scholarly journals Fluid therapy in trauma resuscitation : A review of changing practices.

2018 ◽  
Vol 6 (1) ◽  
pp. 31-39
Author(s):  
Kaja Mohammad Rasheed
Keyword(s):  
Fluid Resuscitation ◽  
Massive Transfusion ◽  
Single Case ◽  
Damage Control ◽  
Fluid Management ◽  
Laboratory Model ◽  
Trauma Resuscitation ◽  
High Quality ◽  
Acute Trauma ◽  
Medline Search

Background: Haemorrhage is the leading preventable cause of post trauma death. Acute trauma resuscitation has evolved over the last decade. The ATLS guidance used since 2012 is being updated in 2018.Objectives : To search relevant representative literature over 6 years between 2012 and 2018 to gain an insight into changing concepts, practices and recent advances in acute trauma fluid resuscitation and provide a structured review of the topic.Search methods: A relevant MEDLINE search was undertaken to obtain a list of 1512 articles from which 107 were utilised to prepare this review.Selection criteria:1. Inclusion: Articles from human medicine relevant to fluid resuscitation in trauma published in English between January 2012 and January 2018. 2.Exclusion: Articles restricted to Brain, spinal trauma or cardiovascular trauma, post traumatic arrest patients, animal or human laboratory model studies and articles on septic, postoperative, obstetric patients and single case studies were excluded.Results: This review categorises the topic into various parts to explain the evolving understanding of fluid resuscitation, trauma induced coagulopathy and endotheliopathy of trauma. The strategies for acute fluid management like damage-controlled resuscitation, balanced and haemostatic resuscitation and massive transfusion protocol are explained. A detailed discussion is carried out regarding crystalloid, colloid and blood transfusion. Special consideration is given to specific age groups, combat casualties and prehospital trauma care.Conclusions: Fluid resuscitation in trauma is a complex and rapidly evolving subject. Massive transfusion protocols and principles of damage control are significant for patient outcome. Standard guidance like ATLS is relevant and important for training professionals to deliver systematic, high quality of trauma care. There is scope for local improvisation based on resources and need for more high-quality trials and frequent systematic reviews.Bangladesh Crit Care J March 2018; 6(1): 31-39

Evidence-Based Practice & Practice-Based Evidence Applied to Adult, Medical Speech-Language Pathology

2013 ◽  
Vol 18 (1) ◽  
pp. 14-26 ◽  
Author(s):  
Rik Lemoncello ◽  
Bryan Ness
Keyword(s):  
Evidence Based Practice ◽  
Single Case ◽  
Quality Data ◽  
Evidence Based ◽  
Speech Language Pathology ◽  
Clinical Practices ◽  
High Quality ◽  
Randomized Controlled Clinical Trials ◽  
Relative Paucity ◽  
Language Pathology

In this paper, we review concepts of evidence-based practice (EBP), and provide a discussion of the current limitations of EBP in terms of a relative paucity of efficacy evidence and the limitations of applying findings from randomized controlled clinical trials to individual clinical decisions. We will offer a complementary model of practice-based evidence (PBE) to encourage clinical scientists to design, implement, and evaluate our own clinical practices with high-quality evidence. We will describe two models for conducting PBE: the multiple baseline single-case experimental design and a clinical case study enhanced with generalization and control data probes. Gathering, analyzing, and sharing high-quality data can offer additional support through PBE to support EBP in speech-language pathology. It is our hope that these EBP and PBE strategies will empower clinical scientists to persevere in the quest for best practices.

Anesthetic management of a patient with hollow viscus perforation due to blunt abdominal trauma with grade IV hemorrhagic shock

2021 ◽  
Vol 25 (2) ◽  
Author(s):  
Reza Widianto Sudjud ◽  
Djoni Kusumah Pohan ◽  
Muhammad Budi Kurniawan ◽  
Hana Nur Ramila
Keyword(s):  
Hemorrhagic Shock ◽  
Blunt Abdominal Trauma ◽  
Massive Transfusion ◽  
Damage Control ◽  
Anesthetic Management ◽  
Hollow Viscus ◽  
Permissive Hypotension ◽  
Massive Transfusion Protocol ◽  
Transfusion Protocol ◽  
Hollow Viscus Perforation

