Resuscitation
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Attempts at prehospital fluid replacement should not delay the patient's transfer to hospital. Before bleeding has been stopped, a strategy of controlled fluid resuscitation should be adopted. Thus, the risk of organ ischaemia is balanced against the possibility of provoking more bleeding with fluids. ⋯ In the presence of SIRS, hydroxyethyl starch may reduce capillary leak. Hypertonic saline solutions may have some benefit in patients with head injuries although this has yet to be proven beyond doubt. It is likely that one or more of the haemoglobin-based oxygen carriers currently under development will prove to be valuable in the treatment of the trauma patient.
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In western countries, injuries remain the leading cause of death in young adults (Jennett B. Epidemiology of head injury. J Neurol Neurosurg Psychiatry 1996; 60: 362-369). ⋯ In: Cooper PR, Ed. Head Injury, 3rd ed. Baltimore, MD: William Wilkins, 1993), and in addition to causing death often causes severe and long-lasting functional impairment in survivors.
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The poor outcome for resuscitation from cardiopulmonary arrest in childhood is widely recognised. The European Resuscitation Council has adopted the Advanced Paediatric Life Support course (originating in the UK and now available in a number of countries) as its course for providers caring for children. This paper outlines the course content and explains its remit, which is to reduce avoidable deaths in childhood by not only resuscitation from cardiac arrest but, more effectively, by recognising and treating in a timely and effective fashion life-threatening illness and injury in infants and children. Two related courses Paediatric Life Support, a less intense course for less advanced providers, and Pre-Hospital Paediatric Life Support for immediate care providers are also described.