Management Major Bleeding and Coagulopathy Following Trauma

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MANAGEMENT OF

MAJOR BLEEDING AND COAGULOPATHY

FOLLOWING TRAUMA

EUROPEAN GUIDELINES: FIFTH EDITION

JOURNAL READING - EMERGENCY MEDICINE

dr. Erka Wahyu Kinanda – KAN dr. Rico Wicaksana Putra – WAP dr. Yuli Prastio – YIP

Supervisor : dr. Yuddy Imowanto, SpEM

KEC

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Updated in 2019

• European Society for Trauma and Emergency System

• European Society of Anesthesiology

• European Shock Society

• European Society for Emergency Medicine

• European Society of Intensive Care Medicine

• Network for the Advancement of Patient Blood Management, Hemostasis and Thrombosis

Consist of 9 sections with a total of 39

recommendations and each recommendation was graded using GRADE system

Guideline for major bleeding and

coagulopathy

following trauma

2

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1. Introduction

2. Basic concept of Trauma, Resuscitation and Coagulopathy

3. Recommendation 1-13 : WAP 4. Recommendation 14-27 : KAN 5. Recommendation 28-39 : YIP 6. Conclusion

OUTLINE

JOURNAL READING - EMERGENCY MEDICINE 3

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INTRODUCTION

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BASIC CONCEPT OF TRAUMA, RESUSCITATION AND TRAUMATIC COAGULOPATHY

JOURNAL READING - EMERGENCY MEDICINE 4

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I. INITIAL RESUSCITATION AND PREVENTION OF FURTHER BLEEDING

• We recommend that severely injured patients be transported directly to an appropriate trauma facility (Grade 1B)

• We recommend that the time elapsed between injury and bleeding control be minimized (Grade 1A)

Recommendation 1 – Minimal elapsed time

JOURNAL READING - EMERGENCY MEDICINE 3

Explanation :

• ‘Systemized’ trauma center inter-hospital

The main goal is to give each patient to the most appropriate trauma facility in timely manner

• Minimizing elapsed time between traumatic injury to emergency surgical bleeding control

Onset of Traumatic Injury

Appropriate trauma facility

Emergency surgery for bleeding control

Minimal elapsed time

Avoid transporting patient to incapable facility

e.g Traumatic Brain Injury patient transferred to Hospital without CT-scan, or profuse bleeding patient transferred to Hospital without Emergency Operating Theatre

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I. INITIAL RESUSCITATION AND PREVENTION OF FURTHER BLEEDING

• We recommend local compression to limit life-threatening bleeding (Grade 1A)

• We recommend adjunct tourniquet used to stop life-threatening bleeding from open extremity injury in the pre-surgical setting (Grade 1B)

• We recommend the adjunct use of pelvic binder to limit life-threatening bleeding in the presence of a suspected pelvic fracture in the pre-surgical setting (Grade 1B)

Recommendation 2 – Local Bleeding Management

JOURNAL READING - EMERGENCY MEDICINE 3

Explanation :

• Manual compression, pressure-bandages or topical hemostatic agents with direct pressure bandage

can be used for bleeding control

• Tourniquet for severe external bleeding

• Time span should be restricted (max 2h) – to avoid nerve paralysis and limb ischemia

• No support using of tourniquet for closed injuries

Manual compression

Pressure-bandage Tourniquet

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I. INITIAL RESUSCITATION AND PREVENTION OF FURTHER BLEEDING

• We recommend local compression to limit life-threatening bleeding (Grade 1A)

• We recommend adjunct tourniquet used to stop life-threatening bleeding from open extremity injury in the pre-surgical setting (Grade 1B)

• We recommend the adjunct use of pelvic binder to limit life-threatening bleeding in the presence of a suspected pelvic fracture in the pre-surgical setting (Grade 1B)

Recommendation 2 – Local Bleeding Management

JOURNAL READING - EMERGENCY MEDICINE 3

Explanation :

• Pelvic binder

Pelvic-binder

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I. INITIAL RESUSCITATION AND PREVENTION OF FURTHER BLEEDING

• We recommend local compression to limit life-threatening bleeding (Grade 1A)

• We recommend adjunct tourniquet used to stop life-threatening bleeding from open extremity injury in the pre-surgical setting (Grade 1B)

• We recommend the adjunct use of pelvic binder to limit life-threatening bleeding in the presence of a suspected pelvic fracture in the pre-surgical setting (Grade 1B)

Recommendation 2 – Local Bleeding Management

JOURNAL READING - EMERGENCY MEDICINE 3

Explanation :

• Pelvic binder

Pelvic-binder

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PRESENTATION OF THE CENTER'S

FUNDAMENTAL VALUES AND OBJECTIVES

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PERSONALIZED APPROACH

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PROFESSIONAL TEAM

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MEASURES TO ENSURE PATIENT SAFETY AND COMFORT

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laboris nisi ut aliquip ex ea commodo consequat.

Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt

Management Major Bleeding and Coagulopathy Following Trauma

MANAGEMENT OF

MAJOR BLEEDING AND COAGULOPATHY

FOLLOWING TRAUMA

EUROPEAN GUIDELINES: FIFTH EDITION

JOURNAL READING - EMERGENCY MEDICINE

dr. Erka Wahyu Kinanda – KAN dr. Rico Wicaksana Putra – WAP dr. Yuli Prastio – YIP

Supervisor : dr. Yuddy Imowanto, SpEM

KEC

Guideline for major bleeding and

coagulopathy

following trauma

2

1. Introduction

2. Basic concept of Trauma, Resuscitation and Coagulopathy

3. Recommendation 1-13 : WAP 4. Recommendation 14-27 : KAN 5. Recommendation 28-39 : YIP 6. Conclusion

OUTLINE

JOURNAL READING - EMERGENCY MEDICINE 3

INTRODUCTION

JOURNAL READING - EMERGENCY MEDICINE 4

BASIC CONCEPT OF TRAUMA, RESUSCITATION AND TRAUMATIC COAGULOPATHY

JOURNAL READING - EMERGENCY MEDICINE 4

I. INITIAL RESUSCITATION AND PREVENTION OF FURTHER BLEEDING

• We recommend that severely injured patients be transported directly to an appropriate trauma facility (Grade 1B)

• We recommend that the time elapsed between injury and bleeding control be minimized (Grade 1A)

Recommendation 1 – Minimal elapsed time

JOURNAL READING - EMERGENCY MEDICINE 3

Explanation :

• ‘Systemized’ trauma center inter-hospital

The main goal is to give each patient to the most appropriate trauma facility in timely manner

• Minimizing elapsed time between traumatic injury to emergency surgical bleeding control

Minimal elapsed time

I. INITIAL RESUSCITATION AND PREVENTION OF FURTHER BLEEDING

• We recommend local compression to limit life-threatening bleeding (Grade 1A)

• We recommend adjunct tourniquet used to stop life-threatening bleeding from open extremity injury in the pre-surgical setting (Grade 1B)

• We recommend the adjunct use of pelvic binder to limit life-threatening bleeding in the presence of a suspected pelvic fracture in the pre-surgical setting (Grade 1B)

Recommendation 2 – Local Bleeding Management

JOURNAL READING - EMERGENCY MEDICINE 3

Explanation :

• Manual compression, pressure-bandages or topical hemostatic agents with direct pressure bandage

can be used for bleeding control

• Tourniquet for severe external bleeding

• Time span should be restricted (max 2h) – to avoid nerve paralysis and limb ischemia

• No support using of tourniquet for closed injuries

I. INITIAL RESUSCITATION AND PREVENTION OF FURTHER BLEEDING

• We recommend local compression to limit life-threatening bleeding (Grade 1A)

• We recommend adjunct tourniquet used to stop life-threatening bleeding from open extremity injury in the pre-surgical setting (Grade 1B)

• We recommend the adjunct use of pelvic binder to limit life-threatening bleeding in the presence of a suspected pelvic fracture in the pre-surgical setting (Grade 1B)

Recommendation 2 – Local Bleeding Management

JOURNAL READING - EMERGENCY MEDICINE 3

Explanation :

• Pelvic binder

I. INITIAL RESUSCITATION AND PREVENTION OF FURTHER BLEEDING

• We recommend local compression to limit life-threatening bleeding (Grade 1A)

• We recommend adjunct tourniquet used to stop life-threatening bleeding from open extremity injury in the pre-surgical setting (Grade 1B)

• We recommend the adjunct use of pelvic binder to limit life-threatening bleeding in the presence of a suspected pelvic fracture in the pre-surgical setting (Grade 1B)

Recommendation 2 – Local Bleeding Management

JOURNAL READING - EMERGENCY MEDICINE 3

Explanation :

• Pelvic binder

PRESENTATION OF THE CENTER'S

FUNDAMENTAL VALUES AND OBJECTIVES

PERSONALIZED APPROACH

PROFESSIONAL TEAM

MEASURES TO ENSURE PATIENT SAFETY AND COMFORT

EMOTIONAL CONNECTION

FOCUS ON

COLLABORATION AND COMMUNICATION

WITHIN THE TEAM

THANK

YOU VERY MUCH!

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RESUSCITATION-1