Damage control resuscitation: addressing trauma-induced coagulopathy

2009 ◽  
Vol 70 (1) ◽  
pp. 22-25 ◽  
Author(s):  
Juan C Duchesne ◽  
John B Holcomb
2021 ◽  
Author(s):  
Diego A Vicente ◽  
Obinna Ugochukwu ◽  
Michael G Johnston ◽  
Chad Craft ◽  
Virginia Damin ◽  
...  

ABSTRACT Introduction Navy Medicine's Role 2 Light Maneuver (R2LM) Emergency Resuscitative Surgical Systems (ERSS) are austere surgical teams manned, trained, and equipped to provide life-saving damage control resuscitation and surgery in any environment on land or sea. Given the restrictions related to the COVID-19 pandemic, the previously established pre-deployment training pipeline for was modified to prepare a new R2LM team augmenting a Role 1 shipboard medical department. Methods The modified curriculum created in response to COVID-19 related restriction is compared and contrasted to the established pre-deployment R2LM ERSS curriculum. Subject Matter Experts and currently deployed R2LM members critically evaluate the two curricula. Results Both curricula included the team R2LM platform training and exposure to cadaver based team trauma skills training. The modified curriculum included didactics on shipboard resuscitation, anesthesia and surgery, shipboard COVID-19 management, and prolonged field care in austere maritime environments. Conclusions We describe Navy Medicines R2LM ERSS capability and compare and contrast the standard R2LM pre-COVID-19 curriculum to the modified curriculum. Central to both curricula, the standard R2LM platform training is important for developing and honing team dynamics, communication skills and fluid leadership; important for the successful function austere surgical teams. Several opportunities for improvement in the pre-deployment training were identified for R2LM teams augmenting shipboard Role 1 medical departments.


2012 ◽  
Vol 73 ◽  
pp. S459-S464 ◽  
Author(s):  
Keith Palm ◽  
Amy Apodaca ◽  
Debra Spencer ◽  
George Costanzo ◽  
Jeffrey Bailey ◽  
...  

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Daniela Schmulevich ◽  
Pamela Z. Cacchione ◽  
Sara Holland ◽  
Kristin Quinlan ◽  
Alyson Hinkle ◽  
...  

2017 ◽  
pp. 57-75
Author(s):  
Jacob R. Peschman ◽  
Donald H. Jenkins ◽  
John B. Holcomb ◽  
Timothy C. Nunez

2012 ◽  
Vol 73 (3) ◽  
pp. 674-678 ◽  
Author(s):  
Marquinn D. Duke ◽  
Chrissy Guidry ◽  
Jordan Guice ◽  
Lance Stuke ◽  
Alan B. Marr ◽  
...  

2017 ◽  
Author(s):  
Ronald Chang ◽  
John B. Holcomb

Exsanguination occurs rapidly after trauma (median 2 to 3 hours after admission) and is the leading cause of preventable trauma deaths. The modern treatment for traumatic hemorrhagic shock is simultaneous mechanical hemorrhage control and damage control resuscitation (DCR), which emphasizes using plasma as the primary means for volume expansion. Other core DCR principles include minimization of crystalloid, permissive hypotension, and goal-directed resuscitation. The treatment of traumatic hemorrhage is complicated by trauma-induced coagulopathy (TIC); DCR is thought to address TIC directly despite incomplete understanding of the underlying mechanisms. Recent data point to a 1:1:1 ratio of plasma and platelets to red blood cells as the optimal blood product ratio for acute traumatic hemorrhage. However, this paradigm may soon be supplanted by a transition back to whole blood. Although it is intuitive to apply these same protocols and algorithms to patients with nontraumatic hemorrhage, the scientific evidence is lacking. Key words: endotheliopathy, hemorrhage, massive transfusion, trauma-induced coagulopathy


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