Review Note
Last Update: 09/18/2024 11:36 PM
Current Deck: Pato Qx examen
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Commit #152029
Circulation
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Commit #152029Provide immediate hemodynamic support and hemostatic measures while identifying sources of bleeding, e.g., external hemorrhage, thoracic cavity, abdominal cavity, thighs, retroperitoneal space.
- Assess hemodynamic status.
- Assess central pulses, level of consciousness, and capillary refill time.
- Monitor vitals and continuous cardiac telemetry.
- Perform initial interventions.
- Place two large-bore IVs (at least 18-gauge).
- Consider intraosseous access if peripheral IV cannot be obtained.
- Administer 1 L warmed isotonic crystalloid bolus.
- If unresponsive to IV fluid, proceed to blood transfusion.
- Localize hemorrhage.
- Perform FAST to rapidly identify hemopericardium, and intrathoracic, intraabdominal, and/or intrapelvic bleeding in unstable patients.
- Identify obvious pelvic or long bone (e.g., femur) deformity.
- Identify major bleeding vessels (e.g., in the neck, groin, chest, or proximal extremities).
- Identify indications for immediate surgery (e.g., exploratory laparotomy, urgent thoracotomy) and/or angioembolization.
- Treat hemorrhagic shock.
- Administer emergency transfusion with universal donor blood products (e.g., type O blood) if required.
- Provide crossmatched blood products as soon as they are available.
- Follow local massive transfusion protocol if indicated, e.g., plasma, platelets, and pRBCs at a 1:1:1 ratio.
- Consider tranexamic acid (TXA). [10][11]
- Consider reversal of anticoagulation.
- Allow for permissive hypotension.
- Perform bedside hemorrhage control.
- Apply pressure or tourniquet to control active external hemorrhage.
- Apply pelvic binder for suspected bleeding pelvic fractures
- Insert chest tube for suspected massive traumatic hemothorax
- Treat obstructive shock: e.g., chest tube insertion for tension pneumothorax, pericardial window for cardiac tamponade
If there is a loss of vital signs, treat traumatic cardiac arrest with emergency chest decompression and emergency thoracotomy.
Suspect cardiac tamponade in patients with penetrating chest injury with Beck triad and a positive FAST scan, and expedite urgent pericardial fluid drainage via thoracotomy.
Penetrating abdominal injury with signs of shock is usually an indication for exploratory laparotomy.