Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 7.159
Filtrar
1.
Vasc Endovascular Surg ; 54(2): 169-171, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31714183

RESUMO

Retroperitoneal haemorrhage is a rare but potentially life-threatening event. It may occur either spontaneously or secondary to percutaneous vascular access procedures, trauma, or ruptured aortic, iliac, or mesenteric aneurysms. As a result, the clinical presentation is variable. Computed tomography and/or angiography are vital for diagnosis. Management may range from conservative treatment for stable patients to emergency laparotomy or embolization for catastrophic haemorrhage. Direct percutaneous puncture of a deep intra-abdominal pseudoaneurysm is an accepted but infrequently performed technique due to a number of diagnostic and technical challenges. We describe the successful percutaneous transabdominal angioembolization of a superior mesenteric artery rupture in a 77-year-old woman with a large retroperitoneal haematoma. This was performed after a conventional femoral transarterial approach was unsuccessful.


Assuntos
Falso Aneurisma/terapia , Aneurisma Roto/terapia , Embolização Terapêutica , Hemorragia/terapia , Artéria Mesentérica Superior , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/fisiopatologia , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/fisiopatologia , Feminino , Hematoma/etiologia , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Humanos , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/fisiopatologia , Espaço Retroperitoneal , Circulação Esplâncnica , Resultado do Tratamento
2.
Presse Med ; 48(12): 1416-1421, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31679898

RESUMO

Antiplatelet therapy is the cornerstone of coronary artery disease treatment and prevention. Combination of aspirin and P2Y12 inhibitor is recommended after acute coronary syndrome and after elective percutaneous coronary intervention. The optimal duration of dual antiplatelet therapy depends on the individual ischemic and bleeding risk of the patient. Bleeding on dual anti platelet therapy remains the most frequent complication of antiplatelet therapy even is mostly minimal or moderate. Beyond individualized evaluation of patients' bleeding risk, management of patients with severe bleeding complications is a challenging situation and requires general and specific recommendations with interruption of the dual antiplatelet therapy in the vast majority of the cases.


Assuntos
Anticoagulantes/efeitos adversos , Hemorragia/induzido quimicamente , Hemorragia/terapia , Inibidores da Agregação de Plaquetas/efeitos adversos , Anticoagulantes/administração & dosagem , Quimioterapia Combinada , Hemorragia/epidemiologia , Hemorragia/patologia , Humanos , Inibidores da Agregação de Plaquetas/administração & dosagem , Índice de Gravidade de Doença , Stents/efeitos adversos , Trombose/tratamento farmacológico , Trombose/epidemiologia , Trombose/etiologia
3.
J Radiol Case Rep ; 13(2): 34-42, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31565170

RESUMO

Trans-radial access offers several unique advantages and is being used more frequently for interventional radiology procedures. We report the use of trans-radial arterial access to embolize a large bleeding angiomyolipoma in a 30-year-old pregnant patient presenting in the first trimester. Trans-radial approach was chosen to minimize the effects of radiation on the fetus. Subsequent postprocedural pregnancy course was uneventful with stability of the angiomyolipoma and no further hemorrhage. This case highlights the benefits of trans-radial embolotherapy in gravid patients to reduce the risk of radiation exposure to the fetus.


Assuntos
Angiomiolipoma/complicações , Embolização Terapêutica/métodos , Hemorragia/etiologia , Hemorragia/terapia , Neoplasias Renais/complicações , Complicações Neoplásicas na Gravidez/terapia , Adulto , Angiografia Digital , Angiomiolipoma/diagnóstico por imagem , Feminino , Fluoroscopia , Hemorragia/diagnóstico por imagem , Humanos , Neoplasias Renais/diagnóstico por imagem , Gravidez , Complicações Neoplásicas na Gravidez/diagnóstico por imagem , Artéria Radial , Tomografia Computadorizada por Raios X , Ultrassonografia
4.
Am Surg ; 85(8): 904-908, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31560311

