title: Haemorrhage control in severely injured patients.
abstract: Most surgeons have adopted damage control surgery for severely injured patients, in which the initial operation is abbreviated after control of bleeding and contamination to allow ongoing resuscitation in the intensive-care unit. Developments in early resuscitation that emphasise rapid control of bleeding, restrictive volume replacement, and prevention or early management of coagulopathy are making definitive surgery during the first operation possible for many patients. Improved topical haemostatic agents and interventional radiology are becoming increasingly useful adjuncts to surgical control of bleeding. Better understanding of trauma-induced coagulopathy is paving the way for the replacement of blind, unguided protocols for blood component therapy with systemic treatments targeting specific deficiencies in coagulation. Similarly, treatments targeting dysregulated inflammatory responses to severe injury are under investigation. As point-of-care diagnostics become more suited to emergency environments, timely targeted intervention for haemorrhage control will result in better patient outcomes and reduced demand for blood products. Our Series paper describes how our understanding of the roles of the microcirculation, inflammation, and coagulation has shaped new and emerging treatment strategies.
authors.affiliation: National Trauma Research Institute, The Alfred Hospital, Monash University, Melbourne, VIC, Australia. r.gruen@alfred.org.au
authors.forename: Russell L
authors.initials: RL
authors.lastname: Gruen
authors.forename: Karim
authors.initials: K
authors.lastname: Brohi
authors.forename: Martin
authors.initials: M
authors.lastname: Schreiber
authors.forename: Zsolt J
authors.initials: ZJ
authors.lastname: Balogh
authors.forename: Veronica
authors.initials: V
authors.lastname: Pitt
authors.forename: Mayur
authors.initials: M
authors.lastname: Narayan
authors.forename: Ronald V
authors.initials: RV
authors.lastname: Maier
mesh_terms: D001778:Blood Coagulation Disorders / Q000209:etiology / Q000628:therapy; D006470:Hemorrhage / Q000209:etiology* / Q000517:prevention & control*; D006489:Hemostatic Techniques; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D008833:Microcirculation / Q000502:physiology; D012771:Shock, Hemorrhagic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000628:therapy; D014947:Wounds and Injuries / Q000150:complications* / Q000601:surgery
chemical_list: D006490:Hemostatics