American journal of surgery
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Comparative Study
Comparison of the relative effectiveness of colloids and crystalloids in emergency resuscitation.
Over a 2.5 year period, the fluid management of 600 hypotensive patients entering our surgical emergency department was evaluated during a prospective clinical trial of a resuscitation algorithm. The major clinical determinants (low mean arterial pressure, age, severity of illness, primary illness or injury, amount of blood loss, volume of fluids given, use of a protocol or clinical algorithm and satisfactory compliance with the algorithm) were controlled by grouping the patients into specific strata; the resuscitation times were almost always shorter with a regimen of about one-fourth colloids than with crystalloids only. This is consistent with the observations of greater increases in hemodynamic and oxygen transport variables after albumin than after lactated Ringer's solution when the latter was given in either 2 or 4 times the volume.
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(1) Emergency thoracotomy can be a lifesaving procedure in critically injured patients who present with no detectable pulse or blood pressure. (2) Emergency thoracotomy is nonproductive if cardiac electrical activity is absent. (3) Best results are achieved in patients with chest injuries and the worst results in those with isolated blunt abdominal injury. (4) Survival was better if patient was taken directly to the operating room with ongoing cardiopulmonary resuscitation. (5) Prehospital airway control, volume resuscitation and cardiopulmonary resuscitation play a significant role in improving the outcome in traumatized patients who undergo emergency thoracotomy.