Advertisement

Initial Assessment and Early Resuscitation

  • Louis H. Alarcon
  • Andrew B. Peitzman

Abstract

During the initial assessment and early resuscitation phase, a multiple trauma patient (25-year-old man) is determined to be in hemorrhagic shock and has the following findings:
  • Multiple abrasions (head, torso, and extremities)

  • Dilated right pupil

  • Precordial bruises (chest x-ray demonstrates fully expanded bilateral lungs with an endotracheal tube above the carina; a widened mediastinum; obliterated pulmonary-aortic window and aortic knob)

  • Soft abdomen

  • Unstable pelvic fracture (pneumatic garment is now inflated)

Keywords

Septic Shock Severe Sepsis Trauma Patient Hemorrhagic Shock Acute Abdominal Pain 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    American College of Surgeons Committee. Advanced Trauma Life Support Instructor Manual, 6th ed. Chicago: American College of Surgeons, 1997.Google Scholar
  2. 2.
    Lo RV, III, Bellini LM. William of Occam and Occam’s razor. Ann Intern Med 2002; 136(8):634–635.Google Scholar
  3. 3.
    Nicholas JM, Rix EP, Easley KA, Feliciano DV, Cava RA, Ingram WL, et al. Changing patterns in the management of penetrating abdominal trauma: the more things change, the more they stay the same. J Trauma 2003; 55(6):1095–1108.PubMedCrossRefGoogle Scholar
  4. 4.
    Miner JR, Heegaard W, Plummer D. End-tidal carbon dioxide monitoring during procedural sedation. Acad Emerg Med 2002; 9(4):275–280.PubMedCrossRefGoogle Scholar
  5. 5.
    Baer GA, Paloheimo M, Rahnasto J, Pukander J. End-tidal oxygen concentration and pulse oximetry for monitoring oxygenation during intratracheal jet ventilation. J Clin Monit 1995; 11(6):373–380.PubMedCrossRefGoogle Scholar
  6. 6.
    Rhee KJ, O’Malley RJ, Turner JE, Ward RE. Field airway management of the trauma patient: the efficacy of bag mask ventilation. Am J Emerg Med 1988; 6(4):333–336.PubMedCrossRefGoogle Scholar
  7. 7.
    Mandavia DP, Qualls S, Rokos I. Emergency airway management in penetrating neck injury. Ann Emerg Med 2000; 35(3):221–225.PubMedCrossRefGoogle Scholar
  8. 8.
    Sing RF, Rotondo MF, Zonies DH, Schwab CW, Kauder DR, Ross SE, et al. Rapid sequence induction for intubation by an aeromedical transport team: a critical analysis. Am J Emerg Med 1998; 16(6):598–602.PubMedCrossRefGoogle Scholar
  9. 9.
    Wayne MA, Friedland E. Prehospital use of succinylcholine: a 20-year review. Prehosp Emerg Care 1999; 3(2): 107–109.PubMedCrossRefGoogle Scholar
  10. 10.
    Li J, Murphy-Lavoie H, Bugas C, Martinez J, Preston C. Complications of emergency intubation with and without paralysis. Am J Emerg Med 1999; 17(2):141–143.PubMedCrossRefGoogle Scholar
  11. 11.
    Salvino CK, Dries D, Gamelli R, Murphy-Macabobby M, Marshall W. Emergency cricothyroidotomy in trauma victims. J Trauma 1993; 34(4):503–505.PubMedGoogle Scholar
  12. 12.
    Kishikawa M, Yoshioka T, Shimazu T, Sugimoto H, Yoshioka T, Sugimoto T. Pulmonary contusion causes longterm respiratory dysfunction with decreased functional residual capacity. J Trauma 1991; 31(9):1203–1208.PubMedCrossRefGoogle Scholar
  13. 13.
    Clark GC, Schecter WP, Trunkey DD. Variables affecting outcome in blunt chest trauma: flail chest vs. pulmonary contusion. J Trauma 1988; 28(3):298–304.PubMedCrossRefGoogle Scholar
  14. 14.
    Glinz W. Problems caused by the unstable thoracic wall and by cardiac injury due to blunt injury. Injury 1986; 17(5):322–326.PubMedCrossRefGoogle Scholar
  15. 15.
    Johnson JA, Cogbill TH, Winga ER. Determinants of outcome after pulmonary contusion. J Trauma 1986; 26(8):695–697.PubMedCrossRefGoogle Scholar
  16. 16.
    Abouhatem R, Hendrickx P, Titeca M, Guerisse P. Thoracic epidural analgesia in the treatment of rib fractures. Acta Anaesthesiol Belg 1984; 35(Suppl):271–275.PubMedGoogle Scholar
  17. 17.
    Luchette FA, Radafshar SM, Kaiser R, Flynn W, Hassett JM. Prospective evaluation of epidural versus intrapleural catheters for analgesia in chest wall trauma. J Trauma 1994; 36(6):865–869.PubMedCrossRefGoogle Scholar
  18. 18.
    Mackersie RC, Shackford SR, Hoyt DB, Karagianes TG. Continuous epidural fentanyl analgesia: ventilatory function improvement with routine use in treatment of blunt chest injury. J Trauma 1987; 27(11):1207–1212.PubMedCrossRefGoogle Scholar
  19. 19.
    Soliman IE, Safwat AM. Successful management of an elderly patient with multiple trauma. J Trauma 1985; 25(8):806–807.PubMedCrossRefGoogle Scholar
  20. 20.
    Worthley LI. Thoracic epidural in the management of chest trauma. A study of 161 cases. Intensive Care Med 1985; 11(6):312–315.PubMedCrossRefGoogle Scholar
  21. 21.
    Moon MR, Luchette FA, Gibson SW, Crews J, Sudarshan G, Hurst JM, et al. Prospective, randomized comparison of epidural versus parenteral opioid analgesia in thoracic trauma. Ann Surg 1999; 229(5):684–691.PubMedCrossRefGoogle Scholar
  22. 22.
