Resuscitation of Polytrauma Patients: The Management of Massive Skeletal Bleeding

نویسندگان

  • Enrique Guerado
  • Maria Luisa Bertrand
  • Luis Valdes
  • Encarnacion Cruz
  • Juan Ramon Cano
چکیده

The term 'severely injured patient' is often synonymous of polytrauma patient, multiply-injured patient or, in some settings, polyfractured patient. Together with brain trauma, copious bleeding is the most severe complication of polytrauma. Consequently hypotension develop. Then, the perfusion of organs may be compromised, with the risk of organ failure. Treatment of chest bleeding after trauma is essential and is mainly addressed via surgical manoeuvres. As in the case of lesions to the pelvis, abdomen or extremities, this approach demonstrates the application of damage control (DC). The introduction of sonography has dramatically changed the diagnosis and prognosis of abdominal bleeding. In stable patients, a contrast CT-scan should be performed before any x-ray projection, because, in an emergency situation, spinal or pelvic fractures be missed by conventional radiological studies. Fractures or dislocation of the pelvis causing enlargement of the pelvic cavity, provoked by an anteroposterior trauma, and in particular cases presenting vertical instability, are the most severe types and require fast stabilisation by closing the pelvic ring diameter to normal dimensions and by stabilising the vertical shear. Controversy still exists about whether angiography or packing should be used as the first choice to address active bleeding after pelvic ring closure. Pelvic angiography plays a significant complementary role to pelvic packing for final haemorrhage control. Apart from pelvic trauma, fracture of the femur is the only fracture provoking acute life-threatening bleeding. If possible, femur fractures should be immobilised immediately, either by external fixation or by a sheet wrap around both extremities.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Critical care considerations in the management of the trauma patient following initial resuscitation

BACKGROUND Care of the polytrauma patient does not end in the operating room or resuscitation bay. The patient presenting to the intensive care unit following initial resuscitation and damage control surgery may be far from stable with ongoing hemorrhage, resuscitation needs, and injuries still requiring definitive repair. The intensive care physician must understand the respiratory, cardiovasc...

متن کامل

Positive FAST without hemoperitoneum due to fluid resuscitation in blunt trauma.

BACKGROUND The focused assessment with sonography in trauma (FAST) examination is an important screening tool in the evaluation of blunt trauma patients. OBJECTIVES To describe a case of a hemodynamically unstable polytrauma patient with positive FAST due to fluid resuscitation after blunt trauma. CASE REPORT We describe a case of a hemodynamically unstable polytrauma patient who underwent ...

متن کامل

HEATER PROBE THERMOCOAGULATION A S A SUBSTITUTE FOR SURGICAL INTERVENTION TO ARREST MASSIVE PEPTIC ULCER BLEEDING: A CONTROLLED, PROSPECTIVE ANALYSIS OF 42 CASES

The goal of this study was to compare the effect of heater probe thermocoagulation for massive bleeding of peptic ulcers with a control group. Between March 1992 and August 1995 we used heater probe thermocoagulation endoscopically to treat 42 patients with active UGl bleeding or nonbleeding visible vessels at the base of ulcer craters within 2-3 hours of admission. We also selected 42 pati...

متن کامل

The pulmonary physician in critical care c Illustrative case 7: Assessment and management of massive haemoptysis

The unpredictable and potentially lethal course of massive haemoptysis requires prompt resuscitation, airway protection, and correction of coagulopathy. Early investigation with bronchoscopy is recommended for localisation and control of bleeding by the application of topical adrenaline, balloon tamponade, or selective lung intubation. There is increasing acceptance of bronchial artery embolisa...

متن کامل

Successful use of recombinant factor Viia in traumatic liver injury--a case report.

The paper describe the use of rFVIIa in the management of massive bleeding in a patient with polytrauma involving liver injury. An 18-year-old girl with severe polytrauma sustained during a bus-car collision. She had multiple musculoskeletal injuries, severe concussion of the liver with amputation of the left liver lobe, disruption of the left hepatic vein from the inferior vena cava, and impai...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:

دوره 9  شماره 

صفحات  -

تاریخ انتشار 2015