J Trauma
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Resuscitation can exacerbate cellular injury caused by hemorrhagic shock, and the type of fluid used for resuscitation may play an important role in this injury. Unlike some factors in the treatment of combat casualty, the method of resuscitation is under our control. The prevention of cellular injury through wiser resuscitation strategies would be more advantageous than attempting complex immunomodulation after the damage has already occurred. ⋯ Hypertonic fluids cause suppression of neutrophil activation and a milder increase in the expression of cell injury markers compared with isotonic fluids. The effect of various resuscitation fluids on core cellular functions such as gene regulation is also summarized in this article. Finally, because of the uniqueness of combat care, a set of new recommendations for initial fluid resuscitation of combat casualties is proposed.
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The medical issues faced by military medics in the combat environment frequently represent a significant variation from their training and civilian experience. The differences between care delivered by military medics under fire and care rendered by civilian medics are profound. ⋯ These differences revolve around a lack of basic monitoring capability, significant logistical constraints, and prolonged evacuation times. The resuscitation algorithm presented in this article represents a consensus of military and civilian trauma experts.
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Good Level I scientific evidence supporting the efficacy (decreased morbidity and mortality) of prehospital fluid administration by civilian Emergency Medical Services personnel is lacking. The efficacy of this procedure in the hands of army Combat Lifesavers is even less well substantiated. ⋯ A method is described to assist medical educators in making decisions as to which skills should be taught to health care providers, and this method is loosely applied in the following discussion about whether Combat Lifesavers should receive training to start and administer intravenous fluids. Good scientific studies, based on valid data, need to be performed to determine the efficacy of intravenous fluid administration and other combat medical skills.
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This study reports on the results of hemorrhagic shock (HS) plus resuscitation on the coagulation profile in severely injured patients and on the role of fresh frozen plasma (FFP) supplementation in a canine HS model. ⋯ Resuscitation from hemorrhagic shock can be successfully implemented by restoration of blood loss with blood, crystalloid, and FFP added to maintain coagulation proteins.
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We previously demonstrated that trauma patient volume affects attrition rate of Advanced Trauma Life Support (ATLS)-acquired skills. This study assesses the possible roles of age, gender, and practice specialty on attrition of these skills over 8 years. ⋯ Trauma patient volume is the most critical determinant of attrition rate of ATLS-acquired skills. Gender, age (at time of taking the course), and practice specialty do not alter this attrition rate.