Modify Your Subscription
Home > List Archives
Permissive hypotension - firstname.lastname@example.org email@example.com
Thu, 26 Jun 2003 11:16:24 -0500
- Previous message: Permissive hypotension - military
- Next message: Field Management of Chest Trauma....
- Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]
Thank you Sir Keep your head down! Dave Padgett PA-C LTJG (ret.) -----Original Message----- From: Richard Wigle MD FACS [mailto:firstname.lastname@example.org] Sent: Thursday, June 26, 2003 11:12 AM To: email@example.com Subject: RE: Permissive hypotension - military I have some old work at home but I'm in the boondocks The Jof Trauma issue has a very decent summary R Wigle LTC USAMC --- DPadgett@sblhs.org wrote: > Do you have any studies available RE 3%NS in trauma > Thanks! Dave P > > -----Original Message----- > From: Richard Wigle MD FACS [mailto:firstname.lastname@example.org] > Sent: Wednesday, June 25, 2003 10:40 PM > To: email@example.com > Subject: Re: Permissive hypotension - military > > > Matt > > The military apsects of permissive hypotension were quite > nicely reviewed (with, of course, no definitive answers) > in > the May J of Trauma- entire issue as a matter of fact > dedicated to combat type issues. > > I'm introducing the topic to my corpsmen and primary > responders with a degree of trepidation. Most of our > peace > time response times aren't that out of line with the > civilian community however and it is obviously > applicable. > Unfortunately one of the first things our non medical > people want to be taught( after the acursed CPR), and one > of the first things our medics are prone to do is IV > access. In fact our infantry generally each carry a bag > of > Ringers and tubing. With the vagaries of combat I'm not > sure what the right answer is but I suspect part of it > will > require the medics to exercise much more judgement (and > be > better trained) than they are at present. > > I am watching the developing hypertonic saline protocols > with interest and I suspect that, at least in the US, in > a > few years the doctrine will be 250 mls of 3NS either on > the > field or at the collection point > > R Wigle > LTC USAMC > Medical Task Force, Republic of Georgia > > > --- Matthew Boylan <firstname.lastname@example.org> wrote: > > > > I am aware that the subject of permissive hypotension > > (PH) in cases of > > non-compressible haemorrhage in trauma has been dealt > > with extensively (and > > repeatedly) on this trauma list. However, as a military > > man I would like to > > pose a few questions to the more experienced members of > > the list on its use > > within a military context. > > > > In the examples discussed on this list so far PH has > been > > considered in the > > civilian context where there is usually relatively > rapid > > access to > > definitive surgical care. Indeed this situation is > > comparable, and the > > techniques therefore applicable in the vast majority of > > military deployments > > that we undertake. For example we have field surgical > > units and > > comprehensive casualty evacuation systems that can > > provide casualties with > > near-equivalent care as that which they would have > > received in there home > > land. > > > > That said there are situations where this system may > not > > be available, where > > definitive care cannot be rapidly accessed, where > > casualties have to be held > > in the field. It is in this situation where I would > like > > your views/opinions > > on: > > > > How long can permissive hypotension be safely used for? > > hours, days? > > Are there likely to be any adverse affects of > maintaining > > an individual in > > this state for a prolonged period of time? Renal > damage? > > Acidosis? > > Is there a time period after which the 'clot' is likely > > to have become > > organized sufficient to allow the intravascular > pressure > > to be raised to > > higher levels (? thereby improving overall tissue > > perfusion)? > > Is permissive hypotension actually applicable in this > > circumstance? If not > > what would you use? > > > > I realise very little, if any, research is available on > > this subject and am > > hoping there will be some interesting work stemming > from > > the latest jaunt to > > Iraq. I would be grateful for your thoughts on the > > subject. > > > > Cheers all > > > > Dr Mat Boylan > > (British army, RAMC) > > > > > _________________________________________________________________ > > Tired of 56k? Get a FREE BT Broadband connection > > http://www.msn.co.uk/specials/btbroadband > > > > > > -- > > trauma-list : TRAUMA.ORG > > To change your settings or unsubscribe visit: > > http://www.trauma.org/traumalist.html > > > __________________________________ > Do you Yahoo!? > SBC Yahoo! DSL - Now only $29.95 per month! > http://sbc.yahoo.com > > -- > trauma-list : TRAUMA.ORG > To change your settings or unsubscribe visit: > http://www.trauma.org/traumalist.html > > -- > trauma-list : TRAUMA.ORG > To change your settings or unsubscribe visit: > http://www.trauma.org/traumalist.html __________________________________ Do you Yahoo!? SBC Yahoo! DSL - Now only $29.95 per month! http://sbc.yahoo.com -- trauma-list : TRAUMA.ORG To change your settings or unsubscribe visit: http://www.trauma.org/traumalist.html