    Chesnut RM, Marshall LF, Klauber MR, Blunt BA, Baldwin N, Eisenberg HM, et al. The role of secondary brain injury in determining outcome from severe head injury. J Trauma 1993; 34(2):216–222.PubMedCrossRefGoogle Scholar
  23. 23.
    Barcelona SL, Vilich F, Cote CJ. A comparison of flow rates and warming capabilities of the Level 1 and Rapid Infusion System with various-size intravenous catheters. Anesth Analg 2003; 97(2):358–363, table.PubMedCrossRefGoogle Scholar
  24. 24.
    Burris D, Rhee P, Kaufmann C, Pikoulis E, Austin B, Eror A, et al. Controlled resuscitation for uncontrolled hemorrhagic shock. J Trauma 1999; 46(2):216–222.PubMedCrossRefGoogle Scholar
  25. 25.
    Capone AC, Safar P, Stezoski W, Tisherman S, Peitzman AB. Improved outcome with fluid restriction in treatment of uncontrolled hemorrhagic-shock. J Am Coll Surgeons 1995; 180(1):49–56.Google Scholar
  26. 26.
    Kowalenko T, Stern S, Dronen S, Xu W. Improved outcome with hypotensive resuscitation of uncontrolled hemorrhagic-shock in a swine model. J Trauma 1992; 33(3):349–353.PubMedCrossRefGoogle Scholar
  27. 27.
    Abu Hatoum O, Bashenko Y, Hirsh M, Krausz MM. Continuous fluid resuscitation and splenectomy for treatment of uncontrolled hemorrhagic shock after massive splenic injury. J Trauma 2002; 52(2):253–258.CrossRefGoogle Scholar
  28. 28.
    Holmes JF, Sakles JC, Lewis G, Wisner DH. Effects of delaying fluid resuscitation on an injury to the systemic arterial vasculature. Acad Emerg Med 2002; 9(4):267–274.PubMedCrossRefGoogle Scholar
  29. 29.
    Abu-Hatoum O, Bashenko Y, Hirsh M, Krausz MM. Continuous fluid resuscitation and splenectomy for treatment of uncontrolled hemorrhagic shock after massive splenic injury. J Trauma 2002; 52(2):253–258.PubMedCrossRefGoogle Scholar
  30. 30.
    Krausz MM, Bashenko Y, Hirsh M. Crystalloid and colloid resuscitation of uncontrolled hemorrhagic shock following massive splenic injury. Shock 2001; 16(5):383–388.PubMedCrossRefGoogle Scholar
  31. 31.
    Bickell WH, Wall MJ, Pepe PE, Martin RR, Ginger VF, Allen MK, et al. Immediate versus delayed fluid resuscitation tation for hypotensive patients with penetrating torso injuries. N Engl J Med 1994; 331(17):1105–1109.PubMedCrossRefGoogle Scholar
  32. 32.
    Kwan I, Bunn F, Roberts I. Timing and volume of fluid administration for patients with bleeding. Cochrane Database Syst Rev 2003; (3):CD002245.Google Scholar
  33. 33.
    Fleming A, Bishop M, Shoemaker W, Appel P, Sufficool W, Kuvhenguwha A, et al. Prospective trial of supranormal values as goals of resuscitation in severe trauma. Arch Surg 1992; 127(10):1175–1179.PubMedGoogle Scholar
  34. 34.
    McKinley BA, Kozar RA, Cocanour CS, Valdivia A, Sailors RM, Ware DN, et al. Normal versus supranormal oxygen delivery goals in shock resuscitation: the response is the same. J Trauma 2002; 53(5):825–832.PubMedCrossRefGoogle Scholar
  35. 35.
    Balogh Z, McKinley BA, Cocanour CS, Kozar RA, Valdivia A, Sailors RM, et al. Supranormal trauma resuscitation causes more cases of abdominal compartment syndrome. Arch Surg 2003; 138(6):637–642.PubMedCrossRefGoogle Scholar
  36. 36.
    Younes RN, Aun F, Accioly CQ, Casale LP, Szajnbok I, Birolini D. Hypertonic solutions in the treatment of hypovolemic shock: a prospective, randomized study in patients admitted to the emergency room. Surgery 1992; 111(4): 380–385.PubMedGoogle Scholar
  37. 37.
    Mattox KL, Maningas PA, Moore EE, Mateer JR, Marx JA, Aprahamian C, et al. Prehospital hypertonic saline/ dextran infusion for post-traumatic hypotension. The U.S.A. Multicenter Trial. Ann Surg 1991; 213(5):482–491.PubMedCrossRefGoogle Scholar
  38. 38.
    Wade CE, Kramer GC, Grady JJ, Fabian TC, Younes RN. Efficacy of hypertonic 7.5% saline and 6% dextran-70 in treating trauma: a meta-analysis of controlled clinical studies. Surgery 1997; 122(3):609–616.PubMedCrossRefGoogle Scholar
  39. 39.
    Wade C, Grady J, Kramer G. Efficacy of hypertonic saline dextran (HSD) in patients with traumatic hypotension: meta-analysis of individual patient data. Acta Anaesthesiol Scand Suppl 1997; 110:77–79.PubMedGoogle Scholar
  40. 40.
    Wade CE, Grady JJ, Kramer GC, Younes RN, Gehlsen K, Holcroft JW. Individual patient cohort analysis of the efficacy of hypertonic saline/dextran in patients with traumatic brain injury and hypotension. J Trauma 1997; 42(5 Suppl):S61–S65.PubMedCrossRefGoogle Scholar
  41. 41.
    Human albumin administration in critically ill patients: systematic review of randomised controlled trials. Cochrane Injuries Group Albumin Reviewers. BMJ 1998; 317(7153):235–240.Google Scholar
  42. 42.
