M. Margaret Knudson, M.D., Professor of Surgery
 
As the Principal Investigator of the CDC-Sponsored San Francisco Injury Center, I am involved in a number of projects related to injury and injury prevention. These projects include:

1. Resuscitation following Traumatic Brain Injury (Laboratory Study): In a controlled model of traumatic brain injury, we are using tissue oxygen probes placed at various locations to better define the brain injury and the effects of ventilation, oxygenation, hemorrhage, and resuscitation on tissue oxygen and capillary metabolism (Lactate/pyruvate/glutamate) following brain injury.

2. A Comparison of Muscle Lactate Levels with Tissue Oxygen and Metabolism (Laboratory Study): In a small animal model, we are comparing serum and tissue lactate levels with other markers (tissue oxygen, bicarbonate, pyruvate) in order to better define the role of lactate as a measure of resuscitation. We are also measuring lactate levels following shock and resuscitation with fluids and various vasoactive agents.

3. Brain Tissue Oxygen Monitoring and Microdialysis Following Severe Traumatic Brain Injury (Clinical Study): Patients with severe brain injury who require ICP monitors are also being monitored with brain oxygen ad microdialysis probes in order to better define their brain injury and response to interventions.

4. Muscle Oxygen Monitoring in Critically Ill Patients (Clinical Study): Tissue oxygen levels measured in the muscle of critically ill trauma patients may be used to help guide resuscitation. We are comparing two methods of measuring tissue oxygen (direct probes versus near infra-red techniques) and correlating these measurements with microdialysis data as well as standard variable used to measure resuscitation (blood pressure, pulse, serum bicarbonate levels etc).

5. Posttraumatic Stress Disorder in Injured Children (Clinical Study): Injured children are particularly vulnerable to the development of PTSD. In a prospective study being conducted at Children’s Hospital, Oakland, we are following children for up to 1 year post injury for the development of PTSD and comparing interventions designed to lessen these symptoms.

6. Use of ultrasound in patients with Solid Organ Injuries managed nonoperatively: (Clinical study)Using ultrasound, we are attempting to define the grade of liver/spleen/ or renal injuries resulting from blunt trauma and following these patients with serial ultrasound exams for progression of their injury, need for operative intervention based on the amount of hemorrhage, and the development of complications associated with non- operative management.

7. Prevention Research and Activities: Through the Injury Center, we are involved in a wide range of prevention projects that include pedestrian crashes, violent injuries, pediatric trauma, advocacy, and the development of educational programs in injury prevention for surgeons, medical students, and elementary students.

8. Posttraumatic Thromboembolism: (Analytical Study): Using the National Trauma Data Base, we are developing a report on the current incidence of DVT/PE in the United States following injury, describing risk factors, and analyzing the effectiveness of prevention strategies.

9. Simulation and Trauma: (Clinical Study): We are designing clinical scenarios that can be utilized in simulation in order to prepare senior surgical residents for their rotation on the trauma service. We hope to validate the use of simulation for this purpose.

10. Outcome following isolated, mild traumatic brain injury: (Clinical Study) As part of a multi- institutional study, we are prospectively following patient with isolated brain injuries for their functional outcomes for a period of one year, and comparing outcomes in elderly versus younger patients