RESUMO

Delayed splenic bleeding (DSB) is a poorly understood complication of blunt splenic injury. Treatment for splenic bleeding may involve splenectomy, but angioembolization is becoming a widely used adjuvant for management. Using the North Carolina Trauma Registry, this study aimed to evaluate the incidence, mortality, and risk factors for DSB in North Carolina. Using ICD-9 and ICD-10 codes, patients were stratified into two cohorts, those who underwent immediate splenectomy and those who were initially managed nonoperatively. DSB was then defined as splenectomy at greater than 24 hours after presentation. Of the 1688 patients included in the study, 269 patients (16%) underwent immediate splenectomy and 1419 (84%) were managed nonoperatively initially, with 32 (2%) having delayed splenectomy. Older age (≥30 years) was associated with increased odds of having delayed splenectomy (odds ratio 4.30; 95% confidence interval 1.08, 17.17; P = 0.04). Four per cent of patients managed nonoperatively and undergoing an angioembolization procedure eventually required splenectomy. Risk factors for DSB remain elusive. Splenic artery embolization may be used as an adjuvant to splenectomy for stable patients, but it is not always a definitive treatment, and patients may still require splenectomy.


Assuntos
Embolização Terapêutica , Hemorragia/etiologia , Hemorragia/terapia , Baço/lesões , Esplenectomia , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/terapia , Adulto , Fatores Etários , Feminino , Hemorragia/mortalidade , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , North Carolina/epidemiologia , Sistema de Registros , Fatores de Risco , Artéria Esplênica/lesões , Centros de Traumatologia , Ferimentos não Penetrantes/mortalidade
5.
West J Emerg Med ; 20(5): 770-783, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31539334

RESUMO

Owing to the propensity of anticoagulated patients to bleed, a strategy for reversal of anticoagulation induced by any of the common agents is essential. Many patients are anticoagulated with a variety of agents, including warfarin, low molecular weight heparin, and the direct oral anticoagulants such as factor Xa and factor IIa inhibitors. Patients may also be using antiplatelet agents. Recommendations to reverse bleeding in these patients are constantly evolving with the recent development of specific reversal agents. A working knowledge of hemostasis and the reversal of anticoagulation and antiplatelet drugs is required for every emergency department provider. This article reviews these topics and presents the currently recommended strategies for dealing with bleeding in the anticoagulated patient.


Assuntos
Anticoagulantes/efeitos adversos , Emergências , Serviço Hospitalar de Emergência , Inibidores do Fator Xa/efeitos adversos , Hemorragia/terapia , Técnicas Hemostáticas , Inibidores da Agregação de Plaquetas/efeitos adversos , Hemorragia/induzido quimicamente , Humanos
6.
J Spec Oper Med ; 19(3): 31-44, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31539432

RESUMO

The 2012 study Death on the battlefield (2001-2011) by Eastridge et al.1 demonstrated that 7.5% of the prehospital deaths caused by potentially survivable injuries were due to external hemorrhage from the cervical region. The increasing use of Tactical Combat-Casualty Care (TCCC) and other medical interventions have dramatically reduced the overall rate of combat-related mortality in US forces; however, uncontrolled hemorrhage remains the number one cause of potentially survivable combat trauma. Additionally, the use of personal protective equipment and adaptations in the weapons used against US forces has caused changes in the wound distribution patterns seen in combat trauma. There has been a significant proportional increase in head and neck wounds, which may result in difficult to control hemorrhage. More than 50% of combat wounded personnel will receive a head or neck wound. The iTClamp (Innovative Trauma Care Inc., Edmonton, Alberta, Canada) is the first and only hemorrhage control device that uses the hydrostatic pressure of a hematoma to tamponade bleeding from an injured vessel within a wound. The iTClamp is US Food and Drug Administration (FDA) approved for use on multiple sites and works in all compressible areas, including on large and irregular lacerations. The iTClamp's unique design makes it ideal for controlling external hemorrhage in the head and neck region. The iTClamp has been demonstrated effective in over 245 field applications. The device is small and lightweight, easy to apply, can be used by any level of first responder with minimal training, and facilitates excellent skills retention. The iTClamp reapproximates wound edges with four pairs of opposing needles. This mechanism of action has demonstrated safe application for both the patient and the provider, causes minimal pain, and does not result in tissue necrosis, even if the device is left in place for extended periods. The Committee on TCCC recommends the use of the iTClamp as a primary treatment modality, along with a CoTCCC-recommended hemostatic dressing and direct manual pressure (DMP), for hemorrhage control in craniomaxillofacial injuries and penetrating neck injuries with external hemorrhage.


