Fluid Resuscitation State of the Science for Treating Combat Casualties and Civilian Injuries (1999) / Chapter Skim
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Pages 185-196
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From page 185... ...
course, 100, 102 Aeromedical evacuation, prompt, 106 Airway and breathing, 10~106 obstruction of, 10 securing, 99, 101, 104-105 Airway-breathing-circulation format, 103 Albumin-containing solutions advantages of, 60 185 as a resuscitation fluid, 39, 51, 60 Altered physiologic states, 93 American College of Emergency Physicians (ACEP) , 102 American College of Surgeons, 102, 1 18119 Committee on Trauma, 39 Analgesia, administering, 101 Anemia, 51 Anesthesia cardiovascular effects of, 1 14 depressant effects of, 1 14-1 15 inhalant, 1 14 intravenous, 114 role in hemorrhagic shock, I 10, 1 14115 Animal models, 3, 109-112 canine, 109-110, 112 primate, 1 10, 1 12 rodent, 1 1 ()
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From page 186... ...
See also Oxygen therapeutics Blood transfusions, 38 alternatives to, 41-42 risks of, 41 "Boutique fluids," 79 Brain injury, 10 compression, 29 Brain isehemia, 33 free fatty acids released during? 27 reducing, 85 salvaging vulnerable neurons after, 34 Breathing and airway, 101, 10~106 C Bacterial diseases, transmitted by transfusions, 41 Calpain-specific degradation fragments of Basic tactical casualty management plan, speetrin, testing for' 43 for Special Operations forces, 101 Cancer and Leukemia Group B
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From page 187... ...
, 71-73 informed consent, 120 role in developing therapies, 115 116 in trauma centers, 121-122 unique problems of, 3, 12(~121 Clotting, 51 Clotting factors, alterations in amount of, 40 Coagulation disseminated intravascular, 42~3 effects of fluid resuscitation on, 5153 Colloid-deferoxamine conjugates, 88 Colloid resuscitation, 47-51 complications of, 60-62 187 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, 10~105 Compartmentalization, ion, 26-27 Compensatory mechanisms, 80 Complement activation, 84 "Congestive atelectasis," 15 Consent.
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From page 188... ...
, 41~3 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 eIF2a, 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, resuscitationrelated changes in, 53 Endothelin production, 52 Endotoxin shock, 28 Endpoints of clinical trials, 11 7-11 8 surrogate, 1 17 Energy depletion, 22 Energy metabolism, altered, 25-26 EPR.
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From page 189... ...
uncontrolled, 1 12-1 13, 123 189 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, 1 1~1 1 1 studies of injury with, 111 treating on the battlefield, 103-105 Hemorrhagic gastritis, 22 Hemorrhagic shock animal models of, 109-1 12 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-radicalmediated injury in, 55-56 pathophysiology of acute, 19-44, 80 pure, 3 roles of induced nitric oxide in, 58 technical models of, 11 2-11 4 Hemostasis, achieving adequate, 29 Hemothora~c, detection and treatment of, 99 Heparin therapy, 43 "Hibernation," pharmacologically induced, 93 Homeostasis, hypotheses involving, I 10 Hormonal influences, intervening in shock, 92 HSD. See Hypertonic saline-dextran Human genes, encoding CED-9-related proteins, 32 Human immunodef~ciency virus (HIV)
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From page 190... ...
, 1 1~119 Inner city, casualties in, 15, 99 Institute ofMedicine, 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 INDEX Intervening in shock, 8~92 diagnostic instrumentation, 92 hormonal influences, 92 targets for, 8~86 therapies for reperfusion-mediated free-radical damage, 86-91 Intraosseous administration, 2, 103-104 Intravascular coagulation, disseminated, 42~3 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.
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From page 191... ...
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, 40~1 defined, 40 Medical litter, monitoring, 10~107 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.
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From page 192... ...
synthetase (PARS) , 57 Polyhemoglobin, 86 Polymorphonuclear neutrophil adherence, inhibiting, 89 Polynitroxylation, of biomacromolecules, Polyoxyethlene hemoglobin, 82 Polypharmaceutical treatment approaches, 44 Postischemic reperfusion, high doses of insulin needed during, 37 Prehospital Trauma Life Support (PHTLS)
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From page 193... ...
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 wish, 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, 2~25 "Shock lung," 15, 39 Shock syndrome, treating complications of, 4 Signal transduction, 29 evolutionary development of mechanisms for, 35
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From page 194... ...
See also Blood transfusions alternatives to, 41-42 massive, 40-41 of the patient in shock, 39~0 transmitting diseases, 41 Trauma fundamental alterations in, 29-36 initiation system for protein synthesis, 32 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, 118119 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 Traumatic shock.
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From page 195... ...
, 1 1 6-l 17 U.S. Navy Seals, 103 Urban warfare, 97 Utstein system, 1 19 V Vasoactivity, factors influencing, 82 Vasoconstriction, 52 Vasopressin, release of, 24 195 Vietnam conflicts 1O9 159 22, 399 5O9 100 Viral diseases, transmitted by transfusions, 419 539 60 Vital signs, monitoring, 106 Vitamins, 87 adding to lactated Ringer9s solution, 3 Volume replacement therapy, 4, 14 goal of early, 24-25 W Wars of the future, 10-1 1 WorldWarI,13-14,39 World War II, 9, 15, 39, 50 Wounds date on, 10 dressing, 101 X Xanthine oxidase, 55 y Yom Kippur War, 22
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