The American College of Surgeons in 2008 released the Advanced Trauma Life Support (ATLS) updates (eighth edition) with recommendations based on evidence-based medicine in addition to the expert consensus. A general summary and explanation of the updates were previously published in Trauma Reports.1The authors provide a more detailed report of the literature since the last ATLS update on fluid resuscitation and blunt cerebrovascular injury, based on their relevance and importance to patient outcomes.
Optimal management of hypotensive trauma patients is still under investigation, with the method of fluid delivery and the type of fluid used controversial. The concept of permissive hypotension has been around since the early 1900s, but has been revisited since military experience and landmark studies indicated that aggressive fluid resuscitation might cause more harm than originally anticipated.
Blunt cerebrovascular injury (BCVI) is another topic that has recently garnered more attention from physicians managing victims of motor vehicle collisions. For years it was thought to be a rare occurrence, but advances in imaging technology have identified BCVI as a more common entity. BCVI is catastrophic, with a high morbidity and mortality in previously young healthy people, so it is critical to identify, risk stratify, and treat these patients appropriately.
—Ann M. Dietrich, MD, Editor