Fluid Resuscitation State of the Science for Treating Combat Casualties and Civilian Injuries (1999) / Chapter Skim
Currently Skimming:
1 Introduction
1 Introduction
Pages 9-18
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 9... ...
Twenty-five percent died of massive mutilating torso injuries, 10 percent died of torso injuries that with timely surgical intervention could have been salvageable, and another 9 percent had peripheral exsanguinating injuries that also could have been salvaged with 9
|
From page 10... ...
Unfortunately, no good comprehensive wound data for the latter group are available, so it is impossible to identify clearly what percentage of these patients are truly potentially salvageable (Bowen and Bellamy, 1998; Koehler et al., 1994~. It is clear, however, that the single major cause of death in the potentially salvageable battlefield casualty is hemorrhage.
|
From page 11... ...
The availability of fluids of the appropriate volume and physiologic effect in the field may play a part in the provision of lifesaving treatments given the time frame from the injury to medical evacuation and the availability of care after initial resuscitation. Thus, it is reasonable to conclude that there is a definite subset of battlefield combatants who now die of hemorrhagic shock but who are potentially salvageable with timely battlefield interventions (e.g., fluid resuscitation)
|
From page 12... ...
Part of the difficulty in achieving consensus is that trauma and hemorrhage do not produce standard clinical situations; and the variation in injuries, the duration of periods of hypotension, hypoperfusion, and hypothermia, and the time lapse before def~nitive care is rendered make it particularly difficult to evaluate treatment protocols. Furthermore, much of the past research has been done with animals whose responses do not wholly parallel those of humans and whose experimental injuries are dissimilar from those incurred in battle; that is, induced hemorrhage in healthy laboratory animals only partially resembles the hemorrhage with additional tissue damage typically observed in human trauma.
|
From page 13... ...
This experience seemed to support the prevailing concept of secondary shock, or multiple-organ failure following apparently successful resuscitation, observed after an initial period of stabilization. In his 1923 landmark work, Walter Cannon summarized the World War I experience and concluded that shock most often resulted from intravascular volume deficits and must be treated with restoration of blood volume to achieve homeostasis (Cannon, 1923~.
|
From page 14... ...
, disagreed with the first two reasons. The first statement about shock associated with hemoconcentration may be traced to a World War ~ observation by Cannon, who reported higher red blood cell concentrations in capillary blood than in venous blood.
|
From page 15... ...
The syndrome was popularly referred to as "Danang lung," "shock lung," or "traumatic wet lung" and was later labeled "acute respiratory distress syndrome." It had occasionally been noted in World War II and was described under the name of "congestive atelectasis" by Jenkins and colleagues (1950~. Overhydration was the most frequently cited etiology.
|
From page 16... ...
Additional attention is given to resuscitation strategies needed in the civilian sector. The remainder of this report is organized into chapters that address the pathophysiology of acute hemorrhagic shock (Chapter 2)
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.