Resuscitation and coagulation in the severely injured trauma patient

Abstract

Developments in the resuscitation of the severely injured trauma patient in the last decade have been through the increased understanding of the early pathophysiological consequences of injury together with some observations and experiences of recent casualties of conflict. In particular, the recognition of early derangements of haemostasis with hypocoagulopathy being associated with increased mortality and morbidity and the prime importance of tissue hypoperfusion as a central driver to this process in this population of patients has led to new resuscitation strategies. These strategies have focused on haemostatic resuscitation and the development of the ideas of damage control resuscitation and damage control surgery continuum. This in turn has led to a requirement to be able to more closely monitor the physiological status, of major trauma patients, including their coagulation status, and react in an anticipatory fashion.

In Vitro Hemostatic Properties of French Lyophilized Plasma

“…Various experimental and clinical data have provided evidence that the volume resuscitation with crystalloids or colloids can induce a coagulopathy characterized by a compromised clot development, whereas the initiation of coagulation is unaffected. 1,2 Thus, a large amount of data advocate for liberal and early use of plasma in a concept of "damage control resuscitation" [3][4][5] to manage massive hemorrhage. To foster these new guidelines and to deliver plasma earlier in the emergency setting, many centers are using thawed plasma for the resuscitation of major trauma.…”

Haemorrhage and coagulopathy in the Defence Medical Services

“…The physiological data needed to assess and monitor the patient's condition must be rapidly responsive and readily accessible to the managing clinical team [6]. Many laboratory-measured parameters require time to send, analyse and return data to the clinical area by which time the results are of historic interest only as the patient's condition will have changed in the intervening interval.…”

“…The UK military base the management of these casualties around damage control resuscitation (DCR). The elements of DCR have been described as permissive hypotension, haemostatic resuscitation and damage control surgery (DCS) [5] but this is now evolving into an integrated 'damage control resuscitation -damage control surgery' sequence [6] demanding clear clinical leadership and logistic support. Permissive hypotension is when fluid administration is restricted, whilst accepting a limited period of suboptimum end-organ perfusion until haemorrhage is controlled [5].…”

Travmatik hepato-pankreatiko-duodenal yaralanmalara güncel yaklaşım: Olgu sunumu ve literatüre bakış

“…Hypoperfusion leads the activation of protein C and hyperfibrinolysis. As a result of hypoperfusion and anaerobic respiration, acidosis occurs (2,3). This approach is useable only in selected groups of trauma patients.…”