Assuntos
Hemorragia/terapia , Traumatismos Maxilofaciais/complicações , Medicina Militar , Lesões do Pescoço/complicações , Guias de Prática Clínica como Assunto , Lesões Relacionadas à Guerra/complicações , Ferimentos Penetrantes/complicações , Hemorragia/etiologia , Hemostáticos , Humanos
7.
Transfus Apher Sci ; 58(4): 423-428, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31383540

RESUMO

BACKGROUND: Plasma transfusion is not without risks. Despite a limited spectrum of indications, plasma is frequently used as prophylaxis in non-bleeding patients, to correct altered coagulation tests. A high rate of inappropriate use of plasma transfusion is frequently reported, as well as underdosage. STUDY DESIGN AND METHODS: Since 2010 we started an education program that occurred in several phases to disseminate the knowledge of plasma transfusion guidelines. Since 2014 a 'zero tolerance' policy was applied: except for massive bleedings, plasma requests were prospectively evaluated, rejecting those without an appropriate indication. When indicated, at least 10 mL/Kg b.w.were issued. The previous five year period (2005-2009) served as control. RESULTS: The number of patients transfused/year decreased by 67.6% vs the control period (149 vs 460), and the liters of plasma issued/year decreased by 70.4% (233 vs 795). The deepest fall was observed in acute care wards (-70.8%). The mean volume transfused per episode raised from 731 mL ±â€¯70 to 879 mL ±â€¯154. The Prothrombin Time ratio at the moment of transfusion request increased from a mean of 1.35 (Interquartile range 1.20-2.64) in the control period to 1.62 (Interquartile range 1.43-1.98) in the last period (p < 0.001). CONCLUSION: With a proactive educational approach a remarkable reduction of plasma order and administration has been obtained, without any consequence on morbidity and mortality and with an estimated saving since 2014 of 750,000 €. A 'zero tolerance' policy can be effectively implemented only with a thorough workup with the local physicians, including repeated rounds of information and refreshing of the updated transfusion practice and knowledge of the established guidelines over the time.


Assuntos
Transfusão de Componentes Sanguíneos/normas , Hemorragia/terapia , Hospitais/normas , Política Organizacional , Plasma , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
8.
J Laparoendosc Adv Surg Tech A ; 29(10): 1281-1284, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31397620

RESUMO

Background: Recently, several series have reported the use of laparoscopy in pediatric trauma, most commonly for bowel and pancreatic injury within the first 12 or 24 hours. During a multicenter trial at 10 Level 1 pediatric trauma centers, selective use of laparoscopy in children with blunt liver or spleen injury (BLSI) was noted. A secondary analysis was performed to describe the frequency and application of these procedures to pediatric BLSI. Patients and Methods: Prospective data were collected on all children age ≤18 years with BLSI presenting to 1 of 10 pediatric trauma centers. An unplanned secondary analysis of children who underwent laparoscopy was done. Results: Of 1008 children with BLSI, 59 initially underwent a laparotomy, but 11 underwent a laparoscopic procedure during their index admission; 1 of these was 22 hours postlaparotomy and 2 others were laparoscopy-assisted and converted to laparotomy. Median age of patients undergoing a laparoscopic procedure was 11.5 years (interquartile range [IQR]: 5.8-16.4). Laparoscopy was performed at 7 of the 10 centers. Median time to surgery was 42 hours (IQR: 8-96). Most patients had a liver (n = 6) injury; 4 had spleen and 1 had both. One of the laparoscopies was for pancreatic surgery, and 2 were for bowel injury (but converted to open). Conclusions: Laparoscopy was utilized in 16% of children requiring abdominal surgery after BLSI, with a median time of 42 hours postinjury. Uses included diagnostic laparoscopy, drain placement, laparoscopic pancreatectomy, and washout of hematoma.


