Hemorrhage is a major cause of death in trauma patients. The medical definition of hemorrhagic shock is tissue hypoperfusion resulting from a reduction of blood volume. Decreased blood pressure resulting from acute blood loss induces cardiac stimulation, systemic vasoconstriction, and volume redistribution. These effects are due to the baroreceptor reflex, the humoral compensatory mechanisms including the renin angiotensin system, and the release of catecholamine and vasopressin. Hemorrhagic shock causes acidosis, hypothermia, and coagulopathy, known as ‘the lethal triad.’ Tissue hypoxia induces metabolic acidosis by producing lactic acid. The three components of the lethal triad amplify each other and form a vicious cycle, eventually causing the death of the patient. To reduce the risk of mortality in severely bleeding patients, we need to understand the pathophysiology of hemorrhagic shock and the related complications.
Acidosis ; Anoxia ; Baroreflex ; Blood Pressure ; Blood Volume ; Cause of Death ; Disseminated Intravascular Coagulation ; Hemorrhage ; Humans ; Hypothermia ; Lactic Acid ; Mortality ; Renin-Angiotensin System ; Shock, Hemorrhagic* ; Vasoconstriction ; Vasopressins

OBJECTIVE: To summarize the solved homicide cases taking place in Suzhou city and to find out the characteristics and commonness of them in order to analyze the key points of investigation at the scene. METHODS: The data of 483 solved homicide cases occurring from January 2006 to March 2010 in the city were analyzed. RESULTS: Most cases involved 1 victim and 1 suspect, with young male adults dominated. Most of them were non-local residents. The majority of suspects were intentional by passion due to quarrel and dispute. The most common weapons were sharp instruments generally carried by the suspects. Mechanical asphyxia and mechanical injury were the two most common causes of death in these cases. CONCLUSION The social characteristics of suspects, criminal motivation, injury instruments, distribution of injuries, cause of death, and manner of death in Suzhou showed similar general characteristics as the experience for detecting homicide cases in the future.
Adult ; Age Distribution ; Asphyxia/mortality* ; Cause of Death ; Crime Victims/statistics & numerical data* ; Criminal Psychology ; Female ; Forensic Pathology ; Homicide/statistics & numerical data* ; Humans ; Male ; Retrospective Studies ; Sex Distribution ; Shock, Hemorrhagic/mortality* ; Socioeconomic Factors ; Weapons/statistics & numerical data* ; Wounds and Injuries/pathology*

BACKGROUNDVascular hyporeactivity, which occurs in the terminal stage of hemorrhagic shock, is believed to be critical for treating hemorrhagic shock. The present study was designed to examine whether the CB1 cannabinoid receptor (CB1R) was involved in the development of vascular hyporeactivity in rats suffering from hemorrhagic shock.

METHODSSixteen animals were randomly divided into two groups (n = 8 in each group): sham-operated (Sham) and hemorrhagic shock (HS) groups. Hemorrhagic shock was induced by bleeding. The mean arterial pressure (MAP) was reduced to and stabilized at (25 +/- 5) mmHg for 2 hours. The vascular reactivity was determined by the response of MAP to norepinephrine (NE). In later experiments another twelve animals were used in which the changes of CB1R mRNA and protein in aorta and superior mesenteric artery (SMA) were analyzed by RT-PCR and Western blotting. In addition, we investigated the effects of a CB1R antagonist on the vascular hyporeactivity and survival rates in rats with hemorrhagic shock. Survival rates were analyzed by the Fisher's exact probability test. The MAP response was analyzed by one-way analysis of variance (ANOVA).

RESULTSVascular hyporeactivity developed in all animals suffering from hemorrhagic shock. The expression of CB1R mRNA and protein in aorta and 2 - 3 branches of the SMA were significantly increased in the HS group after the development of vascular hyporeactivity when compared to those in Sham group. When SR141716A or AM251 was administered, the MAP response to NE was (41.75 +/- 4.08) mmHg or (44.78 +/- 1.80) mmHg respectively, which was higher than that in saline groups with (4.31 +/- 0.36) mmHg (P < 0.01). We also showed an increased 4-hour survival rate in the SR141716A or AM251-treated group with 20% or 30%, but with a statistically significant difference present between the AM251-treated and saline groups (P < 0.05).

