Managing Active Hemorrhage ( Mt )

Resuscitation in the ED. Rapid Quantitative resuscitation is recommended in all patients with tissue hypoperfusion. According to the SSC guidelines, the goals of fluid resuscitation include a CVP of 8-12 mm Hg, a MAP > 65 mm Hg, urine

Hemorrhages, or internal bleeding, account for a large portion of deaths in the world. Hemorrhages are an extremely life threatening injury that require immediate medical attention. These injuries are extremely sensitive to the time of injury and the time it takes for surgery to begin. Hemorrhages fall into two main categories: non-compressible and compressible. Compressible hemorrhages can be treated with external compression, tourniquets, and dressings. Non-compressible hemorrhages can not be treated with these techniques, because the injury is usually deep inside the abdominal part of the body and either not visible, or not within reach. This makes non-compressible hemorrhages much more challenging to treat.

Furthermore, prompt infusion of antimicrobial agents ought to be priority and this may require extra vascular access ports (Dellinger, et al., 2008). Early goal-directed resuscitation has confirmed to improved survival for emergency department patients presenting with septic shock in a randomized, controlled, single-center study. Resuscitation lessen 28-day death rate (Dellinger, et al., 2008). In a reviewed conducted by Dellinger, et al., (2012) advocated administering one litre of crystalloid or 300-500ml of colloid more than 30 minutes, to accomplish a central venous pressure (CVP) of 8 mm Hg to 12 mm Hg. Volumes ought to be increased if there are huge indications of hypoperfusion (Dellinger, 2014).

The characters in the novels Romeo and Juliet, The Odyssey, and Persepolis all have one thing in common, fighting for people they love. Whether it is a family member or a lover, each character plays a role in doing anything they can to stay faithful. The heroes in each novel earned my respect because they stood strong in the face of adversity and fought for who they loved. In Romeo and Juliet, the star crossed lovers did everything they thought of to stay together. These two characters chose death over departure, thinking they would still be with one another in heaven if suicide needed to be attempted.

The one child policy was a decision made by China because China had the largest population and they didn’t have enough resources to help the whole population, but a man named “Mao” wanted people to have many kids because they were precious and it could make China a better place. The policy has its ups and downs. It was a good idea and also a bad one at the same time. One reason I think the one child policy was a bad idea is because people should never be forced to have a certain number of kids because if a couple were to have twins only one child could stay, the other would have to go into adoption or the couple would have to pay a large amount of money to keep a kid which is very cruel. Another reason I think it is a bad idea is because there are only a small number of people that can have more than 1 child which won't really help the population because over 90% of people can have a single child while that small group can have up to 3 kids which is unfair to the people.

For decades prehospital providers have been treating trauma patients by initiating intravenous access and administering crystalloid fluids. The debate has been over what crystalloid fluid to administer for volume replacement, at what amount, and if we should be administering fluids at all. Many products are available and much research has been conducted with results showing that not all fluids are created equal. Some products have the ability to replace volume but provide little more benefit and may actually be harmful. Other products, when administered at much lower volumes, provide far greater benefits and greater potential for a positive outcome for the patient. Most ground ambulances carry Sodium Chloride 0.9% (Normal Saline) even though all research shows that its performance is inferior in comparison to other fluids. In this paper we will look at several recent studies, in which the effects of fluid administration/volume replacement in hypovolemic trauma patients are measured, with a concentrated look at normal saline.

Disseminated intravascular coagulation (DIC) is an acquired syndrome that occurs when a stimulus pathologically activates intravascular coagulation and fibrinolysis resulting in an unbalanced hemostasis (Cunningham, 1999; Huether & McCance, 2008; Wada, 2008). The initiation of DIC starts with the release of tissue factor (TF) by the endothelial cells or white blood cells (WBCs). TF are present on many different cell types including lungs, brain, and placenta. The release of TF is subsequent to a variety of causes including trauma, ischemia, excessive metabolic stress, tumors, infectious organisms, exposure to cytokines and endotoxins (Baglin, 1996; Vinay, Abul, Nelson, & Richard, 2007). The release of endotoxin is the means by which

