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Management for bleeding

Evidence-based recommendations are needed to guide the acute management of the bleeding trauma patient, which when implemented may improve patient outcomes. The.Endorsed by the European Society of Anaesthesiology (ESA), the European Society of Intensive Care Medicine (ESICM), the European Shock Society (ESS), the European Society of Trauma and Emergency Surgery (ESTES) and the European Society for Emergency Medicine (EuSEM).Recommendations are grouped by category and somewhat chronologically in the treatment decision-making process, but not by priority or hierarchy.A number of different products are currently available and have been shown to be efficient for external use.Case series using thrombelastometry to assess trauma patients have been published.

We suggest that antifibrinolytic agents be considered in the bleeding trauma patient (Grade 2C).PubMed Google Scholar Ertel W, Keel M, Eid K, Platz A, Trentz O: Control of severe hemorrhage using C-clamp and pelvic packing in multiply injured patients with pelvic ring disruption.We also include new recommendations on the use of tourniquets as an adjunct to halt life-threatening open extremity injuries, ionised calcium monitoring and treatment, and the use of local haemostatic agents and desmopressin in the bleeding trauma patient.We recommend that patients presenting with haemorrhagic shock and an unidentified source of bleeding undergo immediate further investigation (Grade 1B).We recommend both serum lactate and base deficit measurements as sensitive tests to estimate and monitor the extent of bleeding and shock (Grade 1B).AS represented the European Shock Society (ESS) on the ABC-T Task Force.PubMed Google Scholar Claridge JA, Sawyer RG, Schulman AM, McLemore EC, Young JS: Blood transfusions correlate with infections in trauma patients in a dose-dependent manner.We suggest that hypertonic solutions also be considered during initial treatment (Grade 2B).

PubMed Google Scholar Oz MC, Cosgrove DM, Badduke BR, Hill JD, Flannery MR, Palumbo R, Topic N: Controlled clinical trial of a novel hemostatic agent in cardiac surgery.There are several potential mechanisms for the adverse effects of hyperventilation and hypocapnia, including increased vasoconstriction with decreased cerebral blood flow and impaired tissue perfusion.

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The remaining recommendations have been reevaluated and graded based on literature published since the last edition of the guideline.Delayed phase CT may be used to detect active bleeding in solid organs.

The formulation and grading of the recommendations presented here are therefore weighted to reflect both this reality and the current state-of-the-art.More research is required in this area, and in the meantime physicians should make their own judgement when developing local policies.

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This document presents an updated version of the guideline published by the group in 2007.PubMed Central PubMed Google Scholar Human albumin administration in critically ill patients: systematic review of randomised controlled trials.The need for massive transfusion is relatively rare, occurring in less than 2% of civilian trauma patients, but higher (7%) in the military setting.They are often combined with a procoagulant substance such as thrombin to enhance the haemostatic effect.The different types of local haemostatics are briefly presented according to their basis and haemostatic capacity.

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Transfer times to and from all forms of diagnostic imaging need to be considered carefully in any patient who is haemodynamically unstable.We do not recommend the use of antithrombin concentrates in the treatment of the bleeding trauma patient (Grade 1C).

PubMed Google Scholar Kessler CM: Urgent reversal of warfarin with prothrombin complex concentrate: where are the evidence-based data.Citrate exerts its anticoagulant activity by binding ionised calcium, and hypocalcaemia is most common in association with FFP and platelet transfusion because these products contain high citrate concentrations.

JD is a member of the ABC-T European medical education initiative faculty.Family physicians frequently encounter patients with epistaxis (nasal bleeding).We do not suggest that desmopressin be used routinely in the bleeding trauma patient (Grade 2C).A number of patients who present with free intra-abdominal fluid according to FAST can safely undergo further investigation with MSCT.The task force consisted of the core group, additional experts in haematology and guideline development, and representatives of relevant European professional societies, including the European Society of Anaesthesiology, the European Society of Intensive Care Medicine, the European Shock Society, the European Society of Trauma and Emergency Surgery and the European Society for Emergency Medicine.In the absence of such evidence, case-control studies, observational studies and case reports were considered.ACOG Practice Bulletin Number 136: Management of Abnormal Uterine Bleeding Associated With Ovulatory Dysfunction, July.Reprinted with permission from the American College of Chest Physicians.

We recommend early treatment with thawed FFP in patients with massive bleeding (Grade 1B).The early detection of these injuries and initial efforts to reduce disruption and stabilise the pelvis as well as containing bleeding is therefore crucial.PubMed Google Scholar Watts DD, Trask A, Soeken K, Perdue P, Dols S, Kaufmann C: Hypothermic coagulopathy in trauma: effect of varying levels of hypothermia on enzyme speed, platelet function, and fibrinolytic activity.PubMed Google Scholar Jayaraman S, Sethi D: Advanced trauma life support training for hospital staff.PubMed Google Scholar Becker CD, Poletti PA: The trauma concept: the role of MDCT in the diagnosis and management of visceral injuries.

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Management of bleeding in early pregnancy in accident and emergency departments.Promising results have been obtained with hypertonic solutions.Weak recommendation, moderate-quality evidence Benefits closely balanced with risks and burden RCTs with important limitations (inconsistent results, methodological flaws, indirect or imprecise) or exceptionally strong evidence from observational studies Weak recommendation, best action may differ depending on circumstances or patient or societal values.This guideline reviews appropriate physiological targets and suggested use and dosing of fluids, blood products and pharmacological agents in the bleeding trauma patient.PubMed Google Scholar Salzman EW, Weinstein MJ, Weintraub RM, Ware JA, Thurer RL, Robertson L, Donovan A, Gaffney T, Bertele V, Troll J, Smith MS, Chute BA: Treatment with desmopressin acetate to reduce blood loss after cardiac surgery.

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Motor vehicle crashes cause approximately 60% of pelvic fractures followed by falls from great heights (23%).We recommend that crystalloids be applied initially to treat the bleeding trauma patient (Grade 1B).