The concept of damage control: Extending the paradigm in the prehospital setting
The purpose of this review is to present the progressive extension of the concept of damage control resuscitation, focusing on the prehospital phase.
Review of the literature in Medline database over the past 10years.
Medline database looking for articles published in English or in French between April 2002 and March 2013. Keywords used were: damage control resuscitation, trauma damage control, prehospital trauma, damage control surgery. Original articles were firstly selected. Editorials and reviews were secondly studied.
The importance of early management of life-threatening injuries and rapid transport to trauma centers has been widely promulgated. Technical progress appears for external methods of hemostasis, with the development of handy tourniquets and hemostatic dressings, making the crucial control of external bleeding more simple, rapid and effective. Hypothermia is independently associated with increased risk of mortality, and appeared accessible to improvement of prehospital care. The impact of excessive fluid resuscitation appears negative. The interest of hypertonic saline is denied. The place of vasopressor such as norepinephrine in the early resuscitation is still under debate. The early use of tranexamic acid is promoted. Specific transfusion strategies are developed in the prehospital setting.
It is critical that both civilian and military practitioners involved in trauma continue to share experiences and constructive feedback. And it is mandatory now to perform well-designed prospective clinical trials in order to advance the topic.
Available from: Patrizio Schinco
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ABSTRACT: Receiving domestic violence victims in ER is a relatively common occurrence for the medical staff, who is however rarely willing to intervene
Available from: Anand Ramasubramanian
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ABSTRACT: This review is a synopsis of the decisions that shaped global policy on platelet storage temperature and a focused appraisal of the literature on which those discussions were based. We hypothesize that choices were centered on optimization of preventative platelet transfusion strategies, possibly to the detriment of the therapeutic needs of acutely bleeding patients. Refrigerated platelets are a better hemostatic product and they are safer in that they are less prone to bacterial contamination. They were abandoned during the 1970s due to the belief that clinically effective platelets should be both hemostatically functional and survive in circulation for several days as indicated for prophylactic transfusion; however, clinical practice may be changing. Data from two randomized controlled trials brings into question the concept that stable autologous stem cell transplant patients with hypoproliferative thrombocytopenia should continue to receive prophylactic transfusions. At the same time, new findings regarding the efficacy of cold platelets and their potential role in treating acute bleeding have revived the debate regarding optimal platelet storage temperature. In sum, a "one-size-fits-all" strategy for platelet storage may not be adequate, and a re-examination of whether cold-stored platelets should be offered as a widely-available therapeutic product may be indicated.
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