Prehospital care of the patient with major trauma

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Recent research efforts have demonstrated that many longstanding practices for the prehospital resuscitation of trauma patients may be inappropriate under certain circumstances. For example, traditional practices, such as application of anti-shock garments and IV fluid administration to raise blood pressure, may even be detrimental in certain patients with uncontrolled bleeding, particularly those with penetrating injuries. ETI, although potentially capable of transiently prolonging a patient's ability to tolerate circulatory arrest, may also be harmful if overzealous PPV further compromises cardiac output, particularly in those patients with severe hemodynamic instability. In addition, if these procedures delay patient transport, any benefit that they may offer could be outweighed by the delay in definitive care. Although traditionally taught to "hyperventilate" the patient with severe head injury, current recommendations are to avoid this tactic unless there is evidence of herniation. Even time-honored traditions, such as universal spinal precautions and CPR during circulatory arrest, are being scrutinized [2,134]. Further prospective randomized clinical trials are needed to better define the role of many overlapping therapies in prehospital trauma care. Such research must specifically address and stratify the different mechanisms of injury, anatomic areas involved, and the physiologic staging of the injury. Furthermore, the efficacy of a single intervention may be masked by a confounding variable [5]. For example, a trial of an effective new HBOC in moribund patients that indicates no advantage in the study results may have been confounded by overzealous PPV, which may have led to suboptimal outcomes. It is hoped that, in the future, EMS physicians will be able to not only better discriminate in their management of patients with major trauma but also improve outcomes as a result.

Original languageEnglish (US)
Pages (from-to)953-974
Number of pages22
JournalEmergency Medicine Clinics of North America
Volume20
Issue number4
DOIs
StatePublished - 2002

Fingerprint

Patient Care
Wounds and Injuries
Universal Precautions
Clothing
Confounding Factors (Epidemiology)
Cardiopulmonary Resuscitation
Craniocerebral Trauma
Research
Resuscitation
Cardiac Output
Shock
Randomized Controlled Trials
Hemodynamics
Hemorrhage
Blood Pressure
Physicians

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Nursing(all)
  • Emergency Medicine

Cite this

Prehospital care of the patient with major trauma. / Fowler, Raymond; Pepe, Paul E.

In: Emergency Medicine Clinics of North America, Vol. 20, No. 4, 2002, p. 953-974.

Research output: Contribution to journalArticle

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