Traumatic life-threatening hemmorhage
When injuries occur, life-threatening bleeding may develop with no obvious external signs, which could warn you. Our algorithm is based on the actual case history about the patient who suffered from a serious car accident.
Review
Severe bleeding is one of the main causes of preventable death of trauma patients. The keystone of successful management of these patients is adherence to the ABCDE approach at the site of injury, then Triage, and a decision on the correct direction of the patient care. In the early hospital phase, it is a priority to follow the ABCDE approach again with basic paraclinical examinations. If the patient is stable, even in the case of proven bleeding, a CT scan, that can accurately diagnose even the retroperitoneal trauma, is indicated (the basic limitations of ultrasound examination of the abdomen). Examination of the coagulation state by viscoelastic methods (TEG, ROTEM) is an example of modern access to trauma patients. Their advantage lies in the possibility of targeted therapy. However, if the patient is hemodynamically unstable, it remains a clear priority according to the evidence based medicine to start a massive blood transfusion protocol, meaning the administration of the plasma, red blood cells and platelets in the ratio 1 : 1 : 1.
Sources
Doc. MUDr. Eduard Kasal, CSc. Život ohrožující krvácení [online]. Univerzita Karlova v Praze, Lékařská fakulta a Fakultní nemocnice Plzeň, Anesteziologicko-resuscitační klinika, 2012 [cit. 2015-12-02]. Dostupné z: http://zdravi.euro.cz/…/po…/zivot-ohrozujici-krvaceni-464722
Život ohrožující krvácení. Anesteziologie a urgentní medicína [online]. 2013 [cit. 2015-12-02]. Dostupné z: http://ans.arim.cz/postupy/zivot-ohrozujici-krvaceni/
ROTEM® parameters [online]. [cit. 2015-12-10]. Dostupné z:http://www.haemoview.com.au/…/25498232/the_5_rotem_tests.pdf
Trauma Guideline Manual [online]. Upstate University Hospital, 2013 [cit. 2015-12-01]. Dostupné z: http://www.upstate.edu/…/healthcare/trauma/trauma_guideline…
Robert Reardon, M.D. Ultrasound in Trauma - The FAST Exam: Focused Assessment with Sonography in Trauma [online]. 2008 [cit. 2015-11-27]. Dostupné z:http://www.sonoguide.com/FAST.html