CONCLUSIONSCB1R is involved in vascular hyporeactivity resulting from hemorrhagic shock in rats, and CB1R antagonist may be useful in treating patients with traumatic, hemorrhagic shock who need field-rescue or initial treatment.

Animals ; Blotting, Western ; Gene Expression Regulation ; drug effects ; Hypotension ; metabolism ; Male ; Piperidines ; pharmacology ; Pyrazoles ; pharmacology ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Receptor, Cannabinoid, CB1 ; antagonists & inhibitors ; genetics ; metabolism ; physiology ; Reverse Transcriptase Polymerase Chain Reaction ; Shock, Hemorrhagic ; metabolism ; mortality ; Survival Rate

OBJECTIVETo evaluate the effects of methylene blue (MB) on refractory hemorrhagic shock.

METHODSTotally 24 rabbits subjected to prolonged hemorrhagic shock and resuscitation were randomly divided into hemorrhagic shock group (12 rabbits) and MB group (12 rabbits; MB was administered immediately after resuscitation was performed). The plasma levels of tumor necrosis factor alpha (TNFalpha) , interleukin (IL)-6, IL-8, nitric oxide (NO), lactic acid (LA) , and mean arterial pressure (MAP) were detected before shock, immediately after resuscitation, and 0.5, 2, and 4 hours after resuscitation. The 12-hour survival rates were observed.

RESULTSThe plasma levels of TNFalpha, IL-6, IL-8, NO and LA after shock were significantly higher than before shock (P <0.01), and maintained at high levels. Compared with the shock group, higher MAP and lower plasma levels of TNFalpha, IL-6, IL-8, NO, and LA were observed in the MB group after resuscitation (P<0.01). The 12-hour survival rates were not significantly different between shock group and MB group.

CONCLUSIONAlthough MB can not improve the prognosis of refractory hemorrhagic shock, it can increase and maintain the MAP and thus play a beneficial role in the treatment of hemorrhagic shock.

Animals ; Blood Pressure ; drug effects ; Disease Models, Animal ; Female ; Interleukin-6 ; blood ; Interleukin-8 ; blood ; Lactic Acid ; blood ; Male ; Methylene Blue ; therapeutic use ; Nitric Oxide ; blood ; Rabbits ; Random Allocation ; Shock, Hemorrhagic ; blood ; drug therapy ; mortality ; Survival Rate ; Tumor Necrosis Factor-alpha ; blood

BACKGROUND: Major vascular injuries can jeopardize a patient's life or imperil limb survival. We performed this study to establish an optimal management plan for vascular injuries. MATERIAL AND METHOD: We retrospectively reviewed 26 cases of vascular injury that were treated at Pusan National University Hospital from May, 1999 to September, 2004. The age and sex distribution, the locations and causes of vascular injury, the diagnostic tools, the degree of injuries, clinical manifestations, the treatment modality and complications were reviewed. RESULT:The mean age was 39.5 years (range: 12~86) and the male to female ratio was 22:4. The injuries were in 6 descending thoracic aortas, 4 femoral arteries, 4 popliteal veins and so on. The causes of injury were iatrogenic in 8 cases, traffic accident in 7, stab injury in 6 and industrial accident in 5. The most commonly used diagnostic tools were CT and angiography. The degrees of arterial injury were pseudoaneurysm in 10 cases, partial severance in 5, complete severance in 3 and thrombosis in 3. The degrees of venous injury were partial severance in 6 cases, complete severance in 2 and arteriovenous fistula in 2. The clinical manifestations were absence of pulse in 8 cases, coldness in 7, chest pain in 6, swelling in 5, bleeding in 5 and so on. The most frequently used type of revascularization was graft interposition in 11 cases. Two arteriovenous fistulae were repaired by endovascular procedure. There was one case of mortality due to multi-organ failure after hemorrhagic shock. There were three major amputations, and two of them were due to delayed diagnosis and treatment. CONCLUSION: A system for the early diagnosis and treatment is essential for improving limb salvage and patient mortality. As a consequence of the widespread application of endovascular procedures, the incidence of iatrogenic injuries has recently increased. Educating physicians is important for the prevention of iatrogenic injury. Easy communication and cooperation for earlier involvement of a vascular surgeon is also an important factor.
Accidents, Occupational ; Accidents, Traffic ; Amputation ; Aneurysm, False ; Angiography ; Aorta, Thoracic ; Arteriovenous Fistula ; Busan ; Chest Pain ; Delayed Diagnosis ; Early Diagnosis ; Endovascular Procedures ; Extremities ; Female ; Femoral Artery ; Hemorrhage ; Humans ; Incidence ; Limb Salvage ; Male ; Mortality ; Popliteal Vein ; Retrospective Studies ; Sex Distribution ; Shock, Hemorrhagic ; Thrombosis ; Transplants ; Vascular System Injuries*

