Ugeskrift for laeger
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Ugeskrift for laeger · May 2011
[Prehospital treatment of severely injured patients with focus on damage control-surgery].
The majority of patients undergoing damage control surgery initially receive prehospital treatment. Bleeding causes 40% of trauma deaths, half of which happen in the prehospital setting. Future research and improved treatment before hospital admission should focus on control of the bleeding, avoidance of hypothermia, minimising the time to definitive surgery, and a restrictive and goal directed therapy with regard to the intake of fluids. On occasion, lifesaving procedures could be performed during transport to the hospital.
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Damage control orthopedics (DCO) is a concept for treatment of fractures in severely injured patients. The fractures are stabilized with external fixators instead of primary definitive osteosynthesis, known as early total care (ETC). The purpose of DCO is to minimize time of surgery and bleeding and thereby minimize the "second hit". Not all patients require DCO, patients with stable vital functions can safely be treated with primary definitive osteosynthesis, DCO is, however, a safe method that can be used, when shorter time of surgery is desirable or a systemic immune response is imminent.
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Ugeskrift for laeger · May 2011
Case Reports[Resuscitation and abdominal surgical aspects of damage control surgery].
In multitrauma patients continuous bleeding is one of the major killers. Coagulation defects have been shown to be a primary event and to occur very early in multitrauma patients (acute traumatic coagulopathy). It is enhanced by acidosis, hypothermia and further coagulation disorders in the "bloody vicious cycle". Due to this a new resuscitation practice has been defined; damage control resuscitation, consisting of hypotensive resuscitation (restricted use of crystalloids), haemostatic resuscitation (balanced use of blood components) in combination with surgical haemostatic procedures (damage control surgery).
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Ugeskrift for laeger · May 2011
[Hyperfibrinolysis as the cause of haemorrhage and increased mortality in trauma patients].
Trauma-associated coagulopathies are at times present upon arrival at the emergency department. Hyperfibrinolysis is a condition in which the natural ability to dissolve blood clots is pathologically enhanced. ⋯ The condition is treated with antifibrinolytics such as tranexamic acid--whereas transfusion with blood products is inefficient. This article explores the mechanisms and diagnostics of hyperfibrinolysis in trauma patients and the relevant treatment options.
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Ugeskrift for laeger · May 2011
[Functional haemostatic tests are fast and reliable by transfusion demanding bleeding].
Viscoelastic haemostatic tests (VHT) like thrombelastography (TEG) and rotationel thrombelastometry (ROTEM) are cell-based whole blood assays, which assess the viscoelastic properties of coagulation. The focus of this narrative review is to describe the TEG/ROTEM methodology and interpretation of the TEG/ROTEM results. Current clinical applications and limitations are also discussed. It is concluded that VHT are inexpensive point of care assays that allow quick assessment of the haemostatic function and thereby allow faster and more focused interventions than traditional coagulation tests do.