scholarly journals Factors Associated With Pelvic Fracture-Related Arterial Bleeding During Trauma Resuscitation

2014 ◽  
Vol 28 (9) ◽  
pp. 489-495 ◽  
Author(s):  
Laszlo Toth ◽  
Kate L. King ◽  
Benjamin McGrath ◽  
Zsolt J. Balogh
Keyword(s):  
Pelvic Fracture ◽  
Trauma Resuscitation ◽  
Factors Associated ◽  
Arterial Bleeding

scholarly journals Place of preperitoneal pelvic packing in severe pelvic traumatisms: About 20 cases performed in a French military level one trauma center

2021 ◽  
Author(s):  
Hardy Julie ◽  
Coisy Marie ◽  
Monchal Tristan ◽  
Bourguoin Stéphane ◽  
Long Depaquit Thibaut ◽  
...  
Keyword(s):  
Pelvic Fracture ◽  
Trauma Center ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Safe Procedure ◽  
Pelvic Packing ◽  
Preperitoneal Pelvic Packing ◽  
Arterial Bleeding ◽  
Lethal Triad ◽  
Overall Mortality

AbstractBackgroundThe overall mortality of hemodynamically unstable pelvic fractures is high. Hemorrhage triggers off the Moore lethal triad. Hemostatic management during the golden hour is essential. Combined with pelvic stabilisation, preperitoneal pelvic packing (PPP) is proposed to control venous and bony bleeding, while arterioembolisation can stop arterial bleeding. No international consensus has yet prioritized these procedures. The aim of this study was to analyse a serie of PPP in a military level one trauma center and propose an algorithm for hemodynamically unstable pelvic traumas regardless of the military facility.MethodFrom January 2010 to December 2020, every patient from our military institution with a hemodynamically unstable pelvic fracture underwent PPP combined with pelvic stabilisation. Before 2012 data were retrospectively collected from database (PMSI), after 2012 data were prospectively recorded in our polytrauma database and retrospectively analysed. The care algorithm applied focused on hemodynamic status of polytraumatised patients on admission. Primary criteria were early hemorrhage-induced mortality (<24h) and overall mortality (<30d). Secondary criteria were systolic blood pressure (SBP) and red blood cells (RBC) units administered.Results20 patients with a pelvic fracture had a PPP. Mean age was 49,65 +/-23,97 years and median ISS was 49 (31; 67). The decrease of blood transfusion and increase of SBP between pre- and postoperative values were statistically significant. Eight patients (40%) had postoperative arterial pelvic blush and 7 patients were embolised. The early mortality by refractory hemorrhagic shock was 25% (5/20). Overall mortality at 30 days was 50% (10/20).ConclusionPPP is a quick, easy, efficient and safe procedure. It can control venous, bony and sometimes arterial bleeding. PPP is part of damage control surgery and we propose it in first line. Angio-embolization remains complementary. Besides, PPP is the only means available in precarious conditions of practice, notably in military forward units.

Factors associated with patient exposure and environmental control during pediatric trauma resuscitation

2013 ◽  
Vol 74 (2) ◽  
pp. 622-627 ◽  
Author(s):  
Deirdre C. Kelleher ◽  
Lauren J. Waterhouse ◽  
Samantha E. Parsons ◽  
Jennifer L. Fritzeen ◽  
Randall S. Burd ◽  
...  
Keyword(s):  
Environmental Control ◽  
Pediatric Trauma ◽  
Patient Exposure ◽  
Trauma Resuscitation ◽  
Factors Associated

scholarly journals Relationship between door-to-embolization time and clinical outcomes after transarterial embolization in trauma patients with complex pelvic fracture

2021 ◽  
Author(s):  
Hohyun Kim ◽  
Chang Ho Jeon ◽  
Jae Hun Kim ◽  
Hoon Kwon ◽  
Chang Won Kim ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Pelvic Fracture ◽  
Proportional Hazards ◽  
Transarterial Embolization ◽  
Negative Relationship ◽  
Cox Proportional Hazards ◽  
Red Blood Cell Transfusion ◽  
Trauma Patients ◽  
Regression Analyses ◽  
Arterial Bleeding

