Cited by 238
Brigham Young University
Publishes on Trauma, Hemostasis, Coagulopathy, Resuscitation, Sepsis Diagnosis and Treatment, Cardiac Arrest and Resuscitation. 148 papers and 2.7k citations.
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A statistical study is reported of 17,726 wounded American soldiers in Viet Nam over 15 months from March 1966 to July 1967. Causes, location, treatment, and results were analyzed for various regions, organs, and tissues. Results of treatment were remarkably good, the best in the history of military surgery. Major problems of resuscitation and treatment of local tissue injury which had not before been treated on a large scale were treated with excellent results.
The most important treatment of noncardiac shock is fluid volume administration given, if necessary, to the point of an elevated central venous or pulmonary artery pressure. Adequate volume is more important than the type of fluid administered. Blood is given only up to a normal red blood cell mass. If these measures are not adequate, a vasodilator may produce dramatic improvement. No detrimental effect was ever seen. Vasopressors may produce detrimental effects in shock. An adequate arterial oxygen pressure (Po2) is essential and often requires tracheotomy or tracheal intubation with oxygen and a respirator to obtain. It has been possible to correct all hemodynamic defects in shock. Patients who have died have done so as a result of pulmonary lesions. Disseminated intravascular coagulation is usual in severe shock. Its onset is heralded by a clotting defect frequently only noted by laboratory test. In some cases it causes important clinical hemorrhage and requires treatment. It may play an important part in the development of lethal shock including acute pulmonary failure.
Adult respiratory distress syndrome (ARDS) has a high mortality. Its only effective treatment is respiratory therapy. If this fails mortality is probably 100 per cent. No other treatment for ARDS has proved effective including "magic bullets." Twenty patients suffering from ARDS secondary to trauma and/or sepsis failed to respond to treatment with mechanical ventilation and positive end-expiratory pressure. On the assumption that disseminated intravascular coagulation initiates ARDS by occluding the pulmonary microcirculation with microclots, the patients were treated with plasminogen activators. The patients responded with significant improvement in partial pressure of oxygen in arterial blood. No bleeding occurred and clotting parameters remained normal. We conclude that ARDS can be safely treated with plasminogen activator.