial , Lesões do Sistema Vascular/terapia , Adulto , Idoso , Cateterismo Periférico/efeitos adversos , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Estudos de Viabilidade , Feminino , Hemodinâmica , Hemorragia/diagnóstico , Hemorragia/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , New Jersey , Punções , Artéria Radial/diagnóstico por imagem , Radiografia Intervencionista , Estudos Retrospectivos , Stents , Centros de Traumatologia , Resultado do Tratamento , Serviços Urbanos de Saúde , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/fisiopatologia , Adulto Jovem
18.
J Spec Oper Med ; 20(2): 76-82, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32573742

RESUMO

BACKGROUND: We sought new knowledge by further developing a model of using calculations in the simulation of a first-aid task. The purpose of this study was to develop the model to investigate the performance of tourniquet use in its component steps. METHODS: We aimed to design an experiment on a desktop computer by mathematically manipulating simulated data in tourniquet use. A time factor of tourniquet use was ranged widely through time challenges in five degrees from ideal to worst performances. Redesigning the task was assessed by time costs and blood losses. RESULTS: The step of tourniquet application took 17% of the trial time and securing the tourniquet after bleeding control took the longest amount of the trial time, 31%. A minority of the time (48% [17% + 31%] to apply tourniquet plus secure it) was spent after the tourniquet touched the patient, whereas most of the time (52%) was spent before the tourniquet touched the patient. The step of tourniquet application lost 14% of the total blood lost, whereas no blood was lost during securing the tourniquet, because that was the moment of bleeding control despite securing the tourniquet taking much time (31%). Most (86%) of blood lost occurred before the tourniquet touched the patient. But blood losses differed 10-fold, with a maximum of 2,434mL, which, when added to a pretask indication blood loss of 177mL, summed to 2,611mL. Before redesigning the task, costs of donning gloves and calling 9-1-1 included uncontrolled bleeding, but gloving mitigated risk of spreading pathogens among people. By step and person, redesigns of the task altered the risk-benefit profile. CONCLUSIONS: The model was useful because it simulated where most of the bleeding occurred before the tourniquet touched the patient. Modeling simulated redesigns of the task, which showed changes in the task's risk-benefit profile by step and among persons. The model generated hypotheses for future research, including the capability to screen candidate ideas among task designs.


Assuntos
Primeiros Socorros , Hemorragia/terapia , Torniquetes , Simulação por Computador , Humanos , Fatores de Tempo
19.
J Spec Oper Med ; 20(2): 110-114, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32573746

RESUMO

INTRODUCTION: Abdominal-pelvic hemorrhage (i.e., originates below the diaphragm and above the inguinal ligaments) is a major cause of death. It has diverse etiology but is typically associated with gunshot or stab wounds, high force or velocity blunt trauma, aortic rupture, and peripartum bleeds. Because there are few immediately deployable, temporizing measures, and the standard approaches such as direct pressure, hemostatics, and tourniquets are less reliable than they are with compressible extremity injuries, risk for death resulting from abdominal-pelvic hemorrhage is high. This review concerns the exciting potential of proximal external aortic compression (PEAC) as a temporizing technique for life-threatening lower abdominal-pelvic hemorrhage. PEAC can be accomplished by means of a device, two locked arms (manual), or a single knee (genicular) to press over the midline supra-umbilical abdomen. The goal is to compress the descending aorta and slow or halt downstream hemorrhage while not delaying more definitive measures such as hemostatic packing, tourniquets, endovascular balloons, and ultimately operative repair. METHODS: Clinical review of the Ovid MEDLINE, In-Process, & Other Non-Indexed, and Google Scholar databases was performed for the period ranging from 1946 to 3 May 2019 for studies that included the following search terms: [proximal] external aortic compression OR vena cava compression AND (abdomen or pelvis) OR (hemorrhage) OR (emergency or trauma). In addition, references from included studies were assessed. CONCLUSION: Sixteen studies met the inclusion criteria. Evidence was grouped and summarized from the specialties of trauma, aortic surgery, and obstetrics to help prehospital responders and guide much-needed additional research, with the goal of decreasing the high risk for death after life-threatening abdominal-pelvic hemorrhage.


Assuntos
Traumatismos Abdominais/terapia , Hemorragia/terapia , Pelve/lesões , Humanos , Pressão , Torniquetes
20.
J Spec Oper Med ; 20(2): 116-122, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32573747

RESUMO

The American College of Surgeons' "Stop the Bleed" (STB) campaign emphasizes how to apply the Combat Application Tourniquet (CAT), a device adopted by the military to control extremity hemorrhage. However, multiple commercially available alternatives to the CAT exist, and it would be helpful for instructors to be knowledgeable about how these other models compare. A PubMed search from January 2012 to January 2020 cross-referenced with a Google search for "tourniquet" was performed for commercially available tourniquets that had been trialed against the CAT. Windlass-type models included the Special Operations Forces Tactical Tourniquet (SOFT-T), the SOFT-T Wide (SOFFT-W), the SAM-XT tourniquet, the Military Emergency Tourniquet (MET), and the Tactical Medical Tourniquet (TMT). Elastic-type tourniquets included were the Stretch, Wrap, And Tuck Tourniquet (SWAT-T), the Israeli Silicone Tourniquet (IST), and the Rapid Activation Tourniquet System (RATS). Ratchet-type tourniquets included were the Ratcheting Medical Tourniquet (RMT) and TX2/TX3 tourniquets, and pneumatic-type tourniquets were the Emergency and Military Tourniquet (EMT) and Tactical Pneumatic Tourniquet (TPT). This review aims to describe the literature surrounding these models so that instructors can help laypeople make more informed purchases, stop the bleed, and save a life.


Assuntos
Primeiros Socorros , Hemorragia/terapia , Torniquetes , Humanos
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