Assuntos
Traumatismos Abdominais/cirurgia , Hemorragia/terapia , Laparoscopia/estatística & dados numéricos , Laparotomia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Baço/lesões , Ferimentos não Penetrantes/cirurgia , Traumatismos Abdominais/complicações , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Hemorragia/etiologia , Humanos , Lactente , Recém-Nascido , Fígado/lesões , Fígado/cirurgia , Masculino , Estudos Retrospectivos , Baço/cirurgia , Centros de Traumatologia , Estados Unidos , Ferimentos não Penetrantes/complicações
9.
Am J Disaster Med ; 14(1): 17-23, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31441025

RESUMO

OBJECTIVE: Compare QuikClot Combat Gauze (QCG) and Celox Rapid (CR) for initial hemostasis and over a 1-hour period. DESIGN: Experimental study. SETTING: Approved animal laboratory. SUBJECTS: Twenty-one Yorkshire swine. INTERVENTIONS: Subjects were randomly assigned to either the QCG (n = 11) or CR (n = 10) group. An arteriotomy was made in the right femoral artery with a 6-mm vascular punch. Bleeding was allowed for 45 seconds. QCG or CR was applied followed by firm pressure for 3 minutes according to Committee on Tactical Combat Casualty Care guidelines. A 10-pound weight simulating a pressure dressing was applied, and the wound was observed for 1 hour. Dressing failure was bleeding > 2 percent of blood volume. MAIN OUTCOME MEASURES: Achievement and maintenance of hemostasis and amount of hemorrhage during observation. Odds of successful hemostasis. RESULTS: QCG was significantly better than CR in initial hemostasis (p = 0.049) and maintaining hemostasis over 1 hour (p = 0.020). One hundred percent of QCG subjects and 70 percent of CR subjects achieved initial hemostasis. During the 1-hour observation, one additional CR subject failed to maintain hemostasis. CR had significantly more hemorrhage than QCG during the 1-hour observation (p = 0.027). QCG had no bleeding compared to CR that had a mean of 162 ± 48 mL (standard error of mean) over 2 minutes. QCG had 15.9 times greater odds of success compared to CR over a period of 1 hour. Over the 1-hour observation time, 100 percent of QCG achieved hemostasis compared to 60 percent of CR.


Assuntos
Bandagens , Hemorragia/terapia , Hemostáticos/administração & dosagem , Ferimentos e Lesões/terapia , Animais , Biopolímeros , Modelos Animais de Doenças , Artéria Femoral/lesões , Hemostasia , Técnicas Hemostáticas/instrumentação , Distribuição Aleatória , Suínos , Fatores de Tempo , Resultado do Tratamento
10.
Medicine (Baltimore) ; 98(34): e16752, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441848

RESUMO

RATIONALE: Tumor rupture and bleeding at initial presentation of infants with neuroblastoma (NBL) is a rare, but life threatening condition and challenge in pediatric oncology. Here, we report successful multidisciplinary management of an abdominal compartment syndrome as a result of tumor rupture and bleeding in an infant with bilateral high risk stage 4 NBL. PATIENT CONCERNS: The patient was admitted to a cooperating hospital with vomiting, failure to thrive and a large mass in the abdomen and was then referred to our center. DIAGNOSES: Stage 4 NBL with MYC-N amplification and 1p36 deletion was diagnosed in an 11 months old girl. Due to rapid and massive tumor growth she developed abdominal compression with renal failure, severe bleeding, and tumor lysis syndrome (TLS). INTERVENTIONS: Surgical decompression by enterostomy, local, and systemic bleeding control with platelets and coagulation factors, antiinfective and TLS therapy were effective in stabilizing the patient's condition. This allowed initiation of the multimodal antineoplastic treatment according to protocol NB 2004. OUTCOMES: Mechanical ventilation was stopped after 11 days, the abdominal wall was closed 3 months after the start of therapy, and treatment according to the protocol be started and successfully completed. LESSONS: Only the immediate, coordinated multidisciplinary intervention managed to overcome the life-threatening abdominal compartment syndrome and its associated problems, eventually enabling successful curative treatment.


Assuntos
Hemorragia/complicações , Hipertensão Intra-Abdominal/etiologia , Hipertensão Intra-Abdominal/terapia , Neuroblastoma/complicações , Anti-Infecciosos/uso terapêutico , Fatores de Coagulação Sanguínea , Enterostomia/métodos , Feminino , Hemorragia/terapia , Humanos , Lactente , Estadiamento de Neoplasias , Neuroblastoma/patologia
11.
Clin Adv Hematol Oncol ; 17(6): 344-351, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31437138

RESUMO

Hemophilia A and B are inherited bleeding disorders characterized by deficiency or dysfunction of coagulation protein factors VIII and IX, respectively. Recurrent joint and muscle bleeds are the major clinical manifestations. Replacement therapy with clotting factors, either at the time of bleeding or as part of a prophylactic regimen, is adapted to individual patient needs. The major complication of therapy is the development of neutralizing antibodies. In response, researchers have developed novel agents to both reduce the treatment burden and prevent bleeding regardless of the presence of inhibitors. Another new development, gene therapy, has the potential for a definitive cure. This review summarizes the pathophysiology, clinical presentation, diagnosis, and treatment of hemophilia, as well as information regarding neutralizing antibodies, immune tolerance induction, novel agents, and gene therapy.


