![]() The young patient with a thoraco-abdominal gunshot wound who presents hypotensive and tachycardic is exactly the type of patient who will benefit from the principles of damage control resuscitation – hemostatic blood product administration, restrictive fluid administration, permissive hypotension, early surgical control for blood loss. If you anticipate the need for more than 3-4 units of packed cells in the first few hours, you’re in it The state in which a patient arrives to the operating room or the intensive care unit – alive or near death, cold and coagulopathic or warm and well perfused – is up to you. To be clear, the most important step in managing these patients is surgical source control – most patients with massive hemorrhage need an operation to stay the hemorrhage. And while much of the damage from head injury is spoken for at the time of accident, the initial resuscitation of a bleeding trauma patient can have a tremendous impact on survival. If you’re going to die from injury, statistically speaking it will be due to a severe traumatic brain injury close behind that is death from exsanguination. Preventing death from hemorrhage is a team sport, and resuscitationist’s game * Some academics have argued that the game has in fact not changed, but has just become more fierce see Slim Charles vs. So, inspired by Biggie’s Descartesian ten-point discourse on method, I present the ten rules of the contemporary trauma resuscitation game as I see them – backed by science, and occasionally editorialized with personal opinion. From damage control to fibrinogen, from TXA to thromboelastometry, there is no doubt that resuscitating a bleeding trauma patient is a more nuanced endeavor than we originally envisioned it. While new science on trauma resuscitation has helped us understand how flawed that paradigm is, the new school can be some tricky water to navigate. It was easier in the old days: 2L of crystalloid for a hypotensive patient, and then blood. While not much is new in the world of hustlin’, when it comes to trauma resuscitation, the game done changed*. A strong word called consignment If you ain’t got the clientele say hell no If you ain’t getting bags stay the f*ck from policeġ0. Keep your family and business completely separatedĩ. ![]() Never let no one know how much dough you holdħ. Life pearls like “Never let ‘em know your next move” and “Never keep no weight on you” have helped guide me through some challenging life decisions.ġ. You know, whether you sling crack rocks or not, there are some sage words of wisdom in the late Notorious BIG’s Ten Crack Commandments. There’s rules to this sh*t I wrote me a manual” Such an increase in acidity damages the tissues and organs of the body and can reduce myocardial performance, further reducing the oxygen delivery.“I’ve been in this game for years, it made me an animal In the absence of blood-bound oxygen and nutrients ( hypoperfusion), the body's cells burn glucose anaerobically for energy, causing the release of lactic acid, ketone bodies, and other acidic compounds into the blood stream, which lower the blood's pH, leading to metabolic acidosis. This in turn can halt the coagulation cascade, preventing blood from clotting. Severe haemorrhage in trauma diminishes oxygen delivery, and may lead to hypothermia. ![]() The three conditions share a complex relationship each factor can compound the others, resulting in high mortality if the cycle continues uninterrupted. Commonly when someone presents with these signs damage control surgery is employed to reverse the effects. This combination is commonly seen in patients who have sustained severe traumatic injuries and results in a significant rise in the mortality rate. The trauma triad of death is a medical term describing the combination of hypothermia, acidosis and coagulopathy.
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