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Suggested Citation:"Index." Institute of Medicine. 1999. Fluid Resuscitation: State of the Science for Treating Combat Casualties and Civilian Injuries. Washington, DC: The National Academies Press. doi: 10.17226/9625.
×

Index

A

ABCs. See Airway-breathing-circulation format

Actin, testing for caspase-specific degradation fragments from, 43

Acute hemorrhagic shock, pathophysiology of, 4, 19-44

''Acute respiratory distress syndrome,''15

Acute respiratory failure, 50

Adenosine, 74

Adenosine diphosphate (ADP)

phosphorylation of, 26

release of, 52

Adenosine triphosphate (ATP)

depletion during ischemia, 26, 55

production of, 26, 55

Adhesion molecules, intracellular, 58

Adrenergic downregulation, 37

Advanced Trauma Life Support® (ATLS® course, 100, 102

Aeromedical evacuation, prompt, 106

Airway

and breathing, 104-106

obstruction of, 10

securing, 99, 101, 104-105

Airway-breathing-circulation format, 103

Albumin-containing solutions

advantages of, 60

as a resuscitation fluid, 39, 51, 60

Altered physiologic states, 93

American College of Emergency Physicians (ACEP), 102

American College of Surgeons, 102, 118-119

Committee on Trauma, 39

Analgesia, administering, 101

Anemia, 51

Anesthesia

cardiovascular effects of, 114

depressant effects of, 114-115

inhalant, 114

intravenous, 114

role in hemorrhagic shock, 110, 114-115

Animal models, 3, 109-112

canine, 109-110, 112

primate, 110, 112

rodent, 110-112

shortcomings of, 112-113, 122

standardizing. 3

swine, 109, 111

value of, 112

Antibiotics, administering. 101

Antibodies, monoclonal, 89

Antioxidants, adding to lactated Ringer's solution, 3, 76

Suggested Citation:"Index." Institute of Medicine. 1999. Fluid Resuscitation: State of the Science for Treating Combat Casualties and Civilian Injuries. Washington, DC: The National Academies Press. doi: 10.17226/9625.
×

Antioxidant strategies, 86-87

endogenous, 54

APACHE scoring system, 118

Apoptotic signals, originating from cellular organelles, 35

Apoptosis, 29-36, 65-66

complexity of system for, 36

cytoplasmic, 30

defined, 29-30

developmental, 30

plasmalemma receptor-induced, 30

Aptotic internucleosomal DNA fragmentation, 35

Arachidonate, oxidative metabolism of, 27

ARDS. See Acute respiratory distress syndrome

Arginine administration, 57

Ascorbic acid, 87

Assessment methodologies, 118

Asymmetric battlefields, 10

ATLS®. See Advanced Trauma Life Support® course

Auto-tyrosine phosphorylation, 36

B

Bacterial diseases, transmitted by transfusions, 41

Basic tactical casualty management plan, for Special Operations forces, 101

Basic Trauma Life Support (BTLS) course, 102

Battlefield

bulk of solutions that must be transported onto, 51

expected condition of combatants on, 98

ideal solution for fluid resuscitation on, 98

limits of care on, 98-99, 102

resuscitation needs on, 98-99

salvageable casualties on, 9, 98

Battlefield injuries

compared with inner city, 15

modeling, 113

Bleeding. See Blood loss

Blood, citrate-preserved, 38

Blood banking, 38

Blood hemoglobin concentration. acute isovolemic reduction of, 80-81

Blood loss, 9-10, 100-101

handling on battlefield, 2

intraoperative, 29, 42

molecular and cellular responses to, 4

rates of, 113

Blood plasma, 14

drawbacks of, 60

Blood pressure, 113

Blood substitutes, 41-42.

See also Oxygen therapeutics

Blood transfusions, 38

alternatives to, 41-42

risks of, 41

"Boutique fluids," 79

Brain injury, 10

compression, 29

Brain ischemia, 33

free fatty acids released during. 27

reducing, 85

salvaging vulnerable neurons after, 34

Breathing and airway, 101, 104-106

C

Calpain-specific degradation fragments of spectrin, testing for, 43

Cancer and Leukemia Group B, 121

Cannon, Walter, 13-14

Capillary leak syndrome, 15

Cardiac myocytes, ischemic death of, 30

Cardiogenic shock, defined, 20-21

Cardiopulmonary resuscitation, 101

Cardiovascular collapse, 114

Carolina Rinse solution, 73-74

Caspases

mediating degradation of eIF4G, 33

prototypic, 32

receptor-mediated activation of, 30

Caspase-specific degradation fragments from actin, testing for, 43

Catalase, 82, 86

Catecholamines, 111-112

CD 18 cells, altering, 111

Cell hypoxia, 20

Suggested Citation:"Index." Institute of Medicine. 1999. Fluid Resuscitation: State of the Science for Treating Combat Casualties and Civilian Injuries. Washington, DC: The National Academies Press. doi: 10.17226/9625.
×

