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05. There were no differences in blood product volume, hemolysis labs, transfusion reactions, complications, or survival. We then separated patients by Rh status (577 were Rh+, 70 were Rh-). Rh- patients were Rh- were older (median age 54 vs 39), more likely to be female (57 vs 26%), and more likely to have sustained blunt trauma than their Rh + counterparts (92 vs. 70%); all p < 0.05. There were no differences in hemolysis labs, transfusion reactions, complications, or survival between Rh + and Rh- patients, regardless of Rh product received.

When Rh- whole blood is unavailable or in short supply, Rh + LTO-WB appears to be a safe alternative for the resuscitation of hemorrhagic shock, in both Rh + and Rh- patients. Use of Rh + product may help trauma centers incorporate LTO-WB into their hospital and improve sustainability of such programs.

III.

III.

Opioids have been proven effective in pain management, but over-prescription can lead to addiction and abuse. Although current guidelines regarding opioid prescription for chronic and acute pain are available, they fail to address the use of opioids for pain management in traumatic injury patients who undergo operations. The primary objective of this study is to examine opioid prescribing practices for United States (US) adult trauma patients who require surgical management, based on prior history of opioid use, type of surgical practice, and age.

PubMed and Cochrane Journals were used to identify relevant articles between October 2010 and December 29, 2020. Our primary outcome was discrepancies of morphine milligram equivalents (MME) prescribed to trauma patients. Significance was defined as p < 0.05.

Eleven studies on US trauma patients prescribed opioids were evaluated, creating a total of 30,249 patients stratified by prior opioid use, age, and race. Patterns seen among patients with prior opioid use include higher MMEs prescribed, lower likelihoods of opioid discontinuation, higher mortality rates, and higher complication rates. Orthopedic surgeons prescribed higher values of MMEs than non-orthopedic surgeons.

Higher incidences of opioid prescriptions are seen with orthopedic trauma surgery, and prior opioid use by the patient. We recommend further development of national protocol implementation for acute pain management for the US trauma population.

III.

III.

Inflammatory lipid mediators in mesenteric lymph (ML), including arachidonic acid (AA), are considered to play an important role in the pathogenesis of multiple organ dysfunction (MOD) after hemorrhagic shock. A previous study suggested vagus nerve stimulation (VNS) could relieve shock-induced gut injury and abrogate ML toxicity, resulting in the prevention of MOD. However, the detailed mechanism of VNS in lymph toxicity remains unclear. The study aimed to investigate the relationship between VNS and inflammatory lipid mediators in ML.

Male Sprague-Dawley rats underwent laparotomy and superior mesenteric artery obstruction (SMAO) for 60 min to induce intestinal ischemia followed by reperfusion and observation. The ML duct was cannulated, and ML samples were obtained both before and after SMAO. The distal ileum was removed at the end of the observation period. In one group of animals, VNS was performed from 10 min before 10 min after SMAO (5 V, 0.5 Hz). Selleckchem IRAK-1-4 Inhibitor I Liquid chromatography-electrospray ionization-tandem mass spectrometry analysis of AA was performed for each ML sample. The biological activity of ML was examined using a monocyte nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) activation assay. Western blotting of phospholipase A2 group IIA (PLA2-IIA) was also performed for ML and ileum samples.

VNS relieved the SMAO-induced histological gut injury. The concentration of AA and level of NF-κB activation in ML increased significantly after SMAO, whereas VNS prevented these responses. Western blotting showed PLA2-IIA expression in the ML and ileum after SMAO; however, the appearance of PLA2-IIA band was remarkably decreased in the samples from VNS-treated animals.

The results suggested that VNS could relieve gut injury induced by SMAO and decrease the production of AA in ML by altering PLA2-IIA expression in the gut and ML.

The results suggested that VNS could relieve gut injury induced by SMAO and decrease the production of AA in ML by altering PLA2-IIA expression in the gut and ML.Major pelvic hemorrhage remains a considerable challenge of modern trauma care associated with mortality in over a third of patients. Efforts to improve outcomes demand continued research into the optimal employment of both traditional and newer hemostatic adjuncts across the full spectrum of emergent care environments. The purpose of this review is to provide a concise description of the rationale for and effective use of currently available adjuncts for the control of pelvic hemorrhage. Additionally, the challenges of defining the optimal order and algorithm for employment of these adjuncts will be outlined.

IV.

IV.

Assess the relationship between availability of round-the-clock (RTC) in-house intensivists and patient outcomes in people who underwent surgery for a life-threatening emergency general surgery (LT-EGS) disease such as necrotizing soft-tissue infection, ischemic enteritis, perforated viscus, and toxic colitis.

Data on hospital-level critical care structures and processes from a 2015 survey of 2,811 United States (US) hospitals were linked to patient-level data from 17 State Inpatient Databases (SID). Patients who were admitted with a primary diagnosis code for an LT-EGS disease of interest and underwent surgery on date of admission were included in analyses.

We identified 3,620 unique LT-EGS admissions at 368 hospitals. 83.5% (n = 3,021) of patients at 66% (n = 243) hospitals were treated at hospitals with RTC intensivist-led care. These facilities were more likely to have in-house respiratory therapists and protocols to ensure availability of blood products or adherence to Surviving Sepsis Guidelines. When accounting for other key factors including overnight surgeon availability, perioperative staffing, and annual EGS case volume, not having a protocol to ensure adherence to Surviving Sepsis Guidelines (aOR 2.10, 95% CI 1.12-3.94) was associated with increased odds of mortality.

Our results suggest that focused treatment of sepsis along with surgical source control, rather than round-the-clock intensivist presence, are key features of optimizing EGS patient outcomes.

III, Therapeutic.

III, Therapeutic.