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Seriously injured patients frequently develop coagulopathy, which makes resuscitation (and survival) more challenging. The US military has adopted its routine use at forward combat hospitals. This can and does occur with military type injuries. But for our military colleagues, this could be a very valuable tool!
CRYSTALLOIDS Too much crystalloid resuscitation in traumatic hemorrhagic shock can increase dilutional coagulopathy, as well as increase morbidity and mortality Bickell WH et al. I recently gave a talk on the initial management of trauma patients with hemorrhagic shock. vs SBP target <90mmHg which resulted in a mortality of 33.4%
Calcium and resuscitation Severely injured trauma patients are commonly hypocalcemic. Giancarelli et al found that 97% of patients who underwent massive transfusion protocols during trauma resuscitation were hypocalcemic (iCa < 1.1 Prehospital Ca administration reduces risk of hypoCa on arrival (70% vs. 28%). Am J Emerg Med.
Researchers from the US Army performed a retrospective registry study on a sample of military casualties over four years. I’m surprised that a military registry could only come up with 75 patients a year to analyze. They identified soldiers who received either room-temperature or cold-stored platelets.
Scientific Rigor Red Cross resuscitation courses closely align with the International Liaison Committee on Resuscitation (ILCOR) recommendations. Major resuscitation organizations worldwide meet in this forum to share knowledge and best practices. All three leverage the latest educational methodologies.
2][3] If earlier treatment with TXA is better, would there be benefit in its administration in the prehospital setting? Association between prehospital tranexamic acid administration and outcomes of severe traumatic brain injury. If so, could this be done safely? These questions are asked in the first paper that we reviewed.
The latter 1950s and 1960s, quested for nerve gas defense studying expired air resuscitation and modern resuscitology; developing intensive care units. To me, it harkens a new scientific renaissance of resuscitation science, emergency care, and creating systems for care. 1950s & 1960s Resuscitation Research.
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