PURPOSE: The management of hemorrhagic shock is critical for trauma patients. To assess hemorrhagic shock, the clinician commonly uses a change in positional blood pressure, the shock index, an estimate of the diameter of inferior vena cava based on sonography, and an evaluation of hypoperfusion complex shown on a CT scan. To add the finding for the hypoperfusion complex, the 'halo sign' was introduced recently. To our knowledge, this 'halo sign' has not been evaluated for its clinical usefulness, so we designed this study to evaluate its usefulness and to find the useful CT signs for hypoperfusion complex. METHODS: The study was done from January 2007 to May 2007. All medical records and CT images of 124 patients with trauma were reviewed, of which 103 patients were included. Exclusion criteria was as follows: 1) age < 15 year old and 2) head trauma score of AIS > or = 5. RESULTS: The value of kappa, to assess the inter-observer agreement, was 0.51 (p < 0.001). The variables of the halo-sign-positive group were statistically different from those of the halo-sign-negative group. The rate of transfusion for the halo-sign-positive group was about 10 times higher than that of the halo-sign-negative group and the rate of mortality was about 6 times higher. CONCLUSION: In the setting of trauma, early abdominal CT can show diffuse abnormalities due to hypoperfusion complex. Recognition of these signs is important in order to prevent an unwanted outcome in hemorrhagic shock. We conclude that the halo sign is a useful one for hypoperfusion complex and that it is useful for assessing the degree of hemorrhagic shock.
Adolescent ; Blood Pressure ; Craniocerebral Trauma ; Humans ; Medical Records ; Mortality ; Shock ; Shock, Hemorrhagic ; Tomography, X-Ray Computed ; Vena Cava, Inferior

PURPOSE: There have been many reports that point to the increasing death and emergency operation rate in traumatic hemorrhagic shock patients. The purpose of this study was to discover the clinical difference between the hypotensive traumatic patients and the non-hypotensive traumatic patients that had been managed in intensive care unit (ICU). METHODS: We retrospectively reviewed the medical records of 122 patients admitted to ICU for trauma from January 2001 to December 2002. We compared the hypotensive (systolic blood pressure (SBP) < 90 mmHg) group with the non-hypotensive group about age, diastolic blood pressure, initial hemoglobin, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), transfusion volume at emergency department, blood pH, blood base deficit, duration of admission, ICU stay, death rate, transfusion volume and others. RESULTS: There was no difference between two groups in age, causes of injury, situation whether or not the patient was directly transported from the scene and ISS. But there were differences between two groups in initial hemoglobins, GCS, RTS, blood pH, blood base deficit, duration of admission, ICU stay, and death rate. It was documented that the ICU stay correlated with systolic blood pressure, diastolic blood pressure, initial hemoglobin, blood base deficit, ISS, GCS, and RTS but not correlated with transfusion volume in emergency department. CONCLUSION: Systolic blood pressure is not the sensitive parameter of blood loss. Various kinds of indices of hypotensive group are more severe than non-hypotensive group. If traumatic patients are hypotensive blood pressure on arrival at emergency department, we should be careful of the state of these patients.
Blood Pressure ; Emergencies ; Emergency Service, Hospital ; Glasgow Coma Scale ; Humans ; Hydrogen-Ion Concentration ; Injury Severity Score ; Intensive Care Units ; Medical Records ; Mortality ; Retrospective Studies ; Shock, Hemorrhagic

