A model for testing topical haemostatic dressings for peripheral extremity haemorrhage following amputation

AbstractAimsTo assess the viability of a peripheral extremity amputation and haemorrhage model for testing topical haemostatic dressings, and secondarily to test whether a topical haemostatic dressing would arrest bleeding and maintain haemostasis without a tourniquet in this model.MethodsAn animal model was used during proof of principle model development. Bilateral through-elbow amputations were performed on a single swine under anaesthetic and treated with application of Celox Rapid topical haemostatic dressing (Celox gauze) to the stump after 30 seconds of free bleeding. Following initial haemostasis, the wound sites were bandaged using standard trauma dressings. Vital signs were monitored throughout the study.ResultsThe animal survived and, in both amputations, haemorrhage was successfully controlled. There was no evidence of re-bleeding during the 30 minutes post-injury or following removal of the packed Celox gauze from the wound sites.ConclusionTopical haemostatic dressings could be considered alongside tourniquets for use as a primary treatment of peripheral extremity haemorrhage due to traumatic amputation. It may be useful in prolonged field care where evacuation is delayed or where tourniquet alone does not provide adequate haemorrhage control.

Download Full-text

Abstract 15232: Lifetime Risk of Nontraumatic Lower-extremity Amputation: The Atherosclerosis Risk in Communities Study

Circulation ◽

10.1161/circ.142.suppl_3.15232 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Ning Ding ◽

Yejin Mok ◽

Yingying Sang ◽

Maya Salameh ◽

Weihong Tang ◽

...

Keyword(s):

Black Women ◽

Lower Extremity ◽

Black Men ◽

White Men ◽

Lower Extremity Amputation ◽

Lifetime Risk ◽

Area Deprivation ◽

Low Ses ◽

Traumatic Amputation ◽

Extremity Amputation

Introduction: Nontraumatic lower-extremity amputation is a serious clinical outcome. Major risk factors include peripheral artery disease and diabetic neuropathy. Although incidence rates of amputation have been reported, no lifetime risk estimates are available. Hypothesis: The lifetime risk of amputation is higher in men, blacks, and those of low socioeconomic status (SES). Methods: In 15,744 ARIC participants aged 45-64 at baseline (1987-89), we estimated the lifetime risk of amputation through age 80 by race-sex and race-SES using Fine and Gray’s proportional subhazards model accounting for the competing risk of death. This method is optimal for time-fixed exposures and thus our primary exposures are sex and race. SES included education, annual family income, and the Area Deprivation Index linked to census tract geocoding. Non-traumatic amputation was identified from hospitalization ICD codes (e.g., 84.1, Z89.4) and related operation codes. Results: There were 253 non-traumatic amputations during a median follow up of 29 years. Lifetime risk of amputation at age 80 was highest in black men (4.6%), followed by black women (2.8%), white men (1.1%) and white women (0.7%) ( Figure ). Blacks of low SES showed the highest lifetime risk (4.5%). Blacks with high SES had a higher lifetime risk of amputation than whites with low SES. The pattern was consistent when we investigated each of education (≤ vs. > high school), income (< vs. ≥$25,000) and Area Deprivation Index (< vs. ≥ race-specific median), separately. Conclusions: In this population-based cohort 5% of black men and 3% of black women experienced a non-traumatic amputation during their lifetime, while only 1% of white men and women had a hospitalization for amputation. The lifetime risk was higher among those with lower SES in both race groups. Future public health and primary care efforts should emphasize risk factor management (e.g., diabetes and smoking) among racial minority groups and those with low SES.

Download Full-text

A teenage girl with low body mass index due to restricting food intake

Child and Adolescent Psychiatry ◽

10.1093/med/9780197577479.003.0023 ◽

2021 ◽

pp. 181-188

Author(s):

Kathryn S. Czepiel

Keyword(s):

Body Weight ◽

Vital Signs ◽

Primary Treatment ◽

Evidence Based ◽

Teenage Girl ◽

Refeeding Syndrome ◽

Intense Fear ◽

Low Body Mass Index ◽

Family Based ◽

Evidence Based Psychotherapy

Anorexia nervosa (AN) is an eating disorder that is characterized by restriction of energy intake leading to significantly low body weight, an intense fear of gaining weight or persistent behavior that interferes with weight gain, and disturbance in the way one’s body weight or shape is experienced. Because many patients with AN attempt to conceal their efforts to lose weight and minimize their symptoms, obtaining information from a caregiver is an important part of the assessment. A medical history and physical examination must be completed to assess medical stability, including review of vital signs, electrocardiogram, and laboratory studies. Medically unstable patients require a medical admission for refeeding and stabilization, including monitoring for refeeding syndrome. Pharmacotherapy should not be used as the primary treatment for patients with AN. The most evidence-based psychotherapy approach for children and adolescents is family-based treatment (Maudsley family therapy).

