Kurt Grathwohl - Academia.edu (original) (raw)
Papers by Kurt Grathwohl
The Journal of Trauma: Injury, Infection, and Critical Care, 1995
Journal of Trauma-injury Infection and Critical Care, Feb 1, 2008
Background: To treat the coagulopathy of trauma, some have suggested early and aggressive use of ... more Background: To treat the coagulopathy of trauma, some have suggested early and aggressive use of cryoprecipitate as a source of fibrinogen. Our objective was to determine whether increased ratios of fibrinogen to red blood cells (RBCs) decreased mortality in combat casualties requiring massive transfusion. Methods: We performed a retrospective chart review of 252 patients at a U.S. Army combat support hospital who received a massive transfusion (>10 units of RBCs in 24 hours). The typical amount of fibrinogen within each blood product was used to calculate the fibrinogen-to-RBC (F:R) ratio transfused for each patient. Two groups of patients who received either a low (<0.2 g fibrinogen/RBC Unit) or high (>0.2 g fibrinogen/RBC Unit) F:R ratio were identified. Mortality rates and the cause of death were compared between these groups, and logistic regression was used to determine if the F:R ratio was independently associated with survival. Results: Two-hundred and fifty-two patients who received a massive transfusion with a mean (SD) ISS of 21 (؎10) and an overall mortality of 75 of 252 (30%) were included. The mean (SD) F:R ratios transfused for the low and high groups were 0.1 grams/Unit (؎0.06), and 0.48 grams/Unit (؎0.2), respectively (p < 0.001). Mortality was 27 of 52 (52%) and 48 of 200 (24%) in the low and high F:R ratio groups respectively (p < 0.001). Additional variables associated with survival were admission temperature, systolic blood pressure, hemoglobin, International Normalized Ratio (INR), base deficit, platelet concentration and Combined Injury Severity Score (ISS). Upon logistic regression, the F:R ratio was independently associated with mortality (odds ratio 0.37, 95% confidence interval 0.171-0.812, p ؍ 0.013). The incidence of death from hemorrhage was higher in the low F:R group, 23/27 (85%), compared to the high F:R group, 21/48 (44%) (p < 0.001). Conclusions: In patients with combatrelated trauma requiring massive transfusion, the transfusion of an increased fibrinogen: RBC ratio was independently associated with improved survival to hospital discharge, primarily by decreasing death from hemorrhage. Prospective studies are needed to evaluate the best source of fibrinogen and the optimal empiric ratio of fibrinogen to RBCs in patients requiring massive transfusion.
Southern Medical Journal, Nov 1, 1999
Cureus, Mar 30, 2022
Posterior reversible encephalopathy syndrome (PRES) is a rare neurologic disorder that has recent... more Posterior reversible encephalopathy syndrome (PRES) is a rare neurologic disorder that has recently become more frequently diagnosed. While the exact etiology of PRES remains unclear, multiple diseases are associated with PRES. Moreover, there is increasing recognition of the association of PRES in preeclampsia/eclampsia with advancements in imaging techniques and increased awareness of the disorder. While pre-eclampsia/eclampsia alone presents unique perioperative challenges, PRES further complicates anesthetic management. Unfortunately, the anesthetic management for these critically ill and complex patients is not well elucidated and it is unclear whether the anesthetic choice may actually worsen neurologic symptoms. We describe two different presentations of PRES with pre-eclampsia/eclampsia, their anesthetic implications, and management.
Southern Medical Journal, 1998
Southern Medical Journal, 1998
The American surgeon, 1999
Vascular rings have been well documented to cause respiratory and gastrointestinal symptoms in in... more Vascular rings have been well documented to cause respiratory and gastrointestinal symptoms in infants and children. Few reports document symptomatic vascular rings in adults, and most have emphasized dysphagia as the predominant symptom. We present the case of a 36-year-old white male with a double aortic arch and progressive dyspnea on exertion. This led us to review previous reports of vascular rings in adults. Criteria for review consisted of anatomically complete vascular rings of the aortic arch in adults age 18 years or older. We identified 25 prior cases for review and included our recent patient. The most common vascular ring anomalies in our review of adults is double aortic arch (n = 12; 46%) followed by right aortic arch with aberrant left subclavian artery and ligamentum arteriosum (n = 8; 30%). Of 24 patients (66%), 16 were symptomatic. Reported symptoms involving the respiratory tract (n = 10 of 24; 42%) included dyspnea on exertion (n = 5), bronchitis (n = 2), recurr...