Cellular derangements, accompanying traumatic shock, 4

Cellular organelles, apoptic signals originating from, 35

Cellular responses to shock, 25-28

altered energy metabolism, 25-26

ion compartmentalization, 26-27

lipid metabolism, 27

radical production and metabolism, 27-28

Cellular responsiveness to growth factors, alterations in, 36-38

Central nervous system

inhibiting insulin transport into, 37

injuries to, 9-10

protecting, 85

Circulatory support, 99

Citrate-preserved blood, 38, 40

Civilian data

applicability of, 121

on trauma, 98, 123

Civilian trauma centers, 121-122

Clinically significant function, defined, 116

Clinical practice guidelines, 61

Clinical trauma. See Trauma

Clinical trials

applicability of civilian data, 121

defined, 116

endpoints and indications of, 116-120

heterogeneous subject populations, 120

of hypertonic saline-dextran (HSD), 71-73

informed consent, 120

role in developing therapies, 115-116

in trauma centers, 121-122

unique problems of, 3, 120-121

Clotting, 51

Clotting factors, alterations in amount of, 40

Coagulation

disseminated intravascular, 42-43

effects of fluid resuscitation on, 51-53

Colloid-deferoxamine conjugates, 88

Colloid resuscitation, 47-51

complications of, 60-62

polydisperse, 62

studies of, 12

vs. crystalloid, 51

Colocalization, of inhibited protein synthesis, 37

Combat environment, 97-101

defined, 11

Combat trauma, no "golden hour" in, 9

Combatants

expected condition of, 98

in future battles, 11

injury to, 113-114

limits of care on battlefield, 98-99

mortality rate in battle, 1, 9

resuscitation needs of, 99

tension pneumothorax in, 104-105

Compartmentalization, ion, 26-27

Compensatory mechanisms, 80

Complement activation, 84

"Congestive atelectasis," 15

Consent. See Informed consent

Continuing medical education (CME), 122

Controlled hemorrhage, vs. uncontrolled, 112-113, 123

Cortisol, 112

Crocetin, 84

Crystalloid overresuscitation, 68

Crystalloid resuscitation, 15, 39, 47-51

aggressive, 67

complications of, 62-73

effects on immune function, 62-67

large volume, 15, 68-69

overall cautions concerning, 75

studies of, 12

for treating hypovolemia, 1

vs. colloid, 51

Cyclosporin, 85

Cytokine response, 29, 74, 85

effects of crystalloid resuscitation on, 67-68

effects of hypertonic saline-dextran on, 71

D

"Danang lung," 15

"Death domain," 30

Decompensation, 24-25

Suggested Citation:"Index." Institute of Medicine. 1999. Fluid Resuscitation: State of the Science for Treating Combat Casualties and Civilian Injuries. Washington, DC: The National Academies Press. doi: 10.17226/9625.
×

Deferoxamine (DFO) conjugates, 88

Delphi method, 61

Desferal, 88

DFO. See Deferoxamine conjugates

Diagnostic instrumentation, for intervening in shock, 92

Diaspirin-cross-linked hemoglobin, 82

DIC. See Disseminated intravascular coagulation

Dilutional thrombocytopenia, 40

Disseminated intravascular coagulation (DIC), 41-43

laboratory abnormalities in, 43

thrombosis accompanying, 42

D-lactate, 69-70

removing from lactated Ringer's solution, 3, 76

E

Eastern Cooperative Oncology Group, 121

eIF2α, phosphorylated, 43

eIF4G

caspase-mediated degradation of, 33

proteolytic degradation of, 33

Electrolyte characteristics, of selected resuscitation fluids, 49

Electron paramagnetic resonance (EPR) spectroscopy, 54

Endothelial cell function, resuscitation-related changes in, 53

Endothelin production, 52

Endotoxin shock, 28

Endpoints of clinical trials, 117-118

surrogate, 117

Energy depletion, 22

Energy metabolism, altered, 25-26

EPR. See Electron paramagnetic resonance spectroscopy

Equipment, size and weight limits on, 99

Erythrocytes, 82

Estradiol, 92

Estrogenic effects, potential therapeutic effects of compounds with, 92

Evacuation

limited on battlefield, 98

prompt aeromedical, 106

recommendation concerning, 106

Evaluating resuscitation protocols, 118-120

Exsanguination. See Blood loss

Extraction reserve, 109

F

FDA. See U.S. Food and Drug Administration

First responders.

