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The Hemodynamic
- 1. The hemodynamically unstable patient Jeannouel van Leeuwen MD Trauma in the Caribbean II November 6-8, 2009
- 20. Acute Coagulopathy of Trauma (ACoTS) Hess et al. J Trauma 2008
- 34. SBP > 100 vs. SBP > 70 led to no difference in mortality
- 35. Immediate versus Delayed Fluid Resuscitation for Hypotensive Patients with Penetrating Torso Injuries William H. Bickell, Matthew J. Wall, Paul E. Pepe, R. Russell Martin, Victoria F. Ginger, Mary K. Allen, and Kenneth L. Mattox The New England Journal of Medicine Methods: We conducted a prospective trial comparing immediate and delayed fluid resuscitation in 598 adults with penetrating torso injuries who presented with a prehospital systolic blood pressure ≤ 90 mm Hg. Results: Among the 289 patients who received delayed fluid resuscitation, 203 (70 percent) survived and were discharged from the hospital, as compared with 193 of the 309 patients (62 percent) who received immediate fluid resuscitation (P = 0.04). Volume 331:1105-1109 October 27, 1994 Number 17
Editor's Notes
- * 07/16/96 * ## Coagulopathy associated with traumatic injury is the result of multiple independent but interacting mechanisms. Early coagulopathy is driven by shock and requires thrombin generation from tissue injury as an initiator. Initiation of coagulation occurs with activation of anticoagulant and fibrinolytic pathways. This Acute Coagulopathy of Trauma-Shock is altered by subsequent events and medical therapies, in particular acidemia, hypothermia, and dilution. There is significant interplay between all mechanisms.
- * 07/16/96 * ## Goals. Systolic BP 80-100 mmHg, Hematocrit 25-30%, PT, PTT, INR in normal range, Platelet count > 50,000, Normal serum ionized calcium, Core temp > 36 C, Prevent acidosis from worsening. Increase ambient room temperature, Warmed IV fluids, Level 1or similar infusor, Blood warmers, Forced air warming device,
- * 07/16/96 * ##
- To attack the problems of hemodilution and coagulopathy, it is important to attack the “bloody vicious cycle” at all points. One obvious conclusion is to start blood products early in patients who look they will require large amounts. There is no point in achieving hemodilution any sooner than absolutely necessary.