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Massive posttraumatic bleeding: epidemiology, causes, clinical features, and therapeutic management
Giuseppe Lippi1, Emmanuel J Favaloro, Gianfranco Cervellin
1Dipartimento di Patologia e Medicina di Laboratorio, U.O. Diagnostica Ematochimica, Azienda Ospedaliero-Universitaria di Parma, Italy. glippi@ao.pr.it
Seminars in Thrombosis and Hemostasis
|October 23, 2012
Summary
Severe bleeding, often from trauma, can cause hypovolemic shock and high mortality. Prompt damage control resuscitation, including surgery and blood products, is crucial for survival.
Area of Science:
- Trauma and Emergency Medicine
- Hematology
- Surgical Critical Care
Background:
- Bleeding complications arise from hemostasis disruptions, exacerbated by inherited bleeding disorders.
- Life-threatening hemorrhages commonly result from severe trauma, including penetrating wounds, blunt force, and complex injuries.
- Major hemorrhages lead to significant intravascular volume loss, causing hypovolemic shock and critical ischemia.
Purpose of the Study:
- To outline the pathogenesis of posttraumatic bleeding.
- To emphasize the critical nature of timely treatment for severe posttraumatic bleeding.
- To describe the damage control sequence for managing major hemorrhages.
Main Methods:
- Review of the pathophysiology of posttraumatic bleeding.
- Description of hypovolemic and hemorrhagic shock.
- Outline of the four-step damage control sequence.
Main Results:
- Posttraumatic bleeding involves complex pathogenesis and significant intravascular volume loss.
- Hypovolemic shock can lead to peripheral ischemia, particularly in the CNS and myocardium.
- Mortality rates for severe posttraumatic bleeding can reach 50% without timely intervention.
Conclusions:
- Damage control surgery and resuscitation are vital for managing severe posttraumatic bleeding.
- Correction of coagulopathy using blood products and specific agents is a key component.
- Timely and appropriate treatment significantly impacts survival rates in severe hemorrhage.
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