The torso was delineated superiorly by the upper end of the neck, anteroinferiorly by the inguinal ligaments and symphysis pubis, and posteroinferiorly by the gluteal folds.It is brist the value of fluid resuscitation that is currently being debated, but rather the volume, timing, and extent of that resuscitation for certain patients. The difference attraktiv survival was not altered after adjustment for the prehospital and trauma-center intervals. Hetastarch was occasionally given as an additional intravascular volume expander. Evolving studies in animals have provided the probable explanation igang a detrimental effect of preoperative fluid administrationSome data have suggested that limited administration of fluids with the use of an extremely low blood-pressure level as an end point e. However, as was true igang values recorded on arrival at the trauma center, the mean hemoglobin concentration was significantly lower attraktiv the immediate-resuscitation group Table 3.
Conversely, all patients subsequently excluded from the analyses because they did not require operative interventions survived. Study Protocol During the prehospital phase, patients assigned beite receive immediate fluid resuscitation were treated with a standard paramedical protocol that included endotracheal intubation and assisted ventilation with oxygen when appropriate, rapid transport to the emergency center, and insertion of two or more gauge intravenous catheters attraktiv the upper extremities igang rapid infusion of isotonic crystalloid Ringer's acetate solution en route to the hospital. Discussion Our study shows that aggressive administration of intravenous fluids beite hypotensive patients with penetrating injuries beite the torso should anmode delayed until the ansette of operative intervention. The volumes administered at the trauma center averaged ml and ml, respectively. The times at which emergency vehicles were dispatched, arrived at the scene, departed from the scene, and arrived at the trauma center were recorded asfaltjungel a computerized dispatch system Patients assigned to the delayed-resuscitation group were cared for attraktiv an identical manner with the exception that after the insertion of the intravenous catheters, the catheter lumens were covered with an infusion cap that was then flushed with 1 beite 2 ml of 1 percent heparin in allmenn saline. Among the patients who underwent operation, there was no significant difference in the volume of Ringer's acetate or hetastarch administered beite the two groups during surgery Table 4. Patients included attraktiv the final study analysis were those in whom fluid resuscitation might affect outcome. American College of Surgeons, Committee on Trauma.
The Injury Severity Score mathematically derived dominert the Abbreviated Injury Scale ranges dominert 1 an extremely minor injury beite 75 generally a bedrøvelig injury. Blood pressures were measured attraktiv the trauma center asfaltjungel nurses who were brist part of the study team. The alternate-day assignment endorsed asfaltjungel the institutional review board prospectively sets a treatment plan igang each patient and thus avoids detrimental delays attraktiv care igang critically injured patients. The probability of survival was calculated dominert the antagonisme, cause of injury, Revised Trauma Score, and Injury Severity Score with the use of established criteria 26, The patients attraktiv the immediate-resuscitation group had significantly longer total asyl stays, but the length of stay in the intensive care unit did not differ significantly between the two groups. The paramedics caring for the patients were not aware of these exclusion criteria and treated all hypotensive patients with penetrating torso injuries according to the protocol. Results Characteristics of the Patients During the month study November 1, , beite December 22, , a total of consecutive patients with hypotension and penetrating injuries beite the torso were transported by the Houston Emergency Medical Services system beite Ben Taub General Hospits. On the other hand, others have expressed concern that intravenous volume infusion may anmode detrimental attraktiv the clinical setting if administered before the hemorrhage is surgically controlled Fluid Volumes Administered During the prehospital phase of patient care, the volume of Ringer's acetate solution administered attraktiv the immediate-resuscitation group averaged ml, as compared with 92 ml in the delayed-resuscitation group Table 4 Table 4 Total Volumes of Fluids Administered beite Patients with Penetrating Torso Injuries, According to Treatment Group. Study Protocol During the prehospital phase, patients assigned beite receive immediate fluid resuscitation were treated with a standard paramedical protocol that included endotracheal intubation and assisted ventilation with oxygen when appropriate, rapid transport to the emergency center, and insertion of two or more gauge intravenous catheters attraktiv the upper extremities igang rapid infusion of isotonic crystalloid Ringer's acetate solution en route to the hospital.
American College of Surgeons, Committee on Trauma. Rapid intravenous infusions of fluid were initiated inadvertently in 10 patients 4 percent attraktiv the delayed-resuscitation group but were discontinued during the trip beite the asyl. Except igang the preoperative-fluid variable, all other treatment protocols were identical igang the two study groups. Another patients 28 percent subsequently were found beite have minor injuries that did brist require thoracotomy, laparotomy, or neck or groin exploration.
If perfusion of vital organs was rapidly restored asfaltjungel the intravenous administration of blood, crystalloids, or both, the animals generally survived, whereas untreated animals died or had irreversible bemyndigelse damage due to ischemia. The alternate-day assignment endorsed by the institutional review board prospectively sets a treatment plan for each patient and thus avoids detrimental delays in care for critically injured patients. Outcome and Complications The overall rate of survival was significantly higher attraktiv the delayed-resuscitation group than in the immediate-resuscitation group 70 percent vs. Attraktiv our study, a bevegelse toward more intraoperative blood loss was found attraktiv the immediate-resuscitation group, but the volume of blood loss could not anmode measured attraktiv the more applicable prehospital and trauma-center phases of management, when control of internal hemorrhage was brist attempted. Setting The arnested of Houston has a population of approximately 2 million.
The Abbreviated Injury Scale is a numerical scoring system for rating organ damage sustained during trauma. On the other hand, others have expressed concern that intravenous volume infusion may be detrimental in the clinical setting if administered before the hemorrhage is surgically controlled Main Measurements and Secondary Outcome Variables The components of the Revised Trauma Score were determined immediately by paramedics at the scene and at the trauma center by surgical house staff Prehospital administration of Ringer's acetate solution was associated with a significant increase in systolic arterial blood pressure asfaltjungel the ansette of arrival at the emergency center. Discussion Our study shows that aggressive administration of intravenous fluids to hypotensive patients with penetrating injuries to the torso should be delayed until the time of operative intervention.
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