CE: Trauma-Related Hemorrhagic Shock: A Clinical Review.

Optimal management of trauma-related hemorrhagic shock begins at the point of injury and continues throughout all hospital settings. Several procedures developed on the battlefield to treat this condition have been adopted by civilian health care systems and are now used in a number of nonmilitary hospitals. Despite the important role nurses play in caring for patients with trauma-related hemorrhagic shock, much of the literature on this condition is directed toward paramedics and physicians. This article discusses the general principles underlying the pathophysiology and clinical management of trauma-related hemorrhagic shock and updates readers on nursing practices used in its management.

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as an Option for Uncontrolled Hemorrhagic Shock: Current Best Practices and Anesthetic Implications.

Noncompressible torso hemorrhage is reported to be a leading cause of potentially preventable mortality in both civilian trauma victims and military combat casualties. This hemorrhage may come from venous, arterial, or additional combined sources in the chest, abdomen, pelvis, axilla, or groin regions. Aortic occlusion as an adjunct to strategies for trauma damage control can decrease the amount of bleeding distal to the occluded site and provide a time-sensitive opportunity for resuscitation and definitive hemorrhage control. Recently, resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as a temporary hemorrhage control and resuscitation technique that has the advantage of being minimally invasive and may offer improved patient morbidity and mortality compared with the traditional emergency department thoracotomy. An overview of the history of REBOA and indications and contraindications for its use is provided. A placement strategy for this technology, which includes basic suggested insertion techniques and anatomical placement sites, is also provided. Additionally, device-related morbidity and mortality are addressed. Anesthetic implications in the perioperative period are reviewed in light of current best practices. Recommendations are given for future research aimed at refining and improving the care of seriously injured patients who may require this type of lifesaving treatment.

CE: The Use of Resuscitative Endovascular Balloon Occlusion of the Aorta in Treating Hemorrhagic Shock from Severe Trauma.

: Hemorrhage is the leading cause of preventable death in trauma patients. In recent years, technological innovations and research efforts aimed at preventing death from hemorrhagic shock have resulted in the emergence of resuscitative endovascular balloon occlusion of the aorta (REBOA). REBOA offers a less invasive option for emergent hemorrhage control in noncompressible areas of the body without the added risks and morbidities of an ED thoracotomy. This article outlines the procedure and device used, describes the procedure's evolution, and discusses various considerations, pitfalls, and nursing implications.

Fluid therapy and shock: an integrative literature review.

BACKGROUND: shock refers to a physiological situation that puts life at risk. Its early identification and the timely institution of therapeutic measures can avoid death. Despite the frequent administration of fluid therapy as a treatment for shock, the type and dose of fluids to be delivered remain undetermined. AIM: to determine the type of fluids to be administered and the type of approach to be performed in the different types of shock. METHOD: integrative literature review. RESULTS: data about fluid therapy in hypovolaemic and distributive shock were obtained, specifically in the haemorrhagic and the septic types. None of the articles addressed cardiogenic shock. CONCLUSION: hypotensive resuscitation, with blood, is the most appropriate approach in haemorrhagic shock. There remains a question regarding the best approach in septic shock. However, conservative fluid therapy seems to be appropriate, with preference given to the administration of balanced crystalloids or albumin as an alternative.

Nursing Procedures in Dealing with Haemorrhagic Shock.

Sophie assesses a patient whose condition is deteriorating. She manages the critical situation in conjunction with the doctor on duty.

Massive transfusion for hemorrhagic shock: what every critical care nurse needs to know.

Massive transfusion is defined as complete replacement of a patient's blood volume or approximately 10 units of packed red blood cells within a 24-hour period or one red blood cells volume in 24 hours for a pediatric patient. This article reviews the most recent understanding and recommendations in massive transfusion along with the unintended consequences in the management of patients with profound hemorrhage.

[Physiopathology of multiple trauma]. / Physiopathologie du polytraumatisme.

Multiple trauma is a complex entity that can be life-threatening. It is essential to understand the links between injuries and intervene as quickly as possible to provide the cells with a constant and appropriate supply of oxygen in order to prevent irreversible damage.

[Multi-trauma patients undergoing shock management]. / Le patient polytraumatisé en situation de "déchocage".

Multi-trauma patients need specific care provided by medical teams and hospitals with a technical platform that optimises emergency care.They also require a special 'shock management' unit with staff members available to welcome these patients and maintain their vital functions.

[Fluid resuscitation therapy application and nursing following hemorrhagic shock].

Hemorrhagic shock is the most important cause of early death following major trauma. Aggressive fluid resuscitation therapy is an important treatment approach for hemorrhagic shock, and nurses in critical care units must be adept at the skills to administer such. However, past studies have shown that failure in multiple organs has been induced by aggressive fluid resuscitation therapy. This article first discusses the two hit theory following trauma or shock, then discusses how aggressive crystalloid-based resuscitation strategies are associated with cell, multiple organs and immunological and inflammatory mediator dysfunction. While the Advanced Trauma Life Support (ATLS) training program has provided fluid resuscitation therapy guidelines since 1997, resuscitation volume, rate and time as well as crystalloid and colloid ratios remain uncertain. Therefore, we hope this article can provide evidence-based knowledge related to fluid resuscitation therapy in order to avoid secondary organ damage in critical care.

Nurse-aid management of hypovolaemic shock.

Shock is a potentially life-threatening situation and the nurse aider must therefore be able to recognize its development and take immediate action. This article describes the actions that a nurse aider must take at the scene of an accident.

Fluid resuscitation following multiple trauma.

The initial minutes and hours of nursing care of the trauma victim make a critical difference in the patient's chance for recovery. The critical care and ED nurse's ability to provide fluid resuscitation rapidly to augment the patient's flagging vascular volume is critical to the maintenance of circulation. By administering the most appropriate solution to meet the trauma patient's physiologic requirements, the nurse ensures that the patient will have an adequate circulating volume to meet the oxygenation and nutritional requirements of body tissues. Early, rapid fluid resuscitation is essential to stave off noncompensatory, irreversible shock. By implementing specific nursing care strategies to increase the flow of IV solutions to the patient, the nurse combats the nursing diagnosis appropriate for almost every multiple trauma victim: Fluid Volume Deficit.