J Trauma
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Burn injury remains a constant source of morbidity and mortality in the military environment. The logistic constraints of combat casualty care can make it impossible to provide the large volumes of crystalloid typically used for burn resuscitation. Unlike penetrating trauma, the immediate and sustained fluid requirements necessary for resuscitation of thermal injury preclude the use of limited or hypotensive resuscitation. ⋯ Although strategies such as early use of colloids or hypertonic saline may not reduce morbidity or mortality when compared with large-volume infusions of lactated Ringer's, they can be volume sparing for some hours and sustain life until more definitive therapy is initiated. An intriguing hypothesis is that oral resuscitation can effectively restore plasma volume after thermal injury. We present data from recent experiments of gastric and intestinal infusions of an oral rehydration solution in a porcine burn model that demonstrates restoration of plasma volumes and improvement in hemodynamic parameters associated with significant gastric emptying and intestinal absorption.
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Much can be learned from studying the deaths that occur in trauma systems as they have developed. Understanding these deaths and the potential effect of trauma systems on reducing death has major implications for designing clinical trials in fluid resuscitation. The availability of new, exciting information regarding fluid composition and physiologic effects argues for new, better-designed clinical trials. By agreeing on the form of resuscitation trials in the future, we will increase our ability to see clinically significant differences in outcome as we move from animal data to clinical efficacy.
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In general, the Canadian Forces follow widely accepted principles of fluid resuscitation. These are simply guidelines for fluid resuscitation, and the Canadian Forces currently do not have an absolute doctrine that the clinician in the field must follow. ⋯ Ringer's lactate is the primary resuscitation fluid that is used. Emphasis is placed on attempting to control ongoing hemorrhage specifically either with direct pressure, surgical control, or splinting of long bone or pelvic fractures at the earliest possible stage.
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The most biomechanically stable relationship between the side plate of a compression hip screw (CHS) and retrograde intramedullary (IM) femoral nail has not been described in the literature. This becomes a clinical issue when treating supracondylar femur fractures with a retrograde nail in patients with a history of compression hip screw fixation of intertrochanteric fractures. The proximal end of the nail and the interlocking screws may act as a stress riser in the femoral diaphysis. The purpose of this study is to determine the biomechanical consequences of the amount of implant overlap between a CHS plate and retrograde IM femoral nail. ⋯ Strain patterns are altered by the degree of implant overlap in the proximal femoral diaphysis. Femora with uninstrumented intervals between retrograde nails and side plates fail at lower loads than femora without retrograde nails and those with kissing or overlapping implants. Kissing or overlapping instrumentation increases load to failure and creates a more biomechanically stable construct than gapped implants. The findings of this study suggest an overlapping implant orientation in the femur increases failure load at the implant interface.