Hypotensive+Resuscitaon+For++ PROLONGED+ EVACULATION+...
Transcript of Hypotensive+Resuscitaon+For++ PROLONGED+ EVACULATION+...
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Hypotensive Resuscita0on For PROLONGED EVACULATION
Time is the Enemy
Kevin Ward, MD
University of Michigan
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Why???
Prevent “Iatrogenic” Exsanguina4on Reduce Coagulopathy and Organ Failure
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Trade-‐Off
Sudden Cardiovascular Collapse Irreversible Shock
Worsening Organ Failure Worsening of TBI
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Makes Me Nervous About Hypotensive Resuscita0on (Prolonged)
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Big Differences/Ques0ons
• Civilian Urban Trauma Centers • Good EMS Systems: Rapid response and transport
• Damage Control Resuscita0on • Massive Transfusion Protocols
• Probably Why Hypertonic Saline Trial Showed No Difference
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Field Issues Impact on Execu0on • Following Mental Status – TBI vs. Concussion vs. Analgesic effects – Need Minimal Coronary and Cerebral Perfusion Pressure • Once under it very difficult if not impossible to recover
• For pulse character: What about pain, bradycardic paradox
• Compressible vs. Noncompressible Hemorrhage – Penetra0ng, Blunt, Blast
• Lung Injury and Hypoxemia • Oxygen Debt Prior to Injury (physical ac0vity) • Even with In-‐Field Blood or Plasma what about Blood Pressure Overshoot?
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Knowledge and Technology GAPS
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What Would We Need for a Balanced Approach
• New Methods of Hemostasis • High fidelity Vital Sign Monitor – Con0nuous NIBP
• Metabolic Monitoring – StO2, , Lactate, HRV, VO2
• Small volume-‐Blood-‐Plasma • New Metabolic Therapies