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Surgical Strategies in Trauma

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Penetrating Trauma

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Abstract

Traumatic hemorrhage is a major cause of trauma-related death in both the civilian and military settings. Given the preventable nature of the consequences of hemorrhage, significant energy has been dedicated to better therapeutic considerations. Trunkey et al. stratified traumatic deaths a trimodal distribution: immediate death from massive neurologic or cardiovascular injuries, early death from noncompressible torso trauma and hemorrhage, and late death related to organ failure and death. This concept has been challenged with recent studies suggesting that severely injured patients have only a small percentage of late deaths, with death primarily occurring within the first 6 h of admission. This may be attributed to better postoperative care and hospital systems. These findings place emphasis on the importance of early events in the management of bleeding patients. The basic principles of the contemporary approach to the bleeding trauma patient include:

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Recommended Reading

  1. Alam HB (2006) An update on fluid resuscitation. Scand J Surg 95:136–145

    CAS  PubMed  Google Scholar 

  2. Bickel WH, Wall MJ, Pepe PE, Martin RR, Ginger VF, Allen MK et al (1994) Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med 331:1105–1109

    Article  Google Scholar 

  3. Borgman MA, Spinella PC, Perkins JG et al (2007) The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma 63:805–813

    Article  PubMed  Google Scholar 

  4. CRASH-2 Trial collaborators (2010) Effects of tranexamic acid on death, vascular occlusive events, and blood transfusions in trauma patients with significant haemorrhage: a randomized, placebo-controlled trial. Lancet 376:23–32

    Article  Google Scholar 

  5. Demetriades D et al (2005) Trauma deaths in a mature urban trauma system: is “trimodal” distribution a valid concept? J Am Coll Surg 201(3):343–348

    Article  PubMed  Google Scholar 

  6. Dirkmann D, Hanke AA, Görlinger K, Peters J (2008) Hypothermia and acidosis synergistically impair coagulation in human whole blood. Anesth Analg 106(6):1627–1632

    Article  PubMed  Google Scholar 

  7. Dula DJ, Wood GC, Rejmer AR, Starr M, Leicht M (2002) Use of prehospital fluids in hypotensive blunt trauma patients. Prehosp Emerg Care 6(4):417–420

    Article  PubMed  Google Scholar 

  8. Greaves MW, Hussein SH (2002) Fluid resuscitation in prehospital trauma care: a consensus view. J R Coll Surg Edinb 47(2):451–457

    CAS  PubMed  Google Scholar 

  9. Holcomb JB, Jenkins D, Rhee P et al (2007) Damage control resuscitation: directly addressing the early coagulopathy of trauma. J Trauma 62(307–310):28

    Google Scholar 

  10. Holcomb JB et al (2007) Damage control resuscitation: directly addressing the early coagulopathy of trauma. J Trauma 62:307–310

    Article  PubMed  Google Scholar 

  11. Kwan I, Bunn F, Roberts I (2003) WHO Pre-Hospital Trauma Care Steering Committee: timing and volume of fluid administration for patients with bleeding following trauma. Cochrane Database Syst Rev (3):CD002245

    Google Scholar 

  12. Lin Y, Stanworth S, Birchall J et al (2011) Use of recombinant factor VIIa for the prevention and treatment of bleeding in patients without hemophilia: a systematic review and meta-analysis. CMAJ 183:E9–E19

    Article  PubMed  Google Scholar 

  13. Maegele M, Lefering R, Yucel N et al (2007) Early coagulopathy in multiple injury: an analysis from the German Trauma Registry on 8724 patients. Injury 38:298–304

    Article  PubMed  Google Scholar 

  14. Niles SE, McLaughlin DF, Perkins JG et al (2008) Increased mortality associated with the early coagulopathy of trauma in combat casualties. J Trauma 64:1459–1465

    Article  PubMed  Google Scholar 

  15. Perel P, Roberts I, Shakur H et al (2010) Haemostatic drugs for traumatic brain injury. Cochrane Database Syst Rev (1):CD007877

    Google Scholar 

  16. PROMMT Study collaborators (2013) The Prospective, Observational, Multicenter, Major Trauma Transfusion (PROMMTT) Study: comparative effectiveness of a time-varying treatment with competing risks. JAMA Surg 148(2):127–136

    Article  Google Scholar 

  17. PROPPR Trial collaborators (2015) 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 313(5):471–482

    Article  Google Scholar 

  18. Rotondo M, Schwab CW, Mullins RJ et al (1993) Damage control: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma 35:375–383

    Article  CAS  PubMed  Google Scholar 

  19. Schick KS, Fertmann JM, Jauch K et al (2009) Prothrombin complex concentrate in surgical patients: retrospective evaluation of vitamin K antagonist reversal and treatment of severe bleeding. Crit Care 12:R191

    Article  Google Scholar 

  20. Stannard A, Eliason JL, Rasmussen TE (2011) Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as an adjunct for hemorrhagic shock. J Trauma Inj Inf Crit Care 71:1869–1872

    Article  Google Scholar 

  21. Trunkey DD (1983) Trauma. Sci Am 249(2):20

    Article  Google Scholar 

  22. Turner J, Nicholl J, Webber L et al (2000) A randomized controlled trial of prehospital intravenous fluid replacement therapy in serious trauma. Health Technol Assess 4(31):1–57

    CAS  PubMed  Google Scholar 

  23. Wade CE, Eastridge BJ, Jones JA et al (2010) Use of recombinant factor VIIa in US military casualties for a five-year period. J Trauma 69:353–359

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery, University of Michigan Health Systems, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA

    V. C. Nikolian & P. E. Georgoff

  2. Section Head of General Surgery, University of Michigan Health Systems, Taubman Center Floor 2 Reception F, 1500 E Medical Center Dr SPC 5332, Ann Arbor, MI, 48109-5331, USA

    H. B. Alam

Authors
  1. V. C. Nikolian
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  2. P. E. Georgoff
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  3. H. B. Alam
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Corresponding author

Correspondence to V. C. Nikolian .

Editor information

Editors and Affiliations

  1. Professor of Surgery Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital Harvard University Medical School, Boston, USA

    George C. Velmahos

  2. Professor Emeritus, Department of Surgery, University of the Witwatersrand Medical School, Milpark Hospital Academic Trauma Centre and Leratong Hospital, Johannesburg, South Africa

    Elias Degiannis

  3. Honorary Senior Lecturer, Department of Surgery, University of the Witwatersrand Medical School, Johannesburg, South Africa

    Dietrich Doll

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Nikolian, V.C., Georgoff, P.E., Alam, H.B. (2017). Surgical Strategies in Trauma. In: Velmahos, G., Degiannis, E., Doll, D. (eds) Penetrating Trauma. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-49859-0_25

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  • DOI: https://doi.org/10.1007/978-3-662-49859-0_25

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-49857-6

  • Online ISBN: 978-3-662-49859-0

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