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  • Gruen, Russell L.  (26)
  • Wounds and Injuries
Type of Medium
Language
Year
  • 1
    Language: English
    In: Injury, 2010, Vol.41, pp.S2-S2
    Keywords: Congresses As Topic ; Wounds and Injuries ; Research Design -- Standards;
    ISSN: 0020-1383
    E-ISSN: 1879-0267
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  • 2
    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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  • 3
    In: Medical Journal of Australia, September 2013, Vol.199(5), pp.310-311
    Description: The dilemma that clinicians involved in the resuscitation of severely injured patients face with regards to the inclusion of tranexamic acid (TxA) in trauma management protocols is discussed. However, on the other hand, the need for more evidence to solve ongoing knowledge gaps has been emphasised, especially evidence of who benefits and whether anyone is harmed when TxA is administered to patients treated to modern civilian and military trauma standards.
    Keywords: Emergency Medicine
    ISSN: 0025-729X
    E-ISSN: 1326-5377
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  • 4
    Language: English
    In: The Lancet, 2011, Vol.377(9771), pp.1052-1054
    Description: Unlike coagulopathy that is secondary to haemodilution, hypothermia, or acidosis, acute traumatic coagulopathy is a hyperacute process in which systemic fibrinolysis releases D-dimers that are detectable within 30 min of injury.5 While the mechanisms are poorly understood, shock and tissue injury seem...
    Keywords: Medicine
    ISSN: 0140-6736
    E-ISSN: 1474-547X
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  • 5
    Language: English
    In: The Lancet, 22 September 2012, Vol.380(9847), pp.1033-1034
    Description: By 2030, road traffic injuries are predicted to be the world's fifth leading cause of death and the third leading cause of disability.1 The Lancet's accompanying Series on trauma surgery updates present knowledge of three broad aspects of acute trauma care: haemorrhagic shock (responsible for most preventable...
    Keywords: Medicine
    ISSN: 0140-6736
    E-ISSN: 1474-547X
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  • 6
    Language: English
    In: The Lancet, 2010, Vol.376(9746), pp.1049-1049
    Keywords: Medicine
    ISSN: 0140-6736
    E-ISSN: 1474-547X
    Source: ScienceDirect Journals (Elsevier)
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  • 7
    Language: English
    In: Injury, 2012, Vol.43(1), pp.33-37
    Description: A high ratio of fresh frozen plasma (FFP) to packed red blood cells (PRBC) is currently recognised as the standard of care in some centres during massive transfusion post trauma. The aim of this study was to test whether the presumption of benefit held true for severely injured patients who received a massive transfusion, but did not present with acute traumatic coagulopathy. Data collected in The Alfred Trauma Registry over a 6 year period were reviewed. Included patients were sub-grouped by a high FFP:PRBC ratio (≥1:2) in the first 4 h and compared to patients receiving a lower ratio. Outcomes studied were associations with mortality, hours in the intensive care unit and hours of mechanical ventilation. Of 4164 eligible patients, 374 received a massive transfusion and 179 (49.7%) patients who did not have coagulopathy were included for analysis. There were 66 patients who received a high ratio of FFP:PRBC, and were similar in demographics and presentation to 113 patients who received a lower ratio. There was no significant difference in mortality between the two groups ( = 0.80), and the FFP:PRBC ratio was not significantly associated with mortality, ICU length of stay or mechanically ventilated hours. A small proportion of major trauma patients received a massive blood transfusion in the absence of acute traumatic coagulopathy. Aggressive FFP transfusion in this group of patients was not associated with significantly improved outcomes. FFP transfusion carries inherent risks with substantial costs and the population most likely to benefit from a high FFP:PRBC ratio needs to be clearly defined.
    Keywords: Wounds and Injuries ; Blood Coagulation Disorders ; Blood Transfusion ; Resuscitation
    ISSN: 0020-1383
    E-ISSN: 1879-0267
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  • 8
    Language: English
    In: BMJ : British Medical Journal, 19 November 2012, Vol.345
    Description: Tranexamic acid was discovered in the 1950s and has been used during surgery to minimise blood loss. A systematic review evaluated 126 randomised controlled trials in elective surgery and three in emergency surgery (total of 10 488 patients) that had been conducted between 1972 and 2011. This showed that tranexamic acid reduced blood transfusions by a third (risk ratio 0.62, 95% confidence interval 0.58 to 0.65),4 an effect that persisted when only trials with adequate allocation concealment were considered (0.68, 0.62 to 0.74). In these higher quality trials the effect on mortality was uncertain (0.67, 0.33 to 1.34), as was the effect on myocardial infarction, stroke, and venous thromboembolism.
    Keywords: Change Page
    ISSN: BMJ
    E-ISSN: 1756-1833
    E-ISSN: 17561833
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  • 9
    In: Shock, 2013, Vol.40(2), pp.160-161
    Keywords: Antifibrinolytic Agents -- Therapeutic Use ; Hemorrhage -- Prevention & Control ; Tranexamic Acid -- Therapeutic Use ; Wounds and Injuries -- Drug Therapy;
    ISSN: 1073-2322
    E-ISSN: 15400514
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  • 10
    In: Medical Journal of Australia, March 2014, Vol.200(5), pp.255-255
    Keywords: Emergency Medicine
    ISSN: 0025-729X
    E-ISSN: 1326-5377
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