Download Full-text

Cross-Species Pharmacologic Evaluation of Plasmin as a Direct-Acting Thrombolytic Agent: Ex Vivo Evaluation for Large Animal Model Development

Journal of Vascular and Interventional Radiology ◽

10.1097/01.rvi.0000148828.40438.d3 ◽

2005 ◽

Vol 16 (3) ◽

pp. 369-377 ◽

Cited By ~ 10

Author(s):

Kyle Landskroner ◽

Neil Olson ◽

Gary Jesmok

Keyword(s):

Animal Model ◽

Thrombolytic Agent ◽

Ex Vivo ◽

Model Development ◽

Large Animal Model ◽

Large Animal ◽

Direct Acting

Download Full-text

Dismounted complex blast injuries

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000342 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0003

Author(s):

Paul Ryan ◽

Claude Anderson ◽

Steven Wilding

Keyword(s):

Lower Extremity ◽

Upper Extremity ◽

The United States ◽

Lower Extremity Amputation ◽

Traumatic Amputation ◽

Amputation Level ◽

Skeletal Injury ◽

Knee Amputation ◽

The Us ◽

Extremity Amputation

Category: Trauma Introduction/Purpose: The United States Medical Corps has continued to evaluate and define the injury patterns of our service members in an effort to prevent injury and improve combat casualty care. The pattern of injury can be predicted by the mechanism of injury. One of the more recently described and studied mechanisms has been coined the ‘dismounted complex blast injury. This injury pattern involves traumatic amputation of at least one leg with a second injury involving another extremity in addition to an injury to either the pelvis, the abdomen, or the urogenital region. The purpose of this study was to better define and describe the injuries occurring to the non amputated extremity. Methods: This is a retrospectively review of data from the US and UK Joint Theater Trauma Registries (JTTR) of consecutive patients admitted to the UK Role 3 hospital at Camp Bastion, Afghanistan, from January 1, 2009, to February 29, 2012. Data was obtained from the US JTTR (Joint Theatre Trauma Registry). Each patient was assigned an Injury Severity Score (ISS) and an Abbreviated Injury Scale (AIS) score. Only those patients with an AIS of 3 or greater (a serious injury) were included. All xrays and CT scans were evaluated by two board certified orthopaedic surgeons and one board certified musculoskeletal radiologist. Fisher’s exact test was used to compare categorical data and binomial logistic regression was be used to compare proportions of types of injuries by traumatic amputation level observed. Results: There were 295 patients with lower extremity injuries identified. 201 had traumatic lower extremity amputations, 140 with bilateral lower extremity amputations, 61 with single leg amputations. The mean age was 23.38 +/-3.77 years. All were male. Below the knee amputation was the most frequent amputation type observed, representing 55.7% of the amputations (29/52), the next most frequent was the through knee amputation representing 25%. The least frequent was the through ankle amputation. The presence of a symes level amputation was associated with an 8.1% increase in the odds of the presence of a skeletal foot injury in the rear lower extremity. There was also an association found between AKA level amputation and skeletal injury in the contralateral upper extremity . Conclusion: This is among the first studies to correlate level of injury and associated musculoskeletal injury for the Afghanistan theater of operations. The results of this data set demonstrate that proximal lower extremity amputation levels are significantly associated with distal upper extremity skeletal injury. In addition, the Symes level of amputation is significantly associated with contralateral foot fractures. Amputation levels proximal to the ankle often present with associated Genitourinary injuries. Unique to this study is the demonstration of a significant association of upper extremity injury with a more proximal lower extremity amputation level .

Download Full-text

Development and validation of a novel computer-aided score to predict the risk of in-hospital mortality for acutely ill medical admissions in two acute hospitals using their first electronically recorded blood test results and vital signs: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2018-022939 ◽

2018 ◽

Vol 8 (12) ◽

pp. e022939 ◽

Cited By ~ 7

Author(s):

Muhammad Faisal ◽

Andrew J Scally ◽

Natalie Jackson ◽

Donald Richardson ◽

Kevin Beatson ◽

...

