J Trauma
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Fluid resuscitation of injured combatants in a tactical setting has special challenges which standard civilian protocols do not address. Over a period of a year, four conferences on combat fluid resuscitation were held. The purpose of these conferences was to develop a consensus regarding contemporary practice and to identify and energize a research agenda. ⋯ Food and Drug Administration regulations). A specific research agenda was defined. Since that time, these recommendations have been implemented in many North Atlantic Treaty Organization (NATO) forces and a variety of other activities have served to provide expert support and research focus for the special needs of injured combatants.
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Severe musculoskeletal soft tissue injury sustained after a closed fracture to the extremities significantly influences bone healing and determines the patient's prognosis. The present study was aimed at quantitatively assessing immediate microcirculatory changes in skeletal muscle and periosteum after standardized closed fracture. ⋯ This model permits for the first time direct in vivo visualization and quantification of fracture-induced microhemodynamic changes and cellular interactions within the surrounding soft tissue. It demonstrates that even simple fractures lead to profound microcirculatory disturbances in skeletal muscle and periosteum, and also at sites remote from the diaphyseal fracture site. It provides a useful approach for the development of therapeutic strategies to counteract fracture-induced microvascular dysfunction.
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Meta Analysis
Efficacy of hypertonic saline dextran fluid resuscitation for patients with hypotension from penetrating trauma.
The purpose of this study was to assess whether the administration of hypertonic saline dextran (HSD) was detrimental when administered to patients who were hypotensive because of penetrating injuries to the torso. The administration of HSD causes an immediate and sustained increase in blood pressure that could contribute to an increase in bleeding in the presence of uncontrolled hemorrhage. We prospectively designed a series of questions to be addressed by a meta-analysis of individual patient data using a computerized data file and case report forms from a multicenter study of HSD. ⋯ For patients with penetrating injuries to the torso that result in hypotension, initial fluid resuscitation with HSD is beneficial in improving survival, especially if surgery is subsequently required.