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At least 847 records · Page 47Linked to original sources
PubMed1981

Objective approach to the management of shock.

The objective in managing shock is to prevent anaerobic metabolism in the tissue. In the resuscitation of the acutely hypovolemic patient, volume resuscitation is the key. Drugs are seldom needed to accomplish this goal. Only when shock state results from an increase in the size of the container or from a decrease in the output of the pump, are drugs necessary. The objective management of shock is an understanding of the interrelationship of the pump, the container and the fluid, the mechanisms of monitoring their functions, and the use of the appropriate methods to return them to normal.

Emergencies↗
PubMed1980

Clinical experience with the medical anti-shock trousers (MAST) treatment of hemorrhage, especially from compound pelvic fracture.

The experience and results of treatment with external counterpressure for uncontrollable bleeding in 11 patients with compound pelvic fractures and 7 other patients with various subdiaphragmatic bleeding sites are reported. In 11 cases (61%) the bleeding could be arrested with medical anti-shock trousers (MAST). 9 patients died: 5 due to hemorrhagic shock and 4 of related disorders. Treatment with MAST was unsuccessful in 7 cases of major arterial tears. In patients with compound pelvic fractures the acute blood loss may necessitate further treatment by either arterial embolization, an operation for concomitant traumata, or both. Complications of the use of MAST were minor. The (clinical) use of this garment can therefore be strongly advised in patients with otherwise intractable bleeding.

Adolescent↗
PubMed1995

Controversies in shock research: hypertonic resuscitation--pros and cons.

The proper fluid resuscitation of hemorrhagic shock is still controversial. Hypertonic saline has been suggested for prehospital resuscitation of hemorrhagic shock, because of its superior ability to expand blood volume and elevate systemic blood pressure and cardiac output in a small volume and during a short time period. We have defined two types of hemorrhagic shock: controlled hemorrhagic shock (CHS), where the bleeding source is immediately occluded following hemorrhage, and uncontrolled hemorrhagic shock (UCHS), where bleeding is induced by injury to blood vessels that are left unoccluded. It was observed that hypertonic saline (HTS) treatment of controlled hemorrhagic shock leads to an increase in blood pressure and cardiac output, while HTS treatment of UCHS leads to increased bleeding from injured blood vessels, hemodynamic deterioration, and increased mortality. Conversion of UCHS to CHS by tourniquet, military antishock trousers, or surgical hemostasis prevented excessive bleeding and mortality following HTS. Several clinical studies have used hypertonic saline dextran (HSD) or hypertonic saline (HS) for treatment of trauma casualties, but to date no significant improvement in mortality has been demonstrated by either HS or HSD. A more favorable effect but still not statistically significant effect has been demonstrated in patients with a Glasgow Coma Scale of 8 or less. The efficacy of HS has not clearly been established in clinical trials, in all of which HS was used in combination with conventional crystalloid therapy. Further human trials are required to better define the patient population that would benefit most from the prehospital administration of HS.

Animals↗
PubMed1995

Greyout, blackout, and G-loss of consciousness in the Brazilian Air Force: a 1991-92 survey.

A national survey has been performed with high and medium performance aircraft pilots on the incidence of symptoms due to +Gz acceleration, in order to make up a human centrifuge physiological training profile directed to the needs of the Brazilian Air Force pilots. Anonymous questionnaires were sent to Flight Squadrons of F-5, AMX, Mirage F-103, Xavante AT-26, and Tucano T-27. They consisted of inquiries about the occurrence of visual symptoms and/or loss of consciousness during +Gz (G-LOC) maneuvers, and post-G-LOC symptoms. Some 193 pilots answered the questionnaire: 23 (11.92%) reported greyout and/or loss of peripheral vision; 40 (20.72%) reported blackout; 20 (10.36%) reported G-LOC. Those who reported LOC also reported post-G-LOC symptoms (100%), 16 (80%) being gradual and 4 (20%) instantaneous. Incidence of G-LOC did not depend upon the type of aircraft flown (p > 0.05). Considering the pilots who reported G-LOC, 80% were preceded by blackout, which could allow them to relieve +Gz load before they would reach their endpoint for the occurrence of G-LOC. For these reasons we recommend intensive human centrifuge training periodically, similar to the hypoxia-recognition test in the hypobaric chamber, not only for high performance aircraft pilots but for any pilot who can perform aerobatics (thus exposing himself to the adverse effects of "pulling G"). This will allow each pilot to recognize his consciousness endpoint when undergoing +Gz maneuvers, in a controlled and safe environment.

Acceleration↗
PubMed1995

Venous thromboembolism. Risk factors and prophylaxis.

Most deaths from pulmonary embolism can be prevented by providing adequate prophylaxis for hospital patients who are at high risk for venous thromboembolism. Physicians, however, must be able to identify high-risk patients (including those with major trauma, hip or knee replacement, or pelvic fractures) and prescribe an appropriate prophylactic agent for each patient according to his or her level of risk. A number of prophylactic methods have been proven effective in the prevention of venous thromboembolism, including low-dose heparin, low-molecular-weight heparin, warfarin, graduated compression stockings, and intermittent pneumatic compression of the legs.

Adult↗