Abstract Background While transarterial embolization (TAE) is an effective way to control arterial bleeding associated with pelvic fracture, the clinical outcomes according to door-to-embolization (DTE) time are unclear. This study investigated how DTE time affects outcomes in patients with severe pelvic fracture. Methods Using a trauma database between November 1, 2015 and December 31, 2019, trauma patients undergoing TAE were retrospectively reviewed. The final study population included 192 patients treated with TAE. The relationships between DTE time and patients’ outcomes were evaluated. Multiple binomial logistic regression analyses, multiple linear regression analyses, and Cox hazard proportional regression analyses were performed to estimate the impacts of DTE time on clinical outcomes. Results The median DTE time was 150 min (interquartile range, 121–184). The mortality rates in the first 24 h and overall were 3.7% and 14.6%, respectively. DTE time served as an independent risk factor for mortality in the first 24 h (adjusted odds ratio = 2.00, 95% confidence interval [CI] = 1.20–3.34, p = 0.008). In Cox proportional hazards regression analyses, the adjusted hazard ratio of DTE time for mortality at 28 days was 1.24 (95% CI = 1.04–1.47, p = 0.014). In addition, there was a positive relationship between DTE time and requirement for packed red blood cell transfusion during the initial 24 h and a negative relationship between DTE time and ICU-free days to day 28. Conclusion Shorter DTE time was associated with better survival in the first 24 h, as well as other clinical outcomes, in patients with complex pelvic fracture who underwent TAE. Efforts to minimize DTE time are recommended to improve the clinical outcomes in patients with pelvic fracture treated with TAE.

Identifying Occult Arterial Bleeding by a Relaxing (Loosening) Pelvic Stabilization Device in Severe Pelvic Fracture

2013 ◽  
Vol 79 (2) ◽  
pp. 80-82
Author(s):  
John R. Klune ◽  
Nikhil B. Amesur ◽  
Joshua T. Bautz ◽  
Juan Carlos Puyana
Keyword(s):  
Pelvic Fracture ◽  
Arterial Bleeding ◽  
Pelvic Stabilization

The Diagnostic Accuracy of 64-Slice Computed Tomography in Detecting Clinically Significant Arterial Bleeding after Pelvic Fractures

2011 ◽  
Vol 77 (9) ◽  
pp. 1176-1182 ◽  
Author(s):  
Shahin Mohseni ◽  
Peep Talving ◽  
Leslie Kobayashi ◽  
Lydia Lam ◽  
Kenji Inaba ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Diagnostic Accuracy ◽  
Pelvic Fracture ◽  
Predictive Value ◽  
Clinical Signs ◽  
Pelvic Fractures ◽  
Contrast Extravasation ◽  
Arterial Bleeding ◽  
Transfusion Requirements ◽  
Clinically Significant

The purpose of this study was to determine the diagnostic accuracy of the 64-slice multidetector computed tomography (MDCT) in detecting active pelvic arterial bleeding associated with blunt pelvic fractures. We hypothesized that this modality yields high accuracy. We conducted a retrospective review of all MDCT detected pelvic fractures over an 18-month period admitted to LAC+ USC Medical Center, a Level 1 trauma center. The main outcome was the presence of contrast extravasation (CE) on admission MDCT, consistent with clinically significant arterial bleeding requiring a subsequent embolization or intraoperative ligation of pelvic arteries. Overall, 127 patients met study criteria and 12 per cent (n = 15) had CE on admission MDCT of which four were managed conservatively. Eighty-two per cent (n = 9) of the remaining 11 patients who went on to have invasive procedure had active arterial bleeding that required embolization or surgical ligation. Two of the 112 (1.8%) patients without CE on their admission MDCT were subjected to embolization after further investigation with angiography as a result of the severity of their pelvic fracture and continuous transfusion requirements. The calculated sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of the 64-slice MDCT to identify clinically relevant arterial bleeding were 82, 95, 60, 98, and 94 per cent, respectively. The modern 64-slice MDCT provides relatively high diagnostic accuracy in detecting a clinically relevant arterial hemorrhage after blunt pelvic fracture. Nevertheless, in patients with clinical signs of ongoing hemorrhage, timely angiography or operative intervention is warranted, even in the absence of MDCT contrast extravasation.

scholarly journals A nomogram to predict arterial bleeding in patients with pelvic fractures after blunt trauma: a retrospective cohort study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Myoung Jun Kim ◽  
Jae Gil Lee ◽  
Eun Hwa Kim ◽  
Seung Hwan Lee
Keyword(s):  
Risk Factors ◽  
Blunt Trauma ◽  
Pelvic Fracture ◽  
Bone Fractures ◽  
Fracture Pattern ◽  
Pelvic Fractures ◽  
Pelvic Bone ◽  
Cutoff Value ◽  
Arterial Bleeding ◽  
Independent Risk Factors

