Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2014
ReviewMedical advances in the treatment of postpartum hemorrhage.
Postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide. Recent advances in the management of severe bleeding for trauma patients may provide insight into PPH management, but must be applied with caution considering the significant differences between trauma and obstetric patients. In this review, we summarized evidence for current management strategies for patients with major obstetric hemorrhage, including (1) rapid laboratory assessment of coagulopathy, (2) early transfusion of plasma and high plasma-to-red blood cell transfusion ratios in massive PPH, and (3) use of tranexamic acid and fibrinogen concentrates in the setting of PPH complicated by coagulopathy.
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Anesthesia and analgesia · Nov 2014
ReviewTrauma Bleeding Management: The Concept of Goal-Directed Primary Care.
The early and aggressive high-volume administration of fresh frozen plasma, platelet concentrates, and red blood cells (RBCs), using ratio-driven massive transfusion protocols, has been adopted by many for the treatment of trauma-induced coagulopathy and hemorrhagic shock. However, the optimal ratio of RBC: fresh frozen plasma and RBC:platelet concentrate is still under investigation. ⋯ Both a ratio-driven coagulation therapy and a point-of-care-guided coagulation management based on coagulation factor concentrates aim for the same target-the rapid prevention and treatment of shock and coagulopathy to prevent death from traumatic hemorrhage. In this review, we compare the evidence relating to the effectiveness and safety of the ratio-driven and goal-directed approaches to trauma-induced coagulopathy to draw attention to the potential benefits and drawbacks associated with these management strategies.