Rapid triage and intervention to control hemorrhage are key to survival following traumatic injury. Patients presenting in hemorrhagic shock may undergo resuscitative thoracotomy (RT) or resuscitative endovascular balloon occlusion of the aorta (REBOA) as adjuncts to rapidly control bleeding. We hypothesized that machine learning along with automated calculation of continuously measured vital signs in the pre-hospital setting would accurately predict need for REBOA/RT and inform rapid life-saving decisions.
 
  Prehospital and admission data from 1,396 patients transported from the scene of injury to a level-I trauma center via helicopter were analyzed. Utilizing machine learning and pre-hospital autonomous vital signs, a bleeding risk index (BRI) based on features from pulse oximetry and electrocardiography waveforms and blood pressure (BP) trends was calculated. Demographics, injury severity score (ISS) and BRI were compared using Mann-Whitney-Wilcox test. Area under the receiver operating characteristic cume for team preparedness and guide trauma triage and disaster management.
 
  Level IV Therapeutic/Care Management.
 Level IV Therapeutic/Care Management.
  Prehospital plasma transfusion in trauma reduces mortality. However, the underlying mechanism remains unclear. Reduction in shock severity may play a role. Lactate correlates with physiologic shock severity and mortality after injury. Our objective was to determine if prehospital plasma reduces lactate and if this contributes to the mortality benefit of plasma.
 
  Patients in the Prehospital Air Medical Plasma trial in the upper quartile of injury severity (Injury Severity Score, >30) were included to capture severe shock. Trial patients were randomized to prehospital plasma or standard care resuscitation (crystalloid ± packed red blood cells). Regression determined the associations between admission lactate, 30-day mortality, and plasma while adjusting for demographics, prehospital crystalloid, time, mechanism, and injury characteristics. Causal mediation analysis determined what proportion of the effect of plasma on mortality is mediated by lactate reduction.
 
  A total of 125 patients were included. Thenisms and if a dose response exists.
 
  Therapeutic, level II.
 Therapeutic, level II.
  Plasma has been shown to mitigate the endotheliopathy of trauma. Protection of the endothelium may be due in part to fibrinogen and other plasma-derived proteins found in cryoprecipitate; however, the exact mechanisms remain unknown.  https://www.selleckchem.com/products/Temsirolimus.html  Clinical trials are underway investigating early cryoprecipitate administration in trauma. In this study, we hypothesize that cryoprecipitate will inhibit endothelial cell (EC) permeability in vitro and will replicate the ability of plasma to attenuate pulmonary vascular permeability and inflammation induced by hemorrhagic shock and trauma (HS/T) in mice.
 
  In vitro, barrier permeability of ECs subjected to thrombin challenge was measured by transendothelial electrical resistance. In vivo, using an established mouse model of HS/T, we compared pulmonary vascular permeability among mice resuscitated with (1) lactated Ringer's solution (LR), (2) fresh frozen plasma (FFP), or (3) cryoprecipitate. Lung tissue from the mice in all groups was analyzed for markers of vascular integrityr to FFP. Further investigation is warranted on active components and their mechanisms of action.
 Our data suggest that cryoprecipitate attenuates the endotheliopathy of trauma in HS/T similar to FFP. Further investigation is warranted on active components and their mechanisms of action.
  Exsanguination due to extremity hemorrhage is a major cause of preventable traumatic deaths. Extremity tourniquet use has been shown to be safe and improve survival. The purpose of this study was to compare the efficacy, efficiency, and durability of the Generation 7 Combat Application Tourniquet (CAT), the Tactical Mechanical Tourniquet (TMT), and the SOF Tactical Tourniquet-Wide (SOFTT-W).
 
  This study was a three-phase randomized, cross over trial. In successive trials, subjects were timed during the application of each tourniquet to the upper and lower extremity. Following successful lower extremity application, subjects low crawled 25 feet and then were dragged 25 feet, after which effectiveness was reassessed, as defined by the cessation of distal pulses by doppler ultrasound.
 
  In arm application, both the CAT and TMT had significantly less failure rates than the SOFTT-W (5.56%, 19.44%, 58.33%), with the CAT being the fastest tourniquet when compared to TMT and SOFTT-W (37.8 s, 65.01 s, 63.07s). In leg application, the CAT had significantly less rates of failure when compared to the SOFTT-W, but there was no other significant difference between the tourniquets (27.78%, 44.44%, 61.11%). In addition, the CAT was significantly faster than both the TMT and SOFTT-W when applied to the leg (8.33 s, 40.96 s, 34.5 s). There was no significant difference in tourniquet failure rates between the three tourniquets after subject maneuvers in phase three (34.29%, 42.86%, 45.45%).
 
  The CAT is as effective as the TMT and significantly more effective than the SOFTT-W. In addition, the CAT demonstrated shorter application times than either the TMT or SOFTT-W. However, there was no significant difference between the three tourniquets in their ability to maintain pulselessness after subject maneuvers.
 
  Level II, Care Management.
 Level II, Care Management.
  To characterize and compare the incidence of basketball-related, soccer-related, and hockey-related injuries over a 10-year period.
 
  Cohort analysis of sport-related injuries using multiple Ontario healthcare databases.
 
  Emergency department visits in Ontario, Canada.
 
  Any patient who sustained musculoskeletal injuries sustained while playing basketball, soccer, or hockey between 2006 and 2017 were identified.
 
  Sport of injury, age, sex, rurality index, marginalization status, and comorbidity score.
 
  Annual Incidence Density Rates of injury were calculated for each sport, and significance of trends was analyzed by assessing overlap of 95% confidence intervals.
 
  One lakhs eighty five thousand eighty hundred sixty-eight patients (median age 16 years, interquartile range 13-26) received treatment for sport-related injuries (basketball = 55 468; soccer = 67 021; and hockey = 63 379). The incidence of basketball-related and soccer-related injuries increased from 3.4 (3.3-3.5) to 5.6 (5.5-5.7) and 4.4 (4.3-4.