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????