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The prehospital treatment of the bleeding patient—Dare to dream

2012; Elsevier BV; Volume: 180; Issue: 2 Linguagem: Inglês

10.1016/j.jss.2011.12.022

1095-8673

Chet A. Morrison,

Trauma Management and Diagnosis

Traumatic injuries have been with us since the beginning of civilization and not surprisingly are the topic of the oldest known medical document—the ‘Edwin Smith papyrus [ [1] Feldman R.P. Goodrich J.T. The Edwin Smith surgical papyrus. Child's Nerv Syst. 1999; 15: 281 Crossref Scopus (37) Google Scholar ]. Numerous advances in the care of the injured patient have been accomplished with contributions made from virtually all aspects of surgical research. Nevertheless, there is still a notable fatality rate from patients who are encountered alive but die during prehospital care and transport; this problem is particularly acute in the military setting where as many as 90% of military casualties who die in combat die prior to reaching care [ [2] Holcomb J.B. Methods for improved hemorrhage control. Crit Care. 2004; 8: S57 Crossref PubMed Scopus (92) Google Scholar ]. Thus, it is a worthwhile effort to develop treatments that could alter this mortality; from prehospital administered hemostatic dressings, injections of hemostatic substances in to wounds, and high energy frequency ultrasound, effort continues on this worthwhile goal [ 3 Keirabadi B.S. Edens Jason W. et al. Comparison of new hemostatic granules/powders with currently deployed hemostatic products in a lethal model of extremity arterial hemorrhage in swine. J Trauma. 2009; 66: 316 Crossref PubMed Scopus (4) Google Scholar , 4 Wright F.L. Hua H.T. Velmahos G. et al. Intracorporeal use of the hemostatic agent quickclot in a coagulopathic patient with combined thoracoabdominal penetrating Trauma. J Trauma. 2004; 56: 205 Crossref PubMed Scopus (53) Google Scholar , 5 Cornejo C. Vaezy S. Jurkovich G.J. et al. High-intensity ultrasound treatment of blunt abdominal solid organ injury: An animal model. J Trauma. 2004; 57: 152 Crossref PubMed Scopus (15) Google Scholar ].