"Damage Control Resuscitation"' is an impressive example of a paper on injuries and wounds. The review by Major Alec C. Beekley seeks to identify the effective ways of resuscitation, especially towards the patients of increased or grievous injuries. This is via the utilization of the techniques drawn from the military settings on the effective resuscitation techniques. On focus is the most effective methodologies for deployment during resuscitation procedures being performed under civilian settings. The focus of the review is to reduce the fatalities associated with massive blood transfusions. Background The art of resuscitation has evolved over the years with the central am being the improvement of the response according to the patients necessitating blood transfusion.
The driving force behind the advancement lies in the desire to control the number of fatalities registered under the patients necessitating massive transfusions. On reference is the appropriate ratios of supportive blood components that are desired to be packaged with the erythrocytes. The main focus is the ratios of the platelets to erythrocytes and that of plasma to erythrocytes. The central concern in this expedition is the occurrence of three phenomena, that is acidosis, coagulopathy, and hypothermia (jointly referred to as the ‘ lethal triad’ ). Methodology Current techniques do not favor the prevention of early deaths as a result of hemorrhage. The author of the review shares the opinion that the development calls for the inclusion of alternative approaches to supplement the pre-existing methodologies.
He proceeds to identify several techniques and methodologies that he feels appropriate for the supplement task. Amongst them is the techniques utilized in the incidence of permissive hypotension. This is a technique fetched from the military settings and reflects on the occurrence of a traumatizing moment in a patient that withholds excessive bleeding.
The strategic procedure seeks to reduce hypertension prior to the engagement of surgical based hemorrhage control. In such settings, the author quotes the doctrines of military medicine which calls for a reduced or minimized fluid and blood-based product admission. The author proceeds to reflect on another technique deployed in the occasions of hyperthermia. In such a situation, the effects associated with hypothermia especially towards the cases of coagulation are unreasonable. Key concerns imply the occurrence of occasions related to hypothermia such as reduced metabolic activity.
Amongst the control measures that have provided increased positive response while in the military medical field includes ensuring the body temperature of the patient is boost d. This is achieved via the utilization of additional clothes, as well as ensuring the exposed parts are only the injured parts and those that are under medication. The other also reflects on other settings upon which the boost of internal body temperature can be achieved. Amongst this is the cardiopulmonary bypass. Another proposed military technique s the acidosis.
This involves the restriction or the adjustment of the blood pH to a considerable level. The author is rather categorical to enlist findings of studies by other authors that have indicated the effects of acidosis on the platelet activity, especially their generation. On consideration is the incidents amounting from cases of worsening acidosis via the utilization of extreme alternatives. This may result in fatal results, thus calling for increased cases of vigilance. Such measures can be observed via the introduction of regulatory measures under various incursions.
A typical example of cases that exhibit increased acidosis is the hypoventilation. Prevention of this occasion may lead o a reduced mortality rate. Another technique deployed reflects on the selection of the resuscitation fluid. Amongst the ‘ tetrad lethal’ elements, coagulopathy remains the central course of concern over patient fatality. However, unlike the other two counterparts, the author is rather categorical that there are a variety of ways upon which the situation can be controlled. Apparently, coagulopathy is the most readily treatable syndrome. Progressively, other alternatives that seek towards establishing rapid solutions include a full blood transfusion.
This is coupled with a series of complications, especially towards the quality of the blood and MHC matching. In the quest to develop a rather simplified and safe method, the adoption of blood product ratios is proposed. This focuses on the packaging of erythrocytes and other vital blood necessities such as platelets and plasma. However, the main challenge is achieved over the appropriate ratios upon which the ratios can be modified. There exist pre-established ratios that have been found to bring out favorable results. Another topic the author proposes is the use of Recombinant Factor VIIa.
However, the author is rather categorical to state its shortcomings. This is grossly founded on the fact that the majority of the findings under this study have not been discussed yet. Results Apparently, for one to ensure effective and appropriate results while operating under the civilian settings, the identification of the appropriate candidate is eminent. This enables the identification of the appropriate methodology to place into consideration, as well as offering ample time for sample preparation. Some techniques are rather time-consuming during the preparation time, for example, blood product delivery.
In this regard, the information about the patient destined to receive the delivery needs to be communicated in advance. For effective results, a combination of strategies may be adopted. In this regard, there needs to be the establishment of the preferred rate of each of the drugs, especially with regards to the sequence of performance and efficacy. Progressively, the isolation of quantifying elements in a patent is mandatory, as well. This facilitates the quantification of the appropriate methodologies to apply during resuscitation. Conclusion The methodologies discussed are readily utilized under military settings; however, they can also be utilized under civilian-based clinical settings. The essential aspect towards the realization of their success revolves around the preparation of the medics at hand, especially towards the quantification of the appropriate symptoms that call for the invoke of a given procedure. Comment The review focuses on a wide approach to techniques deployed from military settings.
Their preference is based on the proposal by the author upon identifying their possible contribution towards resuscitation. However, the author could have developed a rather advanced solution if only he had compared the existing solutions deployed towards resuscitation under civilian settings.
The review seems to lean towards the assumption that the military based techniques are superior to the techniques deployed by civilian medics under contemporary settings.
ReferencesBeekley, A. Damage control resuscitation: A sensible approach to the exsanguinating surgical patient. Crit Care Med: 2008. Vol. 36, No. 7 (Suppl.)