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Code Crimson in Trauma Triage
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
An exsanguinating patient will not become stable until the bleeding has been stopped, which depends upon the control of the bleeding as well as treatment of coagulopathy. The history, mechanism of trauma and imaging are very decisive in the management of the source. There are two types of haemorrhage: compressible and non-compressible. Compressible occurs when the haemorrhage is in an accessible area to allow pressure application, whereas non-compressible is not accessible to direct pressure. Apply pressure to the compressible bleeding site, while looking for non-compressible haemorrhage. Perform extended focused assessment sonography for trauma (eFAST) for evaluation of potential spaces of haemorrhage, such as pleural, pericardial, abdominal and pelvic space. The trauma surgeon should rapidly decide (less than 10 min) regarding the further disposition for definitive control of bleeding (operating theatre, interventional radiology, computed tomography).
Mechanism of Injury
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Injury patterns from penetrating trauma are frequently directed towards the thoraco-abdominal region (57%), as well as to the upper extremities (32%).55 Major vascular injury leading to exsanguination is the primary cause of death following penetrating trauma and junctional regions, including the neck, axilla and groin line are vulnerable areas. Penetrating injury can be crudely divided into stab wounds and gunshot wounds. Gunshot wounds carry a significantly higher associated mortality rate, attributable largely to the higher level of energy transferred as a consequence of the injuries.56
Local Anesthetics
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
Elena González Burgos, Luis Luis García-García, M. Pilar Gómez-Serranillos, Francisca Gómez Oliver
This type of anesthesia was first introduced by August Bier in 1908. The anesthetic is administered intravenously to get a regional effect (Stancil, 2014). To avoid any eventual pass of the drug into the systemic circulation, the technique usually involves two extra procedures: Exsanguination of the region, extracting the blood from the region andTourniquets to avoid blood from either flowing in or out of the exsanguinated region.
Comparison of Three Junctional Tourniquets Using a Randomized Trial Design
Published in Prehospital Emergency Care, 2019
Micah J. Gaspary, Gregory J. Zarow, Michael J. Barry, Alexandra C. Walchak, Sean P. Conley, Paul J.D. Roszko
Exsanguination remains a leading cause of potentially preventable death in both civilian (1) and military trauma care (2). Many cases involve traumatic junctional wounds of the proximal leg that are not amenable to treatment with traditional tourniquet techniques (1, 3), and junctional hemorrhage control has been noted as an important area for research in both military and civilian settings (4, 5). Junctional tourniquets (JTQs) are designed to control hemorrhage by applying direct pressure over the femoral artery just distal to the inguinal ligament at the junction of the lower limb and torso. At the time of our study design, 3 JTQs had been cleared by the FDA for junctional hemorrhage control: The Combat Ready Clamp (CRoC®), the Junctional Emergency Treatment Tool (JETT™), and the SAM® Junctional Tourniquet (SJT).
Challenges to improving patient outcome following massive transfusion in severe trauma
Published in Expert Review of Hematology, 2020
Uncontrolled hemorrhage and exsanguination still represent a major problem and the most common cause of preventable death after trauma [1,2]. Additional to exsanguination the development of coagulopathy is a major risk factor. Upon hospital admission, approximately 25% of trauma patients are coagulopathic according to standard coagulation tests (PT, aPTT and/or viscoelastic signs of disturbed hemostasis), which has been associated with poor outcomes [3,4]. Timely action and treatment are important, as death from exsanguination occurs rapidly; the median time to in-hospital death for uncontrolled hemorrhage has remained consistent at 1.65 hours over the last decade [5].
Cavernous sinus haemangioma masquerading as a pituitary macroadenoma: how the unexpected lurks in neurosurgery
Published in British Journal of Neurosurgery, 2023
Simon Lammy, Jennifer Brown, Patricia Littlechild
Cavernous sinus haemangiomas (CSHs) are neoplastic lesions of the cavernous sinus which are notoriously difficult to diagnose and excise.1,2 It has a high operative mortality rate of 12–25%.1–3 Our case demonstrates the importance of remaining ever vigilant in neurosurgical practice despite advanced pre-operative diagnostics. Unexpected intra-operative exsanguination can occur despite advanced haemostatic adjuncts and such a fact remains a clear and present danger for the neurosurgeon, especially in the skull base.