    Wilkes MM, Navickis RJ. Patient survival after human albumin administration. A meta-analysis of randomized, controlled trials. Ann Intern Med 2001; 135(3):149–164.PubMedGoogle Scholar
  43. 43.
    Schierhout G, Roberts I. Fluid resuscitation with colloid or crystalloid solutions in critically ill patients: a systematic review of randomised trials. BMJ 1998; 316(7136):961–964.PubMedGoogle Scholar
  44. 44.
    Friedman Z, Berkenstadt H, Preisman S, Perel A. A comparison of lactated Ringer’s solution to hydroxyethyl starch 6% in a model of severe hemorrhagic shock and continuous bleeding in dogs. Anesth Analg 2003; 96(1): 39–45, table.PubMedCrossRefGoogle Scholar
  45. 45.
    Kellum JA. Fluid resuscitation and hyperchloremic acidosis in experimental sepsis: improved short-term survival and acid-base balance with Hextend compared with saline. Crit Care Med 2002; 30(2):300–305.PubMedCrossRefGoogle Scholar
  46. 46.
    Franz A, Braunlich P, Gamsjager T, Felfernig M, Gustorff B, Kozek-Langenecker SA. The effects of hydroxyethyl starches of varying molecular weights on platelet function. Anesth Analg 2001; 92(6):1402–1407.PubMedCrossRefGoogle Scholar
  47. 47.
    Via D, Kaufmann C, Anderson D, Stanton K, Rhee P. Effect of hydroxyethyl starch on coagulopathy in a swine model of hemorrhagic shock resuscitation. J Trauma 2001; 50(6):1076–1082.PubMedCrossRefGoogle Scholar
  48. 48.
    Wilkes NJ, Woolf R, Mutch M, Mallett SV, Peachey T, Stephens R, et al. The effects of balanced versus salinebased hetastarch and crystalloid solutions on acid-base and electrolyte status and gastric mucosal perfusion in elderly surgical patients. Anesth Analg 2001; 93(4):811–816.PubMedCrossRefGoogle Scholar
  49. 49.
    Uchiyama T, Delude RL, Fink MP. Dose-dependent effects of ethyl pyruvate in mice subjected to mesenteric ischemia and reperfusion. Intensive Care Med 2003; 29(11):2050–2058.PubMedCrossRefGoogle Scholar
  50. 50.
    Tawadrous ZS, Delude RL, Fink MP. Resuscitation from hemorrhagic shock with Ringer’s ethyl pyruvate solution improves survival and ameliorates intestinal mucosal hyperpermeability in rats. Shock 2002; 17(6):473–477.PubMedCrossRefGoogle Scholar
  51. 51.
    Ulloa L, Ochani M, Yang H, Tanovic M, Halperin D, Yang R, et al. Ethyl pyruvate prevents lethality in mice with established lethal sepsis and systemic inflammation. Proc Natl Acad Sci USA 2002; 99(19):12351–12356.PubMedCrossRefGoogle Scholar
  52. 52.
    Venkataraman R, Kellum JA, Song M, Fink MP. Resuscitation with Ringer’s ethyl pyruvate solution prolongs survival and modulates plasma cytokine and nitrite/nitrate concentrations in a rat model of lipopolysaccharideinduced shock. Shock 2002; 18(6):507–512.PubMedCrossRefGoogle Scholar
  53. 53.
    Fink MP. Ringer’s ethyl pyruvate solution: a novel resuscitation fluid for the treatment of hemorrhagic shock and sepsis. J Trauma 2003; 54(5 Suppl):S141–S143.PubMedGoogle Scholar
  54. 54.
    Rizoli SB. Crystalloids and colloids in trauma resuscitation: a brief overview of the current debate. J Trauma 2003; 54(5 Suppl):S82–S88.PubMedGoogle Scholar
  55. 55.
    Choi PT, Yip G, Quinonez LG, Cook DJ. Crystalloids vs. colloids in fluid resuscitation: a systematic review. Crit Care Med 1999; 27(1):200–210.PubMedCrossRefGoogle Scholar
  56. 56.
    Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med 1999; 340(6):409–417.PubMedCrossRefGoogle Scholar
  57. 57.
    Hebert PC, Yetisir E, Martin C, Blajchman MA, Wells G, Marshall J, et al. Is a low transfusion threshold safe in critically ill patients with cardiovascular diseases? Crit Care Med 2001; 29(2):227–234.PubMedCrossRefGoogle Scholar
  58. 58.
    Malone DL, Dunne J, Tracy JK, Putnam AT, Scalea TM, Napolitano LM. Blood transfusion, independent of shock severity, is associated with worse outcome in trauma. J Trauma 2003; 54(5):898–905.PubMedCrossRefGoogle Scholar
  59. 59.
    Claridge JA, Sawyer RG, Schulman AM, McLemore EC, Young JS. Blood transfusions correlate with infections in trauma patients in a dose-dependent manner. Am Surg 2002; 68(7):566–572.PubMedGoogle Scholar
  60. 60.
    Hill GE, Frawley WH, Griffith KE, Forestner JE, Minei JP. Allogeneic blood transfusion increases the risk of post postoperative bacterial infection: a meta-analysis. J Trauma 2003; 54(5):908–914.PubMedCrossRefGoogle Scholar
  61. 61.
    Offner PJ, Moore EE, Biffl WL, Johnson JL, Silliman CC. Increased rate of infection associated with transfusion of old blood after severe injury. Arch Surg 2002; 137(6):711–716.PubMedCrossRefGoogle Scholar
  62. 62.
    Taylor RW, Manganaro L, O’Brien J, Trottier SJ, Parkar N, Veremakis C. Impact of allogenic packed red blood cell transfusion on nosocomial infection rates in the critically ill patient. Crit Care Med 2002; 30(10):2249–2254.PubMedCrossRefGoogle Scholar
  63. 63.
