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Trauma Care

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patients with septic shock. The downside of phenylephrine is that it increases oxygen consumption and may decrease the cardiac output. It is a good choice when the patient is at high risk for tachyarrhythmias.

Most septic shock patients respond well to an increase in fluid volume alone so that the use of vasopressors is not always needed. The goal is to maintain oxygen delivery to the tissues using volume resuscitation first, followed by vasopressors if volume resuscitation doesn’t provide good tissue perfusion. Besides dopamine, norepinephrine, phenylephrine, and epinephrine, dobutamine can be used to maximize tissue perfusion.

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Corticosteroids are often used in the treatment of shock even though it has not been found to be effective in reducing shock, improving mortality, or preventing infection. The routine use of corticosteroids in shock patients isn’t recommended at this time. Patients with refractory shock can be tried on intravenous hydrocortisone for up to a week or until vasopressors are no longer necessary to keep the patient’s blood pressure in the normal range.

The initial evaluation and management of a critically injured patient suffering from multiple trauma can be challenging. In the past few decades, there has been an improvement in the understanding of what goes on when a patient is injured and multiple organ systems are involved so that the mortality rate has declined dramatically.

Deaths from trauma can be immediate, early, or late. Patients who die immediately generally have irreversible injury to the great vessels, heart, or brain. The patient generally dies at the scene of the trauma and is never treated in the emergency department. In some cases, these deaths can be prevented by maximizing resuscitative efforts at the scene.

Early deaths from trauma occur within minutes to several hours following the injury. These patients usually make it to the emergency department and suffer death from overwhelming hemorrhage or cardiovascular collapse that is unresponsive to resuscitative efforts. Late deaths from trauma happen days to weeks after the injury. Adequate critical care is necessary to avert these types of deaths.

Early deaths secondary to trauma stem from failure to oxygenate the vital organs, from severe trauma to the nervous system, infectious diseases, or a combination of these. Things like inadequate oxygenation, poor ventilation, circulatory collapse, and lack of perfusion of end-organs contribute to the patient’s demise. In cases of severe CNS trauma, signals to the heart and lungs are impaired and the patient cannot oxygenate or perfuse their organs.

Early trauma deaths depend on the patient’s age, gender, body habitus, or the environmental conditions surrounding the trauma. Patients who suffer trauma in rural areas have delayed access to trauma care and are at a greater risk of early trauma deaths. The development of the Advanced Trauma Life Support system has improved mortality because rural providers and ambulance personnel have begun to be trained using approaches developed by ATLS. Using ATLS protocols consistently has provided for the best resuscitation of patients with life-threatening injuries. The evaluation and treatment of trauma patients come down to quickly finding those injuries that are life-threatening, adequately supporting,

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