Posts Tagged ‘trauma’

Experience with Trauma Surgery

Author: Larry H. Bernstein, MD, FCAP



In 1987, I went on vacation to Bermuda with my wife and two children.  It was a beautiful place, and the weather and the ocean were wonderful to experience.  One could travel by bus, which was very safe, which I preferred. My older daughter wanted to use a moped, which we allowed on the condition that she first be trained.  On the last day, she went to return the moped, but the station was out for lunch.  I was a photograper and wanted to photograph the white bird of Burmuda. I put my camera in the rear, but as I left the station my moped was hit by an oncoming moped that I failed to see, unaccustomed to the British style driving.  An ambulance arrived within a few minutes as I lay on the ground. My wife sent the kids home and made arrangements for my secretary to look after them.  I was impressed with the surgeon when I arrived at the hospital. He wheeled me to the bed I was to stay in. I had two blood transfusions.  He took me to the operating room, but I don’t recall any details. He had a McGill University resident who later wrote a thesis about the experience.  I was pretty knocked out, but there was another patient in the room who had fallen down his steps. He was a WWII RAF veteran who had bombed the Germans. He told me the stories about his experience.  We contacted the burn surgeon, Walter Pleban, who arranged to have me flown to Bridgeport, CT, and he arranged for the best orthopedic surgeons to admit me on arrival.  In my flight there was another patient who was dying of endstage HIV AIDS.

Herbert Hermele observed how serious this was because there were three fractures of the right tibia. The good news was that there was no need to amputate because I had the nervous innervation, but I lost a popliteal artery.  I was admitted, and at first there was only a small room. The nurse was a very competent young woman of Portuguese descent. She was able to move me as needed. I was moved when a better room became available.  It was very good when the night shift nurse came in because I was able to talk to her with some attachment.  The Vice President had me provided with good meals, as I was the director of blood bank and chemistry.  I also had visits by my supervisors and other staff.

It was not an easy time, but I was privileged because of my standing with the medical and laboratory staff.  I had a longer stay than usual because I had an infection with two gram negative resistant strains of bacteria –serratia marcesans and Enterobacter. I was put on a gram negative penicillin and the next morning I felt dizzy. When Dr. Pleban came to see me I told him that I was having a penicillin reaction because I was aware that my twin sister was allergic to penicillin. As a result, the prescription was changed and it was an improved situation.  I underwent 10 operative procedures in some weeks. Dr. Hermeles partner put an antibiotic plug into the wound and it healed.  It was only after the infection cleared that a superb reconstructive surgeon was called in and he made skin grafts to close the wound after he disconnected a tendon and pulled muscle over the wound.  I also had a call from IJ Good, University Professor of Statistics at Virginia Polytech, who had completed writing a program to analyze data that I had provided him 2 years earlier – of MB isoenzyme CK at 6 hours and 12 hours later for diagnosis of heart attack.  We published the work in the prestigious journal, Clinical Chemistry and the President of the College of American Pathologists took note of the paper. I was finally sent home, without needing excess stay to the hospital environment.  I had physical therapy at home, and my bed was made on the first floor.  When I returned to work my infection site oozed, so I went to the Chief of Infectious Disease.  He prescribed a new quinolone antibiotic that could be taken orally. The infection subsided and it has never returned.

My sister came from San Diego, California and she brought me a recording she made for imaging to heal.  It went on that I was climbing a step to the heavens and getting better and better.  She also emphases laughing.

I can only look back and recall how fortunate I was to have the attention and kindness at that time. It was in excess of what many patients experience.  I do recall that the Hungarian-Cuban music teacher my daughter had had thousands of musical pieces and thousands of stories so that she was one of the most entertaining patients ever admitted to Bridgeport Hospital.





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Reported by: Dr. V. S. Karra, Ph.D.

“Emergency treatments for stopping the flow of blood from cuts and other external injuries save thousands of lives each year,” Lavik pointed out. “But we have nothing that emergency responders or military medics can use to stop internal bleeding permanently or at least long enough to get a patient to a hospital. There’s a tremendous need in the military, where almost 80 percent of battlefield traumas are blast injuries. In civilian life, there are many accidents, violence-related injuries and other incidents that result in internal bleeding.”

Lavik’s team, which is at Case Western Reserve University, was inspired by studies showing there are few options to treat soldiers in Afghanistan and Iraq who suffer internal injuries from the roadside bombs known as improvised explosive devices and other blasts. They wanted to develop a treatment military medics could use in the field to stabilize wounded soldiers en route to definitive care in a hospital.

“The military has been phenomenal at developing technology to halt bleeding, but the technology has been effective only on external or compressible injuries,” Lavik said. “An emergency treatment for internal bleeding could provide a broader ability to stop life-threatening hemorrhage.”

Currently, no effective treatments exist that are portable and can stop internal bleeding at the scene, Lavik explained. At the hospital, however, patients typically undergo surgery and receive donated platelets or something called factor VIIa, which helps with clotting, but both can cause immune problems. Factor VIIa also can potentially cause blood clots elsewhere in the body, not just at the site of bleeding, increasing stroke risk. Other alternatives have been developed in the laboratory, but they’ve had similar side effects and are not currently used in hospitals.

Lavik and colleagues are developing synthetic platelets. These are artificial versions of the disc-shaped particles in blood that collect on the jagged edges of cut blood vessels and launch the chain of biochemical events that result in formation of a clot that stops the flow of blood. The synthetic platelets are special nanoparticles, so small that 10 would fit across the width of a single human hair. Their role is to stick to natural platelets and leverage quicker and more efficient clotting at the site of an internal wound.

The nanoparticles are spheres that are made of the same polyester material used in dissolvable sutures, and they disappear from the body after doing their work. The particles have an outer coating of polyethylene glycol (PEG), the same thick, sticky substance used as a thickening agent in skin creams, toothpastes and other consumer products. Researchers then attach a peptide, or small piece of protein, that sticks to platelets. The end product is a white powder that has a shelf-life without refrigeration of at least two weeks — almost twice as long as the donated natural platelets now administered to control bleeding. Unlike donated platelets or factor VIIa, the synthetic platelets do not require refrigeration.

In tests on laboratory rats, stand-ins for humans in such experiments, the artificial platelets worked better than factor VIIa in stopping internal bleeding and increased survival, explained Lavik. Emergency medical technicians or battlefield medics could carry the powder out into the field to treat patients immediately, which could mean the difference between life and death, Lavik noted.

Lavik explained that the development process is ongoing, and it will take several years for the treatment to reach first-responders. So far, the nanoparticles appear safe, and all of the materials used to make them are already approved for medical use.

Erin Lavik, Sc.D., who described the advance toward developing synthetic platelets, said it is among the efforts underway world-wide to treat bleeding from “blunt-force” injuries ― in car accidents like the crash that killed Princess Diana, for instance, and the battlefield blast waves from bombs and other weapons that are the leading cause of battlefield deaths. Sports injuries, falls and other problems likewise can cause internal bleeding.

Progress toward a new emergency treatment for internal bleeding ― counterpart to the tourniquets, pressure bandages and Quick Clot products that keep people from bleeding to death from external wounds ― was reported at the 244th National Meeting & Exposition of the American Chemical Society, the world’s largest scientific society.



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