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Medical aspects of terrorist bombings – a focus on DCS and DCR

Although terrorist bombings have tormented the world for a long time, currently they have reached unprecedented levels and become a continuous threat without borders, race or age. Almost all of them are caused by improvised explosive devices. The unpredictability of the terrorist bombings, leading t...

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Autores principales: Mutafchiyski, Ventsislav M, Popivanov, Georgi I, Kjossev, Kirien C
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340108/
https://www.ncbi.nlm.nih.gov/pubmed/25722871
http://dx.doi.org/10.1186/2054-9369-1-13
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author Mutafchiyski, Ventsislav M
Popivanov, Georgi I
Kjossev, Kirien C
author_facet Mutafchiyski, Ventsislav M
Popivanov, Georgi I
Kjossev, Kirien C
author_sort Mutafchiyski, Ventsislav M
collection PubMed
description Although terrorist bombings have tormented the world for a long time, currently they have reached unprecedented levels and become a continuous threat without borders, race or age. Almost all of them are caused by improvised explosive devices. The unpredictability of the terrorist bombings, leading to simultaneous generation of a large number of casualties and severe “multidimensional” blast trauma require a constant vigilance and preparedness of every hospital worldwide. Approximately 1-2.6% of all trauma patients and 7% of the combat casualties require a massive blood transfusion. Coagulopathy is presented in 65% of them with mortality exceeding 50%. Damage control resuscitation is a novel approach, developed in the military practice for treatment of this subgroup of trauma patients. The comparison with the conventional approach revealed mortality reduction with 40-74%, lower frequency of abdominal compartment syndrome (8% vs. 16%), sepsis (9% vs. 20%), multiorgan failure (16% vs. 37%) and a significant reduction of resuscitation volumes, both crystalloids and blood products. DCS and DCR are promising new approaches, contributing for the mortality reduction among the most severely wounded patients. Despite the lack of consensus about the optimal ratio of the blood products and the possible influence of the survival bias, we think that DCR carries survival benefit and recommend it in trauma patients with exsanguinating bleeding.
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spelling pubmed-43401082015-02-26 Medical aspects of terrorist bombings – a focus on DCS and DCR Mutafchiyski, Ventsislav M Popivanov, Georgi I Kjossev, Kirien C Mil Med Res Review Although terrorist bombings have tormented the world for a long time, currently they have reached unprecedented levels and become a continuous threat without borders, race or age. Almost all of them are caused by improvised explosive devices. The unpredictability of the terrorist bombings, leading to simultaneous generation of a large number of casualties and severe “multidimensional” blast trauma require a constant vigilance and preparedness of every hospital worldwide. Approximately 1-2.6% of all trauma patients and 7% of the combat casualties require a massive blood transfusion. Coagulopathy is presented in 65% of them with mortality exceeding 50%. Damage control resuscitation is a novel approach, developed in the military practice for treatment of this subgroup of trauma patients. The comparison with the conventional approach revealed mortality reduction with 40-74%, lower frequency of abdominal compartment syndrome (8% vs. 16%), sepsis (9% vs. 20%), multiorgan failure (16% vs. 37%) and a significant reduction of resuscitation volumes, both crystalloids and blood products. DCS and DCR are promising new approaches, contributing for the mortality reduction among the most severely wounded patients. Despite the lack of consensus about the optimal ratio of the blood products and the possible influence of the survival bias, we think that DCR carries survival benefit and recommend it in trauma patients with exsanguinating bleeding. BioMed Central 2014-06-11 /pmc/articles/PMC4340108/ /pubmed/25722871 http://dx.doi.org/10.1186/2054-9369-1-13 Text en © Mutafchiyski et al.; licensee BioMed Central Ltd. 2014 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Review
Mutafchiyski, Ventsislav M
Popivanov, Georgi I
Kjossev, Kirien C
Medical aspects of terrorist bombings – a focus on DCS and DCR
title Medical aspects of terrorist bombings – a focus on DCS and DCR
title_full Medical aspects of terrorist bombings – a focus on DCS and DCR
title_fullStr Medical aspects of terrorist bombings – a focus on DCS and DCR
title_full_unstemmed Medical aspects of terrorist bombings – a focus on DCS and DCR
title_short Medical aspects of terrorist bombings – a focus on DCS and DCR
title_sort medical aspects of terrorist bombings – a focus on dcs and dcr
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340108/
https://www.ncbi.nlm.nih.gov/pubmed/25722871
http://dx.doi.org/10.1186/2054-9369-1-13
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