AACN clinical issues
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AACN clinical issues · Feb 1999
ReviewLimited volume resuscitation in penetrating thoracoabdominal trauma.
Trauma is the leading cause of death in young adults. Development of trauma centers in urban settings including emergency medical services has contributed greatly to the improved quality of trauma patient care. ⋯ This notion has been supported by findings in a recent prospective, randomized study involving patients with penetrating injuries to the torso. This article discusses briefly the pathophysiology of shock and hemostasis and the current literature on fluid resuscitation, with emphasis on limited volume resuscitation in patients with penetrating thoracoabdominal injuries.
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AACN clinical issues · Feb 1999
ReviewRight heart volumetric monitoring: measuring preload in the critically injured patient.
Accurate assessment of preload status is a major concern in the resuscitation of the critically injured patient. Of the three physiologic determinants of stroke volume, preload is the variable that is most frequently influenced by an insult or intervention or both in the trauma patient. ⋯ Until recently, efforts to measure and optimize ventricular preload have focused on intracardiac filling pressures (central venous pressure and pulmonary artery occlusion pressure). The purpose of this review is to discuss the application of volumetric measurements that provide a more accurate means of determining recruitable ventricular preload in the critically injured patient.
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The critically injured trauma patient in severe hemorrhagic shock presents a complex and arduous challenge to even the most experienced trauma staff. Lives are at stake as trauma teams feverishly pour massive amounts of blood into severely injured patients attempting to replace entire blood volumes several times over. ⋯ Other treatments, such as autotransfusion and blood substitutes, are promising adjunctive therapies that may in the near future help to improve outcomes in patients who require massive blood transfusions. This article reviews the current standard of care for the trauma patient requiring massive transfusion.
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AACN clinical issues · Feb 1999
ReviewInitial resuscitation after burn injury: therapies, strategies, and controversies.
Thermal injury disrupts normal hemostasis and sets off a cascade of events: cellular alterations and release of inflammatory mediators cause hypovolemic and cellular shock. Fluid resuscitation in burn injuries has been in use for more than a century, and much research has been devoted to development of resuscitation formulas and appropriate choice of fluid. Parameters for adequate monitoring of resuscitation are greatly debated. Current research efforts focus on minimizing burn edema through mediator modulation and on development of definitive endpoints of resuscitation monitoring.