Severe respiratory failure may develop in the trauma patient as a consequence of direct lung injury, in response to trauma‐associated systemic inflammatory response syndrome (SIRS), as a result of infection, or at times as an unintended consequence of the life‐saving management of the acute traumatic injury. Approximately 0.5% of all adult trauma patients develop some form of pulmonary dysfunction along the acute lung injury (ALI) – acute respiratory distress (ARDS) spectrum, with the incidence of severe respiratory failure reaching 10–20% in multisystem trauma victims. Of concern, mortality in patients with acute respiratory failure who go on to develop severe pulmonary dysfunction can be as high as 37–50% with the use of conventional therapeutic modalities. Extracorporeal membrane oxygenation (ECMO) has been proposed as a rescue strategy when less invasive primary or adjunctive attempts fail. Numerous case reports and single‐center studies demonstrate potential benefits of early implementation of veno‐venous (VV)‐ECMO for the treatment of severe respiratory failure associated with trauma or sequelae of trauma. In this clinical context, VV‐ECMO can be employed to correct for both ventilatory and oxygenation failure while allowing the treating physician to provide much needed rest to the patient's lungs and permit healing to take place. The use of ECMO (mainly veno‐venous, with limited use of veno‐arterial circuits for cardiac indications) has been described in patients with severe chest injuries, traumatic pneumonectomy, bronchopleural fistulas, and various forms of respiratory failure refractory to conventional therapies.
Part of the book: Extracorporeal Membrane Oxygenation
Blood products are frequently required in an inpatient setting for a number of serious conditions. It is of the utmost importance that providers are aware of the potential for adverse reactions and human error when ordering or administering these products. Patients who require blood products should have a signed informed consent form and a type and screen performed prior to transfusion. The patient’s identity should be confirmed using two patient identifiers. There are two major categories for blood transfusion reactions, immune-mediated and nonimmune-mediated. Common manifestations of a transfusion reaction are nonspecific and may be attributed to a patient’s other medical problems, so the index of suspicion must be high in order to identify and treat these reactions.
Part of the book: Vignettes in Patient Safety
International health security (IHS) prioritizes cross-border threats to nations such as epidemics, bioterrorism, and climate change. In the modern era, however, the leading causes of mortality are not infectious. Cardiovascular disease (CVD) is the leading cause of death worldwide. Over three-quarters of CVD deaths take place in low-income countries, illustrating a disparity in care. Traumatic injury also remains one of the leading causes of morbidity and mortality worldwide, placing a particularly heavy burden upon countries with limited resources. Cerebrovascular disease and acute stroke syndromes are major causes of mortality and disability worldwide. Programs leading to timely revascularization have proven to be the most powerful predictor of disease outcomes. The health of women and children is vital to creating a healthy world. The impact of neonatal resuscitation programs on mortality has been a major force in advancing international health security. Finally, the establishment of emergency medical services (EMS) systems has been shown to improve the health of communities in both high- and low-income nations. In order to address health security on a global scale, government authorities and public health institutions must incorporate access to modern systems of care addressing the major determinants of health and primary causes of mortality.