Animals ; Apoptosis ; Blood Pressure ; Disease Models, Animal ; Flow Cytometry ; Fluid Therapy ; In Situ Nick-End Labeling ; Intestinal Mucosa ; pathology ; Lactic Acid ; blood ; Male ; Rats ; Rats, Sprague-Dawley ; Resuscitation ; Shock, Hemorrhagic ; mortality ; pathology ; therapy ; Survival Rate

OBJECTIVETo introduce the concept, methods for calculation and application of "number needs to be exposed (NNE)" in Epidemiological studies.

METHODSData was analyzed from a study on the association between diaspirin cross-linked hemoglobin (DCLHb) with 28-day mortality in patients with severe traumatic hemorrhagic shock.

RESULTSThe crude "number needed to be exposed for one additional person to be harmed" (NNEH) was 3.7 (95% CI: 2.2-11.5) for the exposure to DCLHb. After controlling the confounding bias of the baseline mortality risk, the adjusted NNEH became 2.6 (95% CI: 1.6-8.0) id., on average, among 2.6 patients exposed to DCLHb, one additional case of death would have developed within 28 days after initial hospitalization if the distribution of baseline mortality risk in exposed group had been equal to that in the unexposed group.

CONCLUSIONNNE could be expressed as the estimated average number of persons needed to be exposed for contributing (either developing or preventing for) one additional case of disease or death in a prospective study when compared with the unexposed persons. As a new index for measuring the absolute effect of an exposure, NNE presented the results on epidemiological studies in a more intuitive and understandable manner. Consequently, this method could be favorably accepted by clinicians, health policy makers and the public.

Epidemiologic Studies ; Hemoglobins ; therapeutic use ; Humans ; Logistic Models ; Randomized Controlled Trials as Topic ; Risk ; Shock, Hemorrhagic ; complications ; drug therapy ; mortality ; pathology ; Software ; Wounds and Injuries ; complications

PURPOSE: To investigate the hypothesis that resuscitation with hypertonic saline (HTS) in hemorrhagic shock (HS) will improve the pulmonary function and inflammatory changes in post-hemorrhage induced acute lung injury. METHODS: HS was induced in anesthetized Swiss-Webster mice by removing 0.025cc blood/g. body weight via the carotid artery while under blood pressure monitoring. Mice were divided into 5 groups: Group I (n=12) were cannulated but not bled (sham); Group II (n=12) were bled and received 4mL/kg 7.5% HTS; Group III (n=10) were bled and received 3 times their shed blood (SB) volume of normal saline (NS); Group IV (n=11) were bled and received SB and 4mL/kg 7.5% HTS; Group V (n=9) were bled and received SB and two times their SB volume of NS after 30 minutes shock. Serum lactates (LA) were evaluated at the end of the shock period and after resuscitation. Pulmonary function was measured by whole-body plethysmography prior to any instrumentation and again 24hr, 48hr and 72hr after resuscitation. Pulmonary inflammation was assessed by quantifying bronchoalveolar lavage neutrophil infiltration (BALN) and myeloperoxidase (MPO) activity after 72hr of observation. RESULTS: There were no differences in baseline BP, shock BP, shock LA and LA after resuscitation in each shock group. The survival rates were as follows: Group I, 75.0%; Group II, 33.3%; Group III, 60%; Group IV, 81.8%; and Group V, 88.8% (p=0.046). There were no significant differences in the changes of airway resistance after resuscitation in each group. BALN and MPO activity in Group III were increased. CONCILUSION: HTS resuscitation alone was associated with higher mortality. HTS was decreased pulmonary inflammation but it did not alter respiratory function.
Acute Lung Injury* ; Airway Resistance ; Animals ; Blood Pressure Monitors ; Body Weight ; Bronchoalveolar Lavage ; Carotid Arteries ; Lactates ; Mice ; Mortality ; Neutrophil Infiltration ; Peroxidase ; Plethysmography ; Pneumonia ; Resuscitation* ; Shock ; Shock, Hemorrhagic* ; Survival Rate