Deputy Head of Department for Education, University Hospital Královské Vinohrady, Prague, Czech Republic
It is a well-documented interactive case report with an analysis of a case of an accidental patient who suffered a high-energy injury. Diagnosis and resuscitation care are analyzed from the pre-hospital phase to highly specialized care in the emergency department, which acquaints the reader with the basic aspects of care for the injured patient. It allows to perceive the whole issue in a broader clinical context and understand the individual context. The basis of successful management, in this case, is compliance with the principles of the ATLS protocol at the site of the accident, as well as the correct triage and the decision on the next direction of the patient. In the pre-hospital and early hospital phase, it is necessary to follow the ABCDE assessment with basic clinical and paraclinical examinations. A novelty is the implementation of antifibrinolytic therapy in pre-hospital care for patients with suspected traumatic bleeding. As part of securing the patient in the hospital phase, it is necessary to focus on the diagnosis and treatment of internal bleeding, which is one of the basic causes of preventable death of these patients. If the patient is stable, even with proven internal bleeding, a CT scan has its place, which can accurately diagnose injuries of the retroperitoneum and hollow organs. Examination of the coagulation pathway by viscoelastic methods (ROTEM) is an example of a modern approach to traumatic patients. Their benefit lies in the targeted therapy of patients. In a hemodynamically unstable wounded person, however, activation and administration of a massive transfusion protocol and surgical arrest of bleeding - damage control surgery remain a clear priority.