See also "Trained responders"

needs of, 2

new concept of, 11, 98-99

training, 102

treatment protocol for, 105

FK506, 85

Fluid overload, 68

Fluid redistribution, after major trauma, 48

Fluid resuscitation, 101

on battlefield, 99

defined, 11

experience with and complications of, 5, 47-76

history of, 12-15

immediate vs. delayed, 99

research on, 3

Fluids.

See "Boutique fluids";

Resuscitation fluids;

individual fluids

Fractures, immobilizing, 99, 101

Free fatty acids, release during brain ischemia, 27

Free radical, damage by, 27-28

Free radicals

confirming production of, 90

neutrophil-derived, 58

oxygen-derived, 55-56

preventing generation of, 85

reperfusion-mediated damage by, 54, 86-91

Free-radical scavengers, 53, 55

adding to lactated Ringer's solution, 3, 76

Future directions, in treating hemorrhagic shock, 6-7, 109-124

Suggested Citation:"Index." Institute of Medicine. 1999. Fluid Resuscitation: State of the Science for Treating Combat Casualties and Civilian Injuries. Washington, DC: The National Academies Press. doi: 10.17226/9625.
×

G

Gardenia jaminoides Ellis, 84

Gastrointestinal consequences of shock, 22

Genes. See Human genes

Glasgow Coma Score, 118-119

Global ischemia, development of tolerance to, 4, 93

Glucocorticoids, 37

Glucose-containing solutions

drawbacks off 60

as a resuscitation fluid, 60

Glutathione, 56

adding to lactated Ringer's solution, 3

"Golden hour," 9

Granulocyte colony-stimulating factor (GCSF), altering, 111

Growth factors, alterations in secretion of and cellular responsiveness to, 36-38

H

Hematocrit

decrease in, 52

restoring, 59

Hematologic abnormalities associated with shock, 38-43

disseminated intravascular coagulation, 42-43

transfusion-related, 39-42

Hematologic changes, 23

Hemoconcentration, 13

Hemodilution, 51-52

interoperative, 83

Hemodynamic measurements, 113

Hemoglobin.

See also Stroma-free hemoglobin

diaspirin-cross-linked, 82

polyoxyethlene, 82

recombinant, 82

Hemorrhage

autoregulatory mechanisms involved in, 23-24

consequences triggered by, 4

controlled vs. uncontrolled, 112-113, 123

control of massive, 99

major cause of salvageable battlefield casualty, 10

physiologic responses to, 23-25

regulatory mechanisms involved in, 23

studies of effects of rates of, 110-111

studies of injury with, 111

treating on the battlefield, 103-105

Hemorrhagic gastritis, 22

Hemorrhagic shock

animal models of, 109-112

associated with lactic acidosis, 28-29

definitions of, 19-23

future directions in treating. 6-7, 109-124

organ involvement in, 21-23

oxygen-derived free-radical-mediated injury in, 55-56

pathophysiology of acute, 19-44, 80

pure, 3

roles of induced nitric oxide in, 58

technical models of, 112-114

Hemostasis, achieving adequate, 29

Hemothorax, detection and treatment of, 99

Heparin therapy, 43

"Hibernation," pharmacologically induced, 93

Homeostasis, hypotheses involving. 110

Hormonal influences, intervening in shock, 92

HSD. See Hypertonic saline-dextran

Human genes. encoding CED-9-related proteins, 32

Human immunodeficiency virus (HIV), transmitted through transfusion, 53

Human subjects, protection of, 120

Hydroxyethyl starch, 61

Hyperglycemia, in patients with shock, 38

Hypernatremia, 48

Hypertonic saline-dextran (HSD). 71-73

clinical trials of, 71-73

limits of, 72-73

Hypertonic saline solutions

not causing neutrophil activation. 64

recommendation for using, 2, 103-104

Suggested Citation:"Index." Institute of Medicine. 1999. Fluid Resuscitation: State of the Science for Treating Combat Casualties and Civilian Injuries. Washington, DC: The National Academies Press. doi: 10.17226/9625.
×

