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Acta medica Croatica : Časopis Akademije medicinskih znanosti Hrvatske, Vol. 73 No. 2, 2019.

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POLYTRAUMA AND MASSIVE BLEEDING – CASE REPORT

VIŠNJA NESEK ADAM orcid id orcid.org/0000-0002-6521-4136 ; Sveti Duh University Hospital, Department of Anesthesiology, Reanimatology and Intensive Care, Zagreb, Josip Juraj Strossmayer University in u Osijek, School of Medicine, Osijek, Croatia
ANTONIA BULIĆ MILJAK orcid id orcid.org/0009-0005-8122-5651 ; Sveti Duh University Hospital, Department of Anesthesiology, Reanimatology and Intensive Care, Zagreb, Croatia
FRANJO VOLARIĆ ; Sveti Duh University Hospital, United Central Emergency Reception, Zagreb, Croatia

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Abstract

Trauma is the leading cause of death in patients under 45 years of age, and also the most common reason for massive transfusion. In this paper, we report on the management of a polytraumatized patient admitted to emergency department with severe hemorrhagic shock and concomitant traumatic brain injury, in which the damage control resuscitation (DCR) approach was used to promote hemostatic resuscitation. During the procedure, the patient received 6500 mL of crystalline and 1500 mLl of colloid solutions, 22 doses of red blood cells, 17 doses of fresh frozen plasma, 20 doses of platelets and 5 doses of cryoprecipitate. Tranexamic acid and recombinant factor VII were also administered. Systolic pressure was maintained between 50 and 90 mm Hg with abundant administration of packed red blood cells, other blood components and vasoactive support of noradrenaline. Control lab test results showed satisfactory hemoglobin levels with progression of coagulopathy and pronounced metabolic acidosis. Despite massive transfusion and intensive therapy, the patient died due to secondary intracerebral hemorrhage, edema and brain herniation partly as a result of direct brain trauma and partly due to the development of coagulopathy. Treatment of polytrauma patients requires a multidisciplinary approach aimed at rapid control of bleeding, prevention of the development of coagulopathy and maintenance of appropriate perfusion of the brain and other organs. Particular care is needed in patients with associated traumatic brain injury that further increases the incidence of coagulopathy and thus mortality, and remains a major challenge in clinical practice.

Keywords

massive transfusion; coagulopathy

Hrčak ID:

224711

URI

https://hrcak.srce.hr/224711

Publication date:

6.9.2019.

Article data in other languages: croatian

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