    Moore FA, Moore EE, Sauaia A. Blood transfusion. An independent risk factor for postinjury multiple organ failure. Arch Surg 1997; 132(6):620–624.PubMedGoogle Scholar
  64. 64.
    Chang TM. A new red blood cell substitute. Crit Care Med 2004; 32(2):612–613.PubMedCrossRefGoogle Scholar
  65. 65.
    Sampson JB, Davis MR, Mueller DL, Kashyap VS, Jenkins DH, Kerby JD. A comparison of the hemoglobin-based oxygen carrier HBOC-201 to other low-volume resuscitation fluids in a model of controlled hemorrhagic shock. J Trauma 2003; 55(4):747–754.PubMedCrossRefGoogle Scholar
  66. 66.
    van Iterson M, Siegemund M, Burhop K, Ince C. Hemoglobin-based oxygen carrier provides heterogeneous microvascular oxygenation in heart and gut after hemorrhage in pigs. J Trauma 2003; 55(6):1111–1124.PubMedCrossRefGoogle Scholar
  67. 67.
    Katz LM, Manning JE, McCurdy S, Pearce LB, Gawryl MS, Wang Y, et al. HBOC-201 improves survival in a swine model of hemorrhagic shock and liver injury. Resuscitation 2002; 54(1):77–87.PubMedCrossRefGoogle Scholar
  68. 68.
    Manning JE, Katz LM, Brownstein MR, Pearce LB, Gawryl MS, Baker CC. Bovine hemoglobin-based oxygen carrier (HBOC-201) for resuscitation of uncontrolled, exsanguinating liver injury in swine. Carolina Resuscitation Research Group. Shock 2000; 13(2):152–159.PubMedCrossRefGoogle Scholar
  69. 69.
    Gould SA, Moore EE, Hoyt DB, Burch JM, Haenel JB, Garcia J, et al. The first randomized trial of human polymerized hemoglobin as a blood substitute in acute trauma and emergent surgery. J Am Coll Surg 1998; 187(2):113–120.PubMedCrossRefGoogle Scholar
  70. 70.
    Gould SA, Moore EE, Hoyt DB, Ness PM, Norris EJ, Carson JL, et al. The life-sustaining capacity of human polymerized hemoglobin when red cells might be unavailable. J Am Coll Surg 2002; 195(4):445–452.PubMedCrossRefGoogle Scholar
  71. 71.
    Sprung J, Kindscher JD, Wahr JA, Levy JH, Monk TG, Moritz MW, et al.The use of bovine hemoglobin glutamer-250 (Hemopure) in surgical patients: results of a multicenter, randomized, single-blinded trial. Anesth Analg 2002; 94(4):799–808, table.PubMedCrossRefGoogle Scholar
  72. 72.
    Creteur J, Vincent JL. Hemoglobin solutions. Crit Care Med 2003; 31(12 Suppl):S698–S707.PubMedCrossRefGoogle Scholar
  73. 73.
    Arnoldo BD, Minei JP. Potential of hemoglobin-based oxygen carriers in trauma patients. Curr Opin Crit Care 2001; 7(6):431–436.PubMedCrossRefGoogle Scholar
  74. 74.
    Velmahos GC, Degiannis E, Souter I, Allwood AC, Saadia R. Outcome of a strict policy on emergency department thoracotomies. Arch Surg 1995; 130(7):774–777.PubMedGoogle Scholar
  75. 75.
    Grove CA, Lemmon G, Anderson G, McCarthy M. Emergency thoracotomy: appropriate use in the resuscitation of trauma patients. Am Surg 2002; 68(4):313–316.PubMedGoogle Scholar
  76. 76.
    Aihara R, Millham FH, Blansfield J, Hirsch EF. Emergency room thoracotomy for penetrating chest injury: effect of an institutional protocol. J Trauma 2001; 50(6):1027–1030.PubMedCrossRefGoogle Scholar
  77. 77.
    Rhee PM, Acosta J, Bridgeman A, Wang D, Jordan M, Rich N. Survival after emergency department thoracotomy: review of published data from the past 25 years. J Am Coll Surg 2000; 190(3):288–298.PubMedCrossRefGoogle Scholar
  78. 78.
    Battistella FD, Nugent W, Owings JT, Anderson JT. Field triage of the pulseless trauma patient. Arch Surg 1999; 134(7):742–745.PubMedCrossRefGoogle Scholar
  79. 79.
    Working Group, Ad Hoc Subcommittee on Outcomes, American College of Surgeons-Committee on Trauma. Practice management guidelines for emergency department thoracotomy. J Am Coll Surg 2001; 193(3):303–309.CrossRefGoogle Scholar
  80. 80.
    Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal reexploration. Ann Surg 1984; 199(1):28–30.PubMedCrossRefGoogle Scholar
  81. 81.
    Ivatury RR, Porter JM, Simon RJ, Islam S, John R, Stahl WM. Intra-abdominal hypertension after life-threatening penetrating abdominal trauma: prophylaxis, incidence, and clinical relevance to gastric mucosal pH and abdominal compartment syndrome. J Trauma 1998; 44(6):1016–1021.PubMedCrossRefGoogle Scholar
  82. 82.
    Tiwari A, Haq AI, Myint F, Hamilton G. Acute compartment syndromes. Br J Surg 2002; 89(4):397–412.PubMedCrossRefGoogle Scholar
  83. 83.
    Michard F, Teboul JL. Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest 2002; 121(6):2000–2008.PubMedCrossRefGoogle Scholar
  84. 84.
    Ba ZF, Wang P, Koo DJ, Cioffi WG, Bland KI, Chaudry IH. Alterations in tissue oxygen consumption and extraction after trauma and hemorrhagic shock. Crit Care Med 2000; 28(8):2837–2842.PubMedCrossRefGoogle Scholar
  85. 85.
