Perspectives of solution to the problem of persistent intra-abdominal hemorrhage at the prehospital stage

Abstract

A post-hoc analysis of 338 casualties demonstrating persistent intra-abdominal hemorrhage has been carried out, the proportion of this group being 16.5% in overall casualty structure or 64% in the group of casualties with abdominal injuries. Lethal outcome rate in the studied group was 13%, the complication rate was 53.2%. Traumatic shock was found in 86% of casualties, the greatest proportion was accounted for by the first and second degree (59.1%). Lethality rate in the case of the third degree traumatic shock and terminal state was 34.4%. Injured parenchymal organs and abdominal major vessels showed the greatest blood loss 2348 250 ml. The time of arrival of casualties with persistent intra-abdominal hemorrhage to the advanced trauma management stage or definitive surgical care stage was virtually similar amounting to 2.6 0.4 hr. Injuries to hollow organs (34.1%) were most commonly found, injuries to parenchymal organs (24.9%) occurred less frequently, the rate of combination of injuries to abdominal internal organs was approximately the same (24.9%). Major vessels injuries were diagnosed only in one casualty (0.3%), while those combined with internal organs injuries in 37(11%)of casualties. As regards favorable prognosis this group was considered to be the least perspective owing to high rate of hemorrhage and inability to achieve effective hemostasis at the prehospital stage. Thus, persistent hemorrhage was not profuse, and the majority of casualties (88.7%) should be considered as perspective recipients to achieve temporary hemostasis at the prehospital stage. It is this approach based on the principles of early pathogenetic management that could reduce the rate of complications and lethality in casualties with persistent intra-abdominal hemorrhage.