The Science Behind Trauma Care. Dr. Bryan E. Bledsoe Professor, Emergency Medicine The George Washington University Medical Center. Audience Interaction. Which of the following actresses is my favorite? A. Sandra Bullock B. Angelina Jolie C. Salma Hayek D. Nicole Kidman E. George Michael.
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Dr. Bryan E. Bledsoe
Professor, Emergency Medicine
The George Washington University Medical Center
Ia. Meta-analysis of RCTs
Ib. One RCT.
IIa. Controlled trial without randomisation.
IIb. One other type of quasi-experimental study.
III. Descriptive studies, such as comparative studies, correlation studies, and case-control studies.
IV. Expert committee reports or opinions, or clinical experience of respected authorities or both.
1. Positive randomized controlled trials.
2. Neutral randomized controlled trials.
3. Prospective, non-randomized controlled trials.
4. Retrospective, non-randomized controlled trials
5. Case series (no control group)
6. Animal studies
8. Rational conjecture (common sense)
Carl Sagan, PhD
3. The available research should be searched using appropriate and comprehensive search terminology.
4. A thorough review of the scientific literature should precede guideline development.
5. The evidence should be evaluated and weighted, depending upon the scientific validity of the method used to generate the evidence.
6. The strength of the evidence should be reflected in the strength of the recommendations reflecting scientific certainty (or the lack thereof).
7. Expert judgement should be used to evaluate the quality of the literature and to formulate guidelines when the evidence is weak or nonexistent.
8. Guideline development should be a multidisciplinary process, involving key groups affected by the recommendations.
Phase I: Determined baseline survival rate for each study community (36 months) prior to Phase II.
Phase II: Assessed the survival for 12 months after the introduction of rapid defibrillation and demonstrated that relatively inexpensive community rapid defibrillation programs increase survival for cardiac arrest patients (n=5,000+ patients).
Phase III: Assessed survival outcomes months after the introduction of full ALS programs for 36 months for cardiac arrest patients and major trauma patients, and for 6 months for respiratory distress patients.
At this time, intravenous fluid resuscitation should probably be delayed until hemostasis is obtained.
CPP = MAP- ICP
MAP = [DBP+1/3 (SBP-DBP)]
UCSD (San Diego
Scripps Mercy (San Diego)
Denver H&H (Denver)
Methodist Hospital (Indianapolis)
U of K (Lexington)
Metro Health (Cleveland)
Lehigh Valley (Allentown)
UTHSCSA (San Antonio)
Occupational Deaths per 100,000/year (U.S. 1995-2001)
Source: Johns Hopkins University School of Public Health