Assuntos
Hemofilia A , Hemofilia B , Hemorragia , Hemofilia A/sangue , Hemofilia A/diagnóstico , Hemofilia A/imunologia , Hemofilia A/terapia , Hemofilia B/sangue , Hemofilia B/diagnóstico , Hemofilia B/imunologia , Hemofilia B/terapia , Hemorragia/sangue , Hemorragia/diagnóstico , Hemorragia/imunologia , Hemorragia/terapia , Humanos
12.
Medicine (Baltimore) ; 98(35): e16984, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464946

RESUMO

INTRODUCTION: Chronic myelogenous leukemia (CML), a clonal disorder of pluripotent stem cell, rarely presents with bleeding in chronic phase due to the function preservation of the platelets. Factor (F) XIII deficiency, an extremely rare hemorrhagic disease, can cause fatal bleeding, which has been previously described in autoimmune disorders and leukemias. PATIENT CONCERNS: A 38-year-old woman with a 20-day history of spontaneous subcutaneous hemorrhage visited our hospital, who presented with intracranial hemorrhage, hematuria, and delayed hematoma after a bone marrow puncture. Initial management included cytogenetics analysis, molecular analysis, and coagulation evaluation. DIAGNOSIS: Bone marrow puncture, cytogenetics, and molecular analysis indicated the diagnosis of CML. With the normal results of clotting screening tests and platelet counting, as well as the relief of bleeding after infusion of fresh frozen plasma (FFP), acquired rare bleeding disorder probably associated with factor XIII (FXIII) deficiency. INTERVENTIONS: Management with anti-hyperleukocytosis and chemotherapy, hydration, alkalization, diuresis, uric acid-lowering, molecular targeted drugs, and freshly frozen plasma transfusion therapy resolved the bleeding diathesis. OUTCOMES: The patient survived from the initial bleeding, however, she died. Twenty six months later due to the progression of CML. LESSONS: CML can initially present as unusual bleeding, possibly related to FXIII defect. It is essential to screen coagulopathy including FXIII activity and to supplement plasma for CML patients who present initially as bleeding, which cannot be deciphered by the routine clotting screening test.


Assuntos
Deficiência do Fator XIII/complicações , Hemorragia/complicações , Hemorragia/terapia , Leucemia Mielogênica Crônica BCR-ABL Positiva/complicações , Leucemia Mielogênica Crônica BCR-ABL Positiva/diagnóstico , Adulto , Antineoplásicos/uso terapêutico , Terapia Combinada , Feminino , Humanos , Plasma
13.
Prehosp Disaster Med ; 34(4): 401-406, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31389327

RESUMO

INTRODUCTION: The aim of this study was to determine if school personnel can understand and apply the Sort, Assess, Life-saving interventions, Treat/Transport (SALT) triage methods after a brief training. The investigators predicted that subjects can learn to triage with accuracy similar to that of medically trained personnel, and that subjects can pass an objective-structured clinical exam (OSCE) evaluating hemorrhage control. METHODS: School personnel were eligible to participate in this prospective observational study. Investigators recorded subject demographic information and prior medical experience. Participants received a 30-minute lecture on SALT triage and a brief lecture and demonstration of hemorrhage control and tourniquet application. A test with brief descriptions of mass-casualty victims was administered immediately after training. Participants independently categorized the victims as dead, expectant, immediate, delayed, or minimal. They also completed an OSCE to evaluate hemorrhage control and tourniquet application using a mannequin arm. RESULTS: Subjects from two schools completed the study. Fifty-nine were from a private school that enrolls early childhood through grade eight, and 45 from a public school that enrolls grades seven and eight (n = 104). The average subject age was 45 years and 68% were female. Approximately 81% were teachers and 87% had prior cardiopulmonary resuscitation (CPR) training. Overall triage accuracy was 79.2% (SD = 10.7%). Ninety-six (92.3%) of the subjects passed the hemorrhage control OSCE. CONCLUSIONS: After two brief lectures and a short demonstration, school personnel were able to triage descriptions of mass-casualty victims with an overall accuracy similar to medically trained personnel, and most were able to apply a tourniquet correctly. Opportunities for future study include integrating high-fidelity simulation and mock disasters, evaluating for knowledge retention, and exploring the study population's baseline knowledge of medical care, among others.


