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Sun Oct 15 17:33:33 BST 2006

I'm reviewing my ATLS for a class at the end of the month, so this will  come 
in several parts, as I run into things.

Chapter 1, Section II, B Inhospital Phase (page 12): "Warmed Intravenous  
crystalloid solutions (eg, Ringer's Lactate)....

Change to "Low volumes of Normal Saline"- 

Rational: there have been a number of studies out over the last several  
years calling into question the utility of adding additional lactate to an  
already stressed, possibly lactate overloaded, system. This would be especially  
true if the patient was a diabetic already on one of the lactate system blocking  
agents (eg. Metformin). In addition, many studies have shown the value of low 
 volume resuscitation in preventing "Shock Lung" or ARDS, and in preventing  
additional internal bleeding by not raising the systolic blood pressure to the 
 point of 'popping the clot' prior to obtaining definite bleeding control by  
either direct or radiologic intervention methods.

Same chapter and section (page 13): "Most prominent among these diseases  are 
hepatitis and the acquired immune deficiency syndrome (AIDS)." 

Change to specifically add Hepatitis B and C and change the other to refer  
to HIV infection. 

Rational: Hepatitis B is readily preventable by immunization, Hepatitis C  is 
much more common than previously thought (up to 2% of the population in some  
areas) and NOT immunizable, and while we rarely see full blown AIDS  anymore, 
at least here in North America, the term 'HIV infection' is more  inclusive.

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