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  • 1
    Article
    Article
    British Medical Journal Publishing Group
    Language: English
    In: BMJ : British Medical Journal, 11 September 2012, Vol.345
    Description: A DCR strategy applies to patients who present with suspected major haemorrhage. While many definitions exist, the most practical in the acute trauma setting is for estimated blood transfusion volumes of over four units in the initial 2-4 h. Identifying these patients can be a challenge because they are often young with good physiological reserve and may have no physiological evidence of hypovolaemic shock.7 A number of tools have been developed to identify this group of patients; however, physician decision and experience have been found to be just as accurate.w9 w10 w11 w12 w13 Failure to identify these patients early and to apply DCR is associated with excess mortality.8
    Keywords: Cme
    ISSN: 09598138
    E-ISSN: 1756-1833
    E-ISSN: 17561833
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  • 2
    Language: English
    In: PLoS ONE, 01 January 2014, Vol.9(7), p.e103082
    Description: Trauma is a global disease and is among the leading causes of disability in the world. The importance of outcome beyond trauma survival has been recognised over the last decade. Despite this there is no internationally agreed approach for assessment of health outcome and rehabilitation of trauma patients.To systematically examine to what extent outcomes measures evaluate health outcomes in patients with major trauma.MEDLINE, EMBASE, and CINAHL (from 2006-2012) were searched for studies evaluating health outcome after traumatic injuries.Studies of adult patients with injuries involving at least two body areas or organ systems were included. Information on study design, outcome measures used, sample size and outcomes were extracted. The World Health Organisation International Classification of Function, Disability and Health (ICF) were used to evaluate to what extent outcome measures captured health impacts.34 studies from 755 studies were included in the review. 38 outcome measures were identified. 21 outcome measures were used only once and only five were used in three or more studies. Only 6% of all possible health impacts were captured. Concepts related to activity and participation were the most represented but still only captured 12% of all possible concepts in this domain. Measures performed very poorly in capturing concepts related to body function (5%), functional activities (11%) and environmental factors (2%).Outcome measures used in major trauma capture only a small proportion of health impacts. There is no inclusive classification for measuring disability or health outcome following trauma. The ICF may provide a useful framework for the development of a comprehensive health outcome measure for trauma care.
    Keywords: Sciences (General)
    E-ISSN: 1932-6203
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  • 3
    Language: English
    In: The Lancet, 25 February 2016, Vol.387, pp.S46-S46
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/S0140-6736(16)00433-5 Byline: Lewis Gall, Ross Davenport, Karim Brohi Abstract: Tranexamic acid (TXA) in traumatic haemorrhage reduces death from bleeding. However, its effect on the coagulation system after trauma is unclear. We aimed to assess the effect of TXA on functional clotting dynamics in patients with suspected traumatic haemorrhage. Author Affiliation: (a) Queen Mary University of London, London, UK
    Keywords: Medicine
    ISSN: 0140-6736
    E-ISSN: 1474-547X
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  • 4
    Article
    Article
    In: Anesthesiology, 2017, Vol.127(3), pp.585-586
    Keywords: Blood Coagulation Disorders ; Thrombin;
    ISSN: 0003-3022
    E-ISSN: 15281175
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  • 5
    Language: English
    In: Intensive Care Medicine, 2014, Vol.40(11), pp.1727-1730
    Description: Byline: Karim Asehnoune (1,2), David Faraoni (3), Karim Brohi (4) Author Affiliation: (1) Pole PHU3, Service d'Anesthesie Reanimation Chirurgicale, Hotel Dieu, CHU Nantes, 44035, Nantes cedex 1, France (2) Laboratoire UPRES EA 3826, Therapeutiques cliniques et experimentales des infections, Faculte de Medecine, Faculte de Nantes, Universtie de Nantes, Nantes, France (3) Department of Anesthesiology, Centre Hospitalier Universitaire Brugmann-Hopital Universitaire des Enfants Reine Fabiola, Free University of Brussels, 15 JJ Crocq Avenue, 1020, Brussels, Belgium (4) Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK Article History: Registration Date: 27/06/2014 Received Date: 22/06/2014 Accepted Date: 27/06/2014 Online Date: 08/07/2014
    Keywords: Blood Coagulation Disorders–Etiology ; Fluid Therapy–Therapy ; Hemodynamics–Methods ; Humans–Methods ; Resuscitation–Complications ; Wounds and Injuries–Complications;
    ISSN: 0342-4642
    E-ISSN: 1432-1238
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  • 6
