IntroductionRetrospective studies have demonstrated a potential survival benefit from transfusion strategies using an early and more balanced ratio between fresh frozen plasma (FFP) concentration and packed red blood cell (pRBC) transfusions in patients with acute traumatic coagulopathy requiring massive transfusions. These results have mostly been derived from non-head-injured patients. The aim of the present study was to analyze whether a regime using a high FFP:pRBC transfusion ratio (FFP:pRBC ratio >1:2) would be associated with a similar survival benefit in severely injured patients with traumatic brain injury (TBI) (Abbreviated Injury Scale (AIS) score, head ≥3) as demonstrated for patients without TBI requiring massive transfusion (≥10 U of pRBCs).MethodsA retrospective analysis of severely injured patients from the Trauma Registry of the Deutsche Gesellschaft für Unfallchirurgie (TR-DGU) was conducted. Inclusion criteria were primary admission, age ≥16 years, severe injury (Injury Severity Score (ISS) ≥16) and massive transfusion (≥10 U of pRBCs) from emergency room to intensive care unit (ICU). Patients were subdivided into patients with TBI (AIS score, head ≥3) and patients without TBI (AIS score, head <3), as well as according to the transfusion ratio they had received: high FFP:pRBC ratio (FFP:pRBC ratio >1:2) and low FFP:pRBC ratio (FFP:pRBC ratio ≤1:2). In addition, morbidity and mortality between the two groups were compared.ResultsA total of 1,250 data sets of severely injured patients from the TR-DGU between 2002 and 2008 were analyzed. The mean patient age was 42 years, the majority of patients were male (72.3%), the mean ISS was 41.7 points (±15.4 SD) and the principal mechanism of injury was blunt force trauma (90%). Mortality was statistically lower in the high FFP:pRBC ratio groups versus the low FFP:pRBC ratio groups, regardless of the presence or absence of TBI and across all time points studied (P < 0.001). The frequency of sepsis and multiple organ failure did not differ among groups, except for sepsis in patients with TBI who received a high FFP:pRBC ratio transfusion. Other secondary end points such as ventilator-free days, length of stay in the ICU and overall in-hospital length of stay differed significantly between the two study groups, but not when only data for survivors were analyzed.ConclusionsThese results add more detailed knowledge to the concept of a high FFP:pRBC ratio during early aggressive resuscitation, including massive transfusion, to decrease mortality in severely injured patients both with and without accompanying TBI. Future research should be conducted with a larger number of patients to prove these results in a prospective study.

Trauma patients receiving less than massive transfusion might also benefit from higher FFP:pRBC ratios, as these were associated with significantly lower mortality rates and decreased blood product utilization during subsequent ICU treatment, whereas morbidity was comparable among groups. Additional prospective trials are necessary.

Specimens are allowed to remain in this until they begin to turn a pale yellow (cover-glass preparations, about a quarter of an hour) ; they are then again rinsed in 70 per cent, alcohol, and are hardened (at least a quarter of an hour) in 80 per cent, alcohol, where, unless they are to be stained or embedded immediately, they should remain for future use.Osmic Acid (Lee). A mixture of 2 parts osmic acid in 100 parts of a 1 per cent, chromic acid solution should be kept in readiness as a foundation for F lemming's mixture and for the fixing of cover-glass preparations in osmium vapour. This latter method may be employed for blood parasites and Infusoria (see later, under special heading).Acetic Acid Solution of Chromium and Osmium (Flemming). One part of the above osmic acid mixture, 4 parts 1 per cent, chromic acid, 2 parts 1 per cent, acetic acid, 13 parts distilled water. This mixture should not be prepared until it is required for use. It may be employed with advantage for the preservation of blood containing parasites, for cover-glass preparations of certain Protozoa, as well as for small portions of organs containing parasites. It acts upon thin cover-glass preparations and upon blood (the latter should be allowed to drop into the solution) in ten to fifteen minutes ; and upon pieces of organic tissue, which should be as small as possible, in half an hour to one hour. The specimens should be very carefully washed in distilled water, after which they are transferred to alcohol, the concentration of which is gradually increased. They are finally coloured with ironhaematoxylin or aniline dyes, or (though this is not so good) with ordinary hsematoxylin or carmine.Acetic Acid Solution of Chloride of Platinum and Osmium (Hermann). Fifteen parts 1 per cent, platinic chloride solution, 1 part glacial acetic acid, 4 parts 2 per cent, osmic acid. To be used instead of Flemming's mixture and in the same way.Acetic Acid Solution of Picric Acid and Mercurial Sublimate (Bath).Equal parts of saturated solution of mercuric chloride (see alcohol sublimate) and picric acid (1 per cent, in distilled water), with the addition of | to 1 per cent, glacial acetic acid. Very useful for fixing portions of tissue containing parasites. Specimens should be left in the mixture for several hours, after which they should be washed, first in 50 per cent., and afterwards in 70 per cent, alcohol.Picro-formol (Bouin). Fifteen parts saturated watery solution of picric acid, 5 parts formalin (of commerce), 1 part acetic acid. This is said to produce very good results indeed, and is employed in the same way as picrin-sublimate.Absolute alcohol is used to fix dry cover-glass preparations (see later, under Examination of Blood). PEOTOZOA 9Parasitic Protozoa are fixed either in cover-glass preparations or in tissues from which sections are to be cut.Cover-glass preparations should be made exclusively upon coverglasses, as these are easier to manipulate in the later stages of preparation than glass slides.Cover-glass preparations from organs are ma...

