Fight with acute blood loss in trauma
Traumatology / / August 12, 2017
Severe disorders of hemodynamics in patients with multiple fractures require emergency blood transfusion therapy.During the first 30-40 minutes, should compensate the alleged shortage of circulating blood volume due to various gemokorrektorov.These include polyionic solutions (Acesol, laktasol, kvartasol, Chlosol, Trisol, Ringer's lactate), colloid (dextran preparations, gelatin, vinyl compounds), blood substitutes complex action (Polifer, reoglyuman, glyuman).With limited amounts of blood loss a positive effect is achieved by the introduction of mere polyionic solutions.If massive blood loss needed transfusion of colloidal solutions, blood products, whole blood.
Choice colloids depends on the purpose of transfusion.The smaller molecule colloid, so it is active as a antiagregatine and anti-toxic agent, but the less it stay in the bloodstream.Therefore, the use of middle and krupnomolekulyarnyh media (polyglukin, makrodeks, ferroglyukin) more effectively to meet the challenges prolonged increase bcc and
transfusion rate in critical situations should be large, of 400-500 ml / min, while in the first 3-5 minutes, must be handled at least 0.5 liters, and the next 20 min - 1 liter.High speed injection is rapidly increasing bcc and eliminates hypoxia.
ineffectiveness of massive blood transfusions often associated with continued bleeding, the source of which, in addition to internal organs breaks, can be smashed with extensive tissue damage (or failure) of the limbs.Such bleeding are dangerous because they lead to large blood loss quickly, because, firstly, they are hidden layered bandages (big towels, sheets), and secondly, the rate of low blood pressure is low (about 100 ml / h).However, we must bear in mind that with the improvement in hemodynamic krovoplazmopoterya crushing tissue increases, you lose the full blood of the patient, and it is replaced or preserved blood or plasma substitutes.
- Infections with traumas
- main symptoms of multiple rib fractures
- Bilateral fractures of the humerus
- Bilateral fractures of the forearm bones
- Treatment of combined traumatic brain injury
- Bilateral femoral fractures
- Bilateral fractures of the patella
- Combined treatment of injuries
- Bilateral fractures of the fibula
- Bilateral fractures of the foot
- bilateral calcaneus fractures
eliminate these sources of blood loss is impossible without early surgical intervention, the ratio of whichIt should be the same as in the case of internal organs damages.The volume transfusions should be regulated in accordance with clinical and laboratory data.With symptoms of shock I-II degree of the patient to be transfused during the first day at least 2-3 liters of fluids (blood transfusions are not required), with severe shock - at least 3-4 liters (30% of the blood), and terminal states - at least6.8 l (50% of blood).
criteria for reducing the rate and volume of transfusion therapy are: blood pressure of 13.3 kPa (100 mm Hg..) And above, pulse 90-100 beats / min (satisfactory filling in the peripheral arteries), the appearance of pink color in the lips,ears, fingers, warming the skin (especially on the limbs).The total volume of transfusions polytrauma rarely exceeds 2 or more times the proper value of the bcc.However, uncontrolled sverhtransfuzii lead to the development of heart failure, pulmonary edema, pneumonia.