repeat administration of, 104

safety and efficacy of, 71-73

using minimum volumes of, 61

Hyponatremia, 48

Hypoperfusion, 25

Hypotension, studies of effects of, 110-111

Hypovolemia, crystalloid resuscitation for treating, 1

Hypovolemic shock

after trauma, 47, 79

defined, 20-21, 80

Hypoxanthine, 55

Hypoxia, reducing vulnerability to, 4, 93

I

Immune function

effects of crystalloid resuscitation on, 62-67

effects of hypotension and hemorrhage on, 110-111

Immunochemical assays, 43

Immunological impairment, 22-23, 65-66

Indexing systems, of trauma research findings, 3, 123

Inducible isoform of nitric oxide synthase (iNOS), 89-90

Informed consent, 120

Injury.

See also Combatants;

Combat trauma

inflammatory and organ dysfunction responses to, 50

penetrating vs. blunt, 15, 98, 113

protocols for care at the site of, 97-107

soft-tissue, 113

system for categorizing, 4

types of, 9-10

Injury severity score (ISS), 118-119

Inner city, casualties in, 15, 99

Institute of Medicine, 1, 16

Insulin

high doses needed during postischemic reperfusion, 37

neuron-sparing effects of, 36-37

Insulin resistance, in patients with shock, 38

"Internal armor" concept, 92

Intervening in shock, 84-92

diagnostic instrumentation, 92

hormonal influences, 92

targets for, 84-86

therapies for reperfusion-mediated free-radical damage, 86-91

Intraosseous administration, 2, 103-104

Intravascular coagulation, disseminated, 42-43

Intravenous therapy, 101

Intubating laryngeal mask airway (LMA), 104

Ion compartmentalization, 26-27

Iron chelators, 88-89

adding to lactated Ringer's solution, 3

Ischemia.

See also Brain ischemia;

Global ischemia;

Myocardial ischemia

consequences triggered by, 4

enzymatic consequences of, 26-27

neuron-sparing effects in, 36

prolonged, 24

relationship to oxygen reperfusion, 87

transient forebrain, 37

"whole body," 55, 58

Ischemia-reperfusion research, 4, 82

Isobaric models, 109

Isotonic solutions, 39

large volume use of, 47

Israeli Defense Forces, 10

ISS. See Injury severity score

K

Ketones, adding to lactated Ringer's solution as an energy source, 3, 76

Korean War, 22, 39

Krebs cycle, failure of, 22

Kupffer cells, 28

L

Lactated Ringer's solution

adverse effects, 39, 67, 69-70

increasing neutrophil activation, 62

need for modifying, 2-3, 12-13, 76

safety of current regimens of, 70

Suggested Citation:"Index." Institute of Medicine. 1999. Fluid Resuscitation: State of the Science for Treating Combat Casualties and Civilian Injuries. Washington, DC: The National Academies Press. doi: 10.17226/9625.
×

upregulation of intracellular adhesion molecules by, 58

Lactic acidosis, hemorrhagic shock associated with, 28-29

Large volume use

of crystalloid resuscitation, 15, 68-69

of isotonic salt solutions, 47-48

Laryngeal mask airway (LMA), intubating, 104

"Lazarus solutions," 81

Lethal dose, 123

Leukocytosis, 84

Lipid metabolism, 27

Lipid peroxidation products and proteins, testing for, 43

Liposomes, for preventing shock, 83-84

L-lactate, reducing total load of in lactated Ringer's solution, 3, 76

LMA. See Laryngeal mask airway

Longer-term survival, 3

Lysis of clots, 29

M

Macrophage function, alterations in, 28-29

Major trauma, fluid redistribution following, 48

Massive transfusions, 40-41

defined, 40

Medical litter, monitoring, 106-107

Melatonin therapy, 91

Mercaptoethylguanidine (MEG), 85-86

Metabolic acidosis, 20, 39

Metabolic derangements, accompanying traumatic shock, 4

Metabolism

of lipids, 27

of radicals, 27-28

Methionine, 32

Military Trauma Life Support course, 102

Mitochondrial aerobic metabolism, 26

Models of hemorrhagic shock.

