Hemostatic Resuscitation of the Trauma Patient
What is it?
Keeping Blood Systolic Blood Pressure ~ 80 until bleeding is controlled
Giving PRBC’s, Plasma & Platelets early to closely approximate whole blood minimizing acidosis and coagulopathy
Delivering an Anesthetic to patient promoting vasodilation and perfusion
Warm patient preventing hypothermia
History
1980-1990’s: Goal was to normalize Blood Pressure by giving LR in 3:1 ratio (Fluid Resuscitate)
Give PRBC’s later to bring Hgb ~10Give FFP/Plasma even later (often after 10
units of PRBC’s)This resulted in………
Triad of Death
Change in Practice 1990-2000Damage Control Surgical Techniques evolved
Animal Research = Decreased Mortality with less fluid resuscitation
Human Research out of Houston and Baltimore showed less or no change in mortality with less fluid
Less Complications like Abdominal Compartment Syndrome
Iraqi War Changed Practice
Data showed increased survival with hemostatic resuscitation techniques
Rapid triage and care from battlefield
Plenty of resources like blood bank, walking blood bank and personnel
When to Use It?
Hypotensive Patient with Uncontrolled Bleeding
Pregnant PatientsPatient >65 yrs of age or with CV Problems
When to Not Use It
Head Injuries
Physiology
Hypovolemia causes vasoconstriction maintaining blood pressure
Vasoconstriction causes decreased DO2 and Acidosis
Acidosis compounds coagulopathy
Slowly giving Fentanyl will decrease catecholamine and vasodilate patient
Blood//FFP//Plts given to fill patient up
What not to Give
Vasopressor (unless refractory shock)
NaHCO3
Crystalloid
Albumin (no advantage and some problems)
BP OF 90HR < 120
+ U/OPH > 7 .25
LACTATE CORRECTINGBASE DEFICIT CORRECTING
IMPROVING ICANORMOTHERMIA
DEEP ANESTHESIAPLT > 50KINR< 1 .6
Goals for Early Resuscitation
After Bleeding Controlled
Don’t Forget!!
These patients are coagulapatic upon arrival to the ED!!
Several Mechanisms for Coagulopathy
Don’t delay in MTP
Questions????
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