    Pastores SM, Katz DP, Kvetan V. Splanchnic ischemia and gut mucosal injury in sepsis and the multiple organ dysfunction syndrome. Am J Gastroenterol 1996; 91(9):1697–1710.PubMedGoogle Scholar
  86. 86.
    Doig CJ, Sutherland LR, Sandham JD, Fick GH, Verhoef M, Meddings JB. Increased intestinal permeability is associated with the development of multiple organ dysfunction syndrome in critically ill ICU patients. Am J Respir Crit Care Med 1998; 158(2):444–451.PubMedGoogle Scholar
  87. 87.
    Third European Consensus Conference in Intensive Care Medicine. Tissue hypoxia: how to detect, how to correct, how to prevent. Societe de Reanimation de Langue Francaise. The American Thoracic Society. European Society of Intensive Care Medicine. Am J Respir Crit Care Med 1996; 154(5):1573–1578.Google Scholar
  88. 88.
    Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001; 345(19):1368–1377.PubMedCrossRefGoogle Scholar
  89. 89.
    James JH, Luchette FA, McCarter FD, Fischer JE. Lactate is an unreliable indicator of tissue hypoxia in injury or sepsis. Lancet 1999; 354(9177):505–508.PubMedCrossRefGoogle Scholar
  90. 90.
    Ivatury RR, Sugerman H. In quest of optimal resuscitation: tissue specific, on to the microcirculation. Crit Care Med 2000; 28(8):3102–3103.PubMedCrossRefGoogle Scholar
  91. 91.
    Kincaid EH, Chang MC, Letton RW, Chen JG, Meredith JW. Admission base deficit in pediatric trauma: a study using the National Trauma Data Bank. J Trauma 2001; 51(2):332–335.PubMedCrossRefGoogle Scholar
  92. 92.
    Porter JM, Ivatury RR. In search of the optimal end points of resuscitation in trauma patients: a review. J Trauma 1998; 44(5):908–914.PubMedCrossRefGoogle Scholar
  93. 93.
    Rixen D, Raum M, Bouillon B, Lefering R, Neugebauer E. Base deficit development and its prognostic significance in posttrauma critical illness: an analysis by the trauma registry of the Deutsche Gesellschaft fur Unfallchirurgie. Shock 2001; 15(2):83–89.PubMedCrossRefGoogle Scholar
  94. 94.
    Rutherford EJ, Morris JA, Jr, Reed GW, Hall KS. Base deficit stratifies mortality and determines therapy. J Trauma 1992; 33(3):417–423.PubMedCrossRefGoogle Scholar
  95. 95.
    Siegel JH, Rivkind AI, Dalal S, Goodarzi S. Early physiologic predictors of injury severity and death in blunt multiple trauma. Arch Surg 1990; 125(4):498–508.PubMedGoogle Scholar
  96. 96.
    Davis JW, Parks SN, Kaups KL, Gladen HE, O’Donnell-Nicol S. Admission base deficit predicts transfusion requirements and risk of complications. J Trauma 1996; 41(5):769–774.PubMedCrossRefGoogle Scholar
  97. 97.
    Rixen D, Raum M, Bouillon B, Lefering R, Neugebauer E. Base deficit development and its prognostic significance in posttrauma critical illness: an analysis by the trauma registry of the Deutsche Gesellschaft fur Unfallchirurgie. Shock 2001; 15(2):83–89.PubMedCrossRefGoogle Scholar
  98. 98.
    Stacpoole PW. Lactic acidosis. Endocrinol Metab Clin North Am 1993; 22(2):221–245.PubMedGoogle Scholar
  99. 99.
    Totapally BR, Fakioglu H, Torbati D, Wolfsdorf J. Esophageal capnometry during hemorrhagic shock and after resuscitation in rats. Crit Care 2003; 7(1):79–84.PubMedCrossRefGoogle Scholar
  100. 100.
    Baron BJ, Inerrt R, Zehtabchi S, Stavile KL, Scalea TM. Diagnostic utility of sublingual PCO2 for detecting hemorrhage in patients with penetrating trauma. Acad Emerg Med 2002; 9:492.CrossRefGoogle Scholar
  101. 101.
    Barquist E, Kirton O, Windsor J, Hudson-Civetta J, Lynn M, Herman M, et al. The impact of antioxidant and splanchnic-directed therapy on persistent uncorrected gastric mucosal pH in the critically injured trauma patient. J Trauma 1998; 44(2):355–360.PubMedCrossRefGoogle Scholar
  102. 102.
    Ivatury RR, Simon RJ, Havriliak D, Garcia C, Greenbarg J, Stahl WM. Gastric mucosal pH and oxygen delivery and oxygen consumption indices in the assessment of adequacy of resuscitation after trauma: a prospective, randomized study. J Trauma 1995; 39(1):128–134.PubMedCrossRefGoogle Scholar
  103. 103.
    Ivatury RR, Simon RJ, Islam S, Fueg A, Rohman M, Stahl WM. A prospective randomized study of end points of resuscitation after major trauma: global oxygen transport indices versus organ-specific gastric mucosal pH. J Am Coll Surg 1996; 183(2):145–154.PubMedGoogle Scholar
  104. 104.
    Jin X, Weil MH, Sun S, Tang W, Bisera J, Mason EJ. Decreases in organ blood flows associated with increases in sublingual PCO2 during hemorrhagic shock. J Appl Physiol 1998; 85(6):2360–2364.PubMedGoogle Scholar
  105. 105.
    Marik PE. Sublingual capnography: a clinical validation study. Chest 2001; 120(3):923–927.PubMedCrossRefGoogle Scholar
  106. 106.
    Povoas HP, Weil MH, Tang W, Moran B, Kamohara T, Bisera J. Comparisons between sublingual and gastric tonometry during hemorrhagic shock. Chest 2000; 118(4): 1127–1132.PubMedCrossRefGoogle Scholar
  107. 107.
