2.50
Hdl Handle:
http://hdl.handle.net/10755/163058
Type:
Presentation
Title:
Fluid Resuscitation in Hypovolemic Trauma Patients
Abstract:
Fluid Resuscitation in Hypovolemic Trauma Patients
Conference Sponsor:Emergency Nurses Association
Conference Year:2004
Author:Moeller, Marylou, RN, BSN
P.I. Institution Name:Southeastern Regional Trauma & Emergency Network - New Hanover Regional Medical Center
Title:SERTEN Project Manager (Southeastern Regional Trauma & Emergency Network)
Contact Address:2131 South 17th Street, Wilmington, NC, 28402, USA
Contact Telephone:(910) 342-3219
Purpose: Traditional fluid resuscitation in hypovolemic trauma patients required aggressive infusion of
large fluid volumes. Cannulation with two large-bore wide-open intravenous lines was the standard of practice.
Evolving evidence suggests that this aggressive resuscitation may be harmful by causing increased
hemorrhage, clot dissolution, and disruption of the clotting cascade; thus leading to greater mortality. The
purpose of this study was to determine if there is a relationship between patient mortality and the amount
of fluid administered in the prehospital setting to hypovolemic penetrating trauma patients, controlling for
systolic blood pressure (SBP).
Design/Setting: A retrospective chart review using the National Trauma Registry of the American College
of Surgeons (NTRACS) was conducted at a large regional Level II trauma center in Southeastern North
Carolina. IRB approval was received prior to the initiation of this project.
Sample: Records of 69 patients who had sustained penetrating trauma and were treated in the emergency
department between January 1, 1998 and May 31, 2003 were reviewed for inclusion in the study. Inclusion
criteria were: 1) patient data included in Trauma Registry; 2) an Injury Severity Score (ISS) = 16; 3) a prehospital
SBP = 90; and 4) transport via EMS to the trauma center. Private vehicle transports were excluded.
Twenty-five out of 69 patients met the study criteria.
Methodology: The 25 eligible (hypotensive-penetrating trauma) patients were stratified by the fluid
amount given (< 500 ml, 500 to 2000 ml) in the pre-hospital setting and then stratified by the SBP upon
arrival to the emergency department (< 110, > 110). Logistic regression on mortality by assorted patient
characteristics of the four groups is being performed.
Results: Patients receiving < 500 ml of fluid before arrival to the emergency department with an initial ED
blood pressure of < 110 had lower mortality rates, i.e., 36% of these patients died as compared to 75%
mortality in patients with the same amount of fluids but with systolic blood pressures equal or greater
than 110. Patients receiving 500 to 2000 ml of fluid in the prehospital setting, with an initial ED systolic
blood pressure of < 110 had a higher mortality rate, i.e., 71% of these patients died, compared to 33% mortality
in patients with the same amount of fluids but with systolic blood pressure = 110.
Conclusions: Hypovolemic penetrating trauma patients had increased survival rates with lower SBP and
limited amounts of fluid resuscitation. Further research is needed, in light of the small sample size, as intuitively
one might expect the opposite of these results to occur. Specifically, possible confounding variables,
such as patient size, normal baseline BP, length of time in the prehospital setting, etc., must be analyzed to
describe this data more accurately. [Poster Presentation]
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleFluid Resuscitation in Hypovolemic Trauma Patientsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/163058-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Fluid Resuscitation in Hypovolemic Trauma Patients</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2004</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Moeller, Marylou, RN, BSN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Southeastern Regional Trauma &amp; Emergency Network - New Hanover Regional Medical Center</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">SERTEN Project Manager (Southeastern Regional Trauma &amp; Emergency Network)</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">2131 South 17th Street, Wilmington, NC, 28402, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(910) 342-3219</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">Marylou.Moeller@nhhn.org</td></tr><tr><td colspan="2" class="item-abstract">Purpose: Traditional fluid resuscitation in hypovolemic trauma patients required aggressive infusion of<br/>large fluid volumes. Cannulation with two large-bore wide-open intravenous lines was the standard of practice.<br/>Evolving evidence suggests that this aggressive resuscitation may be harmful by causing increased<br/>hemorrhage, clot dissolution, and disruption of the clotting cascade; thus leading to greater mortality. The<br/>purpose of this study was to determine if there is a relationship between patient mortality and the amount<br/>of fluid administered in the prehospital setting to hypovolemic penetrating trauma patients, controlling for<br/>systolic blood pressure (SBP).<br/>Design/Setting: A retrospective chart review using the National Trauma Registry of the American College<br/>of Surgeons (NTRACS) was conducted at a large regional Level II trauma center in Southeastern North<br/>Carolina. IRB approval was received prior to the initiation of this project.<br/>Sample: Records of 69 patients who had sustained penetrating trauma and were treated in the emergency<br/>department between January 1, 1998 and May 31, 2003 were reviewed for inclusion in the study. Inclusion<br/>criteria were: 1) patient data included in Trauma Registry; 2) an Injury Severity Score (ISS) = 16; 3) a prehospital<br/>SBP = 90; and 4) transport via EMS to the trauma center. Private vehicle transports were excluded.<br/>Twenty-five out of 69 patients met the study criteria.<br/>Methodology: The 25 eligible (hypotensive-penetrating trauma) patients were stratified by the fluid<br/>amount given (&lt; 500 ml, 500 to 2000 ml) in the pre-hospital setting and then stratified by the SBP upon<br/>arrival to the emergency department (&lt; 110, &gt; 110). Logistic regression on mortality by assorted patient<br/>characteristics of the four groups is being performed.<br/>Results: Patients receiving &lt; 500 ml of fluid before arrival to the emergency department with an initial ED<br/>blood pressure of &lt; 110 had lower mortality rates, i.e., 36% of these patients died as compared to 75%<br/>mortality in patients with the same amount of fluids but with systolic blood pressures equal or greater<br/>than 110. Patients receiving 500 to 2000 ml of fluid in the prehospital setting, with an initial ED systolic<br/>blood pressure of &lt; 110 had a higher mortality rate, i.e., 71% of these patients died, compared to 33% mortality<br/>in patients with the same amount of fluids but with systolic blood pressure = 110.<br/>Conclusions: Hypovolemic penetrating trauma patients had increased survival rates with lower SBP and<br/>limited amounts of fluid resuscitation. Further research is needed, in light of the small sample size, as intuitively<br/>one might expect the opposite of these results to occur. Specifically, possible confounding variables,<br/>such as patient size, normal baseline BP, length of time in the prehospital setting, etc., must be analyzed to<br/>describe this data more accurately. [Poster Presentation]</td></tr></table>en_GB
dc.date.available2011-10-27T10:38:51Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:38:51Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.