    In: Nature, 2010, Vol.464(7285), p.104
    Description: Injury causes a systemic inflammatory response syndrome (SIRS) that is clinically much like sepsis (1). Microbial pathogen-associated molecular patterns (PAMPs) activate innate immunocytes through pattern recognition receptors (2). Similarly, cellular injury can release endogenous 'damage'-associated molecular patterns (DAMPs) that activate innate immunity (3). Mitochondria are evolutionary endosymbionts that were derived from bacteria (4) and so might bear bacterial molecular motifs. Here we show that injury releases mitochondrial DAMPs (MTDs) into the circulation with functionally important immune consequences. MTDs include formyl peptides and mitochondrial DNA. These activate human polymorphonuclear neutrophils (PMNs) through formyl peptide receptor-1 and Toll-like receptor (TLR) 9, respectively. MTDs promote PMN [Ca.sup.2+] flux and phosphorylation of mitogen-activated protein (MAP) kinases, thus leading to PMN migration and degranulation in vitro and in vivo. Circulating MTDs can elicit neutrophil-mediated organ injury. Cellular disruption by trauma releases mitochondrial DAMPs with evolutionarily conserved similarities to bacterial PAMPs into the circulation. These signal through innate immune pathways identical to those activated in sepsis to create a sepsis-like state. The release of such mitochondrial 'enemies within' by cellular injury is a key link between trauma, inflammation and SIRS.
    Keywords: Mitochondrial Dna -- Physiological Aspects ; Mitochondrial Dna -- Research ; Infection -- Research ; Inflammation -- Risk Factors ; Inflammation -- Research ; Peptides -- Physiological Aspects ; Peptides -- Research;
    ISSN: 0028-0836
    E-ISSN: 14764687
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  • 7
    Language: English
    In: The Lancet, 22 September 2012, Vol.380(9847), pp.1099-1108
    Description: Most surgeons have adopted damage control surgery for severely injured patients, in which the initial operation is abbreviated after control of bleeding and contamination to allow ongoing resuscitation in the intensive-care unit. Developments in early resuscitation that emphasise rapid control of bleeding, restrictive volume replacement, and prevention or early management of coagulopathy are making definitive surgery during the first operation possible for many patients. Improved topical haemostatic agents and interventional radiology are becoming increasingly useful adjuncts to surgical control of bleeding. Better understanding of trauma-induced coagulopathy is paving the way for the replacement of blind, unguided protocols for blood component therapy with systemic treatments targeting specific deficiencies in coagulation. Similarly, treatments targeting dysregulated inflammatory responses to severe injury are under investigation. As point-of-care diagnostics become more suited to emergency environments, timely targeted intervention for haemorrhage control will result in better patient outcomes and reduced demand for blood products. Our Series paper describes how our understanding of the roles of the microcirculation, inflammation, and coagulation has shaped new and emerging treatment strategies.
    Keywords: Medicine
    ISSN: 0140-6736
    E-ISSN: 1474-547X
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  • 8
    Language: English
    In: BMJ: British Medical Journal, 3 November 2012, Vol.345(7881), pp.32-33
    Keywords: Health sciences -- Medical treatment -- Emergency treatment ; Health sciences -- Medical conditions -- Physical trauma ; Biological sciences -- Biology -- Physiology ; Economics -- Economic disciplines -- Labor economics ; Health sciences -- Medical conditions -- Physical trauma
    ISSN: 09598138
    E-ISSN: 17561833
    Source: Archival Journals (JSTOR)
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  • 9
    Language: English
    In: BMJ: British Medical Journal, 3 November 2012, Vol.345(7881), pp.32-33
    Keywords: FLUID RESUSCITATION IN SEVERE TRAUMA
    ISSN: 09598138
    E-ISSN: 17561833
    Source: Archival Journals (JSTOR)
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  • 10
    Article
    Article
    BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine
    Language: English
    In: Emergency Medicine Journal December 2015, Vol.32(12), p.909
    Description: Data and research sit at the heart of public health models of healthcare systems. It is not an exaggeration to state that no meaningful change is possible without the underlying knowledge that change is first necessary, and subsequent confirmation that change was effective. Only in this way can health systems bootstrap themselves up to effective high quality care. Trauma registries have therefore been at the heart of trauma systems since the concept was first introduced nearly half a century ago.
    Keywords: Trauma
    ISSN: 1472-0205
    ISSN: 14720205
    E-ISSN: 1472-0213
    E-ISSN: 14720213
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