Trauma Surgery & Acute Care Open最新文献

{"title":"Rethinking sepsis: from controversy to precision-driven solutions.","authors":"Jeffrey Upperman, Heather L Evans","doi":"10.1136/tsaco-2025-001810","DOIUrl":"https://doi.org/10.1136/tsaco-2025-001810","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 2","pages":"e001810"},"PeriodicalIF":2.1,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehospital antibiotic administration for suspected open fractures: importance and implementation.","authors":"Matthew J Levy, Mariuxi C Manukyan, James R Ficke","doi":"10.1136/tsaco-2024-001670","DOIUrl":"https://doi.org/10.1136/tsaco-2024-001670","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 2","pages":"e001670"},"PeriodicalIF":2.1,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remote spirometry in rib fracture rehabilitation: a step toward personalized recovery monitoring.","authors":"Christopher Tignanelli","doi":"10.1136/tsaco-2025-001771","DOIUrl":"https://doi.org/10.1136/tsaco-2025-001771","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 2","pages":"e001771"},"PeriodicalIF":2.1,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12001357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hocus pocus: advanced point-of-care ultrasound from the trauma bay to the surgical ICU.","authors":"Ian Ciesielski, Zaffer Qasim","doi":"10.1136/tsaco-2025-001779","DOIUrl":"10.1136/tsaco-2025-001779","url":null,"abstract":"<p><p>The management of the critically injured patient is reliant on a combination of clinical evaluation skills, knowledge of the disease process, and procedural capability. This is supplemented by diagnostic tools. Ultrasound use has rapidly evolved as one such diagnostic tool. The focused assessment by sonography in trauma (FAST) was the index ultrasound protocol for trauma but has since expanded to additional protocols to evaluate shock physiology and independent organ system function and to facilitate procedure techniques. This article reviews the currently applicable techniques relevant to the trauma patient, including regional protocols such as the FAST, extended FAST, and rapid ultrasound for shock and hypotension examinations; organ-system scans, including cardiac, lung, inferior vena cava, and transcranial ultrasound; and the role of ultrasound for various trauma-care procedures such as vascular access and nerve blocks.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 Suppl 1","pages":"e001779"},"PeriodicalIF":2.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A day like no other: the Las Vegas mass shooting lessons from America's largest mass casualty event.","authors":"Christopher K Lake","doi":"10.1136/tsaco-2025-001786","DOIUrl":"10.1136/tsaco-2025-001786","url":null,"abstract":"<p><p>The October 1, 2017, mass shooting at the Route 91 Harvest Festival in Las Vegas, Nevada, represented the largest mass casualty event in modern US history, fundamentally challenging traditional assumptions about hospital disaster response. This review analyzes critical aspects of the hospital response, with particular emphasis on throughput optimization, resource management, and adaptation of conventional trauma protocols. Through detailed examination of hospital responses across multiple facilities, this paper identifies three key paradigm shifts: (1) the primacy of patient throughput over traditional surge capacity metrics, (2) the emergence of combat-style triage protocols in civilian settings, and (3) the development of novel resource management strategies. Key findings demonstrate that traditional surge planning assumptions proved inadequate when faced with hundreds of critically injured patients arriving simultaneously without prehospital triage. The incident forced rapid adaptation of military-style triage protocols and highlighted the critical importance of inter-facility resource sharing networks. These lessons continue to influence emergency preparedness and provide a framework for hospitals worldwide to enhance their mass casualty response capabilities.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 Suppl 1","pages":"e001786"},"PeriodicalIF":2.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invasive and non-invasive monitoring in the ICU.","authors":"Kendall R McEachron, Todd W Costantini","doi":"10.1136/tsaco-2025-001780","DOIUrl":"10.1136/tsaco-2025-001780","url":null,"abstract":"<p><p>Effective invasive and non-invasive monitoring, when coupled with good clinical decision making, can improve outcomes for critically ill patients. When deciding on the best monitoring technique, it is important to consider the specific information that is needed to guide critical care management, while balancing the reliability of the data obtained and the risks of invasive monitor placement. Here, we review invasive and non-invasive options for hemodynamic and neurologic monitoring in the Surgical Intensive Care Unit. Understanding how each monitoring device functions, its indications, risks, and limitations is key when deciding how to monitor bedside physiologic data that guide clinical decision making. Level of evidence: Level IV.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 Suppl 1","pages":"e001780"},"PeriodicalIF":2.