Glasgow Coma Scale ≤ 8 at scene in children with isolated traumatic brain injury is associated with increased risk for coagulopathy and mortality. These results may guide laboratory testing, management, and blood bank resources in acute pediatric trauma care.

Endothelin antagonists may be effective as novel treatments for various neuropathologies.

Zusammenfassung Hintergrund: In der Abrechnungssystematik der Deutschen Krankenh?user (G-DRG-System) sind endoskopische Leistungen weder vollst?ndig noch kostengerecht abgebildet. Hauptursache ist eine Zuordnung der Personalkosten aufgrund veralteter Leistungskataloge sowie das Fehlen einer verpflichtenden Zeiterfassung der Personalbindung. Methodik: Zur Erstellung eines zeitgem??en Leistungskatalogs wurden der DGVS von 50 Kalkulationskrankenh?usern des Instituts f?r das Entgeltsystem im Krankenhaus (InEK) die kompletten gastroenterologischen Kostendatens?tze (2011???2013; ??21,4 KHEntgG) anonymisiert ?berlassen (2499?900 Falldatens?tze) und aus diesen alle Operationen und Prozedurenschl?ssel (OPS) endoskopischer Leistungen in Leistungsgruppen (z.?B. Koloskopie mit Biopsie/Koloskopie mit Stenteinlage)?klassifiziert. Eine Expertengruppe ordnete die Leistungsgruppen nach Fallschwere und wies ihnen gesch?tzte Personalbindungszeiten zu. Von Juni bis November 2014 wurde der Leistungskatalog an 119 Krankenh?usern mittels exakter Personalzeiterfassung in der Endoskopie validiert (38?288 Prozeduren). Ergebnisse: Dieses 3-stufige Vorgehen hat, in enger Abstimmung mit dem InEK, die Erstellung eines zeitgem??en Leistungskatalogs mit 97 Einzelleistungsgruppen erm?glicht, der ?ber 99?% aller durchgef?hrten endoskopischen Prozeduren abdeckt und diese anhand der gemessenen ?rztlichen Personalbindung gewichtet. W?hrend in der?Vergangenheit eine diagnostische Koloskopie im?Vergleich zur ?sophagogastroduodenoskopie (Standardwert 1,0) ein Relativgewicht von 1,13 aufwies, wird der Personalaufwand im Leistungskatalog sachgerechter mit 2,16 abgebildet. Bei der diagnostischen ERCP ?ndert sich das Relativgewicht von 1,7 auf 3,62. Leistungen mit hoher Personalbindung, die bisher nicht erfasst wurden, werden jetzt sachgerecht abgebildet (z.?B. ESD im Magen 16,74). Diskussion: Der neue, in Zusammenarbeit von ?ber hundert Krankenh?usern validierte Leistungskatalog bildet endoskopische Prozeduren in der Gastroenterologie nahezu vollst?ndig ab und weist diesen validierte Relativkostengewichte zu. Der Einsatz des Leistungskatalogs wird vom InEK als Ersatz f?r veraltete GO?-, DKG-NT- und Hauskataloge empfohlen und wird, bis zum fl?chendeckenden Einsatz der Zeiterfassung in der Endoskopie, wesentlich zu einer sachgerechteren Zuordnung der Kosten im deutschen DRG-System beitragen.

The early use of rFVIIa in severely injured patients was not associated with either lower transfusion requirements or with mortality reduction but with increased MOF.

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