Assuntos
Simulação por Computador , Emergências , Socorristas , Hemorragia/prevenção & controle , Instituições Acadêmicas/organização & administração , Triagem/métodos , Adulto , Algoritmos , Criança , Feminino , Hemorragia/terapia , Humanos , Masculino , Incidentes com Feridos em Massa , Pessoa de Meia-Idade , Competência Profissional , Estudos Prospectivos , Estudantes/estatística & dados numéricos , Torniquetes
14.
J Trauma Acute Care Surg ; 87(2): 420-429, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31348403

RESUMO

Over the past decade, the shift toward damage control surgery for bleeding trauma patients has come with an increased emphasis on optimal resuscitation. Two lifesaving priorities predominate: to quickly stop the bleed and effectively resuscitate the hemorrhagic shock. Blood is separated into components for efficient storage and distribution; however, bleeding patients require all components in a balanced ratio. A variety of blood products are available to surgeons, and these products have evolved over time. This review article describes the current standards for resuscitation of bleeding patients, including characteristics of all available products. The relevant details of blood donation and collection, blood banking, blood components, and future therapies are discussed, with the goal of guiding surgeons in their emergency transfusion practice.


Assuntos
Transfusão de Sangue , Serviços Médicos de Emergência , Hemorragia/terapia , Técnicas Hemostáticas , Emergências , Serviços Médicos de Emergência/métodos , Humanos , Ressuscitação/métodos
15.
J Trauma Acute Care Surg ; 87(2): 342-349, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31349348

RESUMO

BACKDROP: Clinicians intuitively recognize that faster time to hemostasis is important in bleeding trauma patients, but these times are rarely reported. METHODS: Prospectively collected data from the Pragmatic Randomized Optimal Platelet and Plasma Ratios trial were analyzed. Hemostasis was predefined as no intraoperative bleeding requiring intervention in the surgical field or resolution of contrast blush on interventional radiology (IR). Patients who underwent an emergent (within 90 minutes) operating room (OR) or IR procedure were included. Mixed-effects Poisson regression with robust error variance (controlling for age, Injury Severity Score, treatment arm, injury mechanism, base excess on admission [missing values estimated by multiple imputation], and time to OR/IR as fixed effects and study site as a random effect) with modified Bonferroni corrections tested the hypothesis that decreased time to hemostasis was associated with decreased mortality and decreased incidence of acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), multiple-organ failure (MOF), sepsis, and venous thromboembolism. RESULTS: Of 680 enrolled patients, 468 (69%) underwent an emergent procedure. Patients with decreased time to hemostasis were less severely injured, had less deranged base excess on admission, and lower incidence of blunt trauma (all p < 0.05). In 408 (87%) patients in whom hemostasis was achieved, every 15-minute decrease in time to hemostasis was associated with decreased 30-day mortality (RR, 0.97; 95% confidence interval [CI], 0.94-0.99), AKI (RR, 0.97; 95% CI, 0.96-0.98), ARDS (RR, 0.98; 95% CI, 0.97-0.99), MOF (RR, 0.94; 95% CI, 0.91-0.97), and sepsis (RR, 0.98; 95% CI, 0.96-0.99), but not venous thromboembolism (RR, 0.99; 95% CI, 0.96-1.03). CONCLUSION: Earlier time to hemostasis was independently associated with decreased incidence of 30-day mortality, AKI, ARDS, MOF, and sepsis in bleeding trauma patients. Time to hemostasis should be considered as an endpoint in trauma studies and as a potential quality indicator. LEVEL OF EVIDENCE: Therapeutic/care management, level III.


