Jaromír Kočí, MD, Ph.D., FACS Head of the department of Emergency medicine, University hospital Hradec Králové, Charles University Faculty of Medicine in Hradec Kralove, Hradec Králové, Czech Republic Fellow, American College of Surgeons
Severe bleeding is one of the main causes of preventable death of trauma patients. The keystone of successful management of these patients is adherence to the ABCDE approach at the site of injury, then Triage, and a decision on the correct direction of the patient care. In the early hospital phase, it is a priority to follow the ABCDE approach again with basic paraclinical examinations. If the patient is stable, even in the case of proven bleeding, a CT scan, that can accurately diagnose even the retroperitoneal trauma, is indicated (the basic limitations of ultrasound examination of the abdomen). Examination of the coagulation state by viscoelastic methods (TEG, ROTEM) is an example of modern access to trauma patients. Their advantage lies in the possibility of targeted therapy. However, if the patient is hemodynamically unstable, it remains a clear priority according to the evidence based medicine to start a massive blood transfusion protocol, meaning the administration of the plasma, red blood cells and platelets in the ratio 1 : 1 : 1.
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