Antithrombotics in the Fall Patient: Appropriateness and Risk-Benefit Analysis.

Falls are the leading cause of hospitalizations following trauma nationwide, resulting in over 3 million admissions in 2020. This population is typically aged, and many are prescribed antithrombotic (AT) therapy. In this prospective study, we aimed to analyze fall history while assessing appropriateness of AT regimen relative to fall risk. Patients presenting following ground level fall (GLF) and meeting inclusion criteria during the study period were enrolled. Primary outcome was the relationship between AT therapy necessity (CHA2DS2-VASc) and fall risk (Morse Fall Risk). The cohort of 30 patients had an average age of 77. CHA2DS2-VASc and Morse Fall Risk showed a moderate-positive correlation (r = 0.47; P = 0.012); however, 17% of patients categorized as high fall risk had a <5% 1-year risk of VTE. This study demonstrates that risks of hemorrhage may outweigh thromboembolism prophylaxis in a significant number of patients and sheds light on the astonishing fall volume in this population.

Delayed vs Early Admission to Intensive Care: A Retrospective Review of Outcomes and Clinical Indicators of Deterioration Following Trauma.

Unplanned admission to an intensive care unit (ICU) is a trauma quality improvement indicator associated with increased morbidity, mortality, and hospital resource usage. We identified demographics, injuries, and other clinical factors between early ICU admission, <72 hrs after admission (EAd), and delayed admission, >72 hrs (DelAd) from a medical/surgical floor. 146 trauma patients admitted to ICU at a level 1 trauma center from January 2020 to March 2023 met inclusion criteria and were divided into EAd and DelAd. No statistical differences in injury mechanism or severity were observed. Delayed admission demonstrated higher mortality (P = .001), more frequent decline in GCS (P = .045), and initiation of anticoagulation (P = .002). Abnormal EKG, orthopedic surgery during admission, and home anticoagulant and antidepressant use were statistically significant in identifying patients requiring early ICU admission.

Thoracotomy Resuscitation of a Patient Who Sustained Blunt Force Trauma with a pH of 6.7 on Admission and Ultra Massive Transfusion of 42 Units of Blood.

Extreme acidosis is a life-threatening physiological state that thwarts resuscitative actions and most frequently ends in mortality. This report describes a case of a successful resuscitation in a patient who presented without vital signs, agonal respirations, dilated, unresponsive pupils, and an initial pH of 6.7. The patient is a 37-year-old man who was ejected from his package delivery vehicle after it was struck by a loaded dump truck. Resuscitative thoracotomy and other ATLS measures were performed to restore spontaneous circulation at 13 minutes after arrival. He underwent subsequent emergent operative interventions for severe chest, lower extremity, and intra-abdominal injuries. He was transfused 15, 27, and 42 total units of packed red blood cells (U-pRBCs) at resuscitation hours 2, 4, and 24. This case reinforces that resuscitative measures should be undertaken on a case-specific basis despite generalized guidelines suggesting futility at pH below 7.0 and at 23 units pRBCs balanced transfusion.