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View Full Version : Doc, right or wrong or a little of both?


MAB32
06-30-2013, 16:19
Is this Doctor right or wrong or a little of both? This is as far as his fluid replacement. NOTE: Some graphic photos.

www.youtube.com/watch?v=tku8YI68-JA

swatsurgeon
06-30-2013, 16:55
What we have learned from military surgical procedures for penetrating trauma is, and I will use my own phrase, : red and yellow save a fellow, clear can kill you.
Packed red blood cells and Fresh frozen plasma in a 1:1 or 1:1.5 ratio does the best job with platelets every 6th unit blood given. Limiting the IVF to less than 2 liters for my cases is the goal and patients do better.
The anesthesiologist has too much IVF for that case IMO. We are also using adjuncts; TXA, PCC, Factor VIIa, etc.
That video has been around and I always enjoy those docs or others that have never operated on the human body explaining just how the body reacts, looks and is injured from their vantage point.

ss

MAB32
06-30-2013, 18:18
Thanks ss!

miclo18d
07-01-2013, 10:53
This doc was spot on with modern medicine techniques (not sharpshooting specific doses, calibers, weapons and such). This was TCCC that I was learning in 2000 at SOCM/SFMS. The Blood/platelet/clotting factor stuff started gaining traction in TCCC around 2005-2006. Wound ballistics info was consistent from when I went to SOT in 93 and 18D course in 2000.

Fluid replacement theory is that clotting factors work better at lower pressures (below 90mmHg) than higher pressures that tend to blow the clot out. You sustain your Pt at lower Systolic BP so that the wound can clot faster and better. As far as pre-op care goes we do this with Tourniquets and monitoring BP with IV therapy titrated to maintain proper BP.

He mentioned an important factor that I have stressed in other medical threads and that is WATER DOES NOT TRANSPORT OXYGEN. Stop bleeding immediately, use fluids to maintain BP, but get blood into the Pt ASAP.

Something else I found of good value was the explanation of entrance/exit wounds. Bullets do crazy things and you will not always get the --entrance here...straight thru...exit here-- Get as much of the clothing off of your Pt so you can find ANY injury and get the holes plugged!