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Critical Care Resuscitation in Trauma Patients: Basic Principles and Evolving Frontiers

  • Cherisse Berry
  • Ronald Tesoriero
  • Thomas ScaleaEmail author
Chapter

Abstract

Hypovolemia secondary to uncontrolled hemorrhage is the most common cause of shock after injury. In the severely injured trauma patient, estimating the depth of shock and adequacy of resuscitation utilizing focused rapid echocardiographic evaluation (FREE) and endpoints of resuscitation including lactate, base deficit, and central venous oxygen saturation is key to developing an optimal resuscitation strategy. Damage control resuscitation (DCR), damage control surgery (DCS), angioembolization, and other endovascular techniques such as thoracic endovascular repair (TEVAR) and resuscitative endovascular balloon occlusion of the aorta (REBOA) have evolved to accomplish the primary objective in the clinical management of shock, which is to stop hemorrhage. In patients with ongoing bleeding, massive transfusion protocols (MTPs) are often activated with the goal of transfusing a balanced ratio of blood products. Unfortunately, these patients are at risk for developing acute traumatic coagulopathy (ATC), which together with acidosis and hypothermia has been recognized for several decades as part of a lethal triad of death. Thus, utilizing point-of-care testing such as thromboelastography (TEG) should be used to guide resuscitation. Extracorporeal therapies including venovenous bypass for management of bleeding from retrohepatic liver injuries and venovenous extracorporeal membrane oxygenation (ECMO) for management of refractory hypoxemia are additional strategies that should be considered in the resuscitation of trauma patients.

Keywords

Shock Resuscitation Focused rapid echocardiographic evaluation (FREE) Damage control resuscitation (DCR) Damage control surgery (DCS) Extracorporeal membrane oxygenation (ECMO) Thromboelastography (TEG) Resuscitative endovascular balloon occlusion of the aorta (REBOA) Acute traumatic coagulopathy (ATC) Hyperfibrinolysis Massive transfusion protocol (MTP) 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Cherisse Berry
    • 1
  • Ronald Tesoriero
    • 1
  • Thomas Scalea
    • 1
    Email author
  1. 1.R Adams Cowley Shock Trauma Center, University of Maryland School of MedicineBaltimoreUSA

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