See Animal models;

Technical models

Monitoring

cardiac output, 106-107

passive, 106

of vital signs, 106

Monitoring equipment, miniaturizing. 106-107

Monitoring medical litter, 106-107

Monoclonal antibodies. 89

Mortality rate

of combatants in battle, 1, 9

reducing, 1-2

Myocardial contraction, decreased, 20

Myocardial ischemia, 30

N

N-acetylcysteine, 86-87

NADPH. See Nicotinamide adenine dinucleotide phosphate

National approach, needed in trauma research, 3-4

National Cancer Institute, 121

National Institutes of Health, 3, 124

National Research Council, 13, 15

Naval Blood Research Laboratory, 52

Naval operations, injuries in, 15

Needle thoracostomy, 100, 105

Nervous system. See Central nervous system

Neurogenic shock, defined, 20-21

Neutrophils

activated in reperfusion-mediated injury, 58-59, 62

fluorescence in, 62, 64

Nicotinamide adenine dinucleotide phosphate (NADPH) oxidase, 53

Nitric oxide (NO)

mediating cell injury, 57

mediating platelet dysfunction, 52

in reperfusion-mediated injury, 56-58

Nitric oxide (NO) synthase

inducible isoform of (iNOS), 89-90

phosphorylation of, 27

Nitrones, 90-91

Nitroxides, developing, 91

Nonlinear battlefields, 10

Nonthoracic trauma, 15

Normochloremic carbonate/carbon dioxide, 3

Novel approaches to treating shock, 4, 6, 75, 79-94

NOX, 90

Suggested Citation:"Index." Institute of Medicine. 1999. Fluid Resuscitation: State of the Science for Treating Combat Casualties and Civilian Injuries. Washington, DC: The National Academies Press. doi: 10.17226/9625.
×

O

Office of Naval Research, 1, 16

Oligosaccharides, 59

Oncotic proteins, 51

Operation Desert Storm, 106

Opsonic proteins, 51

Organelles. See Cellular organelles

Overhydration, 15

Oxygen delivery

consequences of impaired, 4

enhancing, 4

supraphysiologic concentrations of, 53-54

Oxygen-derived free radicals, in reperfusion-mediated injury, 55-56

Oxygen reperfusion, relationship to ischemia, 87

Oxygen therapeutics, for preventing shock, 80-82

Oxygen toxicity, associated with resuscitation, 53-54

Oxyglobin (veterinary use), 81

P

Parameters, of fluid therapy fluids, 2

Parenteral saline, 3

normochloremic carbonate, 75

PARS. See Poly(ADP ribose) synthetase

Pathophysiology of acute hemorrhagic shock, 19-44

Penetrating injury, 113-114

vs. blunt, 15, 98

Perfluorocarbons, as blood substitutes, 42

Perfluorochemicals, for preventing shock, 83

Peroxynitrite, 57-58

scavenging, 89

Pharmaceutical industry, 121

Phosphoprotein phosphatase1, 33

Phosphorylated eIF2α, testing for, 43

Phosphorylation

auto-tyrosine, 36

tyrosine, 37

Physiologic responses to hemorrhage, 23-25

PKR. See Protein kinase

Plasma. See Blood plasma; Reduced plasma

Plasma catecholamines, 111

Plasmalemma receptor-activated caspase response, 31, 35

Platelet aggregation, 52

Platelet dysfunction, nitric oxide-mediated, 52

Pneumothorax, detection and treatment of, 99

Poly(ADP ribose) synthetase (PARS), 57

Polyhemoglobin, 86

Polymorphonuclear neutrophil adherence, inhibiting, 89

Polynitroxylation, of biomacromolecules, 82-83

Polyoxyethlene hemoglobin, 82

Polypharmaceutical treatment approaches, 44

Postischemic reperfusion, high doses of insulin needed during, 37

Prehospital Trauma Life Support (PHTLS) course, 102

Preventing shock, 80-84

first- to third-generation therapeutics, 82-83

liposomes, 83-84

oxygen therapeutics, 80-82

perfluorochemicals, 83

Private sector, 3

Professional organizations, 3

Prolactin release, 92

Protective equipment, need for research into, 92

Protein kinase (PKR), function of, 34

Protein synthesis

colocalization of inhibited, 37

suppression of, 34

Proteolytic degradation, of eIF4G, 33

Protocols of care, 6, 97-107

current, 1, 100-101

evaluating efficacy of, 3

need to change, 2

Protocols of resuscitation, 118-120

Pulmonary edema, 69

contributing factors, 50

Pulmonary infection, following hemorrhagic shock, 28

Purines, oxidation by, 54

Pyruvate, pathway producing, 26

Suggested Citation:"Index." Institute of Medicine. 1999. Fluid Resuscitation: State of the Science for Treating Combat Casualties and Civilian Injuries. Washington, DC: The National Academies Press. doi: 10.17226/9625.
×

R

Radicals.

