Treatment Of Traumatic Shock Research Articles

The Clinical Significance of iNOS/NO Signaling Pathway in Traumatic Shock and the Mechanism under the Promotion on the Development of Traumatic Shock via Endoplasmic Reticulum Stress.

This study aims to clarify the clinical significance of the inducible nitric oxide synthase (iNOs)/nitric oxide (NO) signaling pathway and endoplasmic reticulum stress (ERS) in traumatic shock (TS) and the mechanism of action, so as to offer a novel direction for the emergency treatment of TS in the future. The clinical data of 90 patients with TS treated in our hospital between June 2019 and January 2021 were retrospectively analyzed. Patients were divided into mild (n = 30), moderate (n = 30), and severe group (n = 30) based on their disease severity. Furthermore, patients were assigned into Groups A and B for fluid resuscitation based on a pulse index continuous cardiac output (PICCO) monitor and fluid resuscitation based on monitoring results of central venous pressure (CVP) and mean arterial pressure (MAP), respectively. Additionally, the 18 purchased Sprague Dawley (SD) rats were randomized into model (TS model), control (normal rats) and intervention (TS model injected with iNOS inhibitor) groups, with 6 rats each. iNOs and NO levels were measured by colorimetry, and the concentrations of inflammatory factors were quantified using enzyme-linked immunosorbent assays (ELISAs). Polymerase chain reaction (PCR) and western blot were adopted for the quantification of ERS markers (glucose-related protein 78 (GRP78), GRP94 and C/EBP homologous protein (CHOP)), and hematoxylin-eosin (HE) staining of rat cardiac tissue was carried out to observe the pathological state of myocardial tissue. The moderate group showed higher levels of iNOS, NO, GRP78, GRP94 and CHOP than the mild group and lower levels of them than the severe group (all p < 0.05). MAP, extravascular lung water index (EVLWI), pulmonary vascular permeability index (PVPI), and locus control region (LCR) increased in both Groups A and B after resuscitation, with more significant increases of these parameters in Group A. The application of PICCO technique lowered the levels of iNOS, NO, inflammatory factors, GRP78, GRP94 and CHOP in TS patients. In addition, the intervention group had lower levels of iNOS, NO, inflammatory factors, GRP78, GRP94, and CHOP than the model group and higher levels of them than the control group. According to the results of HE staining of myocardial tissue, the intervention group had significantly alleviated myocardial necrosis than the model group, with slightly stained cytoplasm, visible contraction bands in most myocardium, and significantly reduced neutrophil infiltration. iNOS/NO and ERS increase with the severity of TS, and PICCO can effectively lower their levels. The results of animal experiments suggest that the inhibition of iNOS/NO can relieve inflammation and ERS intensification, thus alleviating the progression of TS.

Walter B. Cannon's World War I experience: treatment of traumatic shock then and now.

Walter B. Cannon (1871-1945), perhaps America's preeminent physiologist, volunteered for service with the Army Expeditionary Force (AEF) during World War I. He initially served with Base Hospital No. 5, a unit made up of Harvard clinicians, before moving forward to the front lines to serve at a casualty clearing station run by the British. During his time there, he performed research on wounded soldiers to understand the nature and causes of traumatic shock. Subsequently, Cannon performed animal experimentation on the causes of traumatic shock in the London laboratory of Dr. William Bayliss before being assigned to the AEF Central Medical Laboratory in Dijon, France, where he continued his experimental studies. During this time, he also developed and taught a curriculum on resuscitation of wounded soldiers to medical providers. Although primarily a researcher and teacher, Cannon also performed clinical duties throughout the war, serving with distinction under fire. After the war, Cannon wrote a monograph entitled Traumatic Shock (New York: Appleton, 1923), which encapsulated the knowledge that had been gained during the war, both from direct observation of wounded soldiers, as well as laboratory experimentation on the causes and treatment of traumatic shock. In his monograph, Cannon elucidates a number of principles concerning hemorrhagic shock that were later forgotten, only to be "rediscovered" during the current conflicts in Iraq and Afghanistan. This paper summarizes Cannon's wartime experiences and the knowledge gained concerning traumatic shock during World War I, with a comparison of current combat casualty care practices and knowledge to that which Cannon and his colleagues understood a century ago.

