List Archives

Sat May 19 15:52:54 BST 2007

you said that nothing preOR is going to help?
l don't intend to be rude or less respectful but are you aware of the fact
that majority of trauma patients die due to load and go management and under
treatment...
OR is the ultimate for trauma patients but it is very handy job to get them
to OR and much can and must be done during that period of time, in many
countries around the world that job is done my non-surgeon physicians
ante

2007/5/19, bensonblues at comcast.net <bensonblues at comcast.net>:
>
> High volume infusion, permissive hypotension, ad nauseum: It all depends.
> Dogma is something that the internists can get away with, but not those of
> us who take care of the injured. Give me a pt with a GSW to the groin and
> on-scene exsanguination, hemostasis achieved with direct pressure, but
> without a blood pressure, the early experiments by Arthur Guyton on
> hemorrhage still prevail: Aggressive volume resuscitation is more likely
> than not to decrease morbidity and mortality. However, give me a pt struck
> by an auto with multiple injuries, uncontrolled intracavitary hemorrhage,
> and no blood pressure, and with the exception of high volume transfusion of
> fresh whole blood (when was the last time you administered that?), high
> volume resuscitation is likely to contribute to hemodilution and
> coagulopathy and continued and worsening hemorrhage. I'm under the firm
> belief that it doesn't really matter what you do preoperatively (with few
> exceptions). The most important determinant of
> surviv
> al from trauma is 1) the time it takes to get the patient to the OR and 2)
> the skills of the surgeon. I hope that this statement is without
> controversy. Every trauma victim is a little different from the next, and
> judgement should prevail. No matter what your management strategy, it always
> depends on the patient injuries, pre-existing medical problems, medications
> the patient is taking, and your available resources. In short, there is a
> role for the high-volume infuser in selected cases. It's utility would be
> greatly increased if fresh whole blood were to be used.
>
> DB
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>

List Archives

For your convenience, find the Trauma List Archive Below

Level I Fluid Warmer