Annales françaises d'anesthèsie et de rèanimation
-
Hemorrhage is the leading cause of death in trauma patients who arrive alive at hospital. This type of hemorrhage has a "coagulopathic" component, specific to major trauma and associated with poor outcomes. ⋯ However, early identification of coagulopathic patients requiring aggressive hemostatic resuscitation remains challenging, with an increasing role of point of care devices for hemostatic diagnosis and monitoring. Efforts have to be focused on the early diagnosis of coagulopathy for immediate delivery of blood products and coagulation factors to the right, accurately screened patients through pre-established protocols within the golden hour.
-
Ann Fr Anesth Reanim · Jul 2013
ReviewOperative care and surveillance in severe trauma patients. Interference between resuscitation treatments and anaesthesiology, and consequence on immunity.
Major trauma remains a worldwide cause of morbi-mortality. Early mortality is the consequence of hemorrhagic shock and traumatic brain injury. During early resuscitation, anaesthesia is often mandatory to perform surgery. ⋯ Nosocomial pneumonia are the consequence of an overwhelming systemic inflammatory response syndrome (SIRS) as well as a trauma-related immunosuppression. The administration of hemisuccinate of hydrocortisone modulates the SIRS and reduces the risk of nosocomial pneumonia as well as the length of mechanical ventilation. Finally in the operating theatre, fighting against hypothermia and un-anatomical positions, which can aggravate rhabdomyolysis, are both mandatory.
-
Ann Fr Anesth Reanim · Jul 2013
ReviewThe initial management of severe trauma patients at hospital admission.
The initial management of trauma patient is a critical period aiming at: stabilizing the vital functions; following a rigorous injury assessment; defining a therapeutic strategy. This management has to be organized to minimize loss of time that would be deleterious for the patients outcome. Thus, before patient arrival, the trauma team alert should lead to the initiation of care procedures adapted to the announced severity of the patient. ⋯ A rapid trauma injury assessment aims not only at guiding resuscitation (chest drainage, pelvic contention, to define the mean arterial pressure goal) but also to decide a critical intervention in case of hemodynamic instability (laparotomy, thoracotomy, arterial embolisation). This initial assessment includes a chest and a pelvic X-ray, abdominal ultrasound (extended to the lung) and transcranial Doppler (TCD). The whole body scanner with administration of intravenous contrast material is the cornerstone of the injury assessment but can be done for patients stabilized after the initial resuscitation.
-
Ann Fr Anesth Reanim · Jul 2013
ReviewThe management of femur shaft fracture associated with severe traumatic brain injury.
The aim of this article is to describe the management of femoral shaft fractures in patients with severe traumatic brain injury (TBI). This is a major problem and two questions remain currently of interest: When and how to perform orthopedic surgery in severe TBI patients? The main point of perioperative management remains the prevention of secondary brain insults and the monitoring of intracranial pressure is essential especially in patients with intracranial lesions on the CT-scan. The "double hit" concept, suggesting that surgery by itself might increase the preexisting systemic inflammatory response, gives argument for very early or delayed surgery. Early definitive femoral osteosynthesis, if requires lengthy surgical procedure, does not seem appropriate in this context and "damage-control orthopedics" with external fixation seems to be a good alternative.
-
Ann Fr Anesth Reanim · Jul 2013
ReviewUpdate on prehospital emergency care of severe trauma patients.
The prognosis of severe trauma patients is determined by the ability of a healthcare system to provide high intensity therapeutic treatment on the field and to transport patients as quickly as possible to the structure best suited to their condition. Direct admission to a specialized center ("trauma center") reduces the mortality of the most severe trauma at 30 days and one year. Triage in a non-specialized hospital is a major risk of loss of chance and should be avoided whenever possible. ⋯ However, it does not help predict the need for urgent resuscitation procedures. Hemodynamic management is central to the care of hemorrhagic shock and severe head trauma. Transport helicopter with a physician on board has an important role to allow direct admission to a specialized center in geographical areas that are difficult to access.