Cherkas David
Department of Emergency Medicine, Mount Sinai School of Medicine, Elmhurst Hospital Center, New York, NY, USA.
Emerg Med Pract. 2011 Nov;13(11):1-19; quiz 19-20.
A number of concerns have been raised regarding the advisability of the classic principles of aggressive crystalloid resuscitation in traumatic hemorrhagic shock. This issue reviews the advances that have led to a shift in the emergency department (ED) protocols in resuscitation from shock state, including recent literature regarding the new paradigm for the treatment of traumatic hemorrhagic shock, which is most generally known as damage control resuscitation (DCR). Goals and endpoints for resuscitation and a review of initial fluid choice are discussed, along with the coagulopathy of trauma and its management, how to address hemorrhagic shock in traumatic brain injury (TBI), and new pharmacologic treatment for hemorrhagic shock. The primary conclusions include the administration of tranexamic acid (TXA) for all patients with uncontrolled hemorrhage (Class I), the implementation of a massive transfusion protocol (MTP) with fixed blood product ratios (Class II), avoidance of large-volume crystalloid resuscitation (Class III), and appropriate usage of permissive hypotension (Class III). The choice of fluid for initial resuscitation has not been shown to affect outcomes in trauma (Class I).
对于创伤性失血性休克积极晶体复苏的经典原则是否明智，人们提出了一些担忧。本问题回顾了导致急诊科复苏方案从休克状态转变的进展，包括近期关于创伤性失血性休克治疗新范式的文献，该范式通常被称为损伤控制复苏（DCR）。讨论了复苏的目标和终点以及初始液体选择的综述，还讨论了创伤性凝血病及其管理、如何处理创伤性脑损伤（TBI）中的失血性休克以及失血性休克的新药治疗。主要结论包括对所有出血无法控制的患者使用氨甲环酸（TXA）（I级）、实施具有固定血液制品比例的大量输血方案（MTP）（II级）、避免大量晶体复苏（III级）以及适当使用允许性低血压（III级）。初始复苏液体的选择尚未显示会影响创伤患者的预后（I级）。
