Reliable variables in the exsanguinated patient which indicate damage control and predict outcome
Section snippets
Methods
Over a 6-year period (January 1993 to December 1998) all patients admitted to the Los Angeles County-University of Southern California (LAC+USC) Medical Center, that met one or more of the following criteria: estimated blood loss of ≥2,000 mL during trauma operation, required ≥1,500 mL of packed red blood cells (PRBC) during resuscitation, and met the trauma registry diagnosis of exsanguination were retrospectively reviewed. Data collected included demographics, age, mechanism of injury,
Results
Over the span of this 72-month study (January 1993 to December 1998) there were 548 patients meeting entry criteria for the study. Their mean age was 30 ± 13 years (range 2 to 94). There were 484 males (88%) and 64 females (12%); 449 patients (82%) were admitted with penetrating injuries: 352 (78%) gunshot wounds, 88 (20%) stabwound (SW), and 9 (2%) shotgun wound (STW). Ninety-nine (18%) were admitted with blunt trauma: 52 (53%) motor vehicle accidents, 36 (36%) pedestrians struck by vehicles,
Comments
Although trauma surgeons recognize exsanguination as a syndrome [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], its multifactorial effects on the cell, microcirculation, inflammatory cascades, and temperature dependent enzymatic functions of both platelets and the coagulation pathways remain to be defined [1], [2], [4], [7], [11]. Shock causing cardiopulmonary arrest or massive injuries responsible for blood losses exceeding more than 40% to 50% with ongoing
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Asensio JA, Britt LD, Borzotia A et al. Multiinstitutional experience with the management of superior mesenteric artery injuries. Journal of the American College of Surgeons Vol 193, No 4, p 354–366 October 2001.