Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-28T13:51:26.571Z Has data issue: false hasContentIssue false

Chapter 31 - Trauma Anesthesia

Published online by Cambridge University Press:  24 May 2023

By
Amanda Frantz ,
Meghan Brennan  and
Corey Scher
Edited by
Alan David Kaye  and
Richard D. Urman
Alan David Kaye
Affiliation:
Louisiana State University School of Medicine
Richard D. Urman
Affiliation:
Brigham and Women’s Hospital, Boston
Get access

Summary

A primary survey is performed immediately on admission to evaluate and treat life-threatening injuries such as hemorrhage, airway, and brain injuries. Hemorrhage leads to 40% of trauma-related deaths, particularly in the first 24 hours. Thromboelastography (TEG), rotational thromboelastometry (ROTEM), complete blood count, fibrinogen, prothrombin time (PT), activated partial thromboplastin time (aPTT), and international normalized ratio (INR) should be obtained to evaluate coagulation targeted to obtain clot stability [1]. It is also essential to measure renal and liver function, as both affect coagulation and drug elimination [2].

Type
Chapter
Information
Cambridge Handbook of Anesthesiology , pp. 472 - 484
Publisher: Cambridge University Press
Print publication year: 2023

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Foster, JC, Sappenfield, JW, Smith, RS, Kiley, SP. Initiation and termination of massive transfusion protocols: current strategies and future prospects. Anesth Analg. 2017;125:2045–55.Google Scholar
Thomas, S, Makris, M. The reversal of anticoagulation in clinical practice. Clin Med (Lond). 2018;18:314–19.Google Scholar
Chignalia, AZ, Yetimakman, F, Christiaans, SC, et al. The glycocalyx and trauma: a review. Shock. 2016;45:338–48.CrossRefGoogle ScholarPubMed
Brohi, K, Singh, J, Heron, M, Coats, T. Acute traumatic coagulopathy. J Trauma. 2003;54:1127–30.Google Scholar
Yee, J, Kaide, CG. Emergency reversal of anticoagulation. West J Emerg Med. 2019;20:770–83.Google Scholar
Grottke, O, Mallaiah, S, Karkouti, K, Saner, F, Haas, T. Fibrinogen supplementation and its indications. Semin Thromb Hemost. 2020;46:38–49.Google Scholar
Levy, JH, Goodnough, LT. How I use fibrinogen replacement therapy in acquired bleeding. Blood. 2015;125:1387–93.Google Scholar
Brohi, K. Prediction of acute traumatic coagulopathy and massive transfusion – is this the best we can do? Resuscitation. 2011;82:1128–9.Google Scholar
Simmons, JW, Pittet, J-F, Pierce, B. Trauma-induced coagulopathy. Curr Anesthesiol Rep. 2014;4:189–99.Google Scholar
Davenport, RA, Brohi, K. Cause of trauma-induced coagulopathy. Curr Opin Anaesthesiol. 2016;29:212–19.Google Scholar
Moore, EE, Moore, HB, Chapman, MP, Gonzalez, E, Sauaia, A. Goal-directed hemostatic resuscitation for trauma induced coagulopathy: maintaining homeostasis. J Trauma Acute Care Surg. 2018;84:S35–40.Google Scholar
Ostrowski, SR, Johansson, PI. Endothelial glycocalyx degradation induces endogenous heparinization in patients with severe injury and early traumatic coagulopathy. J Trauma Acute Care Surg. 2012;73:60–6.CrossRefGoogle ScholarPubMed
Astapenko, D, Benes, J, Pouska, J, Lehmann, C, Islam, S, Cerny, V. Endothelial glycocalyx in acute care surgery – what anaesthesiologists need to know for clinical practice. BMC Anesthesiol. 2019;19:238.Google Scholar
Jensen, NH, Stensballe, J, Afshari, A. Comparing efficacy and safety of fibrinogen concentrate to cryoprecipitate in bleeding patients: a systematic review. Acta Anaesthesiol Scand. 2016;60:1033–42.Google Scholar
Brohi, K, Cohen, MJ, Ganter, MT, Matthay, MA, Mackersie, RC, Pittet, JF. Acute traumatic coagulopathy: initiated by hypoperfusion: modulated through the protein C pathway? Ann Surg. 2007;245:812–18.CrossRefGoogle ScholarPubMed
Davenport, RA, Guerreiro, M, Frith, D, et al. Activated protein C drives the hyperfibrinolysis of acute traumatic coagulopathy. Anesthesiology. 2017;126:115–27.Google Scholar
Roberts, I, Shakur, H, Coats, T, et al. The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technol Assess. 2013;17:1–79.Google Scholar
Watts, DD, Trask, A, Soeken, K, Perdue, P, Dols, S, Kaufmann, C. Hypothermic coagulopathy in trauma: effect of varying levels of hypothermia on enzyme speed, platelet function, and fibrinolytic activity. J Trauma. 1998;44:846–54.Google Scholar
Gonzalez, E, Moore, EE, Moore, HB. Management of trauma-induced coagulopathy with thrombelastography. Crit Care Clin. 2017;33:119–34.CrossRefGoogle ScholarPubMed
Toker, S, Hak, DJ, Morgan, SJ. Deep vein thrombosis prophylaxis in trauma patients. Thrombosis. 2011;2011:505373.Google Scholar
Ruskin, KJ. Deep vein thrombosis and venous thromboembolism in trauma. Curr Opin Anaesthesiol. 2018;31:215–18.Google Scholar
Cuker, A, Burnett, A, Triller, D, et al. Reversal of direct oral anticoagulants: guidance from the Anticoagulation Forum. Am J Hematol. 2019;94:697–709.CrossRefGoogle ScholarPubMed
Baksaas-Aasen, K, Van Dieren, S, Balvers, K, et al. Data-driven development of ROTEM and TEG algorithms for the management of trauma hemorrhage: a prospective observational multicenter study. Ann Surg. 2019;270:1178–85.CrossRefGoogle ScholarPubMed
Gonzalez, E, Moore, EE, Moore, HB, et al. Goal-directed hemostatic resuscitation of trauma-induced coagulopathy: a pragmatic randomized clinical trial comparing a viscoelastic assay to conventional coagulation assays. Ann Surg. 2016;263:1051–9.Google Scholar
Whiting, D, DiNardo, JA. TEG and ROTEM: technology and clinical applications. Am J Hematol. 2014;89:228–32.Google Scholar
Haemonetics. Introducing TEG 6s – White Paper. Available from: https://pdf.medicalexpo.com/pdf/haemonetics/introducing-teg-6s-white-paper/78504-152619.html.Google Scholar
Korpallová, B, Samoš, M, Bolek, T, et al. Role of thromboelastography and rotational thromboelastometry in the management of cardiovascular diseases. Clin Appl Thromb Hemost. 2018;24:1199–207.Google Scholar
Nair, PM, Rendo, MJ, Reddoch-Cardenas, KM, Burris, JK, Meledeo, MA, Cap, AP. Recent advances in use of fresh frozen plasma, cryoprecipitate, immunoglobulins, and clotting factors for transfusion support in patients with hematologic disease. Semin Hematol. 2020;57:73–82.CrossRefGoogle ScholarPubMed
Curry, N, Foley, C, Wong, H, et al. Early fibrinogen concentrate therapy for major haemorrhage in trauma (E-FIT 1): results from a UK multi-centre, randomised, double blind, placebo-controlled pilot trial. Crit Care. 2018;22:164.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×