AACN clinical issues
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AACN clinical issues · Feb 1999
ReviewThe trauma triad of death: hypothermia, acidosis, and coagulopathy.
With the organization of trauma systems, the development of trauma centers, the application of standardized methods of resuscitation, and improvements in modern blood banking techniques, the ability to aggressively resuscitate patients in extremis has evolved. The concept of the "golden hour" has translated into unprecedented speed and efficiency of trauma resuscitation with the ultimate goal of short injury-to-incision times. ⋯ Critical care nurses must understand this triad, because it forms the basis and underlying logic on which the damage control philosophy has been built. This article explores the pathogenesis and treatment of acidosis, hypothermia, and coagulopathy as it applies to the exsanguinating trauma patient.
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The triad of hypothermia, acidosis, and coagulopathy during initial operative and resuscitation efforts has been recognized as a significant cause of death in patients with traumatic injuries. A staged surgical approach with a brief initial laparotomy, subsequent intensive care unit resuscitation, and a planned reoperation is an emerging technique used in trauma surgery, with application to a variety of other surgical challenges. Successful damage control therapy requires a coordinated multidisciplinary team effort by a trauma team experienced in the process of damage control operations, intensive care unit priorities, and potential complications of this innovative surgical approach.
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Shock is defined as inadequate perfusion of tissues with oxygen and nutrients to support cellular function. Resuscitation from shock can therefore only be complete when all evidence of oxygen debt, anaerobic metabolism, and tissue acidosis has been eliminated. All of the diagnostic and therapeutic maneuvers performed by trauma nurses today, whether basic or advanced, whether performed in the field, emergency department, operating room, or intensive care unit, can be traced directly or indirectly to this goal. ⋯ Resuscitation endpoints (i.e., variables or parameters) must be viewed across the continuum of shock because the effectiveness of endpoints varies with the phase of resuscitation. The optimal resuscitation endpoint in trauma is controversial, remains elusive, and is one of the most published topics in modern medical literature. This article presents the current understanding of the resuscitation endpoints in trauma.
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AACN clinical issues · Feb 1999
ReviewTemperature management in trauma patients across the continuum of care: the TEMP Group. Temperature Evaluation and Management Project.
Hypothermia is a potentially preventable consequence of injury in the trauma patient. The physiologic aftermath of hypothermia is such that it is regarded as one of the three components in the trauma triad of death. A multidisciplinary group at a Level I trauma center was formed to originate an innovative team approach to managing temperature in trauma patients. This article describes this unique project to combat a preventable cause of significant morbidity and mortality.
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AACN clinical issues · Feb 1999
Review Case ReportsResuscitation of the multitrauma patient with head injury.
Head injury remains the leading cause of death from trauma. The definitive method for eliminating preventable death from traumatic brain injury remains elusive. New research underscores the danger of inadequate or inappropriate support of oxygenation, ventilation, and perfusion to cerebral tissues. ⋯ A search for optimal treatments based on prospective randomized trials will continue. Development of neuroprotective drugs and use of hypertonic saline may be on the horizon. In an effort to ensure optimal outcome, contemporary trauma nursing must embrace new concepts, shed outmoded therapy, and ensure compliance with the basic tenets of critical care for the multitrauma patient with head injury.