62 research outputs found
sj-pdf-1-asu-10.1177_00031348211050829 – Supplemental Material for Student Perspectives on Implementing Stop the Bleed Training into Medical School Curriculum
No full textSupplemental Material, sj-pdf-1-asu-10.1177_00031348211050829 for Student Perspectives on Implementing Stop the Bleed Training into Medical School Curriculum by Amanda M. Marsh, Whitney Winslow, Jordyn Cohen, Slee Yi, Mario Jacomino, George R. Luck, Robert Moreland and Lawrence Lottenberg in The American Surgeon</p
Pulmonary embolism prophylaxis with inferior vena cava filters in trauma patients: a systematic review using the meta-analysis of observational studies in epidemiology (MOOSE) guidelines
No full textBlunt cerebrovascular injury in rugby and other contact sports: case report and review of the literature
No full textReview of A Large Clinical Series: Once- Versus Twice-Daily Enoxaparin for Venous Thromboembolism Prophylaxis in High-Risk Trauma Patients
No full text Background: Consensus guidelines support the use of low-molecular-weight heparin for venous thromboembolism (VTE) prophylaxis in high-risk trauma patients but do not recommend a specific regimen. The current study compared the effectiveness and safety of enoxaparin 40 mg once-daily versus enoxaparin 30 mg twice-daily for VTE prophylaxis in high-risk trauma patients. Methods: A retrospective chart review was conducted of all trauma patients older than 18 years of age admitted to Shands at the University of Florida between July 1, 2005 and June 30, 2007, who received either dosing regimen. Excluded were patients with Injury Severity Score <9, surviving <2 days, hospital length of stay <2 days, receipt of >1 agent, and/or dosing regimen for VTE prophylaxis during hospitalization, interruption in therapy, pregnancy, or diagnosis of a VTE within 24 hours of admission. Results: A total of 409 patients were treated with once-daily dosing and 278 patients were treated with twice-daily dosing. The overall rate of VTE was 2.9% (95% confidence interval, 1.52, 5.07) in the once-daily group and 1.1% in the twice-daily group (95% confidence interval, 0.22, 3.12; P = .118). Major bleeding occurred in 11 patients in the once-daily group and 5 patients in the twice-daily group (1.8% vs 2.7%; P = .608). Conclusion: Enoxaparin 30 mg twice-daily may be more effective than enoxaparin 40 mg once-daily for prevention of VTE in high-risk trauma patients; however, statistical significance was not achieved. There were no statistically significant differences observed in clinically significant bleeding. Further study is needed to clarify which dosing regimen of enoxaparin is superior with regard to safety and effectiveness. </jats:p
Infection after penetrating brain injury—An Eastern Association for the Surgery of Trauma multicenter study oral presentation at the 32nd annual meeting of the Eastern Association for the Surgery of Trauma, January 15–19, 2019, in Austin, Texas
No full text2019 EAST PODIUM PAPER Infection after penetrating brain injury—An Eastern Association for the Surgery of Trauma multicenter study oral presentation at the 32nd annual meeting of the Eastern Association for the Surgery of Trauma, January 15–19, 2019, in Austin, Texas Harmon, Laura A. MD; Haase, Daniel J. MD; Kufera, Joseph A. MA; Adnan, Sakib BS; Cabral, Donna BNS; Lottenberg, Lawrence MD; Cunningham, Kyle W. MD, MPH; Bonne, Stephanie MD; Burgess, Jessica MD; Etheridge, James MD; Rehbein, Jennifer L. MD; Semon, Gregory DO; Noorbakhsh, Matthew R. MD; Cragun, Benjamin N. MD; Agrawal, Vaidehi PhD; Truitt, Michael MD; Marcotte, Joseph MD; Goldenberg, Anna DO; Behbahaninia, Milad MD; Keric, Natasha MD; Hammer, Peter M. MD; Nahmias, Jeffry MD; Grigorian, Areg MD; Turay, Dave MD; Chakravarthy, Vikram MD; Lalchandani, Priti MD; Kim, Dennis MD; Chapin, Trinette; Dunn, Julie MD; Portillo, Victor MD; Schroeppel, Thomas MD, MS; Stein, Deborah M. MD, MPH Author Information Journal of Trauma and Acute Care Surgery 87(1):p 61-67, July 2019. | DOI: 10.1097/TA.0000000000002327 Buy CME Test Erratum Abstract BACKGROUND
Fatality rates following penetrating traumatic brain injury (pTBI) are extremely high and survivors are often left with significant disability. Infection following pTBI is associated with worse morbidity. The modern rates of central nervous system infections (INF) in civilian survivors are unknown. This study sought to determine the rate of and risk factors for INF following pTBI and to determine the impact of antibiotic prophylaxis. METHODS
Seventeen institutions submitted adult patients with pTBI and survival of more than 72 hours from 2006 to 2016. Patients were stratified by the presence or absence of infection and the use or omission of prophylactic antibiotics. Study was powered at 85% to detect a difference in infection rate of 5%. Primary endpoint was the impact of prophylactic antibiotics on INF. Mantel-Haenszel χ2 and Wilcoxon\u27s rank-sum tests were used to compare categorical and nonparametric variables. Significance greater than p = 0.2 was included in a logistic regression adjusted for center. RESULTS