Assuntos
Hemorragia/terapia , Técnicas Hemostáticas/mortalidade , Ferimentos e Lesões/terapia , Adulto , Hemorragia/sangue , Hemorragia/mortalidade , Humanos , Escala de Gravidade do Ferimento , Pessoa de Meia-Idade , Transfusão de Plaquetas/métodos , Distribuição de Poisson , Indicadores de Qualidade em Assistência à Saúde , Ressuscitação/métodos , Fatores de Tempo , Ferimentos e Lesões/sangue , Ferimentos e Lesões/mortalidade , Adulto Jovem
16.
J Trauma Acute Care Surg ; 87(1): 18-26, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31260423

RESUMO

BACKGROUND: The objective of this study was to compare the efficacy of preperitoneal balloon tamponade (PPB), resuscitative endovascular balloon occlusion of the orta (REBOA), and open preperitoneal packing (OP) in a realistic animal model of pelvic fracture-associated hemorrhage. METHODS: Thirty-nine swine underwent creation of open-book pelvic fracture and iliac vascular injury. Animals were randomized to no intervention (n = 7), OP (n = 10), PPB (n = 9), zone 1 REBOA (n = 7), and zone 3 REBOA (n = 6) at a mean arterial pressure less than 40 mm Hg from uncontrolled hemorrhage. Primary outcome was survival at 1 hour. Secondary outcomes included survival in the immediate 10 m following intervention reversal, peak preperitoneal pressure (PP), blood loss, bleed rate, and peak lactate. RESULTS: Prior to injury, no difference was measured between groups for weight, hemodynamics, lactate, and hematocrit (all p = NS). The injury was uniformly lethal without intervention, with survival time (mean) of 5 m, peak PP of 14 mm Hg, blood loss of 960 g, bleed rate of 450 g/m, and peak lactate of 2.6 mmol/L. Survival time (m) was extended to 44 with OP, 60 with PPB, and 60 with REBOA (p < 0.01). Peak PP (mm Hg) was 19 with OP, 23 with PPB, 10 with zone 1 REBOA, and 6 with zone 3 REBOA (p < 0.05). Blood loss (g) was 850 with OP, 930 with PPB, 610 with zone 1 REBOA, and 370 with zone 3 REBOA (p < 0.01). Peak lactate (mmol/L) was 3.3 with OP, 4.3 with PPB, 13.4 with zone 1 REBOA, and 5.3 with zone 3 REBOA (p < 0.01). Only 33% of zone 1 REBOA animals survived the initial 10 m after balloon deflation, compared to 60% for OP, 67% for PPB, and 100% for zone 3 REBOA (p < 0.01). CONCLUSION: Preperitoneal balloon tamponade and zone 3 REBOA are effective alternatives to OP in this animal model of lethal pelvic fracture-associated hemorrhage. Zone 1 REBOA extends survival time but with high mortality upon reversal.


Assuntos
Aorta , Oclusão com Balão/métodos , Fraturas Ósseas/terapia , Ossos Pélvicos/lesões , Ressuscitação/métodos , Choque Hemorrágico/terapia , Animais , Modelos Animais de Doenças , Hemorragia/terapia , Masculino , Suínos
17.
Medicine (Baltimore) ; 98(26): e16201, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261565

RESUMO

BACKGROUND: To compare the efficacy and safety of the modified sandwich method with lauromacrogol in the treatment of gastric variceal bleeding (GVB) caused by liver cirrhosis with the traditional sandwich method no accompanied by lauromacrogol via a meta-analysis. METHODS: The Cochrane Library, Pubmed, the China National Knowledge Infrastructure (CNKI) database, the Chinese Wanfang database, and the Chongqing VIP database were searched to identify cohort studies comparing modified to traditional sandwich method in the treatment of GVB with liver cirrhosis. The relative risk for hemostasis rate, gastric varices (GV) remission rate, re-bleeding rate, the incidence of post-operative complications (pain, fever, ulcer or erosion, ectopic embolism), and all-cause mortality were calculated. The mean difference for average tissue adhesive dosage per case was calculated. Relevant data were analyzed with the Reviewer Manager 5.3.5. RESULTS: Four cohort studies with a total of 587 patients were included in this meta-analysis. In the treatment of GVB with liver cirrhosis, compared with the traditional sandwich method, the modified sandwich method was associated with a higher GV remission rate (RR: 1.24, 95% CI: 1.09-1.42; P = .001) according to the pooled results. There were no statistically significant differences between the 2 methods in the rate of hemostasis, re-bleeding, pain, fever, ulcer or erosion, ectopic embolism, and all-cause mortality (P ≧ .05). CONCLUSIONS: This meta-analysis indicated that the modified sandwich method with lauromacrogol is more effective than the traditional sandwich method without lauromacrogol. Due to the limited number of studies and samples, more RCT studies are needed to further validate the efficacy and safety of the modified sandwich method with lauromacrogol in the treatment of GVB with liver cirrhosis.


