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2014 ; 4
(3
): 189-199
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Trauma-Induced Coagulopathy
#MMPMID25587242
Simmons JW
; Pittet JF
; Pierce B
Curr Anesthesiol Rep
2014[Sep]; 4
(3
): 189-199
PMID25587242
show ga
Trauma is the leading cause of death among people under the age of 44. Hemorrhage
is a major contributor to deaths related to trauma in the first 48 h.
Accordingly, the management of these patients is a time-sensitive and critical
affair that anesthesiologists responsible for surgical resuscitation will face.
Coagulopathy associated with trauma exists in one-third of all severely injured
patients upon presentation to the hospital. Trauma patients presenting with
coagulopathy have significantly higher mortality. This trauma-induced
coagulopathy (TIC) must be managed adroitly in the resuscitation of these
patients. Recent advancements in our understanding of TIC have led to new
protocols and therapy guidelines. Anesthesiologists must be aware of these to
effectively manage this form of shock. TIC driven by a combination of endogenous
biological processes, as well as iatrogenic causes, can ultimately lead to the
lethal triad of hypothermia, acidemia, and coagulopathy. Providers should
understand how to promptly diagnose TIC and be aware of the early indicators of
massive transfusion. The use of common laboratory studies and patient vital signs
serve as our current guide, but the importance of each is still under debate.
Thromboelastography is a tool used often in the diagnosis of TIC and can be used
to guide blood product transfusion. Certain pharmaceutical strategies and
non-transfusion strategies also exist, which aid in the management of hemorrhagic
shock. Damage control surgery, rewarming, tranexamic acid, and 1:1:1 transfusion
protocols are promising methods used to treat the critically wounded. Though
protocols have been developed, controversies still exist on the optimal
resuscitation strategy.