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Wilderness Environ Med. 2017 Jun;28(2S):S124-S134. doi: 10.1016/j.wem.2017.02.002.

Remote Damage Control Resuscitation in Austere Environments.

Author information

1
Center for Translational Injury Research, University of Texas Health Science Center, Houston, TX; Department of Surgery, University of Texas Health Science Center, Houston, TX (Drs Chang and Holcomb). Electronic address: ronald.chang@uth.tmc.edu.
2
Department of Surgery, University of Texas Health Science Center, San Antonio, TX (Dr Eastridge).
3
Center for Translational Injury Research, University of Texas Health Science Center, Houston, TX; Department of Surgery, University of Texas Health Science Center, Houston, TX (Drs Chang and Holcomb).

Abstract

Hemorrhage is the leading cause of preventable military and civilian trauma death. Damage control resuscitation with concomitant mechanical hemorrhage control has become the preferred in-hospital treatment of hemorrhagic shock. In particular, plasma-based resuscitation with decreased volumes of crystalloids and artificial colloids as part of damage control resuscitation has improved outcomes in the military and civilian sectors. However, translation of these principles and techniques to the prehospital, remote, and austere environments, known as remote damage control resuscitation, is challenging given the resource limitations in these settings. Rapid administration of tranexamic acid and reconstituted freeze-dried (lyophilized) plasma as early as the point of injury are feasible and likely beneficial, but comparative studies in the literature are lacking. Whole blood is likely the best fluid therapy for traumatic hemorrhagic shock, but logistical hurdles need to be addressed. Rapid control of external hemorrhage with hemostatic dressings and extremity tourniquets are proven therapies, but control of noncompressible hemorrhage (ie, torso hemorrhage) remains a significant challenge.

KEYWORDS:

hemorrhage; hemorrhagic shock; remote damage control resuscitation

PMID:
28601205
PMCID:
PMC5608023
DOI:
10.1016/j.wem.2017.02.002
[Indexed for MEDLINE]
Free PMC Article

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