The outcomes of 1120 severe multiple trauma patients with hemorrhagic shock in an emergency department: a retrospective study

Yin, Wen; Hong-yuan, Yang; Wang, Wei; Liu, Shanshou

doi:10.1186/1471-227x-13-s1-s6

Cited by 16 publications

(9 citation statements)

References 6 publications

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“…Severe traumatic injury is the leading cause of death in adolescence globally [ 1 ] and the total number is likely to increase until the year 2020 [ 2 ]. Often, these injuries cause traumatic bleeding, leading to early hypovolemia and shock, thus presenting a severe condition worsening the outcome for polytrauma (PT) patients [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Early structural changes of the heart after experimental polytrauma and hemorrhagic shock

et al. 2017

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Evidence is emerging that systemic inflammation after trauma drives structural and functional impairment of cardiomyocytes and leads to cardiac dysfunction, thus worsening the outcome of polytrauma patients. This study investigates the structural and molecular changes in heart tissue 4 h after multiple injuries with additional hemorrhagic shock using a clinically relevant rodent model of polytrauma. We determined mediators of systemic inflammation (keratinocyte chemoattractant, macrophage chemotactic protein 1), activated complement component C3a and cardiac troponin I in plasma and assessed histological specimen of the mouse heart via standard histomorphology and immunohistochemistry for cellular and subcellular damage and ongoing apoptosis. Further we investigated spatial and quantitative changes of connexin 43 by immunohistochemistry and western blotting. Our results show significantly increased plasma levels of both keratinocyte chemoattractant and cardiac troponin I 4 h after polytrauma and 2 h after induction of hypovolemia. Although we could not detect any morphological changes, immunohistochemical evaluation showed increased level of tissue high-mobility group box 1, which is both a damage-associated molecule and actively released as a danger response signal. Additionally, there was marked lateralization of the cardiac gap-junction protein connexin 43 following combined polytrauma and hemorrhagic shock. These results demonstrate a molecular manifestation of remote injury of cardiac muscle cells in the early phase after polytrauma and hemorrhagic shock with marked disruption of the cardiac gap junction. This disruption of an important component of the electrical conduction system of the heart may lead to arrhythmia and consequently to cardiac dysfunction.

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Section: Introductionmentioning

confidence: 99%

Early structural changes of the heart after experimental polytrauma and hemorrhagic shock

et al. 2017

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“…Notwithstanding, our data are concordant with other reports suggesting that high rates of penetrating trauma are rare outside densely populated urban areas in North America. For example, the prevalence of injuries caused by blunt trauma ranged from 82 to 96% in published reports of trauma cohorts from Germany, [ 31 ] Scandinavia, [ 32 ] China [ 33 ] and across Canada. [ 34 ]…”

Section: Discussionmentioning

confidence: 99%

Vasopressor use following traumatic injury – A single center retrospective study

et al. 2017

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ObjectivesVasopressors are not recommended by current trauma guidelines, but recent reports indicate that they are commonly used. We aimed to describe the early hemodynamic management of trauma patients outside densely populated urban centers.MethodsWe conducted a single-center retrospective cohort study in a Canadian regional trauma center. All adult patients treated for traumatic injury in 2013 who died within 24 hours of admission or were transferred to the intensive care unit were included. A systolic blood pressure <90 mmHg, a mean arterial pressure <60 mmHg, the use of vasopressors or ≥2 L of intravenous fluids defined hemodynamic instability. Main outcome measures were use of intravenous fluids and vasopressors prior to surgical or endovascular management.ResultsOf 111 eligible patients, 63 met our criteria for hemodynamic instability. Of these, 60 (95%) had sustained blunt injury and 22 (35%) had concomitant severe traumatic brain injury. The subgroup of patients referred from a primary or secondary hospital (20 of 63, 32%) had significantly longer transport times (243 vs. 61 min, p<0.01). Vasopressors, used in 26 patients (41%), were independently associated with severe traumatic brain injury (odds ratio 10.2, 95% CI 2.7–38.5).ConclusionsIn this cohort, most trauma patients had suffered multiple blunt injuries. Patients were likely to receive vasopressors during the early phase of trauma care, particularly if they exhibited signs of neurologic injury. While these results may be context-specific, determining the risk-benefit trade-offs of fluid resuscitation, vasopressors and permissive hypotension in specific patients subgroups constitutes a priority for trauma research going forwards.

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“…The findings of the present study might be an alarm for shortcoming in knowledge and skills for circulatory management in the PEMS staff in Kashan city. Therefore, the authorities should establish appropriate programs to prepare their staff in these vital procedures ( 31 ).…”

Section: Discussionmentioning

confidence: 99%

The Quality of Pre-hospital Circulatory Management in Patients With Multiple Trauma Referred to the Trauma Center of Shahid Beheshti Hospital in Kashan, Iran, in the First Six Months of 2013

Maghaminejad¹,

Adib-Hajbaghery²

2016

Nurs Midwifery Stud

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BackgroundCirculatory management is a critical issue in pre-hospital transportation phase of multiple trauma patients. However, the quality of this important care did not receive enough attention.ObjectivesThe aim of this study was to investigate the quality of pre-hospital circulatory management in patients with multiple trauma.Patients and MethodsThis was a cross-sectional study conducted in 2013. The study population consisted of all patients with multiple trauma who had been transferred by emergency medical services (EMS) to the central trauma department in Kashan Shahid Beheshti medical center, Kashan, Iran. We recruited a convenience sample of 400 patients with multiple trauma. Data were collected using the circulatory assessment questionnaire and controlling hemorrhage (CAQCH) that were designed by the researchers and were described by using frequency tabulations, central tendency measures, and variability indices. The chi-square test was used to analyze the data.ResultsThe study sample consisted of 263 males (75.2%); 57.75% had lower levels of education and 28.75% were workers. The most common mechanism of trauma was traffic accident (85.4%). We found that the quality of circulatory management was unfavorable in 61% of the cases. A significant relationship was observed between the quality of circulatory management and type of trauma and staff’s employment status.ConclusionsThe quality of pre-hospital circulatory management provided to patients with multiple trauma was unfavorable. Therefore, establishment of in-service training programs on circulatory management is recommended.

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The outcomes of 1120 severe multiple trauma patients with hemorrhagic shock in an emergency department: a retrospective study

Cited by 16 publications

References 6 publications

Early structural changes of the heart after experimental polytrauma and hemorrhagic shock

Early structural changes of the heart after experimental polytrauma and hemorrhagic shock

Vasopressor use following traumatic injury – A single center retrospective study

The Quality of Pre-hospital Circulatory Management in Patients With Multiple Trauma Referred to the Trauma Center of Shahid Beheshti Hospital in Kashan, Iran, in the First Six Months of 2013

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