Abstract Background Pelvic bone fractures are one of the biggest challenges faced by trauma surgeons. Especially, the presence of bleeding and hemodynamic instability features is associated with high morbidity and mortality in patients with pelvic fractures. However, prediction of the occurrence of arterial bleeding causing massive hemorrhage in patients with pelvic fractures is difficult. Therefore, the aim of this study was to develop a nomogram to predict arterial bleeding in patients with pelvic bone fractures after blunt trauma. Methods The medical records of 1404 trauma patients treated between January 2013 and August 2017 were retrospectively reviewed. Patients older than 15 years with a pelvic fracture due to blunt trauma were enrolled (n = 148). The pelvic fracture pattern on anteroposterior radiography was classified according to the Orthopedic Trauma Association/Arbeitsgemeinschaft fur Osteosynthesefragen (OTA/AO) system. Multivariable logistic regression modeling was used to determine the independent risk factors for arterial bleeding. A nomogram was constructed based on the identified risk factors. Results The most common pelvic fracture pattern was type A (58.8%), followed by types B (34.5%) and C (6.7%). Of the 148 patients, 28 (18.9%) showed pelvic arterial bleeding on contrast-enhanced computed tomography or angiography, or in the operative findings. The independent risk factors for arterial bleeding were a type B or C pelvic fracture pattern, body temperature < 36 °C, and serum lactate level > 3.4 mmol/L. A nomogram was developed using these three parameters, along with a systolic blood pressure < 90 mmHg. The area under the receiver operating characteristic curve of the predictive model for discrimination was 0.8579. The maximal Youden index was 0.1527, corresponding to a cutoff value of 68.65 points, which was considered the optimal cutoff value for predicting the occurrence of arterial bleeding in patients with pelvic bone fractures. Conclusions The developed nomogram, which was based on the initial clinical findings identifying risk factors for arterial bleeding, is expected to be helpful in rapidly establishing a treatment plan and improving the prognosis for patients with pelvic bone fractures.

scholarly journals Relationship Between Door-to-Embolization Time and Clinical Outcomes After Transarterial Embolization in Trauma Patients With Severe Pelvic Fracture

2020 ◽  
Author(s):  
Hohyun Kim ◽  
Chang Ho Jeon ◽  
Jae Hun Kim ◽  
Hoon Kwon ◽  
Chang Won Kim ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Pelvic Fracture ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Transarterial Embolization ◽  
Negative Relationship ◽  
Red Blood Cell Transfusion ◽  
Trauma Patients ◽  
Regression Analyses ◽  
Arterial Bleeding

Abstract Background: While transarterial embolization (TAE) is an effective way to control arterial bleeding associated with pelvic fracture, the clinical outcomes according to door-to-embolization (DTE) time are unclear. This study investigated how DTE time affects outcomes in patients with severe pelvic fracture.Methods: Using a trauma database between November 1, 2015 and December 31, 2019, trauma patients undergoing TAE were retrospectively reviewed. The final study population included 204 patients treated with TAE. The relationships between DTE time and patients’ outcomes were evaluated. Multivariate binomial logistic regression analyses, multivariate linear regression analyses, and multivariate Cox hazard proportional regression analyses were performed to estimate the impacts of DTE time on clinical outcomes.Results: The median DTE time was 150 min (interquartile range, 123–186). The mortality rates at 7 and 28 days and overall were 8.3%, 13.7%, and 15.7%, respectively. DTE time served as an independent risk factor for mortality at 7 and 28 days (adjusted odds ratio = 1.62, 95% confidence interval [CI] = 1.14–2.30, p = 0.007; adjusted odds ratio = 1.48, CI = 1.05–2.07, p = 0.023, respectively). In multivariate Cox proportional hazards regression analyses, the adjusted hazard ratio of DTE time for mortality at 28 days was 1.28 (CI = 1.08–1.30, p = 0.005). In addition, there was a positive relationship between DTE time and requirement for packed red blood cell transfusion during the initial 24 h and a negative relationship between DTE time and ICU-free days to day 28.Conclusions: Shorter DTE time was associated with better survival at 7 and 28 days, as well as other clinical outcomes, in patients with severe pelvic fracture who underwent TAE. Efforts to minimize DTE time are recommended to improve the clinical outcomes in patients with pelvic fracture treated with TAE.

Stain contamination and embedding in electron microscopy

1986 ◽  
Vol 44 ◽  
pp. 50-53
Author(s):  
Hilton H. Mollenhauer
Keyword(s):  
Electron Microscopy ◽  
Information Retrieval ◽  
Epoxy Resins ◽  
Image Contrast ◽  
Sample Preservation ◽  
Factors Associated ◽  
Amount Of Information ◽  
Electron Microscopical ◽  
Contrast Information

Many factors (e.g., resolution of microscope, type of tissue, and preparation of sample) affect electron microscopical images and alter the amount of information that can be retrieved from a specimen. Of interest in this report are those factors associated with the evaluation of epoxy embedded tissues. In this context, informational retrieval is dependant, in part, on the ability to “see” sample detail (e.g., contrast) and, in part, on tue quality of sample preservation. Two aspects of this problem will be discussed: 1) epoxy resins and their effect on image contrast, information retrieval, and sample preservation; and 2) the interaction between some stains commonly used for enhancing contrast and information retrieval.

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