J Trauma
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Resuscitation can exacerbate cellular injury caused by hemorrhagic shock, and the type of fluid used for resuscitation may play an important role in this injury. Unlike some factors in the treatment of combat casualty, the method of resuscitation is under our control. The prevention of cellular injury through wiser resuscitation strategies would be more advantageous than attempting complex immunomodulation after the damage has already occurred. ⋯ Hypertonic fluids cause suppression of neutrophil activation and a milder increase in the expression of cell injury markers compared with isotonic fluids. The effect of various resuscitation fluids on core cellular functions such as gene regulation is also summarized in this article. Finally, because of the uniqueness of combat care, a set of new recommendations for initial fluid resuscitation of combat casualties is proposed.
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This study reports on the results of hemorrhagic shock (HS) plus resuscitation on the coagulation profile in severely injured patients and on the role of fresh frozen plasma (FFP) supplementation in a canine HS model. ⋯ Resuscitation from hemorrhagic shock can be successfully implemented by restoration of blood loss with blood, crystalloid, and FFP added to maintain coagulation proteins.
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We previously demonstrated that trauma patient volume affects attrition rate of Advanced Trauma Life Support (ATLS)-acquired skills. This study assesses the possible roles of age, gender, and practice specialty on attrition of these skills over 8 years. ⋯ Trauma patient volume is the most critical determinant of attrition rate of ATLS-acquired skills. Gender, age (at time of taking the course), and practice specialty do not alter this attrition rate.
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Tourniquet application is a known means for bleeding prevention in the military prehospital setting. ⋯ Tourniquet application is an effective and easily applied (by medical and nonmedical personnel) method for prevention of exsanguination in the military prehospital setting.