Seven hundred sixty-three patients with pTBI were identified over 11 years. 7% (n = 51) of patients developed an INF. Sixty-six percent of INF patients received prophylactic antibiotics. Sixty-two percent of all patients received one dose or greater of prophylactic antibiotics and 50% of patients received extended antibiotics. Degree of dural penetration did not appear to impact the incidence of INF (p = 0.8) nor did trajectory through the oropharynx (p = 0.18). Controlling for other variables, there was no statistically significant difference in INF with the use of prophylactic antibiotics (p = 0.5). Infection was higher in patients with intracerebral pressure monitors (4% vs. 12%; p = \u3c0.001) and in patients with surgical intervention (10% vs. 3%; p \u3c 0.001). CONCLUSION
There is no reduction in INF with prophylactic antibiotics in pTBI. Surgical intervention and invasive intracerebral pressure monitoring appear to be risk factors for INF regardless of prophylactic use. LEVEL OF EVIDENCE
Therapeutic, level IV
The concept of superego in Freuds theory
No full textEste trabalho trata da trajetória do conceito de superego na teoria freudiana desde o momento que os primeiros indícios de sua existência emergiram na clínica da histeria em 1892 até a segunda tópica em 1923, quando esta noção foi formalmente inserida na psicanálise, constituindo um dos pilares do aparelho psíquico ao lado do id e do ego. Para tanto a autora percorreu 1) as experiências pessoais e auto-analíticas de Freud descritas por seus biógrafos e por ele mesmo em sua extensa correspondência com Fliess, e também ao longo de seu livro A interpretação dos sonhos, que na verdade é uma valiosa peça autobiográfica; 2) a percepção de Freud dos fenômenos superegóicos relatados em alguns de seus casos clínicos desde a pré-história da psicanálise; e 3) a teoria psicanalítica, sendo que o foco principal foi o período de investigação conduzido por Freud entre os anos de 1892 e 1923. Ao longo deste estudo foram ressaltados os principais atributos, a natureza, as origens e as funções que o superego desempenha no psiquismo humano e concluiu-se que o superego, por conta de seu vínculo com a pulsão de morte, de sua militância no id e de sua ascendência nos conflitos incestuosos e parricidas do complexo de Édipo, é uma estrutura psíquica por natureza violenta e cruel. Uma vez que a participação do superego é estrutural na organização psíquica, cabe ao ego controlar sua fúria, defendendo o psiquismo de seus ataques destrutivos.This paper follows the trajectory of the concept of the superego in Freudian theory from the first signs of its development in 1892 trough hysteria clinic, to the point in 1923 when it was formally incorporated in his psychoanalysis, forming one of the pillars of the psychical apparatus next to the ego and the id. To achieve this objective, the author examined 1) Freuds personal and auto-analytical experiences as described by his biographers and by himself in both his book The Interpretation of Dreams and in the long and intense correspondence with Wilhelm Fliess; 2) Freuds perceptions of the superegos role in the human psyche as described in some of his clinical cases; and 3) psychoanalytic theory, focused mainly on Freuds work between 1892 and 1923. The author aimed to highlight the main features, the nature, the origins and the functions that the superego performs in the human psyche and concluded that the superego, because of its close link with the death drive, its confrontational relationship with the id and its emergence in the incestuous and parricidal conflicts of the Oedipus complex, is by nature a cruel and violent psychical structure. Given the superegos structural participation in the psychical mechanism, it is up to the ego to control its wrath, defending itself from the destructive assault of the superego
Ultramassive transfusion and adjunctive therapies in a case of blood bank depletion
No full textBackground: We present the case of a patient who presents with a high velocity thoracoabdominal gunshot wound requiring ultramassive transfusion who exhausted the county blood bank requiring adjunctive therapies to balanced blood product transfusion while additional blood products could be obtained. Summary: Thoracoabdominal gunshot wounds carry a high mortality of 14–37 % because of the risk to produce cardiopulmonary, solid organ as well as major vascular injuries (Mandal and Oparah (1989) [1]). Ultramassive transfusion (>20 units of blood product transfusion) also carries high morbidity and mortality and management has generally centered on balanced transfusion (Matthay et al. (2021) [2]). Conclusion: Balanced blood product transfusion reduces mortality for patients requiring ultramassive transfusion but when this is not possible utilization of adjuncts to blood products may temporize resuscitation until additional blood products can be obtained
Comparison of carbon dioxide and iodinated contrast for cavography prior to inferior vena cava filter placement
No full textA Systematic Review and Meta-Analysis Comparing Outcome of Severely Injured Patients Treated in Trauma Centers Following the Establishment of Trauma Systems
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