Hypotensive Resuscitation among Trauma Patients

Carrick, Matthew M.; Leonard, Jan; Slone, Denetta S.; Mains, Charles W.; Bar‐Or, David

doi:10.1155/2016/8901938

Cited by 45 publications

(35 citation statements)

References 32 publications

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“…Restricted fluid resuscitation is conducted at admission, and systolic blood pressure should be maintained at 90 mmHg, heart rate at about 100 times/minute. 6 If patients having severe shock and estimated blood loss is great, consumptive coagulopathy is considered, which needs urgent blood check to ensure a venous channel for blood transfusion during further examination or treatment. This is particularly important for open pelvic fracture patients with large blood loss or elderly patients with poor blood loss tolerance.…”

Section: Discussionmentioning

confidence: 99%

Analysis of early treatment of multiple injuries combined with severe pelvic fracture

Huang

Jin-mou

et al. 2019

Chinese Journal of Traumatology

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Purpose To summarize and analyze the early treatment of multiple injuries combined with severe pelvic fractures, especially focus on the hemostasis methods for severe pelvic fractures, so as to improve the successful rate of rescue for the fatal hemorrhagic shock caused by pelvic fractures. Methods A retrospective analysis was conducted in 68 cases of multiple trauma combined with severe pelvic fractures in recent 10 years (from Jan. 2006 to Dec. 2015). There were 57 males and 11 females. Their age ranged from 19 to 75 years, averaging 42 years. Causes of injury included traffic accidents in 34 cases (2 cases of truck rolling), high falling injuries in 17 cases, crashing injuries in 15 cases, steel cable wound in 1 case, and seat belt traction injury in 1 case. There were 31 cases of head injury, 11 cases of chest injury, 56 cases of abdominal and pelvic injuries, and 37 cases of spinal and limb injuries. Therapeutic methods included early anti-shock measures, surgical hemostasis based on internal iliac artery devasculization for pelvic hemorrhage, and early treatment for combined organ damage and complications included embolization and repair of the liver, spleen and kidney, splenectomy, nephrectomy, intestinal resection, colostomy, bladder ostomy, and urethral repair, etc. Patients in this series received blood transfusion volume of 1200–10,000 mL, with an average volume of 2850 mL. Postoperative follow-up ranged from 6 months to 1.5 years. Results The average score of ISS in this series was 38.6 points. 49 cases were successfully treated and the total survival rate was 72.1%. Totally 19 patients died (average ISS score 42.4), including 6 cases of hemorrhagic shock, 8 cases of brain injury, 1 case of cardiac injury, 2 cases of pulmonary infection, 1 case of pulmonary embolism, and 1 case of multiple organ failure. Postoperative complications included 1 case of urethral stricture (after secondary repair), 1 case of sexual dysfunction (combined with urethral rupture), 1 case of lower limb amputation (femoral artery thrombosis), and 18 cases of consumptive coagulopathy. Conclusion The early treatment of multiple injuries combined with severe pelvic fractures should focus on pelvic hemostasis. Massive bleeding-induced hemorrhagic shock is one of the main causes of poor prognosis. The technique of internal iliac artery devasculization including ligation and embolization can be used as an effective measure to stop or reduce bleeding. Consumptive coagulopathy is difficult to deal with, which should be detected and treated as soon as possible after surgical measures have been performed. The effect of using recombinant factor VII in treating consumptive coagulopathy is satisfactory.

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Section: Discussionmentioning

confidence: 99%

Analysis of early treatment of multiple injuries combined with severe pelvic fracture

Huang

Jin-mou

et al. 2019

Chinese Journal of Traumatology

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“…Historically, the hypotensive trauma patient with suspected traumatic haemorrhage was administered crystalloid [ 10 , 11 ]; however, not without significant adverse effects [ 6 , 12 , 13 ]. Trauma Induced Coagulopathy (TIC) can be sub-divided to endogenous acute traumatic coagulopathy (ATC) and subsequent dilutional coagulopathy [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Mortality of civilian patients with suspected traumatic haemorrhage receiving pre-hospital transfusion of packed red blood cells compared to pre-hospital crystalloid

