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Hemorrhage and coagulopathy are the leading causes of preventable death in war and trauma injuries, constituting approximately 50 percent of deaths in the first 24 hours. The importance of damage control resuscitation by establishing a permissive hypotension, minimizing crystalloid use, and early implementation of blood products is well understood today. The aim of the present review is to highligt the role of massive transfusion protocols with balanced blood component ratios. Physicians dealing with trauma must quickly and accurately predict when a massive transfusion protocol (MTP) should be activated. There have been several validated transfusion scores developped for this purpose. Earlier balanced blood transfusion by using massive transfusion protocol, may be more effective in resuscitating coagulopathic patients. Transfusion ratios approaching 1: 1: 1 of packed red blood cells (PRBCs) to fresh frozen plasma (FFP) to platelet have been shown to improve the survival of the severely injuried patient. Trauma institutions should develop and regularly activate MTPs for trauma and war surgery in proper indications. [ABSTRACT FROM AUTHOR]

Purpose:Anastomotic leaks following intestinal operations may cause devastating effects on patients. Ischemia may also occur at the intestinal walls in the presence of strangulations. In this study, we examined the effects of human recombinant (Hr)-epidermal growth factor (EGF) given at a single intramural dose into the intestinal walls and daily intraperitoneal cavity on ischemia and the healing process of anastomosis.Materials and Methods:Sixteen male New Zeland white rabbits were randomly divided into four groups (n= 4 in each group). In Group 1, two different segments of ileum were identified and, then, transected and the free ends were sutured each other. In the other groups, ischemia was induced by ligating the mesenteric vascular arcade. After the ischemic induction, Group 2 received intramural injections of %0.9 saline, Group 3 received intramural injections of a single dose of EGF, and Group 4 received intramural and intraperitoneal injections of EGF. Bursting pressures and tissue hydroxyproline levels were analyzed. Necrosis, fibroblastic activity, collagen deposition and neovascularization were also studied.Results:The mean levels of bursting pressures in Group 4 (148.6 ± 25.3 mmHg) were higher than Group 2 (70 ± 21.5 mmHg) (p= 0.001). The mean level of bursting pressures was not statistically significant between Group 1 (170.1 ± 35 mmHg) and Group 4 (p= 0.073). Hydroxyproline levels in Group 2 were lower than Groups 3 and 4. There was a statistically significant difference in the mucosal ischemia, mucosal healing and degree of adhesion, but not in the mural anastomotic healing among the groups.Conclusions:Intramural injection with daily intraperitoneal administration of low-dose EGF enhances the bursting pressure and collagen accumulation in ischemic anastomosis, improving many histological variables associated with ischemic intestinal anastomosis. [ABSTRACT FROM AUTHOR]