Heart rate and systolic blood pressure in patients with minor to moderate, non-haemorrhagic injury versus normal controls

Bruijns, Stevan R.; Guly, H R; Bouamra, Omar; Lecky, Fiona; Wallis, Lee

doi:10.1136/emermed-2012-201760

Cited by 4 publications

(2 citation statements)

References 23 publications

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“…This study showed that the SBP was significantly higher at ED triage rather than during ambulance transport. As other causes that could influence vital signs were largely controlled for, and immobilization has been shown not to affect vital signs [10], the increase observed in minimally injured individuals at ED triage was likely because of mild anxiety (or a relative whitecoat effect). An explanation for this finding may relate to the fact that the moderately injured individuals in the ankle/wrist fracture group suffered greater tissue injury than the individuals with neck sprain.…”

Section: Discussionmentioning

confidence: 99%

Vital signs during and following ambulance transfer

Bruijns

Guly²,

Wallis³

2014

European Journal of Emergency Medicine

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The aim of this study was to compare vital signs of minimally injured and moderately injured patients during ambulance transport and subsequent emergency department (ED) assessment. We carried out a retrospective chart review. Patients were divided into two groups: minimally injured patients with neck pain (group 1) and moderately injured patients with a closed ankle or wrist fracture (group 2). The Wilcoxon signed-rank test was used to compare vital signs within groups during transport and ED assessment. Groups 1 and 2 included 90 and 118 patients, respectively. In group 1, systolic blood pressure was significantly lower (P=0.001, median difference 8 mmHg) and heart rate was significantly higher (P<0.01, median difference 3 beats/min) during transport than during ED assessment. There was no significant difference in respiratory rate in group 1 or any of the vital signs in group 2. We conclude that transport anxiety has minimal effect on vital signs. In trauma, clinicians should exclude tissue injury before attributing increased systolic blood pressure or heart rate to anxiety.

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Section: Discussionmentioning

confidence: 99%

Vital signs during and following ambulance transfer

Bruijns

Guly²,

Wallis³

2014

European Journal of Emergency Medicine

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“…Several tools have been developed to identify the cohort of patients that will benefit from this resuscitation strategy but none have proved superior to experienced clinician judgement (McLaughlin et al., 2008; Schreiber et al., 2007; Yucel et al., 2006). Physiological parameters previously advocated for quantifying blood loss and grading shock severity have been found to be insensitive, with patients frequently maintaining normal physiology despite losing up to 40% of their circulating volume (Bruijns et al., 2012; Eastridge et al., 2007). A pragmatic approach is to use initial blood product-based resuscitation in patients whom the trauma team identifies as likely to require 4 or more units of packed red cells in the first 4 h of resuscitation, or greater than one circulating volume in the first 24 h.…”

Section: Haemostatic Resuscitationmentioning

confidence: 99%

Minimising blood loss in early trauma resuscitation

Chesters

Roberts

Harris

2013

Trauma

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Worldwide, trauma is responsible for more than 10,000 deaths each day with hundreds of thousands seriously injured. Current trauma resuscitation strategies are based on supporting haemostasis, maintaining circulating volume and rapidly identifying sites of blood loss. Approaches include hypotensive/hypovolaemic resuscitation, avoidance of colloids and crystalloids, early blood product based resuscitation, early imaging to identify sites of blood loss and damage control surgery. In this paper, we focus on ways to minimise blood loss and preserve the circulating volume. These include minimal movement of the patient, splinting fractures, use of tourniquets, application of local haemostatic dressings/agents, keeping the patient warm and giving tranexamic acid to improve clot strength. The recent CRASH-2 trial provided unequivocal evidence that tranexamic acid reduces mortality in bleeding trauma patients. This will be discussed in detail. When employed as part of a package of care in a well-rehearsed trauma system, these interventions to preserve the remaining circulating volume have the potential to save lives and allow patients to survive until timely definitive haemostasis can occur.

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