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52bravo
08-24-2005, 04:51
what do you do?
we all know it is NPO, but whan you are long way from FST CSH or other MF, what do you then.

i will give fluid PO as long as thay can drink it self, but do enny have some guidsline? backgroud?

cbare
08-24-2005, 14:38
It is very hard to say given the scenario. Allot of what you will do will depend on the extent of injuries, amount of supplies on hand, number of casualties and their injuries, and the clinical presentation of the patient in question. People with extensive hepatic, renal, splenic, and vascular injuries need definitive care (surgery), so in amultiple casualty situation a patient with unstable vital signs and penetrating abdominal trauma may recieve less attention than casualties with more controllable problems, ie extremity hemorrhage. The US Army Casualty Care Course (TC3) may start teaching that careful oral rehydration of trauma patients with a stable airway, intact mentation, and lack of nausea can benefit the patients. I do not know if this is officially being taught but I have the information and proposed updates, and was taught this in a reacent TC3 train the trainer course that I attended. The rationale behind keeping trauma patients NPO is related to two things, 1. Keeping an empty stomach to reduce problems with gastric regurgitation during intubation, and prevent airway collapse from gastric regurgitation, or emesis in a nauseated trauma patient. I guess it really comes down to doing what you can given the situation. If you are intrested I would be more than happy to email some of the TC3 information to you. I hope this helps, cbare.

Sacamuelas
08-24-2005, 16:31
We should wait til Swatsurgeon or Doc T chime in with the REAL expert opinion on this issue of oral rehydration for trauma.... however, I have a thought or two that might not have been considered in this thread.

Along with the already mentioned contraindications about potential vomiting during intubation and/or aspiration risks during intubation...

With a patient who presents with penetrating abdominal wounds, one constant that will be encountered in one form or another with this patient is some degree of shock. The physiology involved in shock causes an initial sympathetic nervous system discharge which leads to aggressive vasoconstriction of the GI arterioles. This causes a significant decrease in blood flow to the GI area. This limits the amount of the resuscitation fluids that can readily diffuse into the circulatory system.

Another factor seen in patients in later stages of shock is generalized cellular deterioration which includes a diminished ability to actively transport ions across the cell membranes. This is important as this active transfer of ions through the gut wall facilitates the isosmotic diffusion of h20 across the gut wall and into the circulatory system. Without this active transport process, H20 is not as easily or quickly absorbed as the chime inside the intestines would have a higher osmolarity than in the circulatory system in that area. This would prevent diffusion of water into the circulatory system.

When you get both these factors working together, it decreases the benefit of giving PO fluids to a severe trauma patient, especially when you weigh in the contraindications.

Course', I could be wrong as the physiology is rarely as simple as I describe in the above. Let's wait and here from some of our trauma experts. :munchin

52bravo
08-25-2005, 04:43
i know of the physiology in shock and GI, but not all in shock so the GI shut down is not alway total.
another thing it is not for shock resus, you can only take around 1000cc/h over the GI some if you realy bleed nop help there.

it more in long evac time for hydration, if you dont drink for 5-6h, you dont get better.