title: [Hb 1.1 g/dl: successful treatment of a polytraumatized patient in hemorrhagic shock].
abstract: We report on the successful treatment of a seriously traumatized patient (injury severity score=59) who presented with exsanguinating hemorrhage in the emergency room. Preclinical and emergency room management included "small volume" hypertonic resuscitation as well as massive transfusion, C-clamp stabilization of a pelvic ring instability, and attachment of external fixators to multiple bone fractures. During the intensive care period,we started enteral immunonutrition immediately after an abdominal compartment syndrome was removed by laparotomy and a jejunal catheter had been inserted. Multiple fractures were stabilized rapidly and the soft tissue wounds were covered by split skin grafts. Additionally, we provided sufficient analgesia with few side effects using an epidural catheter for continuous application of local anesthetics. In summary, an effective synthesis of up-to-date strategies for preclinical, emergency room, and intensive care management prevented multiple organ failure and achieved survival with good quality of life after a "fatal" multiple trauma.
authors.affiliation: Klinik für Anästhesiologie, Universitätsklinikum, Regensburg. lars-peter.kuhr@klinik.uni-regensburg.de
authors.forename: L-P
authors.initials: LP
authors.lastname: Kuhr
authors.forename: T
authors.initials: T
authors.lastname: Bein
authors.forename: U
authors.initials: U
authors.lastname: Schächinger
authors.forename: M
authors.initials: M
authors.lastname: Stumpf
authors.forename: S
authors.initials: S
authors.lastname: Bele
authors.forename: K
authors.initials: K
authors.lastname: Taeger
authors.forename: M
authors.initials: M
authors.lastname: Nerlich
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D001802:Blood Substitutes / Q000008:administration & dosage; D001803:Blood Transfusion; D003422:Critical Care; D004632:Emergency Medical Services; D016267:External Fixators; D005260:Female; D005440:Fluid Therapy; D006452:Hemoglobinometry; D006801:Humans; D009104:Multiple Trauma / Q000000981:diagnostic imaging / Q000601:surgery*; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries*; D011859:Radiography; D012151:Resuscitation; D012771:Shock, Hemorrhagic / Q000000981:diagnostic imaging / Q000601:surgery*
chemical_list: D001802:Blood Substitutes