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martes, 27 de octubre de 2015

10 mandamientos de la Resucitación

R.E.B:E.L. EM - September 10, 2015 - By Chris Hicks - Peer Reviewed By: Salim Rezaie
"While not much is new in the world of hustlin’, when it comes to trauma resuscitation, the game done changed*. It was easier in the old days: 2L of crystalloid for a hypotensive patient, and then blood. While new science on trauma resuscitation has helped us understand how flawed that paradigm is, the new school can be some tricky water to navigate. From damage control to fibrinogen, from TXA to thromboelastometry, there is no doubt that resuscitating a bleeding trauma patient is a more nuanced endeavor than we originally envisioned it.
So, inspired by Biggie’s Descartesian ten-point discourse on method, I present the ten rules of the contemporary trauma resuscitation game as I see them – backed by science, and occasionally editorialized with personal opinion."
  1. Preventing death from hemorrhage is a team sport, and resuscitationist’s game
  2. If you anticipate the need for more than 3-4 units of packed cells in the first few hours, you’re in it
  3. One in four trauma patients is bleeding abnormally from the get-go – and here’s why
  4. Limit early fluid administration in bleeding patients
  5. Give blood products (red cells, plasma, platelets) in a balanced ratio that mimics that of whole blood
  6. Use a massive transfusion protocol to guide blood component therapy
  7. Give a gram of tranexamic acid early to all patients who you think are bleeding
  8. A fibrinogen of less than 1.0 g/L is an indication for cryoprecipitate
  9. If you resuscitate based on vital signs alone, you will under-resuscitate about 50% of trauma patients
  10. Use a base deficit, delta lactate and urine output to guide ongoing resuscitation
http://rebelem.com/ten-trauma-resuscitation-commandments/