The prehospital treatment of the bleeding patient—Dare to dream

Abstract

E-mail address: chet.morrison@hc.msu.e 0022-4804/$ e see front matter a 2013 Elsev doi:10.1016/j.jss.2011.12.022 Traumatic injuries have been with us since the beginning of civilization and not surprisingly are the topic of the oldest known medical documentdthe ‘Edwin Smith papyrus [1]. Numerous advances in the care of the injured patient have been accomplished with contributionsmade from virtually all aspects of surgical research. Nevertheless, there is still a notable fatality rate frompatientswho are encountered alive but die during prehospital care and transport; this problem is particularly acute in the military setting where as many as 90% of military casualties who die in combat die prior to reaching care [2]. Thus, it is a worthwhile effort to develop treatments that could alter this mortality; from prehospital administered hemostatic dressings, injections of hemostatic substances in to wounds, and high energy frequency ultrasound, effort continues on this worthwhile goal [3e5]. For an elegant study demonstrating a different approach, we turn to the current paper, by Dr. Ahmadi-Noorbakhsh and colleagues [6]. In this study, a technique of intraperitoneal fluid or gas administration was used in a rabbit model of intraperitoneal hemorrhage secondary to induced hepatic injury. Using an elegant experimental technique, the authors demonstrated that infusion of either carbon dioxide gas or peritoneal dialysate solution was associated with reduced blood loss and improved blood pressure in these animals, although there was an increased acidosis in the animals that received the