Fluid resuscitation in the initial management of post-traumatic shock: the concept of permissive hypotension

2000 ◽  
Vol 11 (3) ◽  
pp. 121-126
Author(s):  
AS Brett
2019 ◽  
Vol 72 (2) ◽  
pp. 209-215
Author(s):  
Paweł Podsiadło ◽  
Adam Nogalski ◽  
Sylweriusz Kosiński ◽  
Tomasz Sanak ◽  
Kinga Sałapa ◽  
...  

Introduction: Improper initial management of a victim in severe hypothermia is associated with a risk of cardiac arrest. At the same time, an uncontrolled drop in core body temperature in trauma victims is an independent risk factor for mortality. Medical personnel require a thorough understanding of the pathophysiology and treatment of hypothermia. Gaps in this understanding can lead to serious complications for patients. The aim: To compare knowledge concerning hypothermia between medical personnel working in emergency departments (ED) and emergency medical services (EMS). Materials and methods: A total of 5,362 participants were included in the study. In this study, EMS and ED personnel were encouraged to participate in an e-learning course on hypothermia. Subsequently, the scores of a pre-test, lesson tests and post-test completed by participants of this course were compared. Results: Pre-test scores were significantly higher among personnel working in EMS compared with those working in EDs. Nurses employed in EDs had significantly more failures in completing the course than EMS nurses. The most difficult topics for all practitioners were post-traumatic hypothermia and hypothermia-related clotting disorders. Conclusions: EMS personnel have a higher level of knowledge of hypothermia than ED personnel. Moreover, an e-learning course is an effective tool for improving medical personnel’s knowledge of hypothermia.


2020 ◽  
Vol 66 (3) ◽  
Author(s):  
Andrzej Żyluk ◽  
Wojciech Jagielski

Spontaneous colonic necrosis is very uncommon in a patient without predisposed disorders such as end-stage renal failure in dialysed patients, serious cardiac failure, sepsis, post-traumatic shock, and vascular surgery within an abdominal aorta. This paper presents the case of an elderly patient in whom necrosis of almost the whole colon had occurred within 2 days. At presentation the patient had no clinical symptoms or signs suggesting serious abdominal disease. There was also a lack of biochemical abnormalities and changes in angio-CT. Due to deterioration of the patient’s general condition, he underwent surgery which revealed necrosis of almost the whole colon. The necrotic colon was resected, followed by a terminal ileostomy. Despite the operation, the patient died 2 days after.


Author(s):  
T. A. Zayets ◽  
M. I. Marushchak ◽  
I. Ya. Pidhaina

Introduction. Many scientific researches were described about functional state of a liver as a model of multiple organ dysfunction in severe conditions of experimental injury. Important sensitive markers of liver failure are: absorption function and excretion function of a liver, with its function of synthesizing of glycogen.The aim of the study – to learn the dynamics of absorption and excretion of a liver, with its function of synthesizing of glycogen in response to cranioskeletal injury, combined with blood loss.Methods of the research. The experiments were performed on 54 white nonlinear male rats. In both experimental groups with sodium thiopental anesthesia we modeled a closed head injury according to the method in our own modifications. In addition, by a specially designed device was applied one-off challenge on each thigh, causing a closed fracture of the femur. We determined the duration of the selection of bromsulphalein in bile and glycogen content in the liver.Results and Discussion. The results indicated that under the influence of simulated injuries we observed violations of absorption and excretion of a liver, with its function of synthesizing of glycogen. The largest deviations occurred after 7 days of post-traumatic period. Thus, in terms of additional bleeding violation of the liver was bigger. The reasons were: apparently deepening traumatic shock, the development of hypoxia, systemic response to inflammation.Conclusions. The experimental cranioskeletal injury is accompanied by violation of absorption, excretion and function of synthesizing of glycogen, manifested increasing duration of start and duration of bromsulphalein allocation and reduction of glycogen in the liver tissue, especially at 3 and 7 days post-traumatic period. Additional blood loss is accompanied by an even greater violation of these features since the first day of the experiment. After 3 and 7 days post-traumatic period the beginning and duration of allocation of bromsulphalein are significantly higher and glycogen content – less than in the group of animals with cranioskeletal injury, but without additional bleeding.


1995 ◽  
Vol 23 (Supplement) ◽  
pp. A89
Author(s):  
George E. Woodman ◽  
T C Fabian ◽  
M J Schurr ◽  
J M Yockey ◽  
M A Croce ◽  
...  

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