Fluid resuscitation : state of the science for treating combat casualties and civilian injuries / Andrew Pope ... [et al.] ; Institute of Medicine.

Format:

Book

Contributor:

Institute of Medicine (U.S.)

Pope, Andrew MacPherson, 1950-

Language:

English

Subjects (All):

Hemorrhagic shock--Treatment.

Hemorrhagic shock.

Fluid therapy.

Resuscitation.

Medicine, Military.

First aid in illness and injury.

Physical Description:

1 online resource (207 pages) : illustrations

Edition:

1st ed.

Place of Publication:

Washington, D.C. : National Academy Press, c1999.

Language Note:

English

Summary:

The challenges associated with immediate resuscitation of the wounded soldier are daunting and often unappreciated by civilian medical personnel. When you consider that field medics frequently work in less than friendly field conditions, exposed to the elements, while carrying only limited medical gear, potentially under fire, you get a sense for the extraordinary obstacles that must be overcome. Which technologies are best suited to this situation? What are the most promising research directions?

Contents:

Fluid Resuscitation

Copyright

Reviewers

Preface

Photographs

Contents

Executive Summary

1 Introduction

HISTORY OF FLUID RESUSCITATION

ORIGIN, SCOPE AND ORGANIZATION OF THE REPORT

2 Pathophysiology of Acute Hemorrhagic Shock

DEFINITIONS OF HEMORRHAGIC SHOCK

Organ Involvement in Shock

PHYSIOLOGIC RESPONSES TO HEMORRHAGE

Shock Decompensation

Cellular Responses to Shock

Altered Energy Metabolism, Ion Compartmentalization, Lipid Metabolism, and Radical Production and Metabolism

Alterations in Macrophage Function

Surgical Bleeding Disorders

Fundamental Alterations in Transcription and Translation: Apoptosis

Alterations in Secretion of and Cellular Responsiveness to Growth Factors

HEMATOLOGIC ABNORMALITIES ASSOCIATED WITH SHOCK AND RESUSCITATION

Transfusion of the Patient in Shock

Massive Transfusion

Risks of Blood Transfusion

Blood Substitutes and Alternatives to Transfusion

Disseminated Intravascular Coagulation

CONCLUSIONS AND RECOMMENDATIONS

3 Experience With and Complications of Fluid Resuscitation

OVERVIEW OF COLLOID AND CRYSTALLOID RESUSCITATION

COMPLICATIONS OF RESUSCITATION IN GENERAL

Effects of Fluid Resuscitation on Coagulation

Oxygen Toxicity Associated with Resuscitation

Reperfusion-Mediated Injury

Oxygen-Derived Free Radicals

Nitric Oxide

Activated Neutrophils

Complications of Late Resuscitation of Shock

COMPLICATIONS OF COLLOID RESUSCITATION

COMPLICATIONS OF CRYSTALLOID RESUSCITATION

Effects of Crystalloid Resuscitation on Immune Function

Effects of Crystalloid Resuscitation on Cytokine Response

Adverse Effects of Large-Volume Crystalloid Resuscitation

Adverse Effects of Lactated Ringer's Solution

Safety and Efficacy of Hypertonic Saline Solutions

ALTERNATIVE RESUSCITATION APPROACHES

SUMMARY.

CONCLUSIONS AND RECOMMENDATIONS

4 Novel Approaches to Treatment of Shock

PREVENTION

Oxygen Therapeutics

First-, Second-, and Third-Generation Therapeutics

Perfluorochemicals

Liposomes

Other Novel Approaches

INTERVENTION

Targets for Intervention

Therapies for Reperfusion-Mediated Free-Radical Damage

Antioxidant or Scavenging Strategies

Iron Chelation

Inhibition of Polymorphonuclear Neutrophil Adherence and Activation

Nitric Oxide Inhibition

Novel Strategies for Scavenging Free Radicals

Hormonal Influences

Diagnostic Instrumentation

TOLERANCE

RECOMMENDATIONS

5 Protocols of Care at the Site of Injury

THE COMBAT ENVIRONMENT

Expected Condition of Combatant on the Battlefield

Limits of Battlefield Care for the Injured Combatant

Resuscitation Needs of the Injured Combatant on the Battlefield

Immediate Versus Delayed Fluid Resuscitation

Current Protocols

Training First Responders

Available Approaches for Treatment of Injury

Hemorrhage

Airway and Breathing

Additional Considerations

Prompt Aeromedical Evacuation

Monitoring

6 Future Directions

ANIMAL MODELS

Effects of Extent of Hypotension and Rates of Hemorrhage on Immune Function in Mouse Models

Swine Models of Combined Hemorrhage and Injury

Value of Animal Models

Technical Models

Role of Anesthesia

CLINICAL TRIALS

Role of Clinical Trials in Development of Therapies

Endpoints and Indications

Evaluation of Resuscitation Protocols

Unique Problems of Clinical Trials of Trauma

Heterogeneity of Subject Population

Informed Consent

Applicability of Civilian Clinical Data to Military Needs

Clinical Research and Clinical Trials in Trauma Centers

References

Appendixes

A Acknowledgments.

Conference Speakers

Conference Attendees

Other Contributors

B Acronyms

C Conference Agenda

D Committee and Staff Biographies

Committee Biographies

Iom Project Staff

Index.

Notes:

Bibliographic Level Mode of Issuance: Monograph

Includes bibliographical references (p. 125-156) and index.

ISBN:

9786610185962

9780309172790

0309172799

9781280185960

1280185961

9780309597012

0309597013

9780585084947

0585084947

OCLC:

43475659