    Weil MH, Nakagawa Y, Tang W, Sato Y, Ercoli F, Finegan R, et al. Sublingual capnometry: a new noninvasive meas urement for diagnosis and quantitation of severity of circulatory shock. Crit Care Med 1999; 27(7):1225–1229.PubMedCrossRefGoogle Scholar
  108. 108.
    Cosgriff N, Moore EE, Sauaia A, Kenny-Moynihan M, Burch JM, Galloway B. Predicting life-threatening coagulopathy in the massively transfused trauma patient: hypothermia and acidoses revisited. J Trauma 1997; 42(5): 857–861.PubMedCrossRefGoogle Scholar
  109. 109.
    Jurkovich GJ, Greiser WB, Luterman A, Curreri PW. Hypothermia in trauma victims: an ominous predictor of survival. J Trauma 1987; 27(9):1019–1024.PubMedCrossRefGoogle Scholar
  110. 110.
    Schreiber MA, Holcomb JB, Hedner U, Brundage SI, Macaitis JM, Hoots K. The effect of recombinant factor VIIa on coagulopathic pigs with grade V liver injuries. J Trauma 2002; 53(2):252–257.PubMedCrossRefGoogle Scholar
  111. 111.
    Segal S, Shemesh IY, Blumenthal R, Yoffe B, Laufer N, Ezra Y, et al. Treatment of obstetric hemorrhage with recombinant activated factor VII (rFVIIa). Arch Gynecol Obstet 2003; 268(4):266–267.PubMedCrossRefGoogle Scholar
  112. 112.
    Martinowitz U, Kenet G, Lubetski A, Luboshitz J, Segal E. Possible role of recombinant activated factor VII (rFVIIa) in the control of hemorrhage associated with massive trauma. Can J Anaesth 2002; 49(10):S15–S20.PubMedGoogle Scholar
  113. 113.
    Hedner U, Erhardtsen E. Potential role for rFVIIa in transfusion medicine. Transfusion 2002; 42(1):114–124.PubMedCrossRefGoogle Scholar
  114. 114.
    Asensio JA, McDuffie L, Petrone P, Roldan G, Forno W, Gambaro E, et al. Reliable variables in the exsanguinated patient which indicate damage control and predict outcome. Am J Surg 2001; 182(6):743–751.PubMedCrossRefGoogle Scholar
  115. 115.
    Johnson JW, Gracias VH, Schwab CW, Reilly PM, Kauder DR, Shapiro MB, et al. Evolution in damage control for exsanguinating penetrating abdominal injury. J Trauma 2001; 51(2):261–269.PubMedCrossRefGoogle Scholar
  116. 116.
    Rotondo MF, Schwab CW, McGonigal MD, Phillips GR, III, Fruchterman TM, Kauder DR, et al. “Damage control”: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma 1993; 35(3):375–382.PubMedCrossRefGoogle Scholar
  117. 117.
    Cinat ME, Wallace WC, Nastanski F, West J, Sloan S, Ocariz J, et al. Improved survival following massive transfusion in patients who have undergone trauma. Arch Surg 1999; 134(9):964–968.PubMedCrossRefGoogle Scholar
  118. 118.
    Harbrecht BG, Alarcon LH, Peitzman AP. Management of shock. In Moore EE, Feliciano DV, Mattox KL, eds. Trauma. New York: McGraw-Hill, 2004; 201–226.Google Scholar
  119. 119.
    Blalock A. Acute circulatory failure as exemplified by shock and haemorrhage. Surg Gynecol Obstet 1934; 58:551–566.Google Scholar
  120. 120.
    Hollenberg SM, Kavinsky CJ, Parrillo JE. Cardiogenic shock. Ann Intern Med 1999; 131(1):47–59.PubMedGoogle Scholar
  121. 121.
    Hochman JS, Boland J, Sleeper LA, Porway M, Brinker J, Col J, et al. Current spectrum of cardiogenic shock and effect of early revascularization on mortality. Results of an International Registry. SHOCK Registry Investigators. Circulation 1995; 91(3):873–881.PubMedGoogle Scholar
  122. 122.
    Hochman JS, Sleeper LA, Godfrey E, McKinlay SM, Sanborn T, Col J, et al. Should we emergently revascularize occluded coronaries for cardiogenic shock: an international randomized trial of emergency PTCA/CABG-trial design.The SHOCK Trial Study Group. Am Heart J 1999; 137(2):313–321.PubMedCrossRefGoogle Scholar
  123. 123.
    Rozycki GS, Feliciano DV, Schmidt JA, Cushman JG, Sisley AC, Ingram W, et al. The role of surgeon-performed ultrasound in patients with possible cardiac wounds. Ann Surg 1996; 223(6):737–744.PubMedCrossRefGoogle Scholar
  124. 124.
    Rozycki GS, Feliciano DV, Ochsner MG, Knudson MM, Hoyt DB, Davis F, et al. The role of ultrasound in patients with possible penetrating cardiac wounds: a prospective multicenter study. J Trauma 1999; 46(4):543–551.PubMedCrossRefGoogle Scholar
  125. 125.
    Boulanger BR, Kearney PA, Tsuei B, Ochoa JB. The routine use of sonography in penetrating torso injury is beneficial. J Trauma 2001; 51(2):320–325.PubMedCrossRefGoogle Scholar
  126. 126.
    Nagy KK, Lohmann C, Kim DO, Barrett J. Role of echocardiography in the diagnosis of occult penetrating cardiac injury. J Trauma 1995; 38(6):859–862.PubMedCrossRefGoogle Scholar
  127. 127.
    Peitzman AB, Billiar TR, Harbrecht BG, Kelly E, Udekwu AO, Simmons RL. Hemorrhagic shock. Curr Probl Surg 1995; 32(11):925–1002.PubMedCrossRefGoogle Scholar
  128. 128.
