Publications by authors named "Gerald Fortuna"
Article Synopsis
- Noncompressible torso hemorrhage is a major cause of death, and the study examines the effectiveness of REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) at high altitudes.
- In simulations and experiments with female pigs, REBOA was deployed at up to 22,000 feet while maintaining mean arterial pressure (MAP) despite lower systolic blood pressure.
- The findings indicate that REBOA successfully improved MAP regardless of altitude, suggesting its potential efficacy in emergency situations at high elevations.
Article Synopsis
- The First Care Provider (FCP) model aims to train non-medical individuals on life-threatening injury recognition and interventions, emphasizing that rapid evacuation is as critical as hemorrhage control in disaster situations.
- A study was conducted where two demographic groups were formed—one trained in the FCP curriculum and the other untrained—who then participated in a simulated mass casualty event to assess their responses.
- The results showed that the trained group reacted significantly faster than the untrained group in both recognizing the first action needed and resolving the scenario, indicating the effectiveness of the training program.
Background: Rational development of technology for rapid control of noncompressible torso hemorrhage (NCTH) requires detailed understanding of what is bleeding. Our objectives were to describe the anatomic location of truncal bleeding in patients presenting with NCTH and compare endovascular (ENDO) management versus open (OPEN) management.
Methods: This is a retrospective study of adult trauma patients with NCTH admitted to four urban Level I trauma centers in the Houston and San Antonio metropolitan areas in 2008 to 2012.
Objective: The current Society for Vascular Surgery Clinical Practice Guidelines suggest urgent (<24 hours) thoracic endovascular aortic repair for grade (G) II to G IV blunt thoracic aortic injuries (BTAIs). The purpose of this study was to determine whether some patients may require more emergency treatment.
Methods: We reviewed imaging variables of prospectively collected BTAI patients between 1999 and 2014.
Introduction: Delirium is a fluctuating disturbance in consciousness associated with increased mortality. Injured warriors represent a unique unstudied population. We hypothesized delirium is common because of high injury severity scores and multidrug sedation regimens.
View Article and Find Full Text PDFObjectives: To determine the outcomes of vascular injury interventions extending below the knee.
Methods: Vascular injury repairs extending below the knee from January 2008 to December 2014 were collected from six American College of Surgeons Level I trauma centers. Demographics, management, and outcomes were collected and analyzed.
Objective: The treatment of segmental arteriovenous fistula aneurysms (AVFAs) remains a challenge in dialysis access preservation. We examined our experience with the use of tubularized extracellular matrix (ECM; CorMatrix, Roswell, Ga) for AVFA repair.
Methods: Between October 2013 and January 2015, we conducted a prospective study of CorMatrix ECM for AVFA repair.
Background: Multidetector computed tomographic angiography (MDCTA) has become the gold standard for the early assessment of lower extremity vascular injury. The objective of this study was to evaluate the predictive value of MDCTA documented vessel run-off to the foot on limb salvage rates after lower extremity vascular injury.
Methods: All trauma patients undergoing lower extremity MDCTA for suspected vascular injury assessed at 2 high-volume Level I trauma centers between January 2009 and December 2012.
In 2008, a clinical practice guideline (CPG) was developed for the prevention of infections among military personnel with combat-related injuries. Our analysis expands on a prior 6-month evaluation and assesses CPG adherence with respect to antimicrobial prophylaxis for U.S.
View Article and Find Full Text PDFEvaluation of military trauma system practices related to complications after injury.
J Trauma Acute Care Surg
December 2012
Background: The Joint Theater Trauma System (JTTS) was developed with the vision that every soldier, marine, sailor, and airman injured on the battlefield would have the optimal chance for survival and maximum potential for functional recovery. In this analysis, we hypothesized that injury and complication after injury surveillance information diffusion through the JTTS, via the dissemination of clinical practice guidelines and process improvements, would be associated with improved combat casualty clinical outcomes.
Methods: The current analysis was designed to profile different aspects of trauma system performance improvement, including monitoring of frequent posttraumatic complications, the assessment of an emerging complication trend, and measurement of the impact of the system interventions to identify potential practices for future performance improvement.
Background: Early pharmacologic treatment for blunt cerebrovascular injury (BCVI) is often withheld when concomitant traumatic brain injury or cervical spinal cord injury occurs. This study examines the safety and efficacy of early treatment for patients with both BCVI and traumatic neurologic injury (TNI).
Methods: Ten-year retrospective review of patients with BCVI and a TNI was performed.
A significant portion of patients sustaining traumatic brain injury (TBI) take antiplatelet medications (aspirin or clopidogrel), which have been associated with increased morbidity and mortality. In an attempt to alleviate the risk of increased bleeding, platelet transfusion has become standard practice in some institutions. This study was designed to determine if platelet transfusion reduces mortality in patients with TBI on antiplatelet medications.
View Article and Find Full Text PDFBackground: More elderly trauma patients are identified with preinjury use of clopidogrel, aspirin, or warfarin (CAW). The purpose of this study was to determine whether preinjury CAW use was an important predictor of mortality in patients aged >or=50 years with blunt, hemorrhagic brain injury (HBI).
Methods: A retrospective review of patients with blunt, HBI aged >or=50 years with subgroup analysis for older (>70 years) and younger (50-70 years) patients was performed.