Patients trauma

Recommendations in this section may change based on the results from the recent EPO-3 trial (epoetin alfa versus placebo). A difference in red blood cell transfusion rates was not observed between groups. Epoetin alpha therapy improved survival in trauma patients. Epoetin alfa did not have a measurable clinical benefit in medical/surgical non-trauma patients. Epoetin alpha therapy was associated with an increased thrombotic event rate, particularly in patients not receiving pharmacological deep vein thrombosis prophylaxis. 

Copper status effects on resistance to endotoxin-induced injuries because burn and trauma patients show moderate copper deficiency and high risk to sepsis, and copper deficient rats are sensitive to endotoxins causing sepsis (DiSilvestro et al. 1995)... 

Morphine can cause constipation, spasms of the sphincter of Oddi, urinary retention, and pruritus (secondary to histamine release) (see Table 54-4). In head trauma patients who are not ventilated, morphine-induced respiratory depression can increase intracranial pressure and cloud the neurologic examination results. 

Immediately after the trauma, patients should receive treatment individualized to their presenting symptoms (e.g., non-BZ hypnotic, short courses of CBT). Brief courses of CBT in close proximity to the trauma resulted in lower rates of PTSD. 

Table 21.5 Metabolic changes in trauma patients and in cancer patients...

O Keefe GE, GentUello LM, Maier RV. Incidence of infectious comphcations associated with the use of histamine2-receptor antagonists in critically ill trauma patients. Ann Surg 1998 227(l) 120-5. 

Most of the contraindications specific to pentazocine stem from its excitatory effects. Other contraindications are similar to those for morphine. Pentazocine is contraindicated in patients with myocardial infarction because it increases heart rate and cardiac load. Similarly, it is contraindicated in epileptic patients because it decreases seizure threshold. In addition, in head trauma patients, it can increase intracranial pressure and brain injury. Pentazocine use in patients with psychoses is contraindicated because of its psychotomimetic side effects. 

Secondary hypothyroidism, or pituitary hypothyroidism, is the consequence of impaired thyroid-stimulating hormone (TSH) secretion and is less common than primary hypothyroidism. It may result from any of the causes of hypopituitarism (e.g., pituitary tumor, postpartum pituitary necrosis, trauma). Patients with secondary hypothyroidism exhibit undetectable or inappropriately low serum TSH concentrations. In secondary hypothyroidism, a normal thyroid gland lacks the normal level of TSH stimulation necessary to synthesize and secrete thyroid hormones. Such patients usually also have impaired secretion of TSH in response to exogenous thyrotropin-releasing hormone (TRH) administration. 

Soderstrom, C.A. et ah, Marijuana and alcohol use among 1023 trauma patients, Arch. Surg., 123, 733,1988. 

Durham RM, Moran JJ, Mazuski JE, Shapiro MJ, Baue AE, Flint LM (2003) Multiple organ failure in trauma patients. J Trauma 55(4) 608-616 Eckle T, Grenz A, Laucher S, Eltzschig HK (2008) A2B adenosine receptor signaling attenuates acute lung injury by enhancing alveolar fluid clearance in mice. J Clin Invest 118(10) 3301-3315... 

Mansoor O, Beaufrere B, Boirie Y, RaUiere C, Taillandier D, Aurousseau E, Schoeffler P, Arnal M, Adaix D (1996) Increased mRNA levels for components of the lysosomal, Ca2+-activated, and ATP-ubiquitin-dependent proteolytic pathways in skeletal muscle from head trauma patients. Proc Natl Acad Sci U S A 93 2714-8... 

A recent study of 1,023 trauma patients admitted to a shock trauma unit... 

In a randomized controlled trial of trauma patients with hemorrhage receiving at least 2 units of blood, the administration of the compound recombinant BPI showed a favorable trend t in reducing respiratory morbidity endpoints (Demetriades et al., 1999). Additional studies are needed to elucidate whether there is a role of this compound in this patient population. 

Cullinane CA, Brumfield C, Flint LM, Ferrara JJ. Neuroleptic malignant syndrome associated with multiple joint dislocations in a trauma patient. J Trauma 1998 45(1) 168-71. 

There is an association between the illicit use of metamfetamine and traumatic accidents. A retrospective review of trauma patients in California showed that metamfetamine rates doubled between 1989 and 1994, while cocaine showed a minimal increase and alcohol a fall. Metamfetamine-positive patients were most likely to be Caucasian or Hispanic and were most commonly injured in motor vehicle collisions. The authors recommended intervention strategies, similar to those used for preventing alcohol consumption and driving, in order to minimize morbidity and mortality (12). 

James EA, Demian AZ. Acute psychosis in a trauma patient due to ciprofloxacin. Postgrad Med J 1998 74(869) 189-90. 

An external disaster becomes a problem for a facility when the consequences of the event create a demand for services that tax or exceed the usual available resources (e.g., arrival of a large number of trauma patients or victims of a chemical HAZMAT incident). 

Burn Center Care Is the Most Efficient and Cost-Effective Care for Burn Injuries. Burn injuries are not like other trauma injuries burn injuries often require a lengthy course of treatment as compared with simple or even complex trauma patients. For example, for burn patients with 50% body surface area burn, the average length of stay in the intensive care unit is 50 days. In a mass casualty, the average burn is typically greater than 50% body surface area. 

Although other types of shock may be present in the trauma patient, such as cardiogenic and neurologic, hypovolemic shock is the most common. Management... 

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