Recombinant factor VIIa and the patient with neurologic bleeding: separating fact from fiction.

Notwithstanding its limited Food and Drug Administration-approved indications, rFVIIa has rapidly gained widespread use for the treatment of a variety of hemorrhagic conditions, including intracranial bleeding from spontaneous, traumatic, surgical, and coagulopathic causes. Although it appears that the drug only minimally increases the risk of thromboembolic events, its efficacy remains in question. The idea of finding a universal cure for hemorrhage in a medication bottle remains highly appealing, but enthusiasm for the concept is no replacement for evidence.

5-year survival of geriatric patients following trauma center discharge.

Little is known about the impact of trauma on geriatric injury survivors' life expectancy. Does trauma in older adults influence time to death? What key patient and injury variables can predict 5-year postdischarge survival? This retrospective study used Cox proportional hazards models to quantify seniors' risk for death within 5 years of injury and identify variables associated with life expectancy. The hazard ratio for death in subjects versus matched controls was 6.

Trauma in pregnancy.

Although serious trauma during pregnancy is uncommon, it remains a major cause of maternal and fetal death and presents a variety of patient care challenges. The anatomic and physiologic changes of pregnancy can affect both the nature of an injury and the body's response to it. Here, the author describes the mechanisms of traumatic injury during pregnancy, discusses the normal changes of pregnancy and their implications in the care of pregnant trauma patients, and offers strategies for assessment and treatment.

A case of postpartum cerebral venous thrombosis.

Cerebral venous thrombosis, also known as cortical venous, cerebral sinus, cerebral venous sinus, or dural sinus thrombosis, results from clot formation in one of the many outflow tracts of the brain. Obstruction of flow causes venous hypertension, which is responsible for clinical findings associated with this condition. Signs and symptoms of cerebral venous thrombosis include headache, nausea, mental status changes, seizures, and focal neurologic deficits.

Variables predicting trauma patient survival following massive transfusion.

Introduction: The literature contains little information regarding demographic or transfusion-related factors associated with survival following massive blood transfusion in trauma patients. The objective of this study was to describe patient, transfusion, and laboratory variables contributing to survival in this population during the first and second days after arrival at the hospital. A secondary objective was to identify costs associated with massive blood transfusion.

Pass the salt: indications for and implications of using hypertonic saline.

Sodium is the most abundant extracellular ion. Historically, therapy with hypertonic saline was widely used for a variety of conditions. Currently, there are 3 primary indications for its use in critical care: hyponatremia, volume resuscitation, and brain injury.

Rhabdomyolysis. Pathophysiology, recognition, and management.

Rhabdomyolysis is a clinical syndrome in which the contents of injured muscle cells leak into the circulation. This leakage results in electrolyte abnormalities, acidosis, clotting disorders, hypovolemia, and acute renal failure. More than 100 conditions, both traumatic and non-traumatic, can lead to rhabdomyolysis.

Pathophysiology and management of abdominal compartment syndrome.

Abdominal compartment syndrome is a potentially lethal condition caused by any event that produces intra-abdominal hypertension; the most common cause is blunt abdominal trauma. Increasing intra-abdominal pressure causes progressive hypoperfusion and ischemia of the intestines and other peritoneal and retroperitoneal structures. Pathophysiological effects include release of cytokines, formation of oxygen free radicals, and decreased cellular production of adenosine triphosphate.