It's been a fantastic (and busy) day at the EDTCC headquarters. A mammoth whiteboard session with EDExam's very own Andy Buck, on a collaborative upcoming project (more to follow), followed by a podcast on Minh Le Cong's (@rfdsdoc) PHARM blog with some of Oz ED's greats - Casey Parker (@broomedocs) of Broomedocs blog, and the vivacious Michelle Johnston (@Eleytherius) from LITFL blog.
In this article, the key concepts of damage control resuscitation, and fluid resucitation in different settings are explored and outlined. I highly recommend that you get access to the full article.
Critically injured trauma patients may have normal cardiovascular and respiratory parameters (pulse, blood pressure, respiratory rate), and no single physiological or metabolic factor accurately identifies all patients in this group
Initial resuscitation for severely injured patients is based on a strategy of permissive hypovolaemia (hypotension) (that is, fluid resuscitation delivered to increase blood pressure without reaching normotension, aiming for cerebration in the awake patient, or 70-80 mm Hg in penetrating trauma and 90 mm Hg in blunt trauma) and blood product based resuscitation
This period of hypovolaemia (hypotension) should be kept to a minimum, with rapid transfer to the operating theatre for definitive care
Crystalloid or colloid based resuscitation in severely injured patients is associated with worse outcome
Once haemostasis has been achieved, resuscitation targeted to measures of cardiac output or oxygen delivery or use improves outcome
- Tranexamic acid administered intravenously within 3 h of injury improves mortality in patients who are thought to be bleeding"