EARLY RECOGNITION AND RESPONSE TO MASSIVE BLEEDING IN TRAUMA EVALUATION AND CARE

Abstract

　　Controlling the active bleeding in injured patients is vital. Hence, it is necessary for early recognition and respond to massive bleeding. Prediction of massive bleeding includes drop in blood pressure and pulse, shock index, TASH score, ABC score, TBSS score, lactate, FDP, fibrinogen, Focused Assessment with Sonography for Trauma (FAST), and Computed tomographic scanning (CT). Hemostasis monitoring by thromboelastography or thromboelastometry is also useful for evaluating clotting mechanism. Regarding pre-hospital infusion, transportation of patient takes precedence if it is less than 30 minutes after injury. However, at hospitalization, based on the disease condition of the injured person, comprehensive clinical evaluation is needed. Comprehensive clinical management in massive bleeding includes permissive hypotension, tranexamic acid administration, massive transfusion therapy, administration of fibrinogen, and may involve surgical procedure.