Hemorrhagic shock is a form of hypovolemic shock in which severe blood loss leads to inadequate oxygen delivery at the cellular level. Death from hemorrhage represents a substantial global problem, with more than 60,000 deaths per year in the United States and an estimated 1.9 million deaths per year worldwide, 1.5 million of which result from physical trauma. This case report aims to stress the need of handling cases of hemorrhagic shock in accordance with damage control protocol. Hemorrhagic shock management using permissive hypotension management, bleeding control, massive transfusion protocol (MTP), minimal crystalloid therapy, and adjuvant therapy is the best approach to get optimal outcome to prevent triad of death. In this case, the application of damage control resuscitation has not been fully implemented because of several constraints. Key words: Hemorrhage; Hemorrhagic shock; Permissive hypotension; Massive Transfusion Protocol; MTP; Resuscitation; Damage control Citation: Pohan DK, Sudjud RW, Kurniawan MB, Ramila HN. Anesthetic management on patient with hollow viscus perforation due to blunt abdominal trauma with grade IV hemorrhagic shock. Anaesth. pain intensive care 2021;25(2):217-221. DOI: 10.35975/apic.v25i2.1474 Received: 11 January 2021, Reviewed: 15 January 2021, Accepted: 16 February 2021

Restrictive fluid resuscitation in combination with damage control resuscitation

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

Managing Nutrition

2012 ◽  
Author(s):  
Sue Green
Keyword(s):  
Multidisciplinary Team ◽  
Fluid Management ◽  
Care Quality ◽  
Human Nutrition ◽  
Good Knowledge ◽  
Nursing Management ◽  
High Quality ◽  
Nutritional Care ◽  
Anatomy And Physiology ◽  
Care Quality Commission

This chapter addresses the essential nursing responsibility to ensure that adequate nutritional care is offered to all patients, whether in hospital or community-based settings. To provide appropriate nutritional care to patients or clients, nurses must have a good knowledge and understanding of the principles of human nutrition, and be able to deliver nutritional support that is informed by current clinical guidelines and up-to-date evidence, as well as to evaluate that care. Healthcare organizations have a duty to ensure that patients and clients receive high-quality nutritional care. The Council of Europe (2003) has published guidelines on food and nutritional care in hospitals, and a recent Europe-wide campaign has been launched to improve nutritional care in all types of care facility (Ljungqvist et al., 2010). A European strategy to address obesity has also been launched (Commission of the European Communities, 2007). In England, the Care Quality Commission (CQC, 2010), which regulates care settings, has set national standards concerning nutrition. The provision of high-quality nutritional care involves a range of services and requires a multidisciplinary team approach. As a nurse, your role within the multidisciplinary team is fundamental in ensuring the delivery of appropriate nutritional care. In the UK, this is clearly identified by the incorporation of ‘Nutrition and Fluid Management’ within the Essential Skills Clusters for pre-registration nursing education (Nursing and Midwifery Council, 2010). Human nutrition is the study of nutrients and their effect on health, and the processes by which individuals obtain nutrients and use them for growth, metabolism, and repair. The term ‘human nutrition’ therefore incorporates many aspects of behaviour and physiology. The way in which the body obtains, ingests, digests, absorbs, and metabolizes nutrients is described in core anatomy and physiology textbooks (for example, Marieb and Hoehn, 2010), and it is important that a good knowledge and understanding of these processes is gained before considering the nursing management of nutritional care. This chapter considers the principles of human nutrition that underpin the nursing management of nutritional care and focuses on the key nursing interventions that you should be able to provide with confidence. The amount and type of nutrients that a person obtains influences his or her ‘nutritional status’.

scholarly journals Fluid resuscitation in trauma: what are the best strategies and fluids?

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
G. H. Ramesh ◽  
J. C. Uma ◽  
Sheerin Farhath
Keyword(s):  
Fluid Resuscitation ◽  
Trauma Care ◽  
Fluid Management ◽  
Main Body ◽  
Transport Time ◽  
Low Resource ◽  
Prehospital Trauma Care ◽  
Special Groups ◽  
Resuscitation Fluid ◽  
Care Systems

Abstract Background Traumatic injuries pose a global health problem and account for about 10% global burden of disease. Among injured patients, the major cause of potentially preventable death is uncontrolled post-traumatic hemorrhage. Main body This review discusses the role of prehospital trauma care in low-resource/remote settings, goals, principles and evolving strategies of fluid resuscitation, ideal resuscitation fluid, and post-resuscitation fluid management. Management of fluid resuscitation in few special groups is also discussed. Conclusions Prehospital trauma care systems reduce mortality in low-resource/remote settings. Delayed resuscitation seems a better option when transport time to definitive care is shorter whereas goal-directed resuscitation with low-volume crystalloid seems a better option if transport time is longer. Few general recommendations regarding the choice of fluid are provided. Adhering to evidence-based clinical practice guidelines and local modifications based on patient population, available resources, and expertise will improve patient outcomes.

scholarly journals Optimizing the trauma resuscitation bay during the covid-19 pandemic

2020 ◽  
Vol 5 (1) ◽  
pp. e000488 ◽  
Author(s):  
David Hugh Livingston ◽  
Stephanie Bonne ◽  
Catherin Morello ◽  
Adam Fox
Keyword(s):  
Trauma Patient ◽  
Fluid Resuscitation ◽  
Personal Protective Equipment ◽  
Trauma Team ◽  
Protective Equipment ◽  
Trauma Resuscitation ◽  
Global Pandemic ◽  
Ancillary Staff ◽  
Ready Access ◽  
Head Covering

