Shock in polytrauma

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7424.1119 (Published 13 November 2003) Cite this as: BMJ 2003;327:1119
  1. Paul E Pepe, Riggs Family chair in emergency medicine (Paul.Pepe@UTSouthwestern.edu)
  1. University of Texas Southwestern Medical Center, Mail Code 8579, 5323 Harry Hines Boulevard, Dallas, TX 75390-8579, USA

    Needs better definition and perhaps more selective treatment

    By 2020 bodily injuries are predicted to outpace infectious diseases worldwide in terms of years of productive life lost.1 2 Evolving experience has shown that treatment plans for serious injuries require discrimination between the mechanism of injuries, their anatomic involvement, and their “staging.”2 Yet traditionally, many emergency medical services developed more simplified treatment algorithms without such discriminations, leading to mis-interpretations and invalid conclusions from studies.2 Also deployment configurations may account for conflicting data regarding certain interventions and unrecognised confounders (for example, overzealous ventilation or fluid resuscitation in severe haemorrhagic states) may obscure the benefits of other treatment.2 3 4 5 Finally prospective clinical trials to either validate or refute interventions currently used are lacking.3

    Evolving recommendations for haemorrhage after trauma

    With these perspectives in mind traditional recommendations for managing shock in polytrauma are being questioned as being universally applicable, particularly in the preoperative phases of resuscitation.4 5 6 Specifically the strategy of universally providing rapid infusions of crystalloid or colloid …

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