cardiovascular-agents and Wounds-and-Injuries

The obesity pandemic now affects hundreds of millions of people worldwide. As obesity rates continue to increase, emergency physicians are called on with increasing frequency to resuscitate obese patients. This article discusses important anatomic, physiologic, and practical challenges imposed by obesity on resuscitative care. Impacts on hemodynamic monitoring, airway and ventilator management, and pharmacologic therapy are discussed. Finally, several important clinical scenarios (trauma, cardiac arrest, and sepsis), in which alterations to standard treatments may benefit obese patients, are highlighted.

Topics: Airway Management; Analgesics; Anti-Bacterial Agents; Body Composition; Cardiovascular Agents; Cardiovascular Diseases; Dose-Response Relationship, Drug; Emergency Service, Hospital; Heart Arrest; Humans; Hypnotics and Sedatives; Lung Volume Measurements; Obesity; Oxygen Consumption; Pharmacokinetics; Positive-Pressure Respiration; Resuscitation; Sepsis; Wounds and Injuries

This article reviews fluid therapy and medications in pediatric trauma. For resuscitation in the setting of hemorrhagic shock, isotonic crystalloid solution is the first-line agent of choice. Colloid solutions offer no additional benefit, introduce possible increased risks and cost more than crystalloids. Blood products, starting with pRBCs, should be introduced after 20-40 ml/kg of crystalloid has been administered if there is ongoing need for volume replacement. The use of a massive transfusion protocol of 1:1:1 (if >30 kg) or 30:20:20 (if <30 kg) of pRBCs:FFP:platelets is suggested after an initial 30 ml/kg of pRBcs has been administered. Cryoprecipitate should be given for documented low fibrinogen or ongoing bleeding after administration of 1 round of all 3 blood components. For patients at risk of massive hemorrhage, early administration of tranexamic acid with an initial loading dose of 15 mg/kg (maximum 1 g) is recommended. Choice of medication for intubation of the patient with Traumatic Brain Injury (TBI) may best be guided by physiology: in the TBI patient with a high mean arterial pressure, premedication with lidocaine, fentanyl and use of etomidate may be most appropriate, whereas in the hemodynamically compromised patient, use of ketamine alone may be considered. If needed, norepinephrine has been recommended as a temporizing agent for vasopressor support in the setting of fluid-refractory shock. Although controversial, in the setting of significant spinal cord injury, the potential benefits of administering 24-48 hours of steroids (initial 30 mg/kg of methylprednisolone within 8 hours of injury) may outweigh the risks especially in previously healthy pediatric patients.

Topics: Blood Coagulation Disorders; Blood Transfusion; Cardiovascular Agents; Child; Fluid Therapy; Hematologic Agents; Humans; Intubation, Intratracheal; Pediatrics; Rehydration Solutions; Resuscitation; Shock, Traumatic; Wounds and Injuries

Survival from traumatic cardiopulmonary arrest (TCA) has been reported at a rate as low as 0-2.6% in the civilian pre-hospital setting, and many consider resuscitation of this group to be futile. The aim of this investigation was to describe patients who received cardiac massage during TCA in a battlefield setting; we also aimed to identify predictors of survival.. We conducted a review of the Department of Defense Trauma Registry to identify patients who received cardiac massage in the battlefield between 2007 and 2014. Patients were also grouped according to location of cardiac arrest: pre-hospital (PH) and in-hospital (IH). The groups were compared and evaluated by injury, transport time, type of resuscitation, and pre-hospital procedures. Outcome variables included survival to discharge and 30-day survival. Categorical variables were analysed using chi-square or Fisher's exact tests. Wilcoxon tests were performed for continuous variables. Regression modelling was used to assess for predictors of survival.. 75 of all 582 patients (13%, 95% CI 10-16) survived to 30 days, and all survivors were transported out of the battlefield; 23 PH (7.8%, 95% CI 5.2-12) and 52 IH (17%, 95% CI 13-22) patients survived to 30 days (p < 0.001). Closed-chest cardiac massage with the administration of intravenous medications was associated with 30-day survival among IH patients.. We report a 13% survival to 30 days among all patients receiving cardiac massage in a battlefield setting. Closed-chest cardiac massage predicted survival among IH TCA victims who also received intravenous medications in this review of combat-related TCA.