The covid-19 global pandemic due to the SARS-CoV2 (CoV2) virus has created the need to adapt hospital workspaces and staffing models, and trauma is no exception. While the optimal configuration of a trauma resuscitation area is debatable, the space needs to be large enough to accommodate the trauma team and ancillary staff. It also needs to have ready access to supplies and equipment to quickly and easily control hemorrhage, secure an airway and initiate fluid resuscitation. Lastly, stores of personal protective equipment in the form of fluid resistant gowns, head covering, face shield, and gloves (both sterile and non-sterile) should be readily available but under strict access. As CoV2 carriers increased in our population in New Jersey, we treated each incoming trauma patient as a potentially CoV2-positive case and sought to reconfigure out trauma resuscitation area to minimize exposure of our supplies to aerosolized virus.

scholarly journals Predictive Factors for Massive Transfusion in Trauma: A Novel Clinical Score from an Italian Trauma Center and German Trauma Registry

2020 ◽  
Vol 9 (10) ◽  
pp. 3235
Author(s):  
Sara Giulia Cornero ◽  
Marc Maegele ◽  
Rolf Lefering ◽  
Claudia Abbati ◽  
Shailvi Gupta ◽  
...  
Keyword(s):  
Trauma Registry ◽  
Massive Transfusion ◽  
Damage Control ◽  
Area Under The Curve ◽  
Clinical Score ◽  
Limb Amputation ◽  
Predictive Score ◽  
Trauma Patients ◽  
Early Management ◽  
Critical Bleeding

Early management of critical bleeding and coagulopathy can improve patient survival. The aim of our study was to identify independent predictors of critical bleeding and to build a clinical score for early risk stratification. A prospective analysis was performed on a cohort of trauma patients with at least one hypotensive episode during pre-hospital (PH) care or in the Emergency Department (ED). Patients who received massive transfusion (MT+) (≥4 blood units during the first hour) were compared to those who did not (MT−). Hemodynamics, Glagow Coma Score (GCS), diagnostics and blood tests were evaluated. Using multivariate analysis, we created and validated a predictive score for MT+ patients. The predictive score was validated on a matched cohort of patients of the German Trauma Registry TR-DGU. One hundred thirty-nine patients were included. Independent predictors of MT+ included a prehospital (PH) GCS of 3, PH administration of tranexamic acid, hypotension and tachycardia upon admission, coagulopathy and injuries with significant bleeding such as limb amputation, hemoperitoneum, pelvic fracture, massive hemothorax. The derived predictive score revealed an area under the curve (AUC) of 0.854. Massive transfusion is essential to damage control resuscitation. Altered GCS, unstable hemodynamics, coagulopathy and bleeding injuries can allow early identification of patients at risk for critical hemorrhage.

The Many Faces of Survivor Bias in Observational Studies on Trauma Resuscitation Requiring Massive Transfusion

2015 ◽  
Vol 66 (1) ◽  
pp. 45-48 ◽  
Author(s):  
Anthony M.-H. Ho ◽  
Jorge E. Zamora ◽  
John B. Holcomb ◽  
Calvin S.H. Ng ◽  
Manoj K. Karmakar ◽  
...  
Keyword(s):  
Observational Studies ◽  
Massive Transfusion ◽  
Trauma Resuscitation ◽  
Survivor Bias ◽  
The Many

Publishing Single-Case Research Design Studies That Do Not Demonstrate Experimental Control

2017 ◽  
Vol 39 (2) ◽  
pp. 118-128 ◽  
Author(s):  
Matt Tincani ◽  
Jason Travers
Keyword(s):  
Research Design ◽  
Single Case ◽  
Intervention Research ◽  
The Body ◽  
High Quality ◽  
Experimental Control ◽  
Case Research ◽  
Negative Results ◽  
Single Case Research ◽  
Single Case Research Design

Demonstration of experimental control is considered a hallmark of high-quality single-case research design (SCRD). Studies that fail to demonstrate experimental control may not be published because researchers are unwilling to submit these papers for publication and journals are unlikely to publish negative results (i.e., the file drawer effect). SCRD studies comprise a large proportion of intervention research in special education. Consequently, the existing body of research, comprised mainly of studies that show experimental control, may artificially inflate efficacy of interventions. We discuss how experimental control evolved as the standard for high-quality SCRD; why, in the era of evidence-based practice, rigorous studies that fail to fully demonstrate experimental control are important to include in the body of published intervention research; the role of non-replication studies in discovering intervention boundaries; and considerations for researchers who wish to conduct and appraise studies that fail to yield full experimental control.

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