J Trauma
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Comparative Study
Resuscitation from hypovolemia in swine with intraosseous infusion of a saturated salt-dextran solution.
Prehospital fluid resuscitation of traumatic injury is limited by difficulty in delivering large volumes of fluid in the field and time delays associated with gaining vascular access. We addressed these limitations in 14 anesthetized swine by evaluating a highly efficient volume expander, a near-saturated salt-dextran solution (SSD) administered through a new device, which gains vascular access via intraosseous (IO) infusion into the sternal bone marrow. After a steady-state baseline was achieved, all animals were hemorrhaged to 45 mm Hg for one hour. ⋯ In addition, cardiac output was better sustained after 2 hours with SSD than with NS. No deleterious effects of IO infusion of SSD were observed. From the improvement in cardiovascular variables and the lack of significant sternal or pulmonary pathologic perturbations, these data suggest that IO infusion of SSD can effectively treat hypovolemia and may allow field treatment when logistic considerations make conventional resuscitation impractical.
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The American College of Surgeons' (ACS) Committee on Trauma recommends drug and alcohol screening as "essential" for level I and II or "desirable" for level III trauma centers. ⋯ Despite available resources and repeated ACS recommendations, measurements of BACs and drug screens are routine in only 63.7% of level I and 40.0% of level II trauma centers.