Coagulopathy of Trauma & 1:1:1 for dr. Karim Brohi

[IVAN HRONEK]

Dr. Brohi and all, these are the voices for 1:1:1.... as to the question a few weeks ago..http://www.usaisr.amedd.army.mil/gwot/Holcomb_Damage%20Control%20Resuscitation.pdf

> From: mgstein at bezeqint.net> To: trauma-list at trauma.org> Date: Sun, 26 Aug 2007 20:17:04 +0300> Subject: RE: crush injury> > Hi Ross and list....> > Sorry for the awkward format of my last mail.> > Here is an abstract of the article (to repent).> > Mickey> > > > > > > > The Journal of Trauma: Injury, Infection, and Critical Care:Volume> 40(1)January 1996pp 27-30 > > Beaten to Death: Why Do They Die?> > [Current Opinion]> > Hiss, Jehuda MD; Kahana, Tzipi MSc; Kugel, Chen MD> > > > >From the L. Greenberg Institute of Forensic Medicine (J.H., C.K.)> (affiliated with the Sackler Faculty of Medicine), Tel-Aviv, Israel; and the> Israel National Police (T.K.), Israel Police Head Quarters, Division of> Identification and Forensic Science, Investigations Department, Jerusalem,> Israel.> > > > Address for reprints: Tzipi Kahana, 67 Ben Zvi, P. O. Box 49015, Tel-Aviv> 61490, Israel.> > > > Abstract > > The remains of 53 men that had been beaten to death were examined. Six> (11.3%) died of either blood aspiration or intracranial hemorrhage; 15 of> the cases (28.3%) succumbed to hypovolemic shock, and 32 of the cases> (60.4%) died of fat embolism syndrome (FES). Fractures of long bones were> found only in four victims. Fatal FES produced by the mechanical> disintegration of adipose tissue that migrates into the bloodstream seems to> be a common phenomenon in the fatalities examined in this study. No> correlation, however, was found between the presence of long bone fractures> and the severity of FES, and no bone marrow emboli were detected on> histologic examination of target organs. Scattered subcutaneous hematomata> were present in all of the victims, although the volume of extravasated> blood could not be calculated from the total surface area of the bruises.> Contusions limited to the limbs have the potential of masking fatal volumes> of extravasated blood that suffuse the musculature mass. Hypovolemic and> neurogenic shock, as well as systemic effects of crush injury, should be> considered contributing factors to death from FES. These findings contradict> the previously published postulate that victims of blunt force trauma> succumb primarily to massive hemorrhages.> > > > Lethal blunt force trauma, inflicted intentionally to adults by an> aggressor, is rather uncommon in current forensic practice, except in> intradomestic violence, because most homicidal victims succumb to firearms> and sharp force injuries. [1,2] Recently, however, in Israel, we have> encountered a relatively large number of victims who have been beaten to> death, a phenomenon tied to the uprising of the Palestinian people> (Intifada) against the Israeli occupation in Gaza, Judea, and Samaria. [3]> Since the onset of the Intifada (December 8, 1987) to the beginning of the> peace process between the Palestinians and the Israeli government (September> 13, 1993), we have examined 53 cadavers of victims beaten to death: 52 were> beaten by Palestinian vigilantes, because of alleged collaboration with the> occupation authorities, [4] and 1 was beaten during interrogation at an> Israeli security facility. Eighteen of the 53 victims sustained the fatal> aggression from other inmates while held in custody. The blows seem to have> been primarily inflicted with bare hands, although sometimes kicking,> stomping, whipping, and clubbing had been also applied.> > > > Subcutaneous hematomata were the only salient external signs of bodily harm> visible in all victims. In 21 (39.6%) of the autopsies, the volume of> extravasated blood and intracranial hemorrhages was severe enough to cause> death. In the remaining cases, the nature of the lethal mechanism was> revealed by the results of microscopic examination.> > > > > > -----Original Message-----> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]> On Behalf Of Dr Ross Hofmeyr> Sent: Sunday, August 26, 2007 5:17 PM> To: 'Trauma &amp; Critical Care mailing list'> Subject: RE: crush injury> > > > Does anyone have a copy of the paper mentioned below?> > > > Thanks in advance.> > > > Dr Ross Hofmeyr> > MBChB(Stell) ATLS ACLS> > wildmedic at gmail.com> > ross at wildmedix.com> > www.wildmedix.com> > Mobile +2784 54 99259> > Skype: wildmedic> > "Semper Paratus"> > > > > -----Original Message-----> > > From: trauma-list-bounces at trauma.org [mailto:trauma-list-> > > bounces at trauma.org] On Behalf Of kmattox at aol.com> > > Sent: 25 August 2007 10:42 PM> > > To: Trauma &amp; Critical Care mailing list> > > Subject: Re: crush injury> > > > > > Several years ago out of Israel and published in J Trauma was a paper> > > entitled something to the effect, "why do people who are beatened to death> > > die?". They found a high rate of fat emboli syndrome. You might> > > investigate that.> > > > > > K> > > > > > > > > Sent via BlackBerry by AT&T> > > > > > -----Original Message-----> > > From: "Farid Pouralikhan" <faridp at gmx.de>> > > > > > Date: Sat, 25 Aug 2007 22:16:02> > > To:"Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>> > > Subject: Re: crush injury> > > > > > > > > Dear Sa'ad,> > > > > > this is not a common injury in Germany but I should suggest to control his> > > CK, Kreatinin and renal function. How does the urine look like? How is his> > > overall condition?> > > How about 1000ml Ringer plus 40-80mg Lasix? Keep his urine output high!> > > How is the situation of his skin? You mentioned a belt, or was it> > > something> > > more solid? I expect a crush injury from heavier objects.> > > Please keep us informed.> > > > > > Pou> > > > > > Farid Pouralikhan> > > Gen. Surgeon> > > Trauma Centre BG Unfallklinik Duisburg-Buchholz> > > Duisburg/Germany> > > > > > ----- Original Message -----> > > From: "Sa'ad Lahri" <slahri at webmail.co.za>> > > To: <trauma-list at trauma.org>> > > Sent: Saturday, August 25, 2007 9:45 PM> > > Subject: crush injury> > > > > > > > > >> > > >> > > > requesting opinions and possible suggestion for management> > > >> > > > A 25> > > > y old man was caught by members of his community for stealing chickens.> > > He> > > > was beaten with a belt (community assault) and arrived to hospital with> > > > his relatives.> > > >> > > > his back, both arms and thighs were bruised.> > > >> > > > couple of questions regarding crush injury?> > > > how do you> > > > estimate severity? do you use % body surface area involved?> > > > How> > > > useful is CK measurement?> > > > what type of fluid is used?> > > > ringers/saline?> > > >> > > > kind regards> > > > Sa'ad> > > >> > > > Dr Sa'ad> > > > Lahri> > > > Emergency Medicine Registrar> > > > UCT/US> > > > Cape Town> > > > South Africa> > > >> > > >> > > > South Africas premier free email service - www.webmail.co.za> > > > ------------------------------------------------------------------> > > > For super low premiums, click here http://www.webmail.co.za/dd.pwm> > > > --> > > > trauma-list : TRAUMA.ORG> > > > To change your settings or unsubscribe visit:> > > > http://www.trauma.org/index.php?/community/> > > > > > --> > > trauma-list : TRAUMA.ORG> > > To change your settings or unsubscribe visit:> > > http://www.trauma.org/index.php?/community/> > > > --> > trauma-list : TRAUMA.ORG> > To change your settings or unsubscribe visit:> > http://www.trauma.org/index.php?/community/> > --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/