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Old 06-30-2013, 15:19   #1
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Doc, right or wrong or a little of both?

Is this Doctor right or wrong or a little of both? This is as far as his fluid replacement. NOTE: Some graphic photos.


Last edited by MAB32; 06-30-2013 at 15:22.
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Old 06-30-2013, 15:55   #2
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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.

'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )

Education is the anti-ignorance we all need to better treat our patients. ss, 2008.

The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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Old 06-30-2013, 17:18   #3
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Thanks ss!
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Old 07-01-2013, 09:53   #4
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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!
"The rifle itself has no moral stature, since it has no will of its own. Naturally, it may be used by evil men for evil purposes, but there are more good men than evil, and while the latter cannot be persuaded to the path of righteousness by propaganda, they can certainly be corrected by good men with rifles." Jeff Cooper
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