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CRYSTALLOIDS Too much crystalloid resuscitation in traumatic hemorrhagic shock can increase dilutional coagulopathy, as well as increase morbidity and mortality Bickell WH et al. I recently gave a talk on the initial management of trauma patients with hemorrhagic shock. vs SBP target <90mmHg which resulted in a mortality of 33.4%
Priorities for the bleeding trauma patient must include: Minimum time to control of bleeding (tourniquets / haemostatics / knife / interventional radiology) Normothermia Appropriate choice of destination (knife / IR) ? Prehospital Blood Product Resuscitation for Trauma. Lots to think about! 2016 Jul;46(1):3–16.
Aggressive fluid resuscitation as patients may be severely hypovolemic from GI symptoms. Bloodtransfusion for clinically significant blood loss. Case Follow-up: The patient received a fluid resuscitation with 20 mL/kg bolus of normal saline. Radiology in the management of acute iron poisoning. Hosking CS.
5 Initial Evaluation The key to the initial resuscitation of the unstable pelvic trauma patient is to rapidly identify and treat the most life-threatening pathology. 13 Massive transfusion protocols (MTP) are hallmarks of trauma resuscitation, and they are critical to the unstable pelvic fracture patient.
Legal implications vary from country to country. mg/mL) single-dose 2*-mL ampule or equivalent, 2 Lidocaine injection, 20-mg/mL single-dose 5-mL ampule or equivalent, 2 Nitroglycerin, 0.4-mg
REBOA Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is increasingly used as a non-invasive clamp of the aorta. Case courtesy of Dr Paul Clarke Learning bite Avoid unnecessary movement of the patient. DO NOT “spring” the pelvis on examination and DO NOT log-roll if pelvic injury suspected. From the case rID 52597 Fig.
In other patients who are stable and the bleeding has resolved, CTA is of low yield If they are critically ill and have severe bleeding, resuscitate first and consult IR, radiology, and surgery. Severe bleeding and hemodynamically unstable patients: Not the time for colonoscopy; resuscitate and get the CTA. 2017;2(5):354–60.
then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9, then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9,
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