Biological Response of Trauma Patients to Standard Trauma Resuscitation Therapy

Shock is a leading cause of death among American forces in battle, with many trauma victims
dying of early hemorrhagic shock or from late septic shock.1 Shock is defined as circulatory
collapse, when the arterial blood pressure is too low to maintain an adequate supply of
blood to the body's vital organs and tissues. Specifically, hemorrhagic shock results when
blood vessels are physically damaged while septic shock results when microbes or microbial
products enter the blood stream. Despite advances in medical science, including the
development of improved antibiotics, treatments for hemorrhagic and septic shock have
changed little in the past 30-40 years. A wounded soldier bleeding on the battlefield, or a
trauma victim in the United States, is treated today largely as he or she would have been
treated in 1970.

The overall aim of this work is to evaluate new methods of resuscitation that can be applied
by front-line responders on the battlefield (medical corpsmen, combat medics), in civilian
life (Emergency Medical System), or which can be used during initial resuscitation in the
first fixed facility to which the injured patient is brought. This might be a Fire Support
Specialist (FIST) team in a combat theater or a trauma center in the civilian health care
system.

Inclusion Criteria:

- Blunt or penetrating trauma patients who meet TMC criteria for a trauma activation.

- These patients will typically be in shock and have blunt injuries or penetrating
trauma.

- Patients must be alert, awake, oriented, and responsive and be English speaking males
or females between the ages 21-65.

Exclusion Criteria:

- traumatic cardiac arrest patients,

- pregnant patients,

- interhospital transfer patients,

- non-English speaking patients,

- patients with suspected or confirmed Human Immunodeficiency Virus (HIV) or AIDs based
on clear history,

- prior laboratory tests, or strong clinical suspicion; patients with clinical evidence
of impaired mental function;

- patients with continuing hypotension or tachycardia after resuscitation;

- patients with blood alcohol in excess of 80mg/dl;

- signs suggestive of coagulopathy;

- allergy to glutamine;

- liver disease or renal disease.