    Roumen RM, Hendriks T, van der Ven-Jongekrijg J, Nieuwenhuijzen GA, Sauerwein RW, van der Meer JW, et al. Cytokine patterns in patients after major vascular surgery,hemorrhagic shock,and severe blunt trauma.Relation with subsequent adult respiratory distress syndrome and multiple organ failure. Ann Surg 1993; 218(6):769–776.PubMedCrossRefGoogle Scholar
  129. 129.
    Landry DW, Oliver JA. The pathogenesis of vasodilatory shock. N Engl J Med 2001; 345(8):588–595.PubMedCrossRefGoogle Scholar
  130. 130.
    Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992; 101(6):1644–1655.PubMedCrossRefGoogle Scholar
  131. 131.
    Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 Sccm/Esicm/Accp/Ats/Sis International Sepsis Definitions Conference. Crit Care Med 2003; 31(4):1250–1256.PubMedCrossRefGoogle Scholar
  132. 132.
    Friedman G, Silva E, Vincent JL. Has the mortality of septic shock changed with time? Crit Care Med 1998; 26(12):2078–2086.PubMedCrossRefGoogle Scholar
  133. 133.
    Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001; 29(7):1303–1310.PubMedCrossRefGoogle Scholar
  134. 134.
    Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004; 32(3):858–873.PubMedCrossRefGoogle Scholar
  135. 135.
    Gattinoni L, Brazzi L, Pelosi P, Latini R, Tognoni G, Pesenti A, et al. A trial of goal-oriented hemodynamic therapy in critically ill patients. SvO2 Collaborative Group. N Engl J Med 1995; 333(16):1025–1032.PubMedCrossRefGoogle Scholar
  136. 136.
    Hayes MA, Timmins AC, Yau EH, Palazzo M, Hinds CJ, Watson D. Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 1994; 330(24):1717–1722.PubMedCrossRefGoogle Scholar
  137. 137.
    Kreger BE, Craven DE, McCabe WR. Gram-negative bacteremia. IV. Reevaluation of clinical features and treatment in 612 patients. Am J Med 1980; 68(3):344–355.PubMedCrossRefGoogle Scholar
  138. 138.
    Leibovici L, Shraga I, Drucker M, Konigsberger H, Samra Z, Pitlik SD. The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection. J Intern Med 1998; 244(5):379–386.PubMedCrossRefGoogle Scholar
  139. 139.
    Ibrahim EH, Sherman G, Ward S, Fraser VJ, Kollef MH. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest 2000; 118(1):146–155.PubMedCrossRefGoogle Scholar
  140. 140.
    Vallance P, Moncada S. Role of endogenous nitric oxide in septic shock. New Horiz 1993; 1(1):77–86.Google Scholar
  141. 141.
    De Backer D, Creteur J, Silva E, Vincent JL. Effects of dopamine, norepinephrine, and epinephrine on the splanchnic circulation in septic shock: which is best? Crit Care Med 2003; 31(6):1659–1667.PubMedCrossRefGoogle Scholar
  142. 142.
    Hollenberg SM, Ahrens TS, Astiz ME, Chalfin DB, Dasta JF, Heard SO, et al. Practice parameters for hemodynamic support of sepsis in adult patients in sepsis. Crit Care Med 1999; 27(3):639–660.CrossRefGoogle Scholar
  143. 143.
    Martin C, Papazian L, Perrin G, Saux P, Gouin F. Norepinephrine or dopamine for the treatment of hyperdynamic septic shock? Chest 1993; 103(6):1826–1831.PubMedCrossRefGoogle Scholar
  144. 144.
    Martin C, Viviand X, Leone M, Thirion X. Effect of norepinephrine on the outcome of septic shock. Crit Care Med 2000; 28(8):2758–2765.PubMedCrossRefGoogle Scholar
  145. 145.
    Sharshar T, Blanchard A, Paillard M, Raphael JC, Gajdos P, Annane D. Circulating vasopressin levels in septic shock. Crit Care Med 2003; 31(6):1752–1758.PubMedCrossRefGoogle Scholar
  146. 146.
    Holmes CL, Patel BM, Russell JA, Walley KR. Physiology of vasopressin relevant to management of septic shock. Chest 2001; 120(3):989–1002.PubMedCrossRefGoogle Scholar
  147. 147.
    Malay MB, Ashton RC, Jr, Landry DW, Townsend RN. Low-dose vasopressin in the treatment of vasodilatory septic shock. J Trauma 1999; 47(4):699–703.PubMedCrossRefGoogle Scholar
  148. 148.
    Holmes CL, Walley KR, Chittock DR, Lehman T, Russell JA. The effects of vasopressin on hemodynamics and renal function in severe septic shock: a case series. Intensive Care Med 2001; 27(8):1416–1421.PubMedCrossRefGoogle Scholar
  149. 149.
    Annane D, Sebille V, Troche G, Raphael JC, Gajdos P, Bellissant E. A 3-level prognostic classification in septic shock based on cortisol levels and cortisol response to corticotropin. JAMA 2000; 283(8):1038–1045.PubMedCrossRefGoogle Scholar
  150. 150.
    Rothwell PM, Udwadia ZF, Lawler PG. Cortisol response to corticotropin and survival in septic shock. Lancet 1991; 337(8741):582–583.PubMedCrossRefGoogle Scholar
  151. 151.
    Molijn GJ, Spek JJ, van Uffelen JC, de Jong FH, Brinkmann AO, Bruining HA, et al. Differential adaptation of glucocorticoid sensitivity of peripheral blood mononuclear leukocytes in patients with sepsis or septic shock. J Clin Endocrinol Metab 1995; 80(6):1799–1803.CrossRefGoogle Scholar
  152. 152.
    Annane D, Sebille V, Charpentier C, Bollaert PE, Francois B, Kor_ch JM, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 2002; 288(7):862–871.PubMedCrossRefGoogle Scholar
  153. 153.
