Download to read offline
Uploaded byHossam atef
Protocol of trauma resuscitation
This document provides guidelines for trauma patient transfer and resuscitation protocols. It recommends that prior to transfer, patients with airway compromise should be intubated and ventilation should be stable on a transport ventilator. For circulation, intravenous access should be adequate and the patient should be hemodynamically stable. For trauma resuscitation, lactated Ringer's solution is recommended for fluid resuscitation. Target blood pressures for fluid resuscitation depend on trauma type. Early norepinephrine can limit fluid resuscitation and transfusion of blood products should aim to prevent traumatic coagulopathy.
Protocol of trauma resuscitation
- 1. Transfer Protocol inI CU Hosam M Atef
- 2. Airway Patients with(or at risk from) airway compromise should be intubated prior to transfer The tracheal tube should be secured and confirmed in correct position
- 3. Breathing Patient adequatelysedated if ventilated Ventilation established (and stable) on transport ventilator Adequate gas exchange on transport ventilator confirmed by arterial blood gas analysis Adequate oxygen supply on transfer vehicle
- 4. Circulation Adequate intravenousaccess Circulating volume optimized Hemodynamically stable All lines are patent and secured Any active bleeding controlled Long bone/pelvic fractures stabilized ECG and blood pressure monitored
- 5. C. Spine Adequatespinal immobilization (if indicated) Disability No active seizures Initial treatments for raised intracranial pressure (if indicated) Life-threatening electrolyte disturbances corrected Blood glucose >70 mg/dl
- 6. Exposure Patientadequately covered to prevent heat loss
- 7.
- 9. Resuscitation protocol intraumatic hemorrhagic shock General principle: Traumatic death is the main cause of life years lost worldwide. Hemorrhage is responsible for almost 50% of deaths in the first 24 h after trauma. The optimal resuscitative strategy is controversial: Choice of fluid Target of hemodynamic goals for hemorrhage control The optimal prevention of traumatic coagulopathy are questions.
- 10. Fluid resuscitation I.Type of fluid Lactated Ringer’s solution is recommended as first- line resuscitation fluid in trauma patients Albumin should be avoided in patients with TBI In patients with TBI, isotonic saline should be preferred over hypotonic fluids because it can reduce the risk of cerebral edema.
- 11. II. Endpoints ofresuscitation Three different target systolic blood pressure values can be considered for three different traumatic conditions before controlling source of hemorrhage: 60–70 mmHg for penetrating trauma 80–90 mmHg for blunt trauma without TBI 100–110 mmHg for blunt trauma with TBI Lactate ≥ 2 mmol/L and base deficits ≥ -5 mEq/L have been demonstrated useful to stratify patients who need a larger amount of fluid after the initial resuscitation.
- 12. III. Vasopressor Earlyuse of norepinephrine could limit fluid resuscitation and hemodilution. The dose of norepinephrine should be titrated until we reach the target systolic blood pressure as indicated above
- 13. IV. Transfusion andprevention of acute coagulopathy of trauma The correction and prevention of traumatic coagulopathy have become central goals of early resuscitative management of hemorrhagic shock. a) Red blood cells In patients without TBI: Target haemoglobin level (7-9 g/dL) In patients with severe TBI (GCS ≤ 8): Target haemoglobin level ≥ 10 g/dL
- 14. a) FreshFrozen Plasma (FFP) In all patients FFP should be considered when PT or PTT ≥ 1.5 times normal value The initial recommended dose of FFP is 10 to 15 ml/kg
- 15. b) Platelet In patients without TBI: Platelet transfusion is recommended when platelet count ≤ 50.000/L In patients with TBI: Platelet transfusion is recommended when platelet count ≤ 100.000/L
- 16. c) Fibrinogen Inall patients, fibrinogen level should be maintained ≥ 150-200 mg/dL If The use of FFP failed to rapidly correct the hypofibrinogenemia Resuscitation with 10 to 15 mL/kg of FFP only increased the fibrinogen plasma level to 40 mg/dL More than 30 mL.kg of FPP should be necessary to increase the fibrinogen plasma level to 100 mg/dL Ten single bags of cryoprecipitate derived from whole blood are needed to raise the plasma fibrinogen level by 100 mg/dL
- 17. d) Adjuvant Therapy I. Tranxemic acid: routine administration of tranexamic acid (loading dose of 1 g over 10 min, then infusion of 1g over 8 hr) in patients with hemorrhagic shock was associated with a decreased mortality rate. II. Factor VIIa: No clear recommendation to use activate factor VII and the use of this factor should be discussed on a case-by- case basis. III. Ionized calcium level should be maintained between 1.1-1.3 mmol/L
- 21.