Critical Care Medicine, 2008
Postgraduate medicine, 1995
Preview A patient has an abnormally high concentration of eosinophils in the blood, but initial c... more Preview A patient has an abnormally high concentration of eosinophils in the blood, but initial clinical and laboratory evaluation offers no clues as to the cause. The authors of this article describe such a case and the course of action they took to establish an unexpected diagnosis. Differential diagnosis of eosinophilia is the focus of their discussion.
The western journal of emergency medicine, 2016
Bedside thoracic ultrasound (US) can rapidly diagnose pneumothorax (PTX) with improved accuracy o... more Bedside thoracic ultrasound (US) can rapidly diagnose pneumothorax (PTX) with improved accuracy over the physical examination and without the need for chest radiography (CXR); however, US is highly operator dependent. A computerized diagnostic assistant was developed by the United States Army Institute of Surgical Research to detect PTX on standard thoracic US images. This computer algorithm is designed to automatically detect sonographic signs of PTX by systematically analyzing B-mode US video clips for pleural sliding and M-mode still images for the seashore sign. This was a pilot study to estimate the diagnostic accuracy of the PTX detection computer algorithm when compared to an expert panel of US trained physicians. This was a retrospective study using archived thoracic US obtained on adult patients presenting to the emergency department (ED) between 5/23/2011 and 8/6/2014. Emergency medicine residents, fellows, attending physicians, physician assistants, and medical students p...
Minimally Invasive Urological Surgery, 2005
Front Line Surgery, 2010
You have just finished your second damage control laparotomy of the day, and are nervously watchi... more You have just finished your second damage control laparotomy of the day, and are nervously watching the flurry of ICU nurses around this newly arrived patient. As they connect the arterial line to the monitor you notice that the blood pressure is 80 mmHg and he’s still pretty tachycardic. You order another round of blood products and some labs, but as you are writing the rest of the orders your pager alerts you to the next round of incoming wounded soldiers.
The Journal of trauma, 2007
U.S. Army Medical Department journal
U.S. Army Medical Department journal
U.S. Army Medical Department journal
1. US Army Med Dep J. 2007 Jan-Mar:11-6. Optimizing transport of postoperative damage control pat... more 1. US Army Med Dep J. 2007 Jan-Mar:11-6. Optimizing transport of postoperative damage control patients in the combat zone. Blackbourne LH, Grathwohl K, Eastridge B, MacDonald DL, Holcomb JB. Institute of Surgical Research ...
The Journal of Trauma: Injury, Infection, and Critical Care, 1995
Journal of Trauma-injury Infection and Critical Care, Feb 1, 2008
Background: To treat the coagulopathy of trauma, some have suggested early and aggressive use of ... more Background: To treat the coagulopathy of trauma, some have suggested early and aggressive use of cryoprecipitate as a source of fibrinogen. Our objective was to determine whether increased ratios of fibrinogen to red blood cells (RBCs) decreased mortality in combat casualties requiring massive transfusion. Methods: We performed a retrospective chart review of 252 patients at a U.S. Army combat support hospital who received a massive transfusion (>10 units of RBCs in 24 hours). The typical amount of fibrinogen within each blood product was used to calculate the fibrinogen-to-RBC (F:R) ratio transfused for each patient. Two groups of patients who received either a low (<0.2 g fibrinogen/RBC Unit) or high (>0.2 g fibrinogen/RBC Unit) F:R ratio were identified. Mortality rates and the cause of death were compared between these groups, and logistic regression was used to determine if the F:R ratio was independently associated with survival. Results: Two-hundred and fifty-two patients who received a massive transfusion with a mean (SD) ISS of 21 (؎10) and an overall mortality of 75 of 252 (30%) were included. The mean (SD) F:R ratios transfused for the low and high groups were 0.1 grams/Unit (؎0.06), and 0.48 grams/Unit (؎0.2), respectively (p < 0.001). Mortality was 27 of 52 (52%) and 48 of 200 (24%) in the low and high F:R ratio groups respectively (p < 0.001). Additional variables associated with survival were admission temperature, systolic blood pressure, hemoglobin, International Normalized Ratio (INR), base deficit, platelet concentration and Combined Injury Severity Score (ISS). Upon logistic regression, the F:R ratio was independently associated with mortality (odds ratio 0.37, 95% confidence interval 0.171-0.812, p ؍ 0.013). The incidence of death from hemorrhage was higher in the low F:R group, 23/27 (85%), compared to the high F:R group, 21/48 (44%) (p < 0.001). Conclusions: In patients with combatrelated trauma requiring massive transfusion, the transfusion of an increased fibrinogen: RBC ratio was independently associated with improved survival to hospital discharge, primarily by decreasing death from hemorrhage. Prospective studies are needed to evaluate the best source of fibrinogen and the optimal empiric ratio of fibrinogen to RBCs in patients requiring massive transfusion.
