The challenge in management of hemorrhagic shock in trauma

Abstract

a b s t r a c tTransfusion and resuscitation practices in trauma have undergone a sea change over the past decade. New understanding of transfusion physiology and experiences in military trauma over the last decade has identified key factors taken as challenges in trauma. The most important challenge remains acute traumatic coagulopathy (ATC) which sets in early after a trauma and spirals the patient into shock and continued bleeding. World wide trauma is the leading cause of mortality. More than 6 million deaths occur due to trauma out of which 20% are due to uncontrollable bleeding. Out of the hospital admissions in trauma 20% develop coagulopathy. Mortality is three to four times higher in a patient with coagulopathy and thus prevention and correction of coagulopathy is the central goal of the management of hemorrhagic shock in trauma. Damage control resuscitation (DCR), a strategy combining the techniques of permissive hypotension, hemostatic resuscitation and damage control surgery has been widely adopted as the preferred method of resuscitation in patients with haemorrhagic shock. The over-riding goals of DCR are to mitigate metabolic acidosis, hypothermia and coagulopathy, This article looks at the importance of acute traumatic coagulopathy, its etiology, diagnosis, effects and resuscitation strategies to prevent it and to see the background behind this shift.ª 2014, Armed Forces Medical Services (AFMS). All rights reserved.

Thromboelastography Predictive of Death in Trauma Patients

“…A short clotting time (low R) for example, may represent a disseminated intravascular coagulation state characterized by hypercoagulability and simultaneous fibrinolysis and hemorrhage; end organ injury can occur in this state. TEG has been shown to be able to diagnose and predict the likelihood of a patient developing a hyper‐coagulable state, which corresponds with the noted increase in mortality in this study.…”

Correlation between adiponectin and hemorrhagic shock in mice

“…Previous research has shown that HS has a high rate of mortality; approximately 5.8 million people in the world die from trauma every year and 50% of these cases are due to HS (Jacob and Kumar, 2014;. HS is induced by many factors, including high rate of blood loss, severe vomiting or diarrhea, intestinal obstruction, or profuse sweating.…”

Thromboelastometry-guided hemostatic therapy for hemorrhagic shock in the postoperative period of vascular surgery: a case report

“…Uncontrolled bleeding leads to loss of coagulation factors and a later decrease in platelet counts. Hypovolemia due to intravascular blood volume loss and shock leads to tissue hypoperfusion and endothelial dysfunction [11]. Thrombomodulin (TM) expressed on vascular endothelium binds to thrombin forming a complex and it acts as an anticoagulant.…”

“…Furthermore, currently there is a trend in major centers in Europe to avoid the use of blood components due to the high risk of adverse events. Possible complications associated with transfusion of blood components include transfusion-related acute lung injury (TRALI), transfusion associated circulatory overload (TACO), nosocomial infections, sepsis, transfusion-related immunomodulation (TRIM), and organ dysfunction [10, 11]. …”