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decompressive craniectomy for traumatic brain injury: a review of recent landmark trials.","authors":"Purvi Pravinchandra Patel, Tanya Egodage, Matthew J Martin","doi":"10.1136/tsaco-2025-001784","DOIUrl":"https://doi.org/10.1136/tsaco-2025-001784","url":null,"abstract":"<p><p>Traumatic brain injury (TBI) is a leading cause of trauma-related morbidity and mortality worldwide, with decompressive craniectomy (DC) serving as a critical surgical intervention. This article reviews the recent studies evaluating the role of DC in the management of elevated intracranial pressures (ICPs) associated with TBI and its impact on functional outcomes. Decompressive Craniectomy in Diffuse Traumatic Brain Injury (DECRA), Randomized Evaluation of Surgery with Craniectomy for Uncontrollable Elevation of intracranial pressure (RESCUEicp), and Randomized Evaluation of Surgery with Craniectomy for patients Undergoing Evacuation of Acute Subdural Hematoma (RESCUE-ASDH) are three landmark trials that used varying thresholds for surgical intervention after TBI and examined how functional outcomes improved with time. The DECRA trial evaluated early DC in patients with moderate ICP elevations, demonstrating reduced intensive care unit and hospital stays but poorer functional outcomes at 6 months. Conversely, the RESCUEicp trial emphasized the benefits of delayed DC as a rescue strategy for refractory ICP, showing reduced mortality and improved Glasgow Outcome Scale-Extended scores at 24 months. The RESCUE-ASDH trial compared DC and craniotomy for acute subdural hematoma, finding no significant differences in functional outcomes but distinct profiles of surgical complications. Key recommendations emphasize individualized decision-making based on patient-specific factors, including preinjury functional status and family involvement. This comprehensive review underscores the importance of tailoring DC timing and techniques to optimize functional recovery and align with patient-centered goals, advancing the multidisciplinary management of severe TBI.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 Suppl 1","pages":"e001784"},"PeriodicalIF":2.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mattox Vegas Trauma, Critical Care, and Acute Care Surgery (TCCACS) and the newly expanded Innovation, Simulation, and Technology in Trauma, Critical Care, and MCI (ISTCC-MCI) 2025.","authors":"Kenneth L Mattox, Mary Allen","doi":"10.1136/tsaco-2025-001804","DOIUrl":"https://doi.org/10.1136/tsaco-2025-001804","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 Suppl 1","pages":"e001804"},"PeriodicalIF":2.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking vasopressor use in the trauma bay: a shifting perspective.","authors":"Emma Gilman Burke, Bennett William Hartley, Bahaa Succar, Ryan P Dumas","doi":"10.1136/tsaco-2025-001788","DOIUrl":"https://doi.org/10.1136/tsaco-2025-001788","url":null,"abstract":"<p><p>The use of vasopressors during the acute resuscitation of severely injured patients with trauma has long been controversial. Building on the concept of permissive hypotension, damage control resuscitation focuses on hemostatic transfusion of blood products to maintain perfusion pressures. However, targeting lower perfusion pressures while awaiting definitive hemorrhage control is contraindicated in some patient subpopulations and may be detrimental. Coupled with the shift towards a circulation-first approach to resuscitation, there is increasing interest in the use of vasopressors in the trauma bay. This narrative review aims to summarize the evidence behind trauma bay vasopressors and identify the potential role of vasoactive medications in the early phases of trauma care.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 Suppl 1","pages":"e001788"},"PeriodicalIF":2.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing complicated pancreatitis with more knowledge and a bigger toolbox!","authors":"Chris Cribari, Joshua Tierney, Lacey LaGrone","doi":"10.1136/tsaco-2025-001798","DOIUrl":"10.1136/tsaco-2025-001798","url":null,"abstract":"<p><p>Acute pancreatitis (AP) is a heterogeneous inflammation of the pancreas, most frequently attributable to gallstones or alcohol. AP accounts for an estimated 300 000 patients admitted each year in the USA, and an estimated US$2.6 billion/year in hospitalization costs. Disease severity is classified as mild, moderate, or severe, dependent on the presence or degree of concomitant organ failure. Locally, pancreatitis may be complicated by fluid collections, necrosis, infection, and hemorrhage. Infection of necrotizing pancreatitis (NP) is associated with a doubling of mortality risk. The modern management of AP is evolving. Recent data suggest a shift from normal saline to lactated Ringer's solution, and from aggressive to more judicious volume resuscitation. Similarly, while historical wisdom advocated keeping patients nothing by mouth to 'rest the pancreas', recent data convincingly show fewer complications and reduced mortality with early enteral nutrition, when tolerated by the patient. The use of antibiotics in NP is controversial. Current recommendations suggest reserving antibiotics for cases with highly suspected or confirmed infected necrosis, as well as in patients with biliary pancreatitis complicated by acute cholecystitis or cholangitis. Regarding the management of local complications, control of acute hemorrhage can be attained either endovascularly or via laparotomy. Abdominal compartment syndrome is associated with a mortality risk of 50%-75%. Routine monitoring of intra-abdominal pressure is recommended in patients at high risk. Pancreatic pseudocysts require intervention in symptomatic patients or those with infection or other complications. Endoscopic transmural drainage may be considered as the first step when technically feasible. Necrotizing pancreatitis without suspicion of infection is often managed medically, while the delay, drain, debride approach remains the standard of care for the vast majority of infected pancreatic necrosis. Robotic surgery, in appropriately selected patients, allows for a one-step approach, and merits further study to explore its initially promising results.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 Suppl 1","pages":"e001798"},"PeriodicalIF":2.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}