Bleeding Trauma Patient Analysis

For patients under 40 years old, trauma is the current leading cause of death and hemorrhage is the largest causation of that death. In the first 24 hours, hemorrhage accounts for upwards of 50% of trauma related death. With such a startling statistic, it is important that early identification combined with an aggressive treatment approach is implemented with these patients. This is what the basis of the article New Strategies for Massive Transfusion in the Bleeding Trauma Patient was about, what old strategies work and don’t work, what new strategies are proving to be valid, and what the future of this condition holds. The underlying concept that is really important to understand from this article is the lethal triad and the factors it …show more content…
There have however been many studies and continuous research of factors that lead to the identification of a patient with a coagulopathy and therefore in need of a massive blood transfusion. Throughout all of the research and studies, there have been five key values that are continuously used as part of the identification of coagulopathy. They are thereby considered the “five key triggers” and they are an INR greater than 1.5, systolic blood pressure less than 90-110, base deficit greater than 6, hemoglobin less than 11, and a temperature less than 96.5°. The other factors that are believed to play a factor are age above 55, decreased mental status, and weak/absent pulses. For a patient exhibiting all five key triggers, with or without the additional factors, would indicate that the patient has a coagulopathy problem and is in need of urgent …show more content…
The first treatment method is a massive transfusion. Traditionally massive transfusions involved three milliliters of crystalloid replacement per one milliliter of blood lost, for a maximum of ten units of packed red blood cells (PRBC). Once this was complete, patients would be given fresh frozen plasma (FFP) and platelet (PLT) replacement. It has been found that this traditional treatment method may actually have resulted in adverse reactions due to a high amount of crystalloids infused with no plasma infusion. The new practice is to use crystalloids minimally, only to maintain IV access and as a flush between blood products. Rather FFP, PRBC, and PLT are infused in a 1:1:1 ratio, which has shown to decrease mortality rates. The second treatment method is to maintain the circulation of the patient. Traditionally this was done by raising and maintaining the patient’s systolic blood pressure to a “normal” level. This was found to actually causing rebleeding in the patient by what has been termed “popping the clot.” That means that the normal systolic pressure disturbs the thrombi that are already formed; only increasing hemorrhage. New practice shows that sustaining systolic blood pressure at 90 improves the mortality of the patient while still supporting the circulation needs within the body. The quicker that these interventions can be implemented, the lower the mortality rate for