Control of major haemorrhage

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Control of major haemorrhage

Diagram shows lethal triad mechanism with markings for severe blood loss, blood clotting problem, acidic blood, low body temperature, increased lactic acid in blood, et cetera.

The problem of major haemorrhage in trauma


Uncontrolled haemorrhage has been shown to be the most common cause of preventable deaths in trauma and is responsible for 40% of early in-hospital trauma mortality. Observational studies have shown that 25% of trauma patients also have an established coagulopathy on arrival in the emergency department and that this is associated with a fourfold increase in mortality.


The so-called ‘lethal triad of death’ (Figure 11.1) describes the mutually perpetuating combination of acute coagulopathy, hypothermia and metabolic acidosis. These are seen in exsan­guinating trauma patients. Hypoperfusion results in reduced oxygen delivery and the consequent switch to anaerobic metabolism results in lactate production and therefore metabolic acidosis. Anaerobic metabolism limits heat production, exacerbating hypothermia caused by exposure to cold resus­citation fluids and blood.


Acute coagulopathy in trauma


It is known that disruption of haemostatic equilibrium occurs at the moment of traumatic impact at which point physiological responses are initiated producing acute traumatic coagulopathy. The degree of coagulopathy has been shown to correlate closely with severity of injury, blood product requirements and mortality. Although the aetiology of acute coagulopathy in trauma is not fully understood, it is thought to involve the disruption of the equilibrium of the clotting cascade:

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Mar 13, 2018 | Posted by in Uncategorized | Comments Off on Control of major haemorrhage

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