Clinical effects of intensive insulin therapy treating traumatic shock combined with multiple organ dysfunction syndrome

The therapeutic effects of intensive insulin therapy in treatment of traumatic shock combined with multiple organ dysfunction syndrome (MODS) were investigated. A total of 114 patients with traumatic shock combined with MODS were randomly divided into two groups: control group (n=56) treated with conventional therapy, and intensive insulin therapy group (n=58) treated with conventional therapy plus continuous insulin pumping to control the blood glucose level at range of 4.4-6.1 mmol/L. White blood cells (WBC) counts, prothrombin time (PT), serum creatinine (SCr), alanine aminotransferase (ALT), serum albumin and PaO(2) were measured before and at the day 1, 3, 5, 7 and 14 after treatment. The incidence of gastrointestinal dysfunction, the incidence of MODS, hospital stay and the mortality were also observed and compared. After intensive insulin therapy, the WBC counts, SCr, ALT and PT were significantly reduced (P<0.05), but the level of serum albumin was significantly increased (P<0.05) at the day 3, 5, 7 and 14. In the meantime, the PaO2 was significantly elevated at the day 3, 5 and 7 (P<0.01) after intensive insulin therapy. The incidence of gastrointestinal dysfunction, the incidence of MODS, the length of hospital stay and the mortality were markedly decreased (P<0.01). The results suggest early treatment with intensive insulin therapy is effective for traumatic shock combined with MODS and can decrease the length of hospital stay and the mortality.

Effects of a combination hemoglobin based oxygen carrier–hypertonic saline solution on oxygen transport in the treatment of traumatic shock

BackgroundLogistics complicate fluid resuscitation of traumatic shock on the battlefield. Traumatic shock can result in oxygen debt (O2D) accumulation that is fatal. However, the ability of fluid strategies to repay O2D are not commonly reported. This pilot study examined various resuscitation fluids, including a combination of PEGylated bovine hemoglobin and hypertonic saline (AfterShock™) on their ability to repay O2D in traumatic shock. Methods41 anesthetized swine underwent hemorrhage to an O2D of 80mL/kg. Animals received one of the following: 500mL whole blood, 500mL AfterShock™, 500mL hypertonic (7.2%) saline, 250mL hypertonic (7.2%) saline, 500mL Hetastarch (6%), or 500mL lactated Ringer's. Oxygen transport variables (O2D, oxygen consumption, oxygen delivery, central venous hemoglobin oxygen saturation, oxygen extraction ratios), lactate clearance, and survival were monitored for 3h after treatment. Data were analyzed using mixed-model ANOVA and comparisons were made to the performance of whole blood. ResultsOnly animals receiving AfterShock™, 500mL hypertonic saline, and 500mL Hetastarch survived to 180min. While not statistically significant AfterShock™ demonstrated trends in improving the repayment of O2D and in improving oxygen transport variables despite having lower levels of global oxygen delivery compared to whole blood, Hetastarch and 500mL hypertonic saline groups. ConclusionUse of 500mL AfterShock™, 500mL of 7.2% saline or 500mL of Hetastarch resulted in improved short-term survival. While not statistically significant, AfterShock™ demonstrated trends in improving O2D. These findings may have implications for designing resuscitation fluids for combat casualty care.

The role of colloids in resuscitation

Colloids have been used for many years in resuscitation yet few studies have thoroughly examined their usefulness. Colloids and a combination of crystalloids and colloids continue to be used without any real scientific basis. Scrutiny of review articles, experimental studies, and clinical investigations reveals conflicting and confusing data. There are too many variables to accurately interpret findings, cross species problems with animal studies, different fluids used making comparisons difficult if not impossible, and confounding variables that include: 1 Health status of the patients 2 Severity/type of injury 3 Complications (especially sepsis) 4 Varying grades of shock 5 Variable time scale of administration of fluids 6 Variable volumes administered 7 Differing methods of determining fluid volume depletion 8 Inconsistent monitoring 9 Differing endpoints 10 Different techniques to measure endpoints 11 Comparison of delayed treatment of traumatic shock with blood loss occurring during surgery of questionable validity. One of the areas that has been studied reasonably well is the allergic effects associated with colloid use and more recently the adverse effects associated with the use of dextrose solutions in patients with head injuries. The continued effort to develop satisfactory resuscitation solutions including the recent development of hypertonic saline solutions (usually in combination with a colloid) highlights the uncertainty that exists in relation to the true role of the colloid and crystalloid agents available. Recent studies question the use of fluids to resuscitate patients with penetrating torso injuries. The aim of this paper is to review what is known about the use of colloids and crystalloids in resuscitation and to recommend guidelines as to which fluid should be used in differing clinical situations.

On the use of acth for the treatment of traumatic shock

On the use of acth for the treatment of traumatic shock

Denervation of Abdominal Viscera for the Treatment of Traumatic Shock

Denervation of Abdominal Viscera for the Treatment of Traumatic Shock

Comparative experimental studies on the treatment of traumatic shock

Comparative experimental studies on the treatment of traumatic shock

The Antithrombotic Action of Gelatin

PROPERLY prepared gelatin is now regarded as a satisfactory blood substitute within certain limits for the treatment of traumatic shock.1 , 2 Intravenously administered gelatin, however, has been o...

A New Method for the Treatment of Traumatic Shock

A New Method for the Treatment of Traumatic Shock

The Treatment of Traumatic Shock

The Treatment of Traumatic Shock