Review
Introduction
Damage control resuscitation
Massive transfusion
TASH score | 1. SBP: < 100 mmHg = 4 pts, < 120 mmHg = 1 pt |
(0–28 pts, Increasing TASH-scores were associated with an increasing probability for MT requirement) | 2. Hb: < 7 g/dl = 8 pts, < 9 g/dl = 6 pts, < 10 g/dl = 4 pts, < 11 g/dl = 3 pts, < 12 g/dl = 2 pts |
3. intra-abdominal fluid : 3 pts | |
4. complex long bone and/or pelvic fractures: AIS 3 or 4 = 3 pts, AIS 5 = 6 pts | |
5. HR: > 120 bpm = 2 pts | |
6. BE: < -10 mmol/l = 4 pts, < -6 mmol/l = 3 pts, < -2 mmol/l = 1 pt | |
7. gender: male = 1 pt | |
ABC score | 1. penetrating mechanism: no = 0 pt, yes = 1 pt |
(0–4 pts, a score of 2 or greater was used to predict the need for MT) | 2. SBP < 90 mmHg: no = 0 pt, yes = 1 pt |
3. HR > 120 bpm: no = 0 pt, yes = 1 pt | |
4. positive FAST: no = 0 pt, yes = 1 pt |
Hypotensive resuscitation
Tranexamic Acid | within 3 h of injury loading dose 1 g over 10 min, followed by 1 g over 8 h |
Ionized Calcium Levels | maintain in normal ranges during MT |
Plasma : RBC | at least 1:2 (preferably 1:1) maintain Hb levels: 7–9 g/dl maintain coagulation parameters (repeated monitoring of PT, aPTT, fibrinogen levels, platelets count, viscoelastic testing) in normal ranges during MT |
Fibrinogen | 3–4 g administer in case of thromboelastometric signs of a functional fibrinogen deficit or a plasma fibrinogen level of less than 1.5 to 2 g/l |
Platelet Count | 50 × 109/l if ongoing bleeding and/or TBI: 100 × 109/l initial dose 4–8 single platelet units or 1 aphaeresis pack |
Blood Pressure | SBP: 80 to 90 mmHg until hemorrhage control (no TBI) if severe TBI (GCS ≤ 8) MAP ≥ 80 mmHg |
consider rFVIIa if major bleeding and traumatic coagulopathy persist despite maximal attempts to stop bleeding | |
in case of pre-trauma therapeutic anticoagulation or antiplatelets drugs consider specific treatment (ex. desmopressin, PCC, etc) |
Hemostatic resuscitation
Damage control surgery
Maxillofacial anatomy
Neck anatomy
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Zone I: extends between the clavicle/suprasternal notch and the cricoid cartilage (including the thoracic inlet). Surgical access to this zone may require thoracotomy or sternotomy. Major arteries and veins, trachea and nerves, esophagus, lower thyroid and parathyroid glands and thymus are located in this zone.
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Zone II: lies between horizontal lines drawn at the level of the cricoid cartilage and the angle of the mandible. It contains the internal and external carotid arteries, jugular veins, pharynx, larynx, esophagus, recurrent laryngeal nerves, spinal cord, trachea, upper thyroid and parathyroid glands.
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Zone III: extends between the angle of the mandible and base of skull. It contains the extracranial carotid and vertebral arteries, jugular veins, cranial nerves IX–XII and sympathetic nerve trunk.