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Peri-operative strategy in resuscitation of unstable injured surgical patients: a primer
Shahad Abdulkhaleq Mamalchi1, Maher Matar2, Gary Alan Bass3
1Royal College of Surgeons in Ireland Medical University of Bahrain, Adliya, Bahrain.
Insights
This review offers surgical trainees a framework for trauma resuscitation, emphasizing balanced fluid therapy and damage control surgery (DCS) for better patient outcomes in critical care settings.
Area of Science:
- Trauma Care and Surgical Education
- Emergency Medicine and Critical Care
Background:
- Trauma is a leading cause of death globally, particularly for individuals under 40.
- Effective peri-operative resuscitation is critical for unstable trauma patients.
- The Advanced Trauma Life Support (ATLS) protocol guides initial management, focusing on hemorrhage control.
Purpose of the Study:
- To provide surgical trainees with a structured, evidence-based educational framework for trauma resuscitation.
- To outline key principles in peri-operative trauma management, including fluid therapy and damage control surgery (DCS).
Main Methods:
- A comprehensive literature search was conducted using PubMed and Google Scholar (2000-2024).
- Thematic analysis was used to organize findings on historical perspectives, evidence-based practices, and DCS.
- 55 relevant English-language studies were selected and reviewed.
Main Results:
- Balanced administration of fluids and blood products is crucial.
- Permissive hypotension is a key strategy in managing hemorrhagic shock.
- Damage Control Surgery (DCS) principles are vital for improving outcomes in severe trauma.
Conclusions:
- This review serves as an educational resource for surgical trainees on evidence-based trauma resuscitation.
- Integrating historical context, modern practices, and technology enhances management of unstable trauma patients.
- Interdisciplinary teamwork and personalized strategies are essential for improving clinical outcomes.
Background:
Trauma remains a leading cause of death, both for individuals under 40 in North America, and globally, where it contributes to ~10% of deaths annually. Thoughtful, timely, balanced resuscitation, especially in the peri-operative period for unstable injured surgical patients, is vital for optimizing outcomes. The advanced trauma life support protocol plays a pivotal role in early evaluation and management, emphasizing hemorrhage control and resuscitation strategies.
Objective:
This narrative review provides a structured, evidence-based framework aimed at enhancing the educational experience of surgical trainees. It outlines key principles in peri-operative trauma resuscitation, emphasizing timely intervention, goal-directed fluid therapy, and damage control surgery (DCS) to improve patient outcomes.
Methods:
A comprehensive Scale for Quality Assessment of Narrative Review Articles -guideline compliant literature search was conducted using PubMed and Google Scholar for English-language articles published between January 2000 and February 2024. The search included relevant medical subject headings terms. Additional studies were identified from reference lists. Extracted data were reviewed and organized using thematic analysis, focusing on historical perspectives, evidence-based practices, and the concept of DCS.
Results:
Key findings from the 55 relevant studies selected underscore the importance of balanced fluid and blood product administration, the use of permissive hypotension in hemorrhagic shock, and the application of DCS principles. This review highlights educational strategies that foster a deeper understanding of trauma resuscitation practices, offering practical insights through case studies and technological innovations.
Conclusion:
This review serves as an educational resource for surgical trainees, equipping them with a robust understanding of evidence-based trauma resuscitation. By integrating historical context, modern practices, and emerging technologies, the review aims to enhance both the theoretical knowledge and practical skills necessary for managing unstable trauma patients. Emphasis is placed on interdisciplinary teamwork, continuous education, and personalized resuscitation strategies to improve clinical outcomes.
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