Search tips
Search criteria

Results 1-4 (4)

Clipboard (0)

Select a Filter Below

more »
Year of Publication
Document Types
1.  Quantification of Hypercoagulable State After Blunt Trauma: Microparticle and Thrombin Generation Are Increased Relative to Injury Severity, While Standard Markers are Not 
Surgery  2012;151(6):831-836.
Major trauma is an independent risk factor for developing venous thromboembolism (VTE). While increases in thrombin generation and/or procoagulant microparticles (MP), have been detected in other patient groups at higher risk for VTE, such as cancer or coronary artery disease, this association has yet to be documented in trauma patients. This pilot study was designed to characterize and quantify thrombin generation and plasma MP in individuals early after traumatic injury.
Blood was collected in the trauma bay from 52 blunt injured patients (case) and 19 non-injured outpatients (controls) and processed to platelet poor plasma for 1) isolation of MP for identification and quantification by flow cytometry; and 2) in vitro thrombin generation as measured by calibrated automatic thrombography (CAT). Data collected are expressed as either mean ± standard deviation or median with interquartile range.
Among cases, 39 men and 13 women (age = 40 ± 17), the injury severity score was 13 ± 11, INR 1.0 ± 0.1, PTT 25 ± 3 (sec), and platelet count 238 ± 62 (thousands). The numbers of total (cell-type not specified) procoagulant MP, as measured by Annexin V staining, were increased compared to non-trauma controls (541 ± 139/μl and 155 ± 148/μl, respectively, p<0.001). There was no significant difference in the amount of thrombin generated in trauma patients compared to controls; however, peak thrombin was correlated to injury severity, (Spearman correlation coefficient R= 0.35, p=0.02).
Patients with blunt trauma have greater numbers of circulating procoagulant MP and increased in vitro thrombin generation. Future studies, to characterize the cell-specific profiles of MP and changes in thrombin generation kinetics post-traumatic injury will determine whether they contribute to the hypercoagulable state observed after injury.
PMCID: PMC3356502  PMID: 22316436
2.  Crew resource management in the ICU: the need for culture change 
Intensive care frequently results in unintentional harm to patients and statistics don’t seem to improve. The ICU environment is especially unforgiving for mistakes due to the multidisciplinary, time-critical nature of care and vulnerability of the patients. Human factors account for the majority of adverse events and a sound safety climate is therefore essential. This article reviews the existing literature on aviation-derived training called Crew Resource Management (CRM) and discusses its application in critical care medicine. CRM focuses on teamwork, threat and error management and blame free discussion of human mistakes. Though evidence is still scarce, the authors consider CRM to be a promising tool for culture change in the ICU setting, if supported by leadership and well-designed follow-up.
PMCID: PMC3488012  PMID: 22913855
Intensive care; Human factors; Safety climate; Crew resource management
3.  Patterns in deer-related traffic injuries over a decade: the Mayo clinic experience 
Our American College of Surgeons Level 1 Trauma Center serves a rural population. As a result, there is a unique set of accidents that are not present in an urban environment such as deer related motor vehicle crashes (dMVC). We characterized injury patterns between motorcycle/all-terrain vehicles (MCC) and automobile (MVC) crashes related to dMVC (deer motor vehicle crash) with the hypotheses that MCC will present with higher Injury Severity Score (ISS) and that it would be related to whether the driver struck the deer or swerved.
The records of 157 consecutive patients evaluated at our institution for injury related to dMVC from January 1st, 1997 to December 31st, 2006 were reviewed from our prospectively collected trauma database. Demographic, clinical, and crash specific parameters were abstracted. Injury severity was analyzed by the Abbreviated Injury Scale score for each body region as well as the overall Injury Severity Score (ISS).
Motorcycle crashes presented with a higher median ISS than MVCs (14 vs 5, p < 0.001). Median Abbreviated Injury Score (AIS) of the spine for MCC riders was higher (3 vs 0, p < 0.001) if they swerved rather than collided. Seventy-seven percent of riders were not wearing a helmet which did not result in a statistically significant increase in median ISS (16 vs 10), head AIS (2 vs 0) or spine AIS (0 vs 0).
Within the MVC group, there was no difference between swerving and hitting the deer in any AIS group. Forty-seven percent of drivers were not wearing seat belts which resulted in similar median ISS (6 vs 5) and AIS of all body regions.
Motorcycle operators suffered higher ISS. There were no significant differences in median ISS if a driver involved in a deer-related motor vehicle crash swerved rather than collided, was helmeted, or restrained.
PMCID: PMC2930595  PMID: 20716341
4.  Minimizing charges associated with the determination of brain death 
Critical Care  1997;1(2):65-70.
The purpose of this study was to evaluate the effect of altering the use of the protocol for brain death determination in traumatically injured patients, on time to brain death determination, medical complication rates, organ procurement rates and charges for care rendered during brain death determination. A retrospective chart review of trauma patients with lethal brain injuries at an urban tertiary care trauma center was performed. Two groups of trauma patients with lethal head injuries were compared. Group I consisted of patients pronounced brain dead using a protocol requiring two brain examinations, and group II contained patients evaluated using a protocol requiring one brain examination in conjunction with a nuclear medicine brain flow scan.
Group II had a significantly (P < 0.01) shorter mean brain death stay (3.5 ± 1.8 h) than group I (12.0 ± 1.0 h). Patients in groups I and II developed a similar number of medical complications, 3.2 ± 0.2 and 4.0 ± 1.3, respectively. The number of organs procured per patient did not differ significantly (4.1 ± 0.2 for group I and 4.4 ± 1.4 for group II). There was a significant (P < 0.01) decrease in the brain death stay charges for group II ($6125 ± 1100) compared to group I ($16,645 ± 1223).
Medical complications are universal in the traumatized patient awaiting the determination of brain death. These complications necessitate aggressive and costly care in the intensive care unit in order to optimize organ function in preparation for possible transplantation. In our institution, the determination of brain death using a single clinical examination and a nuclear medicine flow study significantly shortened the brain death stay and reduced associated charges accrued during this period. The complication and organ procurement rates were not affected in this small, preliminary report sample.
PMCID: PMC28989  PMID: 11056697
brain death; cerebral blood flow; organ donor; traumatic brain injury

Results 1-4 (4)