Griggs¹,

Jeyanathan²,

Joy

et al. 2018

Scand J Trauma Resusc Emerg Med

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BackgroundMajor haemorrhage is a leading cause of mortality following major trauma. Increasingly, Helicopter Emergency Medical Services (HEMS) in the United Kingdom provide pre-hospital transfusion with blood products, although the evidence to support this is equivocal. This study compares mortality for patients with suspected traumatic haemorrhage transfused with pre-hospital packed red blood cells (PRBC) compared to crystalloid.MethodsA single centre retrospective observational cohort study between 1 January 2010 and 1 February 2015. Patients triggering a pre-hospital Code Red activation were eligible. The primary outcome measure was all-cause mortality at 6 hours (h) and 28 days (d), including a sub-analysis of patients receiving a major and massive transfusion. Multivariable regression models predicted mortality. Multiple Imputation was employed, and logistic regression models were constructed for all imputed datasets.ResultsThe crystalloid (n = 103) and PRBC (n = 92) group were comparable for demographics, Injury Severity Score (p = 0.67) and mechanism of injury (p = 0.73). Observed 6 h mortality was smaller in the PRBC group (n = 10, 10%) compared to crystalloid group (n = 19, 18%). Adjusted OR was not statistically significant (OR 0.48, CI 0.19–1.19, p = 0.11). Observed mortality at 28 days was smaller in the PRBC group (n = 21, 26%) compared to crystalloid group (n = 31, 40%), p = 0.09. Adjusted OR was not statistically significant (OR 0.66, CI 0.32–1.35, p = 0.26). A statistically significant greater proportion of the crystalloid group required a major transfusion (n = 62, 60%) compared to the PRBC group (n = 41, 40%), p = 0.02. For patients requiring a massive transfusion observed mortality was smaller in the PRBC group at 28 days (p = 0.07).ConclusionIn a single centre UK HEMS study, in patients with suspected traumatic haemorrhage who received a PRBC transfusion there was an observed, but non-significant, reduction in mortality at 6 h and 28 days, also reflected in a massive transfusion subgroup. Patients receiving pre-hospital PRBC were significantly less likely to require an in-hospital major transfusion. Further adequately powered multi-centre prospective research is required to establish the optimum strategy for pre-hospital volume replacement in patients with traumatic haemorrhage.

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“…In general, permissive hypotension appears to result in fewer complications compared to a more aggressive resuscitation approach and yields no added risk for embolism or infarction of any kind. 11 Despite massive blood loss due to the spleen and vascular injury, the mean arterial pressure was above 60 mmHg during the entire course. This dismisses the likelihood of hypotension as a cause for the paraplegia in this case.…”

Section: Discussionmentioning

confidence: 99%

The fat embolism syndrome as a cause of paraplegia

Peters

Witvliet

Vennegoor

et al. 2018

SAGE Open Medical Case Reports

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The fat embolism syndrome is a well-known complication in trauma patients. We describe a rare case of traumatic fat embolism that leads to paraplegia. A 19-year-old male motorcycle accident victim was presented to our hospital. After stabilization and trauma survey, he was diagnosed with bilateral femur fractures, a spleen laceration and a tear in the inferior vena cava, for which damage control surgery was performed. Post-operatively, the patient became paraplegic and developed a fluctuating consciousness, respiratory distress and petechiae. Fat embolism syndrome was considered as the most plausible cause of the paraplegia. The fat embolism syndrome is seen in approximately 1% of trauma patients, mostly those with bilateral fractures of the femur. Prevention of the syndrome depends on early stabilization of fractures. However, even with optimal care, this syndrome can still occur and may have dramatic consequences, as we demonstrate in this case.

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Hypotensive Resuscitation among Trauma Patients

Cited by 45 publications

References 32 publications

Analysis of early treatment of multiple injuries combined with severe pelvic fracture

Analysis of early treatment of multiple injuries combined with severe pelvic fracture

Mortality of civilian patients with suspected traumatic haemorrhage receiving pre-hospital transfusion of packed red blood cells compared to pre-hospital crystalloid

The fat embolism syndrome as a cause of paraplegia

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