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Evaluating New Resuscitation Protocols In Penetrating Trauma

1217 words - 5 pages

Evaluating New Fluid Resuscitation Protocols in Penetrating Trauma Victims
Caitlyn R. Beck
Cedar Crest College

Evaluating New Fluid Resuscitation Protocols in Penetrating Trauma Victims
Article Summary
The field of trauma originated when divisions of military set out to war and needed medical resources for the critically injured soldiers who were traumatically wounded in battle. But many of the ideas and protocols developed by trauma doctors in the military made their way to civilian hospitals and trauma centers that deal with varying traumatic injuries of the general public. A form of trauma, described as penetrating trauma, is an injury that occurs when an outside object pierces ...view middle of the document...

A research study entitled “The Initial Trauma Center Fluid Management of Penetrating Injury: A Systematic Review” performed by Nicole M. Tapia MD, James Suliburk MD, and Kenneth L. Mattox MD, all of Baylor College in Houston, Texas, published in “Clinical Orthopedics and Related Research” evaluates 20 previously published studies that included a total of 12,154 patients. Studies considered in the article needed to have a Newcastle-Ottawa Scale score of 6 or greater, patients who had at least 30% penetrating trauma, utilized transfusions with blood components, and reported mortality rates at any variable amount of time (Tapia, Suliburk, & Mattox, 2013, p. 3962).
Of the 20 studies evaluated, 14 found that when they practiced DCR over current ATLS guidelines, there was improved overall mortality rates amongst patients. An additional 6 studies found equivalent mortality rates but no study performed and evaluated saw worse outcomes amongst its patients (Tapia, Suliburk, & Mattox, 2013, p. 3965). These studies also discovered that higher ratios of blood components infused also positively affected mortality outcomes. Most of these improved mortality rates were measured at 30 days post initial penetrating injury. However, a few studies did see improved mortality rates as early as 6, 12, and 24 hours (Tapia, Suliburk, & Mattox, 2013, p. 3966).There was no definite ratio of blood components described by any study researched, leaving the subject up to debate and no preferred ratio for resuscitation made available in the overall study.
Clinical Connection/Application
From a clinical perspective, one may view three topics regarding DCR with interest. The first topic is the history and reasoning behind current ATLS guidelines. Further research showed that the first crystalloid substances, such as normal saline (NS) and lactated Ringer’s (LR) were first developed in the 1800’s. Blood types were not discovered until 1900 and soon after this discovery, the first blood component transfusions began (Cherkas, 2013, p. 3). Simply due to the fact that crystalloid substances were developed and possibly applied to fluid resuscitation efforts before blood types were even discovered could have led to this practice. Also, a study conducted in the 1960’s that focused on trauma fluid resuscitation found that “trauma led to extracellular fluid volume losses beyond the blood lost and that addition of crystalloid [solutions] to blood could improve survival (Cherkas, 2013, p. 3).
Other factors include the process of blood transfusion itself. It takes time to type a person’s blood and make sure they are receiving the proper type and Rh designated blood. FFP also takes time to thaw and must also be cross-matched before being given to a patient. Many people also see risks with giving blood as an...

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