See also Free radicals

production and metabolism of, 27-28

Recombinant hemoglobin, 82

Recombinant technology, 61

Recommendations, 2-7

Red blood cell

complement-mediated destruction of, 41

substitutes for, 40-41

Reduced plasma, 51

Renal failure, 21-22

Reperfusion

neuron-sparing effects in, 36

postischemic, 37

Reperfusion-mediated injury, 54-59

activated neutrophils, 58-59

nitric oxide, 56-58

oxygen-derived free radicals, 55-56

therapies for intervening in, 86-91

treating, 4

Research, defined, 115-116

Respiratory failure. See Acute respiratory failure

Responders. See First responders

Resuscitation

alternative approaches to, 73-74

complications of, 51-73

disadvantages to current solutions for, 2

evaluating protocols of, 118-120

hematologic abnormalities associated with, 38-43

immediate vs. delayed, 99

initial, 2

late, 59

oxygen toxicity associated with, 53-54

using colloids and crystalloids, 47-51

Resuscitation fluids

developing new, 2

electrolyte characteristics of selected, 49

ideal, 79

for military use, 81

Resuscitation protocols, evaluating, 118-120

Revised Trauma Score (RTS), 118-119

Ringer's solution. See Lactated Ringer's solution

Risks, of blood transfusion, 41

RTS. See Revised Trauma Score

S

Saline solutions.

See also Hypertonic saline solutions

controversy over, 47

Scavenging strategies, 86-87

Scoring systems, 118

Secondary shock, 13

Secretion of growth factors, alterations in, 36-38

Septic shock, 113

defined, 20-21

Shear stress, 52

Shock.

See also Hemorrhagic shock;

Secondary shock

biochemical effects of, 22

cellular responses to, 4, 25-38

classifications of, 19-20

defined, 11, 19

future directions in treating, 6-7, 109-124

gastrointestinal consequences of, 22

hematologic abnormalities associated with, 38-43

increasing tolerance toward, 92-93

insulin resistance and hyperglycemia in patients with, 38

intervention, 4, 84-92

irreversibility in severe, 25

metabolic effects of, 22, 59

molecular responses to, 4

novel approaches to treating, 4, 6, 79-94

organ involvement in, 21

prevention, 80-84

Shock decompensation, 24-25

"Shock lung, 15, 39

Shock syndrome, treating complications of, 4

Signal transduction, 29

evolutionary development of mechanisms for, 35

Suggested Citation:"Index." Institute of Medicine. 1999. Fluid Resuscitation: State of the Science for Treating Combat Casualties and Civilian Injuries. Washington, DC: The National Academies Press. doi: 10.17226/9625.
×

Site of injury, protocols for care at, 6, 97-107

SOD. See Superoxide dismutase

Soft-tissue injury, 113

Southwest Oncology Group, 121

Special Operations forces, 98, 100

basic tactical casualty management plan for, 101

Spectrin, testing for calpain-specific degradation fragments of, 43

Starch-chelator conjugates, 88

Stress measurements, 113

Stroma-free hemoglobin, 42

Superoxide dismutase (SOD), 82, 86

Supplies and equipment, size and weight limits on, 99

Surgeon General's History of Surgery in World War II, 50

Surgical bleeding disorders, 29

Surrogate endpoints, 117

Survival, 115, 117-118, 123

longer-term, 3

probability of, 119

Systemic inflammatory responses, 62-64

T

Tachycardia, 22

Technical models, of hemorrhagic shock, 112-114

Tension pneumothorax, 10, 100

in combat casualties, 104-105

detection and treatment of, 99

symptoms of, 105

Testosterone, adverse effects of, 92

Tetramers, 81

Therapeutic regimens, 97-107

current, 1, 100-101

"Third spacing," 48

Thoracostomy, 105

Thrombocytopenia, 51, 84

dilutional, 40

Thrombosis, accompanying disseminated intravascular coagulation (DIC), 42

Tirilazad mesylate, 88

Tissue macromolecules, radical-mediated damage to, 27

Tissue macrophages, activation of, 28

Tissue perfusion, decreased, 20, 25

T lymphocytes, 28

Torso, injuries to, 9

"Trained responders," 100

Training, for first responders, 102

Transcript formation, 34-35

Transcription and translation, fundamental alterations in, 29-36

Transfusions.

