Aktualne spojrzenie na masywny krwotok actual view-point for massive hemorrhage

Abstract

A massive hemorrhage is the main cause of death in injures caused by war activities, terrorism, and transpotration accidens.The total loss of blood during 24 hours is considered to be massive hemorrhage.The first hours of hemorrhage are connected with a decline of coagulation potential and with development of coagulopathy,witch when combined with a drop of body temperature and a developing metabolic acidosis constitutes a very serious life,s threat.Therefore,the current approach to the treatment of massive hemorrhage is based on the avoidance of an excessive transfusion od blood substitute fluids ,because this leads to a dilution of components of coagulation ,and instead focused on-as aerly as possibile an application of full blood or products from blood particulary those that increase a coagulation potential.Most often it is a FFP ( fresh frozen plasma),or PCC (prothrombin complex concentrate)A special attention is paid to fibrinogen supplementation (usually 2,5–5,0 g/adult and 1–2 g/child is needed),so that it,s level in serum exceeds 150mg/dl.The source of fibrinogen other that FFP are crioprecipitat (0,4g/100ml) and fibrinogen concentrat ( Haemocomplletan®).Thromboelastography is recommended for a lab diagnosis of massive hemorrhage.The basic rule of the initial treatment that determines victim,s future outcome is the demage control resuscitation ,that is,performing only those procedures that are absolutely necessary to save life.With regard to hemorrhage here they are:1. Stop loos of blood with nonsugical or surgical methods depending on their availability.2. Blood transfusion( particulary fresh or fresh / warm ) or blood products with special attention given to fibrynogen supplementation.3. While transfusing blood products are performing has to keep a ratio erythrocytes/thrombocytes/FFP 1:1:1.The level of hemoglobin must be a minimum 7g/dl,fibrinogen 150mg/dl and thrombocytes 100 000/ml4. Prevent dropping body,s temperature.5. Restrict transfusion of fluids such as cristaloids an particulary artificial coloids to a bare minimum.No more that 700 ml in case that hemostasis was not performed.6. Supplemented calcium so that its ionized level does not drop below 0.9 mmol/l.7. Stabilize broken bons ,because its decreases secondary blood loss.8. Prophylacticly prescribe a wide spectrum antibiotic9. Transport a victim patient to higher level hospital.