Keyword(s):

Hospital Mortality ◽

Blood Test ◽

External Validation ◽

Model Development ◽

Vital Signs ◽

Test Results ◽

Medical Admission ◽

Emergency Medical ◽

Computer Aided ◽

Acute Hospitals

ObjectivesThere are no established mortality risk equations specifically for emergency medical patients who are admitted to a general hospital ward. Such risk equations may be useful in supporting the clinical decision-making process. We aim to develop and externally validate a computer-aided risk of mortality (CARM) score by combining the first electronically recorded vital signs and blood test results for emergency medical admissions.DesignLogistic regression model development and external validation study.SettingTwo acute hospitals (Northern Lincolnshire and Goole NHS Foundation Trust Hospital (NH)—model development data; York Hospital (YH)—external validation data).ParticipantsAdult (aged ≥16 years) medical admissions discharged over a 24-month period with electronic National Early Warning Score(s) and blood test results recorded on admission.ResultsThe risk of in-hospital mortality following emergency medical admission was 5.7% (NH: 1766/30 996) and 6.5% (YH: 1703/26 247). The C-statistic for the CARM score in NH was 0.87 (95% CI 0.86 to 0.88) and was similar in an external hospital setting YH (0.86, 95% CI 0.85 to 0.87) and the calibration slope included 1 (0.97, 95% CI 0.94 to 1.00).ConclusionsWe have developed a novel, externally validated CARM score with good performance characteristics for estimating the risk of in-hospital mortality following an emergency medical admission using the patient’s first, electronically recorded, vital signs and blood test results. Since the CARM score places no additional data collection burden on clinicians and is readily automated, it may now be carefully introduced and evaluated in hospitals with sufficient informatics infrastructure.

Download Full-text

Utility of monitoring capnography, pulse oximetry, and vital signs in the detection of airway mishaps: A hyperoxemic animal model

The American Journal of Emergency Medicine ◽

10.1016/s0735-6757(98)90125-5 ◽

1998 ◽

Vol 16 (4) ◽

pp. 350-352 ◽

Cited By ~ 69

Author(s):

Michael P Poirier ◽

Javier A Gonzalez Del-Rey ◽

Constance M McAneney ◽

Gregg A Digiulio

Keyword(s):

Animal Model ◽

Pulse Oximetry ◽

Vital Signs

Download Full-text

Sensory testing as a predictor of short vs. long term trajectory of recovery from concussion

The Journal of Science and Medicine ◽

10.37714/josam.v2i4.71 ◽

2020 ◽

Vol 2 (4) ◽

Author(s):

Eric Francisco ◽

Oleg Favorov ◽

Anna Tommerdahl ◽

Jameson Holden ◽

Mark Tommerdahl

Keyword(s):

Animal Model ◽

Reaction Time ◽

Somatosensory System ◽

Duration Discrimination ◽

Neural Mechanisms ◽

Time Variability ◽

Post Injury ◽

Reaction Time Variability ◽

Temporal Order Judgement ◽

Recovery Trajectory

There have been numerous reports of neurological assessments of post-concussed athletes. However, the majority of the methods commonly deployed are either qualitative assessments that are simply symptom based or are psycho-social questionnaires. The information provided from those studies does not provide insight into the neural mechanisms impacted by concussion, and more importantly, does not contribute to a prognostic view of overall brain health that would facilitate or predict the recovery of the concussed individual. Cortical metrics are measures that were designed to probe brain function via the somatosensory system (i.e., with high fidelity tactile inputs) and have been demonstrated to be both objective, quantifiable and physiologically based. The methods have also been recently reported to parallel findings in a neurophysiological animal model of brain injury (Challener et al, 2020) that support the concept that these metrics parallel alterations in specific neural mechanisms post-injury. In this report, the battery of tactile based measures are reaction time (RT), reaction time variability (RTvar), sequential and simultaneous amplitude discrimination, temporal order judgement (TOJ) and duration discrimination (DD). These methods are administered with a computer mouse sized tactile stimulator (the Brain Gauge) that delivers sinusoidal stimuli to digits 2 and 3 with precision control of both amplitude and frequency. The results obtained during the first week of observation post-injury predict the recovery trajectory of the concussed individual. Interestingly, some of the metrics of the individuals who take longer to recover from injury obtained during the first week outperform the metrics of individuals that recover quickly, and these findings parallel the findings from the animal model.

Download Full-text