A revolution in care for injured patients from the combat theater transitioned into the civilian world

 

Over the last 20 years, care for injured patients has undergone a revolution. Amazing changes have occurred in care in the combat theater, and some of these have transitioned into the civilian world. This is critically important, as the scope of the civilian injury problem is 300 times that of the military, while military-style injuries are, unfortunately, becoming more common in civilian life.

 

STOP BLEEDING IS IMPORTANT

Among other things, the idea that it is important to stop bleeding sounds so obvious. However, 20 years ago the emphasis, when faced with bleeding patients, was largely on resuscitation to various oxygen or cardiac output-based endpoints. Today, we more clearly understand that a variety of interventions are required to save lives. The relationship between the multitude of hemorrhage control devices, (truncal, junctional, extremity, intravascular, and intraperitoneal) combined with hemostatic resuscitation and rapid operative intervention, is critical for survival.

 

 

TRANSFUSION

Those who die after injury frequently do so from exsanguination, the leading cause of potentially preventable death. Bleeding to death occurs rapidly (within 6 hours of admission), and understanding the time course of hemorrhagic death is critical towards effective intervention. Through the conflicts of the last 20 years, we have developed the current treatment for a traumatic hemorrhagic shock – simultaneous mechanical hemorrhage control coupled with damage control resuscitation (DCR) with an emphasis on using plasma as the primary resuscitative fluid. DCR principles include minimization of crystalloid and artificial colloids, permissive hypotension, and balanced resuscitation with early platelets, plasma, cryoprecipitate, and RBCs. Therefore, optimal resuscitation now starts in the prehospital area with blood products. Several civilian trauma systems are now routinely using WB, both prehospital and in the hospital.

 

Our military and civilian leaders must implement the lessons learned on the current battlefield and be held responsible for clinical outcomes across all levels of care, wherever the injury occurs. Read the original article here. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497952/

 

ºM Warmer System is a portable blood and IV fluid warming device that is currently used both in pre-hospital and in-hospital settings. Learn more. www.mequ.dk/product

 

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