TERTIARY SURVEY OF THE TRAUMA PATIENT IN THE INTENSIVE CARE UNIT

Hyperglycemia can be a significant problem in the trauma population and has been shown to be associated with increased morbidity and mortality. Hyperglycemia in the trauma patient, as in other critically ill patients, is caused by a hypermetabolic response to stress and seems to be an entity of its own rather than simply a marker. Although several early studies in a mixed intensive care unit population indicated that insulin protocols aimed at strict glucose control improved outcome, later studies did not support this and, in fact, encountered increased complications due to hypoglycemia. More recent studies in the trauma population, while supporting the correlation between hyperglycemia and increased mortality, seemed to indicate that protocols aimed at moderate glucose control improved outcome while limiting the incidence of hypoglycemic complications.

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OBJECTIVE ASSESSMENT OF THE TRAUMA PATIENT IN A SURGICAL INTENSIVE CARE UNIT

Journal of Trauma and Acute Care Surgery ◽

10.1097/00005373-197705000-00006 ◽

1977 ◽

Vol 17 (5) ◽

pp. 367-372 ◽

Cited By ~ 3

Author(s):

H. SARWAR ◽

P. BARASH ◽

M. KERSTEIN ◽

K. CAMP ◽

N. KOSS

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Trauma Patient ◽

Objective Assessment ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care

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The Pregnant Trauma Patient in the Intensive Care Unit

The Journal of Perinatal & Neonatal Nursing ◽

10.1097/01.jpn.0000311873.53699.7e ◽

2008 ◽

Vol 22 (1) ◽

pp. 33-38 ◽

Cited By ~ 4

Author(s):

Mary Ellen Burke Sosa

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Trauma Patient

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Rapid Ultrasound Methods in Anesthesiology and Critical Care Medicine

Sveikatos mokslai ◽

10.5200/sm-hs.2015.037 ◽

2015 ◽

Vol 25 (2) ◽

pp. 94-102

Author(s):

Andrius Macas ◽

Asta Mačiulienė ◽

Sandra Ramanavičiūtė ◽

Alina Vilkė ◽

Kęstutis Petniūnas ◽

...

Keyword(s):

Intensive Care Unit ◽

Emergency Department ◽

Critical Care ◽

Intensive Care ◽

Trauma Patient ◽

Standard Of Care ◽

Intensive Care Unit Setting ◽

Critically Ill Patient ◽

Essential Information ◽

Ultrasound Applications

The variety of focus assessed ultrasound applications and protocols in emergency department and intensive care unit setting is growing. Focus assessed protocols can provide essential information about critically ill patient. It is now the standard of care to perform focused assessment using sonography for trauma - FAST early in the evaluation of trauma patient. Other focus assessed protocols can prove to be useful as well as FAST.

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REDUCING INTENSIVE CARE UNIT COSTS BY RE-ENGINEERING RESPIRATORY SUPPORT FOR THE EXTUBATED TRAUMA PATIENT

Critical Care Medicine ◽

10.1097/00003246-199801001-00072 ◽

1998 ◽

Vol 26 (Supplement) ◽

pp. 44A

Author(s):

Imtiaz Munshi ◽

Orlando Kirton ◽

Brian DeHaven ◽

Miguel Navarro ◽

Danny Sleeman

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Trauma Patient ◽

Respiratory Support ◽

Unit Costs

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Acute Adrenal Insufficiency May Affect Outcome in the Trauma Patient

The American Surgeon ◽

10.1177/000313480907500404 ◽

2009 ◽

Vol 75 (4) ◽

pp. 287-290 ◽

Cited By ~ 5

Author(s):

Oscar D. Guillamondegui ◽

Oliver L. Gunter ◽

Shivani Patel ◽

Sloan Fleming ◽

Bryan A. Cotton ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Trauma Patient ◽

Adrenal Insufficiency ◽

Hospital Length Of Stay ◽

Trauma Patients ◽

Acute Adrenal Insufficiency ◽

Stimulation Tests ◽

Cortisol Levels ◽

The Impact

Acute adrenal insufficiency in the trauma patient is underrecognized and the impact poorly understood. Our hypothesis was that the identification and treatment of acute adrenal insufficiency reduces mortality in trauma patients. Institutional Review Board approval for the retrospective review of a prospective database from a Level 1 trauma center for 2002 to 2004 was obtained. The study population included patients receiving a cosyntropin stimulation test (250 μg) and/or random Cortisol level based on our practice management guideline and an intensive care unit stay longer than 24 hours. Demographic, acuity, and outcome data were collected. The nonresponders had baseline Cortisol levels less than 20 μg/dL or poststimulation rise less than 9 μg/dL. Independent t tests and χ2 statistics were used. One hundred thirty-seven patients had cosyntropin stimulation tests performed. Eighty-two (60%) patients were nonresponders of which 66 were treated with hydrocortisone and 16 went untreated as a result of the discretion of the attending physician. The 55 (40%) responders showed no statistical differences in outcome variables whether or not they received hydrocortisone. The untreated adrenal-insufficient patients had significantly higher mortality, longer hospital length of stay, intensive care unit days, and ventilator-free days. Conclusions were: 1) treatment of acute adrenal insufficiency reduces mortality by almost 50 per cent in the trauma patient; and 2) acute adrenal insufficiency recognized by low random Cortisol levels or nonresponse to a stimulation tests should be considered for treatment.

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