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Thu, 26 Jun 2003 11:16:24 -0500

Thank you Sir  Keep your head down! Dave Padgett PA-C LTJG (ret.)

-----Original Message-----
From: Richard Wigle MD FACS [mailto:rlwigle@yahoo.com]
Sent: Thursday, June 26, 2003 11:12 AM
To: trauma-list@trauma.org
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:rlwigle@yahoo.com]
> Sent: Wednesday, June 25, 2003 10:40 PM
> To: trauma-list@trauma.org
> 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 <boggy556@hotmail.com> 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)
> > 
> >
>
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Permissive hypotension - military