We were incredibly lucky to have the eminent Dr. Thomas Scalea –Â Francis X. Kelly Professor of Trauma Surgery & Physician-in-Chief at the R Adams Cowley Shock Trauma Center – come to the University of Maryland’s Multidisciplinary Critical Care Conference. Â Dr. Scalea is a world renowned expert in Trauma Critical Care and has been a leader and visionary of critical care medicine and training over the past 20 years. Â In his lecture – Principles of Resuscitation Dr. Scalea gives us a little history, a sound foundation in resuscitation end-points, and a glimpse into the future of how we can better take care of the critically ill patient.
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Pearls
- Unfortunately, the ATLS classification of hemorrhage and shock is just dogma. Â There are no reliable, sequential physiologic changes that occur with acute blood loss.
- Urine output is a poor indicator of shock. Â Early signs of poor perfusion may include oliguria, but normal urine output can occur with both good perfusion and salt wasting nephropathy (high output renal failure)
- Hypotensive resuscitation ends with hemostasis NOT just an operation!
Suggested Reading
- Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001 Nov 8;345(19):1368-77.
- Abramson D, Scalea TM, Hitchcock R, et al. Lactate clearance and survival following injury. J Trauma. 1993 Oct;35(4):584-8; discussion 588-9.