See also Blood transfusions

alternatives to, 41-42

massive, 40-41

of the patient in shock, 39-40

transmitting diseases, 41

Translation

fundamental alterations in, 29-36

initiation system for protein synthesis, 32

Trauma

among civilians, 98, 121, 123

among combatants, 9, 98-99

classifying severity of clinical, 3

fluid redistribution following major, 48

Trauma and injury severity score (TRISS) assessment methodology, 118-119

Trauma centers

civilian, 121-122

clinical trials in, 3

regional, 3, 121-122

Trauma indexing, 3, 123

Trauma research, 3

national approach needed in, 3-4

Traumatic shock.

See also Hemorrhagic shock

associated with tissue injury, 3

defined, 20

metabolic and cellular derangements accompanying, 4

"Traumatic wet lung," 15

Treatment approaches, 102-107

airway and breathing, 104-106

future directions in, 6-7, 109-124

for hemorrhage, 103-104

monitoring, 106-107

novel, 4, 6, 79-94

prompt aeromedical evacuation, 106

repeat administration of hypertonic saline solution, 104

Suggested Citation:"Index." Institute of Medicine. 1999. Fluid Resuscitation: State of the Science for Treating Combat Casualties and Civilian Injuries. Washington, DC: The National Academies Press. doi: 10.17226/9625.
×

TRISS. See Trauma and injury severity score

Trolox, 87

Tubular necrosis, 39

Tumor necrosis factor a, 28, 30

21st century battlefields, 10, 97

Tyrosine phosphorylation, 37

U

Uncontrolled hemorrhage, vs. controlled, 112-113, 123

U.S. Department of Defense, 3, 124

U.S. Department of Veterans Affairs, 3, 124

U.S. Food and Drug Administration (FDA), 116-117

U.S. Navy Seals, 103

Urban warfare, 97

Utstein system, 119

V

Vasoactivity, factors influencing, 82

Vasoconstriction, 52

Vasopressin, release of, 24

Vietnam conflict, 10, 15, 22, 39, 50, 100

Viral diseases, transmitted by transfusions, 41, 53, 60

Vital signs, monitoring, 106

Vitamins, 87

adding to lactated Ringer's solution, 3

Volume replacement therapy, 4, 14

goal of early, 24-25

W

Wars of the future, 10-11

World War I, 13-14, 39

World War II, 9, 15, 39, 50

Wounds

data on. 10

dressing, 101

X

Xanthine oxidase, 55

Y

Yom Kippur War, 22

Suggested Citation:"Index." Institute of Medicine. 1999. Fluid Resuscitation: State of the Science for Treating Combat Casualties and Civilian Injuries. Washington, DC: The National Academies Press. doi: 10.17226/9625.
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Suggested Citation:"Index." Institute of Medicine. 1999. Fluid Resuscitation: State of the Science for Treating Combat Casualties and Civilian Injuries. Washington, DC: The National Academies Press. doi: 10.17226/9625.
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Historically, 20% of all injured combatants die on the battlefield before they can be evacuated to a field hospital. Blood loss—hemorrhage—is the single major cause of death among those killed in action whose lives might otherwise be saved. Fluid resuscitation and the treatment of hypovolemia (the abnormally decreased volume of circulating fluid in the body) offer the greatest opportunity for reducing mortality and morbidity associated with battlefield casualties.

In Fluid Resuscitation, a committee of experts assess current resuscitation fluids and protocols for the treatment of combat casualties and make recommendations for future research. Chapters focus on the pathophysiology of acute hemorrhagic shock, experience with and complications of fluid resuscitation, novel approaches to the treatment of shock, protocols of care at the site of injury, and future directions for research.

The committee explicitly describes the similarities and differences between acute medical care during combat and civilian emergency trauma care. Fluid Resuscitation should help energize and focus research in both civilian and military emergency care and help save the lives of citizens and soldiers alike.

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