Management of a major bleeding
Massive bleeding remains a challenge for modern medicine even today. One third of deaths in trauma patients are caused by bleeding, of which 35% are potentially preventable with timely and successful intervention. Early hemorrhage control is essential, especially in prehospital care, where mortality increases with every unnecessary minute spent on scene. Another cornerstone of therapy in the bleeding patient is rational volume resuscitation and the use of vasopressors within the concept of permissive hypotension to prevent shock. An important but often overlooked principle is the prevention of the lethal triad: hypothermia, acidosis, and coagulopathy. The algorithm therefore emphasizes a systematic approach, standardization of procedures, timely action, and minimization of the interval from the onset of bleeding to primary intervention. The algorithm is primarely based on „The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition, 2023“ and „Pelvic trauma: WSES classification and guidelines, 2017“
Review
The interactive algorithm walks step by step through two illustrative case studies demonstrating current recommendations for the management of life-threatening massive bleeding. Both case studies describe scenarios ranging from layperson first aid at the scene of injury to care provided by emergency medical service crews.
It is a useful study aid that helps not only future physicians but also the general public become familiar with this topic, since a rapid response at the scene is crucial for the injured person’s survival.
Sources
MALÁSKA, Jan; STAŠEK, Jan; KRATOCHVÍL, Milan a ZVONÍČEK, Václav. Intenzivní medicína v praxi. Jessenius. Praha: Maxdorf, [2020]. ISBN 978-80-7345-675-7.
ROSSAINT, Rolf, Arash, AFSHARI, BOUILLON, et al., 2023. The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition. Critical Care [online]. 27(1). Available at: doi:10.1186/s13054-023-04327-7
ZIDEMAN, David A., Eunice M. SINGLETARY, Vere BORRA, Pascal CASSAN, Carmen D. et al., 2021. European Resuscitation Council Guidelines 2021: First aid. Resuscitation [online]. 161. Available at: doi:10.1016/j.resuscitation.2021.02.013
SIMSAM, Mohammad Hmidan, Laurence DELORME, Dylan GRIMM, Fran PRIESTAP, et al. 2023. Efficacy of high dose tranexamic acid (TXA) for hemorrhage: A systematic review and meta-analysis. Injury [online]. 54(3),. Available at: doi:10.1016/j.injury.2022.12.029
SOAR, Jasmeet, Bernd W. BÖTTIGER, Pierre CARLI, Keith COUPER, et al. 2021. European Resuscitation Council Guidelines 2021: Adult advanced life support. Resuscitation [online]. 161. Available at: doi:10.1016/j.resuscitation.2021.02.010
HALAWI, Mohamad J., 2015. Pelvic ring injuries: Emergency assessment and management. Journal of Clinical Orthopaedics and Trauma [online]. 6(4). Available at: doi:10.1016/j.jcot.2015.08.002
COCCOLINI, Federico, Philip F. STAHEL, Giulia MONTORI, Walter BIFFL, et al. 2017b. Pelvic trauma: WSES classification and guidelines. World Journal of Emergency Surgery [online]. 12(1). Available at: doi:10.1186/s13017-017-0117-6
LEE, C. and K. PORTER, 2007. The prehospital management of pelvic fractures. Emergency Medicine Journal [online]. 24(2), 130–133. Available at: doi:10.1136/emj.2006.041384
Learning targets
2. The student will learn how to proceed in the case of major bleeding
3. The student will learn the importance of proactive action in stopping major bleeding.
Key points
2. The condition of a patient after major bleeding is not stable over time, periodical monitoring and repeated reassessment of the entire situation are necessary.
3. During bleeding, the patient is not only threatened by developing shock but also by many other factors that need to be managed.
