Updates on Hemorrhage

[bensonblues at comcast.net]

Hot Off The Presses:

Take note of a recent paper in the Ann Surg (Senthill, et al): IV injection of trauma-hemorrhagic shock mesenteric lymph causes lung injury...inducible iNOS pathway. I know that this work is in rats, but if it can be substatiated in humans, this is big. By blocking this enzyme somehow, we could save lives.

In Hematology this past month, Dr. Hess suggests that we should be thinking more about plasma and blood than crystalloid volume replacement in hemorrhage if we are to avoid the coagulopathy of trauma. The paper also points out that the coagulopathy of trauma is multifactorial, including dilutional, coagulation factor and platelet consumption, hypothermic platelet dysfunction, acidosis-induced suppression of coagulation factor activity, and fibrinolysis.

DB