Southern Medical Journal, Nov 1, 1999
Cureus, Mar 30, 2022
Posterior reversible encephalopathy syndrome (PRES) is a rare neurologic disorder that has recent... more Posterior reversible encephalopathy syndrome (PRES) is a rare neurologic disorder that has recently become more frequently diagnosed. While the exact etiology of PRES remains unclear, multiple diseases are associated with PRES. Moreover, there is increasing recognition of the association of PRES in preeclampsia/eclampsia with advancements in imaging techniques and increased awareness of the disorder. While pre-eclampsia/eclampsia alone presents unique perioperative challenges, PRES further complicates anesthetic management. Unfortunately, the anesthetic management for these critically ill and complex patients is not well elucidated and it is unclear whether the anesthetic choice may actually worsen neurologic symptoms. We describe two different presentations of PRES with pre-eclampsia/eclampsia, their anesthetic implications, and management.
Southern Medical Journal, 1998
Southern Medical Journal, 1998
The American surgeon, 1999
Vascular rings have been well documented to cause respiratory and gastrointestinal symptoms in in... more Vascular rings have been well documented to cause respiratory and gastrointestinal symptoms in infants and children. Few reports document symptomatic vascular rings in adults, and most have emphasized dysphagia as the predominant symptom. We present the case of a 36-year-old white male with a double aortic arch and progressive dyspnea on exertion. This led us to review previous reports of vascular rings in adults. Criteria for review consisted of anatomically complete vascular rings of the aortic arch in adults age 18 years or older. We identified 25 prior cases for review and included our recent patient. The most common vascular ring anomalies in our review of adults is double aortic arch (n = 12; 46%) followed by right aortic arch with aberrant left subclavian artery and ligamentum arteriosum (n = 8; 30%). Of 24 patients (66%), 16 were symptomatic. Reported symptoms involving the respiratory tract (n = 10 of 24; 42%) included dyspnea on exertion (n = 5), bronchitis (n = 2), recurr...
Critical Care Medicine, 2008
Postgraduate medicine, 1995
Preview A patient has an abnormally high concentration of eosinophils in the blood, but initial c... more Preview A patient has an abnormally high concentration of eosinophils in the blood, but initial clinical and laboratory evaluation offers no clues as to the cause. The authors of this article describe such a case and the course of action they took to establish an unexpected diagnosis. Differential diagnosis of eosinophilia is the focus of their discussion.
The western journal of emergency medicine, 2016
Bedside thoracic ultrasound (US) can rapidly diagnose pneumothorax (PTX) with improved accuracy o... more Bedside thoracic ultrasound (US) can rapidly diagnose pneumothorax (PTX) with improved accuracy over the physical examination and without the need for chest radiography (CXR); however, US is highly operator dependent. A computerized diagnostic assistant was developed by the United States Army Institute of Surgical Research to detect PTX on standard thoracic US images. This computer algorithm is designed to automatically detect sonographic signs of PTX by systematically analyzing B-mode US video clips for pleural sliding and M-mode still images for the seashore sign. This was a pilot study to estimate the diagnostic accuracy of the PTX detection computer algorithm when compared to an expert panel of US trained physicians. This was a retrospective study using archived thoracic US obtained on adult patients presenting to the emergency department (ED) between 5/23/2011 and 8/6/2014. Emergency medicine residents, fellows, attending physicians, physician assistants, and medical students p...
Minimally Invasive Urological Surgery, 2005
Front Line Surgery, 2010
You have just finished your second damage control laparotomy of the day, and are nervously watchi... more You have just finished your second damage control laparotomy of the day, and are nervously watching the flurry of ICU nurses around this newly arrived patient. As they connect the arterial line to the monitor you notice that the blood pressure is 80 mmHg and he’s still pretty tachycardic. You order another round of blood products and some labs, but as you are writing the rest of the orders your pager alerts you to the next round of incoming wounded soldiers.
The Journal of trauma, 2007
U.S. Army Medical Department journal
U.S. Army Medical Department journal
U.S. Army Medical Department journal
1. US Army Med Dep J. 2007 Jan-Mar:11-6. Optimizing transport of postoperative damage control pat... more 1. US Army Med Dep J. 2007 Jan-Mar:11-6. Optimizing transport of postoperative damage control patients in the combat zone. Blackbourne LH, Grathwohl K, Eastridge B, MacDonald DL, Holcomb JB. Institute of Surgical Research ...