Toxic Shock Syndrome After Orthopaedic Surgery.

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Abstract

Conflict of interest statement: The authors have declared that no competing interests exist. 18. Injury. 2021 Oct;52(10):2697-2701. doi: 10.1016/j.injury.2020.01.042. Epub 2020 Jan 30. Novel resuscitation strategies in patients with a pelvic fracture. Copp J(1), Eastman JG(2). Author information: (1)Department of Orthopaedic Surgery, University of California, Davis Medical Center, Sacramento, CA, United States. (2)Department of Orthopaedic Surgery, University of California, Davis Medical Center, Sacramento, CA, United States. Electronic address: jgeastman@ucdavis.edu. Patients with a pelvic ring injury and hemodynamic instability can be challenging to manage with high rates of morbidity and mortality rates. Protocol-based resuscitation strategies are critical to successfully manage these potentially severely injured patients in a well-coordinated manner. While some aspects of treatment may vary slightly from institution to institution, it is critical to identify pelvic injuries and their associated injuries expediently. The first step at the scene of injury or in the trauma resuscitation bay should be the immediate application of a circumferential pelvic sheet or binder, initiation of physiologically optimal fluid resuscitation in the form 1:1:1 (pRBC:FFP:platelets) or whole blood, and to consider TXA as a safe adjunct to treat coagulopathy. Providers should have a very low threshold for emergent operative intervention in the form of pelvic external fixation and/or pelvic packing. This occurs in addition to simultaneous interventions addressing the other possible sources of bleeding in patients demonstrating signs of hemorrhagic shock and failure to respond to early resuscitation and external pelvic tamponade. Finally, while arterial injury is only present in a small percentage of patients with a pelvic ring injury, percutaneous vascular intervention with selective angiography and REBOA have been shown to be efficacious for patients with clinical indicators of arterial injury or who remain hemodynamically unstable despite external pelvic tamponade and packing to address venous bleeding. They should be performed when as early as possible for patients in true extremis limit further hemorrhage and allow resuscitation efforts to continue. Published by Elsevier Ltd. DOI: 10.1016/j.injury.2020.01.042