Early management of the severely injured major trauma patient.

The major trauma team relies on an efficient, communicative team to ensure patients receive the best quality care. This requires a comprehensive handover, rapid systematic review, and early management of life- and limb-threatening injuries. These multiple injured patients often present with complex conditions in a dynamic situation. The importance of team work, communication, senior decision-making, and documentation cannot be underestimated.

Altered phosphoinositide fatty acid composition, mass and metabolism in brain essential fatty acid deficiency.

This study describes the specific alterations in phosphoinositide mass and fatty acid composition observed in brain essential fatty acid deficiency (EFAD). These investigations were motivated by the observation that alterations in volatile anesthetic potency were associated with changes in brain arachidonyl-phosphatidylinositol (PI) content, and were aimed at defining whether EFAD might alter the generation of chemical second messengers via the PI cycle. Analyses of cerebral cortical phosphoinositide mass and fatty acid composition showed that EFAD results in specific and preferential depletion of arachidonate (20:4(n - 6); 5,8,11,14-eicosatetraenoic acid) from cerebral cortical polyphosphoinositides, and that this depletion is reversed by parenteral supplementation with linoleic acid (18:2(n - 6); 9,12-octadecadienoic acid). These analyses also showed that, while phosphoinositides containing 20:3(n - 9) (5,8,11-eicosatrienoic acid) accumulated in EFAD, linoleate supplementation decreased 20:3(n - 9)-PI and 20:3(n - 9)-phosphatidylinositol 4-phosphate (PIP), but resulted in accumulation of 20:3(n - 9)-phosphatidylinositol 4,5-bisphosphate (PIP2). Comparison of the fatty acid composition of brain polyphosphoinositides and 1,2-diacylglycerols between treatment groups showed that diacylglycerols contain a lower molar percentage of 20:3(n - 9) and a higher percentage of arachidonate than the corresponding polyphosphoinositides. The combined results of these studies suggest the existence of fatty acid substrate specificity for the hydrolysis of PIP2 by phospholipase C. The biological relevance of these findings is suggested by a strong correlation between the mass of cerebral cortical arachidonyl-PIP2 and the potency of the anesthetic halothane.

The potency of fluorinated ether anesthetics correlates with their 19F spin-spin relaxation times in brain tissue.

In this study, four fluorinated ether anesthetics and one non-anesthetic fluorinated alkane were observed in rat brain and adipose tissue using 19F-NMR spectroscopy. Measurements of 19F spin-spin relaxation times (T2) of the anesthetics in brain revealed T2 values (0.5-4.5 msec) that correlated linearly with the anesthetic potency (ED50) of the drugs. The non-anesthetic was present at very low concentrations in brain and had a T2 value (18.5 msec) far longer than that of any of the anesthetics. All of the drugs were present at high concentration in peripheral adipose tissue. 19F T2 values for these drugs in adipose tissue (200-400 msec) were far larger than the values observed in brain and did not correlate with anesthetic potency. These results indicate that volatile anesthetic molecules have a specific affinity for neural tissue and that immobilization of anesthetic molecules in brain correlates with anesthetic potency. The results with adipose tissue suggest that the interaction of anesthetic with brain tissue cannot be explained by a simple partition of these drugs into lipid.