Annals of emergency medicine
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Acute hemorrhage is a major cause of death in both civilian and military trauma. The suboptimal effect of the volume of standard crystalloids that can be infused during transport has resulted in a need for a more efficacious fluid for the prehospital management of both civilian and military trauma. ⋯ The hypertonic sodium chloride/dextran solution has the potential advantages of improving survival, producing a beneficial hemodynamic effect with smaller fluid volumes, reducing total fluid requirements during resuscitation, and being stored easily. This solution may prove valuable in the early resuscitation of the hypovolemic trauma patient and merits further clinical trials.
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Injury severity determination serves multiple purposes in trauma care systems by aiding prehospital triage, assisting clinical management, and facilitating outcome evaluation. Numerous authors have described methods for quantifying injury severity, most of which use physiologic status or anatomic injury. ⋯ For clinical management, it provides essential information on initial condition and eventual course, including response to therapy. Finally, for outcome evaluation, it enables objective assessment of care quality, using techniques that determine appropriateness of disability, morbidity, mortality, and reimbursement, based on case mix.
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As a result of experimental data and favorable clinical impressions, the pneumatic antishock garment (PASG) has gained widespread acceptance as a reasonable standard of care in emergency medical services (EMS) systems. It is currently legislated as required equipment for medical rescue vehicles in two-thirds of the United States. But despite a decade of widespread use, prospective, randomized, controlled trials that demonstrate the efficacy of the PASG have not been published. ⋯ All victims of injury whose systolic blood pressure was 90 mm Hg or less when they initially presented to paramedics in the field were entered into the study. All patients received the identical treatment protocol, with the sole exception of PASG application and inflation to full pressure prior to intravenous catheterization on an alternate day basis. Prospectively collected demographic data have demonstrated that the two resulting groups of PASG and no-PASG patients are well matched in terms of age, sex, injury type, anatomic location of the injury, initial field trauma score, injury severity score and probabilities of survival, as well as the amounts of IV fluids infused in the prehospital setting and the response, scene, and transport times.(ABSTRACT TRUNCATED AT 250 WORDS)
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Comparative Study
Ground versus air transport of trauma victims: medical and logistical considerations.
Emergency aeromedical transport for trauma victims varies widely, from 10% or less in some programs to more than 90% in others. There is the potential in all such programs for dramatic, lifesaving efforts as well as for costly and dangerous overuse. We propose the following preliminary guidelines for emergency aeromedical transport of trauma victims. ⋯ Scene flights should be dispatched within medical guidelines established by the regional emergency medical services system. Emergency aeromedical evacuation of trauma victims should assist the regionalization of trauma care to centers with special capabilities for the management of seriously injured patients. Promulgation of more detailed guidelines will depend on the accumulation of clinical experience and will be possible only if consistent efforts are made to obtain measures of injury severity, categories of injury, and long-term outcomes of management.