• J R Garrison, J D Richardson, A S Hilakos, D A Spain, M A Wilson, F B Miller, and R L Fulton.
• Department of Surgery, University of Louisville School of Medicine, Kentucky 40292, USA.
• J Trauma. 1996 Jun 1; 40 (6): 923-7; discussion 927-9.

ObjectiveTo determine if the decision to pack for hemorrhage could be refined.Materials And MethodsSeventy consecutive trauma patients for whom packing was used to control hemorrhage were studied. The patients had liver injuries, abdominal vascular injuries, and bleeding retroperitoneal hematomas. Preoperative variables were analyzed and survivors compared with nonsurvivors.ResultsPacking controlled hemorrhage in 37 (53%) patients. Significant differences (p < 0.05) between survivors and nonsurvivors were Injury Severity Score (29 vs. 38), initial pH (7.3 vs. 7.1), platelet count (229,000 vs. 179,000/mm3), prothrombin time (14 vs. 22 seconds), partial thromboplastin time (42 vs. 69 seconds), and duration of hypotension (50 vs. 90 minutes). Nonsurvivors received 20 units of packed red blood cells before packing compared to 13 units for survivors.ConclusionPatients who suffer severe injury, hypothermia, refractory hypotension, coagulopathy, and acidosis need early packing if they are to survive. Failure to control hemorrhage is related to severity of injury and delay in the use of pack tamponade. A specific protocol that mandates packing when parameters reach a critical limit should be considered.

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