    Zeni F, Freeman B, Natanson C. Anti-inflammatory therapies to treat sepsis and septic shock: a reassessment. Crit Care Med 1997; 25(7):1095–1100.PubMedCrossRefGoogle Scholar
  154. 154.
    Wheeler AP, Bernard GR. Treating patients with severe sepsis. N Engl J Med 1999; 340(3):207–214.PubMedCrossRefGoogle Scholar
  155. 155.
    Lorente JA, Garcia-Frade LJ, Landin L, De Pablo R, Torrado C, Renes E, et al. Time course of hemostatic abnormalities in sepsis and its relation to outcome. Chest 1993; 103(5):1536–1542.PubMedCrossRefGoogle Scholar
  156. 156.
    Boldt J, Papsdorf M, Rothe A, Kumle B, Piper S. Changes of the hemostatic network in critically ill patients—is there a difference between sepsis, trauma, and neurosurgery patients? Crit Care Med 2000; 28(2):445–450.PubMedCrossRefGoogle Scholar
  157. 157.
    Powars D, Larsen R, Johnson J, Hulbert T, Sun T, Patch MJ, et al. Epidemic meningococcemia and purpura fulminans with induced protein C deficiency. Clin Infect Dis 1993; 17(2):254–261.PubMedGoogle Scholar
  158. 158.
    Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, et al. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 2001; 344(10):699–709.PubMedCrossRefGoogle Scholar
  159. 159.
    Silen W. Cope’s Early Diagnosis of the Acute Abdomen, 20th ed. New York: Oxford University Press, 2000.Google Scholar
  160. 160.
    de Dombal FT. The OMGE acute abdominal pain survey. Progress report, 1986. Scand J Gastroenterol Suppl 1988; 144:35–42.PubMedGoogle Scholar
  161. 161.
    Boleslawski E, Panis Y, Benoist S, Denet C, Mariani P, Valleur P. Plain abdominal radiography as a routine procedure for acute abdominal pain of the right lower quadrant: prospective evaluation. World J Surg 1999; 23(3):262–264.PubMedCrossRefGoogle Scholar
  162. 162.
    Siewert B, Raptopoulos V, Mueller MF, Rosen MP, Steer M. Impact of CT on diagnosis and management of acute abdomen in patients initially treated without surgery. AJR Am J Roentgenol 1997; 168(1):173–178.PubMedGoogle Scholar
  163. 163.
    Rosen MP, Siewert B, Sands DZ, Bromberg R, Edlow J, Raptopoulos V.Value of abdominal CT in the emergency department for patients with abdominal pain. Eur Radiol 2003; 13(2):418–424.PubMedGoogle Scholar
  164. 164.
    Rozycki GS, Tremblay L, Feliciano DV, Joseph R, DeDelva P, Salomone JP, et al. Three hundred consecutive emergent celiotomies in general surgery patients: influence of advanced diagnostic imaging techniques and procedures on diagnosis. Ann Surg 2002; 235(5):681–688.PubMedCrossRefGoogle Scholar
  165. 165.
    Ahmad TA, Shelbaya E, Razek SA, Mohamed RA, Tajima Y, Ali SM, et al. Experience of laparoscopic management in 100 patients with acute abdomen. Hepatogastroenterology 2001; 48(39):733–736.PubMedGoogle Scholar
  166. 166.
    Cohen SB, Weisz B, Seidman DS, Mashiach S, Lidor AL, Goldenberg M. Accuracy of the preoperative diagnosis in 100 emergency laparoscopies performed due to acute abdomen in nonpregnant women. J Am Assoc Gynecol Laparosc 2001; 8(1):92–94.PubMedCrossRefGoogle Scholar
  167. 167.
    Ou CS, Rowbotham R. Laparoscopic diagnosis and treatment of nontraumatic acute abdominal pain in women. J Laparoendosc Adv Surg Tech A 2000; 10(1):41–45.PubMedCrossRefGoogle Scholar
  168. 168.
    Memon MA, Fitzgibbons RJ, Jr. The role of minimal access surgery in the acute abdomen. Surg Clin North Am 1997; 77(6):1333–1353.PubMedCrossRefGoogle Scholar
  169. 169.
    Geis WP, Kim HC. Use of laparoscopy in the diagnosis and treatment of patients with surgical abdominal sepsis. Surg Endosc 1995; 9(2):178–182.PubMedCrossRefGoogle Scholar
  170. 170.
    Navez B, d’Udekem Y, Cambier E, Richir C, de Pierpont B, Guiot P. Laparoscopy for management of nontraumatic acute abdomen. World J Surg 1995; 19(3):382–386.PubMedCrossRefGoogle Scholar
  171. 171.
    Bender JS, Bouwman DL, Weaver DW. Bleeding gastroduodenal ulcers: improved outcome from a unified surgical approach. Am Surg 1994; 60(5):313–315.PubMedGoogle Scholar
  172. 172.
    Nishida K, Okinaga K, Miyazawa Y, Suzuki K, Tanaka M, Hatano M, et al. Emergency abdominal surgery in patients aged 80 years and older. Surg Today 2000; 30(1): 22–27.PubMedCrossRefGoogle Scholar
  173. 173.
    van Geloven AA, Biesheuvel TH, Luitse JS, Hoitsma HF, Obertop H. Hospital admissions of patients aged over 80 with acute abdominal complaints. Eur J Surg 2000; 166(11):866–871.PubMedCrossRefGoogle Scholar
  174. 174.
    Christou NV, Barie PS, Dellinger EP, Waymack JP, Stone HH. Surgical Infection Society intra-abdominal infection study. Prospective evaluation of management techniques and outcome. Arch Surg 1993; 128(2):193–198.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Louis H. Alarcon
    • 1
  • Andrew B. Peitzman
    • 2
  1. 1.Departments of Critical Care Medicine and SurgeryUniversity of Pittsburgh School of MedicinePittsburghUSA
  2. 2.Department of SurgeryUniversity of PittsburghPittsburghUSA

Personalised recommendations