All over the world, with every new war breaking out, new medical innovations came with it. With each fatal injury incurred on soldiers it was up to surgeons to come up with effective solutions. According to most experts at the time of WW11 stopping the bleeding was in quote "the most vital step" to buy time for the soldier to recuperate and survive, better limb amputation methods led to significantly decreased deaths because of shock or bleeding out. Even today, in specific times in particular during the Afghan war, American medics brought into life new clotting agents that gave the injured more time to get full treatment at a hospital. Another tool that at first was frowned upon by medics

“After a traumatic injury, hemorrhage is responsible for 35% of pre-hospital deaths and over 40% of deaths within the first 24 hours” (NTI, n.d.). I have worked in an intensive care unit and on a flight team. During my time as a nurse, I have cared for many patients following trauma. While working on the flight team, I became acquainted with tranexamic acid (TXA) for trauma patients who were actively, or highly suspected of, bleeding. I was familiar with TXA for post-operation coronary bypass patients, but not for trauma patients.

Of course transfusion was associated with haemoglobin criteria on admission (p=0.001), and the quantity of packed red cells given was also associated with haemoglobin grouping on admission (p70 g/L that received blood transfusions for upper GI bleeding, suggesting that some physicians are initiating blood transfusions with a more liberal strategy in some circumstances. Given the recent evidence finding that blood transfusions can contribute to increased morbidity and mortality in patients, there are grounds for this audit to be expanded and continued to determine the results of a fuller and in-depth cohort to understand the reasons behind liberal strategies for initiating blood

Over the past 11 years to date, the United States has endured almost 8000 casualties from two major conflicts (iCasualties.org, 2012). Although this number is staggering, we have also seen soldiers surviving injuries that were previously fatal (Philpott, 2005). This increase in survivability is largely due to the advancements in medical research and applied training. When it comes to military trauma, our warrior medics should be equipped with the most realistic training attainable. Although several simulation aids are used to provide this training, other methods such as live tissue training are still employed. In

The highest mortality rate in trauma patients with massive haemorrhage initially develops with hypothermia, coagulopathy and acidosis. Coagulopathy, which can be defined as the disorder whereby the body experiences the inability of the blood to coagulate, together with hypothermia and acidosis, form the three main components of “the trauma triad of death”(Anthony et al, 2005) and in lieu of this fact, it is important to ascertain the role of temperature on maintaining homeostasis. With this in mind, an experiment to investigate how the temperature of clotting chemicals affect blood coagulation in the circulatory system, specifically in the cases of hyperthermia and hypothermia, and the effects on homeostasis within the body, will be

Some people wonder why we as a species get fascinated with the allure of fear and the way it frightens us. It could be the imagination our brain creates to scare itself, or possibly the strange unknown… What we don’t understand that makes the phobia come up to the surface and controls our body and mind. In social media, and the content we consume, there are artists and creators that develop it that’s supposed to scare the skeleton out of our skin. How they do it is from transformations.

Exclusion criteria for the study included: Patient refusal to consent (absolute), infection in the patients back near the proposed site of the injection, coagulation disorder :-( defined as PT: > 18 sec, PTT: >40 sec, I.N.R: > 1.5, clotting time: >8 min, platelet disorder: platelet count: < 100.000, bleeding time: >4 min, HELLP Syndrome: - (defined as Hemolysis, Elevated Liver enzymes, Low Platelet count), receiving any anticoagulant drugs, preexisting neurological disease or psychic patients, history of cardiac and respiratory system failure, known allergy to local anesthetics drugs, coexisting renal disease and eclamptic patients.

The market of human blood transfusions is broken down into different uses: Elective Surgery, Emergency Surgery and Trauma. However, Hemopure seems to be suitable only for trauma cases due to its characteristics and, again, high price. To understand the reason, it is important to notice that, actually, only 10% of the 500,000 trauma victims receives RBCs “in the field” or at the site of accident, and the remaining 95% of these people does not receive transfusions until they arrive at the hospital. This delay was often cited as a major factor to the 20,000 trauma deaths. Therefore, since the expected market share for Biopure is 25% and assuming that the total blood transfusions remain stable, the potential market size for Hemopure is approximately $350,000,000. This size is based on an average price of $700 multiplied by 2,000,000 units (around 4 blood units are needed for each Trauma case).