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Medical Principles of Hemostasis: Just Give Me the Nuts and Bolts!

  • Paul B. McBethEmail author
Chapter

Abstract

Careful monitoring of end points of trauma resuscitation and understanding of principles of hemostatic resuscitation are needed to guide management of critically ill patients and improve outcomes. The purpose of this review is to discuss early resuscitation goals, hemostasis management, and thromboelastography to guide resuscitation of trauma patients. Principles of early directed therapy to correct metabolic and physiologic derangements are described. The use of thromboelastography to guide hemostatic resuscitation is reviewed. The techniques outlined in this chapter have the potential to optimize individual patient resuscitation thereby reducing unnecessary blood product utilization.

Keywords

Perioperative trauma care Damage control resuscitation Hemostatic resuscitation Trauma-associated coagulopathy Thromboelastography Fibrinolysis 

References

  1. 1.
    Holcomb JB, del Junco DJ, Fox EE, et al. The prospective, observational, multicenter, major trauma transfusion (PROMMTT) study: comparative effectiveness of a time-varying treatment with competing risks. JAMA Surg. 2013;148(2):127–36.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Holcomb JB, Tilley BC, Baraniuk S, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA. 2015;313(5):471–82.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Ball CG. Damage control surgery. Curr Opin Crit Care. 2015 Dec;21(6):538–43.CrossRefPubMedGoogle Scholar
  4. 4.
    Stainsby D, MacLennan S, Thomas D, Isaac J, Hamilton PJ. Guidelines on the management of massive blood loss. Br J Haematol. 2006;135:634–41.CrossRefPubMedGoogle Scholar
  5. 5.
    Palmer L, Martin L. Traumatic coagulopathy—part 1: pathophysiology and diagnosis. J Vet Emerg Crit Care (San Antonio). 2014;24:63–74.CrossRefGoogle Scholar
  6. 6.
    Wozniak D, Adamik B. Thromboelastography. Anestezjol Intens Ter. 2011;43:244–7.PubMedGoogle Scholar
  7. 7.
    Kashuk JL, Moore EE, Sawyer M, Wohlauer M, Pezold M, Barnett C, et al. Primary fibrinolysis is integral in the pathogenesis of the acute coagulopathy of trauma. Ann Surg. 2010;252:434–44.PubMedGoogle Scholar
  8. 8.
    Hartert H. Blutgerinnungsstudien mit der Thrombelastographie, einem neuen Untersuchungsvefahren. Klin Wochenschr. 1948;26:577–83.CrossRefPubMedGoogle Scholar
  9. 9.
    Pezold M, Moore EE, Wohlauer M, Sauaia A, Gonzalez E, Banerjee A, Silliman CC. Viscoelastic clot strength predicts coagulation-related mortality within 15 minutes. Surgery. 2012 Jan;151(1):48–54.CrossRefPubMedGoogle Scholar
  10. 10.
    Moore HB, Moore EE, Gonzalez E, Chapman MP, Chin TL, Silliman CC, Banerjee A, Sauaia A. Hyperfibrinolysis, physiologic fibrinolysis, and fibrinolysis shutdown: the spectrum of postinjury fibrinolysis and relevance to antifibrinolytic therapy. J Trauma Acute Care Surg. 2014 Dec;77(6):811–7.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Departments of Critical Care Medicine and SurgeryUniversity of CalgaryCalgaryCanada

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