Topics: Administration, Intravenous; Adult; Cardiopulmonary Resuscitation; Cardiovascular Agents; Emergency Medical Services; Female; Heart Arrest; Heart Massage; Humans; Injury Severity Score; Male; Military Health Services; Outcome and Process Assessment, Health Care; Prognosis; Registries; Survival Analysis; United States; Wounds and Injuries

Topics: Administration, Intravenous; Adult; Cardiopulmonary Resuscitation; Cardiovascular Agents; Emergency Medical Services; Female; Heart Arrest; Heart Massage; Humans; Injury Severity Score; Male; Military Health Services; Outcome and Process Assessment, Health Care; Registries; Survival Analysis; United States; Wounds and Injuries

Topics: Cardiopulmonary Resuscitation; Cardiovascular Agents; Congresses as Topic; Electric Countershock; Heart Arrest; Humans; Shock; Treatment Outcome; Wounds and Injuries

Topics: Blood Transfusion; Cardiopulmonary Resuscitation; Cardiovascular Agents; Fluid Therapy; Hemorrhage; Humans; United States; Wounds and Injuries

Topics: Aged, 80 and over; Cardiovascular Agents; Catheterization, Central Venous; Heart Failure; Humans; Jugular Veins; Male; Mediastinal Cyst; Pleural Effusion; Punctures; Thyroid Diseases; Thyroid Gland; Tomography, X-Ray Computed; Ultrasonography, Interventional; Wounds and Injuries

To develop a choice task for eliciting priorities in the face of competing cardiovascular disease (CVD) outcomes, medication-related symptoms, and fall injuries.. Conjoint analysis.. Senior housing site.. Convenience sample of 15 senior housing residents for the pretest, 13 residents for the pilot test.. The final task included 11 sets of choices. In each, one option optimized the risk of one or two of the three outcomes at the expense of the other(s); the second option did the reverse. Relative importance scores for CVD, fall injury, and medication-symptom outcomes were calculated. Reliability was assessed for two administrations using intraclass correlations (ICCs). Wilcoxon rank sum tests were used to evaluate order effects.. The ICCs between choice task administrations were 0.70 for fall injuries, 0.73 for medication symptoms, and 0.56 for CVD outcomes. The ICCs with removal of two outliers were 0.84, 0.72, and 0.84, respectively. Whether CVD or fall injuries appeared first had no effect on scores.. Preliminary evidence of comprehensibility and reliability supports using the choice task to determine whether individuals' priorities differ in the face of competing outcomes.

Topics: Accidental Falls; Aged; Aged, 80 and over; Cardiovascular Agents; Cardiovascular Diseases; Disability Evaluation; Female; Follow-Up Studies; Gait; Health Priorities; Humans; Incidence; Long-Term Care; Male; Pilot Projects; Prognosis; Risk Factors; Survival Rate; United States; Wounds and Injuries

Topics: Accidents; Cardiovascular Agents; Chlorzoxazone; Drug Therapy; Humans; Muscle Relaxants, Central; Musculoskeletal System; Wounds and Injuries

Topics: Analgesics; Cardiovascular Agents; Carisoprodol; Humans; Muscle Relaxants, Central; Psychotherapy; Wounds and Injuries

Topics: Cardiovascular Agents; Humans; Manipulation, Orthopedic; Methocarbamol; Muscle Relaxants, Central; Orthopedic Procedures; Orthopedics; Psychotherapy; Traumatology; Wounds and Injuries

Topics: Cardiovascular Agents; Ether; Ethers; Glycerol; Guaiacol; Muscle Relaxants, Central; Orthopedic Procedures; Orthopedics; Traumatology; Wounds and Injuries

Topics: Adrenal Cortex Hormones; Adrenal Glands; Adrenocorticotropic Hormone; Animals; Cardiovascular Agents; Dogs; Epinephrine; Glucocorticoids; Humans; Norepinephrine; Wounds and Injuries

Topics: Aminopyrine; Cardiovascular Agents; Ergot Alkaloids; Headache; Oxytocics; Thiamine; Wounds and Injuries

Topics: Brain; Brain Concussion; Brain Injuries; Cardiovascular Agents; Ergot Alkaloids; Humans; Oxytocics; Wounds and Injuries