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[Prehospital resuscitation of patients with multiple injuries]
1Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland, winkelmann.marcel@mh-hannover.de.
Insights
Early recognition and management of hemorrhagic shock and trauma-induced coagulopathy are crucial for polytrauma patients. Damage control resuscitation, including permissive hypotension and hemostasis, improves outcomes in prehospital settings.
Area of Science:
- Trauma resuscitation
- Hemorrhagic shock management
- Trauma-induced coagulopathy
Context:
- Polytrauma significantly impacts young adults (35-45 years), with traumatic hemorrhage being a leading preventable cause of death.
- Trauma-induced coagulopathy affects approximately 25% of polytrauma patients.
- Effective prehospital resuscitation is vital for improving survival rates.
Purpose:
- To present current knowledge on prehospital resuscitation for polytrauma patients.
- To outline diagnostic criteria and therapeutic strategies for hemorrhagic shock and coagulopathy.
- To provide evidence-based recommendations for emergency physicians.
Summary:
- Hemorrhagic shock is diagnosed through rapid assessment of the trauma scene, injury patterns, and hemodynamics.
- Trauma-induced coagulopathy results from a complex interplay of tissue damage, shock, hypothermia, acidosis, and dilution.
- Preclinical damage control resuscitation involves controlling hemorrhage, permissive hypotension (target SBP 80-90 mmHg), and correcting hypothermia and acidosis.
Impact:
- Improved recognition of hemorrhagic shock and coagulopathy in prehospital settings.
- Standardized application of damage control resuscitation principles.
- Potential reduction in mortality and morbidity associated with polytrauma.
Introduction:
Polytrauma is the leading cause of morbidity and mortality in young adults (aged 35-45 years). At 30-40%, traumatic hemorrhage is the most frequent preventable cause of death. Approximately every fourth patient with multiple injuries suffers from trauma-induced coagulopathy.
Methods:
The current knowledge of prehospital resuscitation of patients with multiple injuries based on a selective literature research and experience in a level I trauma center are presented.
Results:
Hemorrhagic shock is a clinical diagnosis and the recognition by the first responding emergency physician requires rapid evaluation of the accident situation, injury pattern and patient's hemodynamic status. In the future, tools will help to reliably estimate shock. Development of trauma-induced coagulopathy is multifactorial and is characterized by interaction of tissue damage, shock, hypothermia, acidosis and dilution. Preclinical therapy follows the concept of damage control resuscitation and involves bleeding hemostasis, permissive hypotension with a target systolic blood pressure between 80 and 90 mmHg (≥80 mmHg in presence of traumatic brain injury) by modest infusion of primarily crystalloid solutions, avoiding hypothermia and acidosis.
Conclusion:
The current knowledge and therapy recommendations are presented.
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