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Many materials have been engineered and commercialized as hemostatic agents. However, there is still a gap in the availability of hemostats that offer biocompatibility and biodegradability in combination with effective hemostatic properties. Cellulose nanofibers are investigated as hemostatic materials with most studies focusing on oxidized cellulose-derived hemostats. The recent studies demonstrate that by optimizing the morphological properties of nonoxidized cellulose nanofibers (CNFs) enhanced hemostasis is achieved. Herein, the hemostatic and wound-healing properties of CNFs with optimized morphology using two forms, gel, and sponge is investigated. In vitro thromboelastometry studies demonstrate that CNFs reduce clotting time by 68% (±SE 2%) and 88% (±SE 5%) in gel and sponge forms, respectively. In an in vivo murine liver injury model, CNFs significantly reduce blood loss by 38% (±SE 10%). The pH-neutral CNFs do not damage red blood cells, nor do they impede the proliferation of fibroblast or endothelial cells. Subcutaneously-implanted CNFs show a foreign body reaction resolving with the degradation of CNFs on histological examination and there is no scarring in the skin after 8 weeks. Demonstrating superior hemostatic performance in a variety of forms, as well as biocompatibility and biodegradability, CNFs hold significant potential for use in surgical and first-aid environments.

Introduction: Injuries are a major cause of disability and lost productivity. The case for a national trauma registry has been recognized by the Australian Commission on Safety and Quality in Health Care and at a policy level. Background: The need was flagged in 1993 by the Royal Australasian College of Surgeons and the Australasian Trauma Society. In 2003, the Centre of National Research and Disability funded the Australian and New Zealand National Trauma Registry Consortium, which produced three consecutive annual reports. The bi-national trauma minimum dataset was also developed during this time. Operations were suspended thereafter. Method: In response to sustained lobbying the Australian Trauma Quality Improvement Program including the Australian Trauma Registry (ATR) commenced in 2012, with data collection from 26 major trauma centres. An inaugural report was released in late 2014. Result: The Federal Government provided funding in December 2016 enabling the work of the ATR to continue. Data are currently being collected for cases that meet inclusion criteria with dates of injury in the 2017–2018 financial year. Since implementation, the number of submitted records has been increased from fewer than 7000 per year to over 8000 as completeness has improved. Four reports have been released and are available to stakeholders. Conclusion: The commitment shown by the College, other organizations and individuals to the vision of a national trauma registry has been consistent since 1993. The ATR is now well placed to improve the care of injured people. Published version

Hemorrhage remains a significant cause of morbidity and mortality following trauma and during complex surgeries. A variety of nanomaterials, including oxidized cellulose nanofibers (OCNFs), have been studied to overcome the disadvantages of current commercial topical hemostats. However, the relationship between nano-structural characteristics and hemostatic efficacy of non-oxidized cellulose nanofibers (CNFs) has not been elucidated. Herein, we present the first report of the correlation between structure and hemostatic performance of CNFs. In vitro thromboelastometry studies on CNFs, synthesized by ball-milling, showed that there is an optimum balance point between the aspect ratio (AR) and specific surface area (SSA) of nanofibers in terms of their maximum contribution to platelet function and plasma coagulation. The optimized CNFs with high SSA (17 m2/g) and a high AR (166) shortened normal whole blood clotting time by 68 %, outperforming cellulose-based hemostats. Additionally, CNFs reduced clotting time in platelet-deficient blood (by 80 %) and heparinized blood (by 54 %).

Hemorrhage, or severe blood loss, is one of the main causes of death in trauma, childbirth, and complex surgeries. Bleeding management in the first hour after injury using topical hemostatic agents is the key to minimize the consequent mortality and morbidity. Since the dawn of civilization, numerous topical hemostatic agents have been developed from materials with inherited hemostatic properties. However, the applications of these agents are hampered due to their shortcomings, such as weak hemostatic performance in the presence of coagulopathies and blood disorders, causing bystander cell damage and non-biodegradability. The present article firstly reviews the current market of topical hemostatic agents and their shortcomings. Then, it elaborates on how nanomaterials enabled us to enhance the current hemostatic materials in two aspects; (i) overcoming the drawbacks of current hemostatic materials and (ii) producing new hemostatic agents from materials regardless of their procoagulant properties on the macroscale. Additionally, a particular focus is placed on blood-material interactions to highlight the role of nanoscale structures.

Pseudoaneurysm is a well-recognised form of vascular injury following blunt trauma. Its diagnosis is often delayed due to late manifestation of signs and symptoms. Nonetheless, complications of pseudoaneurysm can be severe and even fatal. A 60-year-old man presented to our tertiary trauma centre with blunt chest trauma. His treatment was initially focused on the left clavicular fracture. He was eventually diagnosed with a dorsal scapular artery pseudoaneurysm and a large chest wall haematoma on computed tomography on his third hospital admission in two weeks. This pseudoaneurysm was treated with endovascular embolisation. This article highlights the value of meticulous clinical examination as well as judicious use of biochemistry and imaging in trauma management.

A 22-year-old University student injured his rightankle while playing soccer. He presented with grossswelling,painaroundtheankleandnumbnessofthetoes. X-ray of the foot revealed soft tissue swellingwith no bony injury. He was initially managed withbed rest, foot end elevation, local ice packs andanti-inflammatory agents. Though most symptomssettled, the numbness in the toes persisted.Duplex Ultrasound of the ankle to grade theseverity of injury, identified a pseudoaneurysm ofthe dorsalis pedis Artery (Fig. 1). It measured3cm 5 cm and had a wide neck of 0.6 cm. Com-pression treatment was not attempted due to pain.The aneurysm was surgically explored. The dor-salis pedis artery was exposed and controlled. Sur-rounding haematoma was evacuated and the rent inthe artery identified (Fig. 2). As it involved morethan two-third the circumference of the artery, itwas transacted and an end-to-end anastomosisdone. A posterior slab was applied to immobilisethe ankle.The patient had an uneventful recovery. Heregained sensation to his toes. Ankle swellingsettled. A good pulse was felt clinically. Duplex scanconfirmed the artery to be patent during immediatepost-operative period and at 6-week follow-up.