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Early Increases In Blood Lactate Following Injury
  1. TJ Coats, MD FRCS FFAEM, Senior Lecturer1,2,
  2. JE Smith, MBBS MRCP RN, Specialist Registrar3,
  3. D Lockey, FRCA, FIMC RCS(Ed) RAMC(V), Fellow in Pre-Hospital Care4 and
  4. M Russell, MRCGP RAMC, Medical Officer Defence Medical Services5
  1. 1Accident, Emergency and Pre-Hospital Care Queen Mary College School of Medicine and Dentistry.
  2. 2The Royal London Hospital, Whitechapel, London E1 1BB t.j.coats{at}qmul.ac.uk
  3. 3Emergency Medicine Defence Medical Services, Royal London Hospital
  4. 4London Helicopter Emergency Medical Service
  5. 5London Helicopter Emergency Medical Service

Abstract

Current pre-hospital trauma triage systems are based mainly on physiological parameters, but in compensated shock injury severity may not be immediately obvious, as the physiological parameters remain normal for some time. Serum lactate, measured in hospital, is known to be a predictor of injury severity and outcome. The technology for easy field lactate measurement has recently become available. We found that capillary lactate is elevated in trauma patients in the early phase of the response to injury. There is a moderate correlation (R2 = 0.44) between early lactate levels and injury severity, in patients who might otherwise be difficult to triage.

Our aims were: (a) To determine if lactate levels are elevated in the pre-hospital phase of trauma, and to establish whether there is a correlation between pre-hospital lactate and injury severity.

(b) To determine if there is a relationship between pre-hospital lactate and injury severity in patients with normal blood pressure and Glasgow Coma Score of greater than 12 (“difficult to triage” group).

Methods Prospective analysis of pre-hospital capillary lactate levels and Injury Severity Score (ISS) in 23 trauma patients attended by the London Helicopter Emergency Medical Service.

Results Capillary lactate is elevated in trauma patients in the early phase of the response to injury. There is a moderate correlation (R2 = 0.44) between early lactate levels and injury severity, in patients who might otherwise be difficult to triage.

Conclusions Lactate is elevated in the earliest prehospital phase of injury following trauma. The potential contribution of this biochemical para-meter to field triage requires further evaluation.

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