title: Key issues in advanced bleeding care in trauma.
abstract: The incidence of hemostatic abnormalities in the early hours after traumatic incident is high and represents an independent predictor of mortality. Key factors in the development of traumatic coagulopathy include the severity of injury, hypothermia, acidosis, hemorrhagic shock, hemodilution, clotting factor consumption, and fibrinolysis. Assessment of bleeding includes evaluation of the mechanism of injury, vital signs, biochemistry, detection of external and internal bleeding sources, injuries found upon secondary investigation, and response to treatment. Priority in treating the bleeding trauma patient should be given to prevention of further bleeding, hypothermia, acidosis, coagulopathy, and maintenance of tissue oxygenation, achieved by careful physical handling, damage control surgery, analgesia, maintenance of normothermia, correction of coagulopathy, control of blood pH, and serum calcium. Priority during initial treatment is to restore tissue perfusion and achieve hemostasis in vital functions; other nonvital procedures may generally be delayed. This state-of-the-art review aims to address key issues in acute control of bleeding in the trauma patient.
authors.affiliation: Department of Anaesthesiology, University Hospital Aachen, Aachen, Germany.rossaint@post.rwth-aachen.de
authors.forename: Rolf
authors.initials: R
authors.lastname: Rossaint
authors.forename: Vladimir
authors.initials: V
authors.lastname: Cerny
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Coats
authors.forename: Jacques
authors.initials: J
authors.lastname: Duranteau
authors.forename: Enrique
authors.initials: E
authors.lastname: Fernández-Mondéjar
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gordini
authors.forename: Philip F
authors.initials: PF
authors.lastname: Stahel
authors.forename: Beverley J
authors.initials: BJ
authors.lastname: Hunt
authors.forename: Edmund
authors.initials: E
authors.lastname: Neugebauer
authors.forename: Donat R
authors.initials: DR
authors.lastname: Spahn
mesh_terms: D006470:Hemorrhage / Q000628:therapy*; D006801:Humans; D014947:Wounds and Injuries / Q000628:therapy*