ISSN:1079-0713    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Shock is defined as inadequate perfusion of tissues with oxygen and nutrients to support cellular function. Resuscitation from shock can therefore only be complete when all evidence of oxygen debt, anaerobic metabolism, and tissue acidnais hag been eliminated. All of the diagnostic and therapeutic maneuvers performed hy trauma nurses today, whether basic or advanced, whether performed in the field, emergency department, operatmg roorn, or intensive care unit, can be traced directly or indirectly to this goal. Resuscitation in trauma is now viewed across the continuum of physiologic insult and response that occurs after hemorrhage or tissue injury. Resuscitation endpoints (i.e., variables or parameters) must be viewed across the continuum of shock because the effectiveness of endpoints varies wilh the phase of resuscitation. The optimal resuscitation endpoint in trauma is controversial, remains elusive, and is one of the most published topics in modern medical literature.This article presents the current understanding of the resuscitation endpoints in trauma.

ISSN:1079-0713    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Accurate assessment of preload status is a major concern in the resuscitation of the critically injured patient. Of the three physiologic determinants of stroke volume, preload is the variable thai is most frequency influenced hy an insult or intervention or both in the trauma patient. In the critically injured patient, clinicians focus on the preload status to restore and maintain intravascular volume in attempts to optimize cardiac output and oxygen delivery. Untill recently, efforts to measure and optimize ventricular preload have focused on intracardiac filling pressures (central venous pressure and pulmonary artery occlusion pressure). The purpose of this review is to discuss the application of volumetric measurements that provide a more accurate means of determining recruitable ventricular preload in the critically injured patent

ISSN:1079-0713    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Head injury remains the leading cause of death from trauma. The definitive method for eliminating preventable death from traumatic brain injury remains elusive. New research underscores the danger of inadequate or inappropriate support of oxygenation, ventilation, and perfusion to cerebral tissues. The belief that sensitivity to hypotension makes the patient with head injury fundamentally different is critical to nursing strategies. The conventional concept that fluid restriction decreases cerebral edema in patients with head injury must be weighed against mounting evidence that aggressive hemodynamic support decreases the incidence of subsequent organ system failure and secondary brain injury. New evidence has triggered a scrutiny of conventional interventions. A search for optimal treatments based on prospective randomized trials will continue. Development of neuroprotecting drugs and use of hypertonic saline may be on the horizon. In an effort to ensure optimal outcome, contemporary trauma nursing must embrace new concepts, shed outmoded therapy, and ensure compliance with the basic tenets of critical care for the multitrauma patient with head injury.

ISSN:1079-0713    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Thermal injury disrupts normal hemostasis and sets off a cascade of events: cellular alterations and release of inflammatory mediators cause hypovolemic and cellular shock. Fluid resuscitation in burn injuries has been a use for mor ethan a century, and much research has been devoted to development of resuscitation formulas and appropriate choice of fluid. Parameters for adequate monitoring of resuscitation are greatly debated. Current research efforts focus on minimizing burn edema through mediator modulation and on development of definitive endpoints of resuscitation monitoring.

ISSN:1079-0713    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Trauma is the leading cause of death in young adults. Development of trauma centers in urban settings including emergency medical services has contributed greatly to the improved quality of trauma patient care. Based on animal experiments performed 3 decades ago, the traditional management of hypovolemic hemorrhagic shock includes adequate circulatory volume with aggressive initial infusion ol crystalloid solution. However in several recent animal studies, investigators have found that aggressive treatment with fluids before control of bleeding results in a higher mortality rats, especially if blood pressure is elevated. This notion has been supported by findings in a recent prospective, randomized study involving patients with penetrating injuries to the torso. This article discusses briefly the pathophysiology of shock and hemostasis and the current literature on fluid resuscitation, with emphasis on limited volume resuscitation in patients with penetrating thoracoabdominal injuries.

ISSN:1079-0713    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The critically injured trauma patient in severe hemorrhagic shock presents a complex and arduous challenge to even the most experienced trauma staff. Lives are at stake as trauma teams feverishly pour massive amounts of blood into severely injured patients attempting to replace entire blood volumes several times over. Prompt identification of patients at risk for hemorrhage and establishment or massive transfusion protocols can provide guidance in managing the transfusion needs of the exsanguinating patient. These state-of-the-art protocols address component therapy, endpoints to transfusion and complications related to massive transfusions. Other treatments, such as autotransfusion and blood substitutes, are promising adjuncts therapies that may in the near future help to improve outcomes in patients who require massive blood transfusions. This article reviews the current standard of care for the trauma patient requiring massive transfusion.

ISSN:1079-0713    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

With the organization of trauma systems, the development of trauma centers, the application of standardized methods of resuscitation, and improvements in modern blood banking techniques, the ability to aggressively resuscitate patients in extremis has evolved. The concept of the “golden hour” has translated into unprecedented speed and efficiency of trauma resuscitation with the ultimate goal of short injury-to-incision times. As the shift in care of patients in extremis has continued to move from the street to the emergency department and beyond, the focus of trauma resuscitation has shifted to the operating room and ultimately to the intensive tare unit, The “new” golden hour may well be the time in the operating room before the patient reaches the physiologic limit, defined as the onset of the triad: hypothermia, acidosis and coagulopathy, Critical care nurses must understand this triad, because it forms the basis and underlying logic on which the damage control philosophy has been built. This article explores the pathogenesis and treatment of acidosis, hypothermia, and coagulopathy as it applies to the exsanguinating trauma patient.

ISSN:1079-0713    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The triad of hypothermia, acidosis, and coagulopathy during initial operative and resuscitation efforts has been recognized as a significant cause of death in patients with traumatic injuries. A staged surgical approach with a brief initial laparotomy, subsequent intensive care unit resuscitation, and a planned reoperation is an emerging technique used in trauma surgery, with application to a variety of other surgical challenges. Successful damage control therapy requires a coordinated multidisciplinary team effort by a trauma team experienced in the process of damage control operations, intensive care unit priorities, and potential complications ol this innovative surgical approach.

ISSN:1079-0713    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Intraabdominal hypertension and abdominal compartment syndrome are increasingly recognized as potential complications in patients who have significant intraabdominal trauma. Intraabdominal hypertension and abdominal compartment syndrome affect all body Systems, most notably the cardiac, respiratory, renal, and neurologic systems. This complication also affects blood flow to various intraabdominal organs and may play a significant role in the sepsis and multiple organ failure syndrome seen in many trauma patients. Nursing knowledge of the risk factors and clinical signs of intraabdominal hypertension and abdominal compartment syndrome can reduce the morbidity and mortality associated with this syndrome.

ISSN:1079-0713    

出版商:OVID    

年代:1999

数据来源: OVID