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POLYTRAUMA AND MASSIVE BLEEDING – CASE REPORT

VIŠNJA NESEK ADAM orcid.org/0000-0002-6521-4136 ; Klinička bolnica Sveti Duh, Klinika za anesteziologiju, reanimatologiju i intenzivno liječenje, Zagreb, Sveučilište Josipa Jurja Strossmayera u Osijeku, Medicinski fakultet, Osijek i Klinička bolnica Sveti Duh, Objedinjeni središnji hitni prijam, Zagreb,
ANTONIA BULIĆ MILJAK orcid.org/0009-0005-8122-5651 ; Klinička bolnica Sveti Duh, Klinika za anesteziologiju, reanimatologiju i intenzivno liječenje, Zagreb, Hrvatska
FRANJO VOLARIĆ ; Klinička bolnica Sveti Duh, Objedinjeni središnji hitni prijam, Zagreb, Hrvatska

Sažetak

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.

Ključne riječi

massive transfusion; coagulopathy

Hrčak ID:

224711

URI

https://hrcak.srce.hr/224711

Datum izdavanja:

6.9.2019.

Podaci na drugim jezicima: hrvatski

Posjeta: 2.498 *