Trauma, Eighth Edition by Ernest E. Moore MD David V. Feliciano MD and Kenneth L. Mattox MD

Author:Ernest E. Moore, MD, David V. Feliciano, MD and Kenneth L. Mattox, MD
Language: eng
Format: epub
Publisher: McGraw-Hill Education LLC
Published: 2017-11-15T00:00:00+00:00

INITIAL MANAGEMENT AND RESUSCITATION

Prehospital Resuscitation

Resuscitation in the field in patients with possible penetrating or blunt abdominal vascular injuries should be restricted to basic airway maneuvers such as intubation or cricothyroidotomy and decompression of a tension pneumothorax at the scene. Insertion of intravenous lines for infusing crystalloid solutions is best attempted during transport to the hospital. Restoration of blood pressure to reasonable levels is critical to neurologic recovery in the rare patients with associated blunt intracranial injuries and possible abdominal vascular injuries.43 In contrast, there is no consistent evidence to support either the aggressive administration of crystalloid solutions during the short prehospital times in urban environments or the withholding of similar solutions (“delayed resuscitation”) in patients with penetrating abdominal vascular injuries.44,45 Even so, a key component of “damage control resuscitation” as espoused by the US military and discussed below is minimization of early crystalloid resuscitation.46

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