Developments in trauma management: From the field to the intensive care unit

There have not been dramatic changes in trauma management in recent years. Nevertheless, there are noteworthy developments that might eventually change both paradigms of trauma systems and clinical management. In the present study, organizational aspects of mass casualty scenarios and what we have learned from the experiences of military doctors are examined. Then, the perennial theme of fluid resuscitation; when, what and how much to give, is examined. The management of bleeding and minimization of allogeneic blood transfusions raise the topics of recombinant factor VIIa and oxygen carrying blood substitutes. Finally, an aspect of intensive care management that is very topical, that of immunonutrition and the modulation of sepsis in intensive care, is examined.