Assuntos
Varizes Esofágicas e Gástricas/terapia , Hemorragia/terapia , Cirrose Hepática/terapia , Escleroterapia , Varizes Esofágicas e Gástricas/complicações , Hemorragia/etiologia , Humanos , Cirrose Hepática/complicações , Polidocanol/uso terapêutico , Soluções Esclerosantes/uso terapêutico , Escleroterapia/métodos , Adesivos Teciduais/uso terapêutico
18.
Vasc Med ; 24(4): 361-366, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31159682

RESUMO

Achenbach syndrome (paroxysmal finger hematoma) refers to a condition in which a patient exhibits episodic pain and swelling in one or more digits along with the subsequent appearance of a hematoma on the palmar side of the proximal phalanges. Achenbach syndrome is a benign condition of unknown etiology in which prodromal symptoms, such as pain, tingling, and itching, may occur from minutes to hours before the color change appears. The subdermal bleeding usually stops spontaneously or after local pressure is applied. The color changes usually disappear within a few days, without permanent sequelae. The diagnosis of Achenbach syndrome is based strictly on its clinical features because the results of all routine investigations are usually normal. Physicians should become aware of this condition in order to advise their patients about its benign prognosis and to avoid unnecessary testing.


Assuntos
Dedos/irrigação sanguínea , Hematoma , Hemorragia , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Hematoma/diagnóstico , Hematoma/etiologia , Hematoma/terapia , Hemorragia/diagnóstico , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Remissão Espontânea , Fatores de Risco , Síndrome
19.
Blood Coagul Fibrinolysis ; 30(5): 239-242, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31157683

RESUMO

: Acquired von Willebrand syndrome (AVWS) is a rare hemorrhagic condition that poses both a diagnostic and a therapeutic challenge. Here we report a singular case of AVWS with two associated conditions, small lymphocytic lymphoma (SLL) and Sjögren's syndrome. The patient presented with recurrent and severe digestive bleeding that forced us to raise a curative attempt of AVWS. A first immunosuppressive therapy with immunoglobulins was unsuccessful and it was later decided to treat lymphoproliferative entity with bendamustine and rituximab effectively achieving SLL and AVWS remission. On the basis of our case and through literature review, we discuss potential strategies to achieve AVWS remission when it appears in the setting of several causative associated conditions.


Assuntos
Leucemia Linfocítica Crônica de Células B/complicações , Síndrome de Sjogren/complicações , Doenças de von Willebrand/complicações , Idoso , Antineoplásicos Alquilantes/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Cloridrato de Bendamustina/uso terapêutico , Feminino , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Imunoglobulinas/uso terapêutico , Leucemia Linfocítica Crônica de Células B/terapia , Rituximab/uso terapêutico , Síndrome de Sjogren/terapia , Doenças de von Willebrand/terapia
20.
AACN Adv Crit Care ; 30(2): 139-150, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31151945

RESUMO

Health care professionals must understand the impact of blood product transfusions and transfusion therapy procedures to ensure high-quality patient care, positive outcomes, and wise use of resources in blood management programs. Understanding transfusions of blood and blood products is also important because of the number of treatments performed, which affects individual patients and health care system resources. This article reviews research findings to acquaint health care professionals with the most successful protocols for blood, blood product, and coagulation factor transfusions. Damage control resuscitation in bleeding trauma patients, protocols for patients without trauma who are undergoing surgical procedures that place them at risk for excessive bleeding, and protocols for patients with sepsis are addressed. Emerging research continues to help guide mass transfusion treatments (restrictive vs liberal, balanced, and goal-directed treatment). Although available study results provide some guidance, questions remain. Additional research by health care professionals is needed.


Assuntos
Transfusão de Componentes Sanguíneos , Ressuscitação/métodos , Medicina Baseada em Evidências , Hemorragia/terapia , Humanos , Sepse/terapia , Ferimentos e Lesões/terapia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA