Trauma and major haemorrhage

2017 ◽  
Author(s):  
Sheila Adam ◽  
Sue Osborne ◽  
John Welch
Keyword(s):  
Emergency Department ◽  
Critical Care Unit ◽  
Burn Injury ◽  
Specific Area ◽  
Fat Embolism ◽  
Major Haemorrhage ◽  
Initial Assessment ◽  
Trauma Patients ◽  
Nursing Management ◽  
Embolism Syndrome

This chapter discusses the medical and nursing management of trauma patients from their initial assessment in the emergency department to their subsequent management in the critical care unit. Each section of the chapter covers a specific area of trauma and describes its underlying physiology, management, and associated complications. Injuries discussed include spinal, head, chest, cardiovascular, genitourinary, renal, abdominal, pelvic, musculoskeletal, burn injury, hypothermia, and drowning. Major complications, such as fat embolism syndrome, compartment syndrome, and rhabdomyolysis, are described in detail. The chapter also discusses the management of major haemorrhage and the complications of massive blood replacement therapy.

Hemostasis and Thrombosis in Trauma Patients

2015 ◽  
Vol 41 (01) ◽  
pp. 026-034 ◽  
Author(s):  
Satoshi Gando
Keyword(s):  
Wound Healing ◽  
Protein C ◽  
Activated Protein C ◽  
Fat Embolism ◽  
Whole Body ◽  
Severe Bleeding ◽  
Trauma Patients ◽  
Embolism Syndrome ◽  
Acute Coagulopathy Of Trauma ◽  
Pathological Reaction

Hemostasis and thrombosis in trauma patients consist of physiological hemostasis for wound healing and the pathological reaction of disseminated intravascular coagulation (DIC). Whole body trauma, isolated brain injury, and fat embolism syndrome, if extremely severe, can cause DIC and affect a patient's prognosis. Shock-induced hyperfibrinolysis causes DIC with the fibrinolytic phenotype, contributing to oozing-type severe bleeding. If uncontrolled, this phenotype progresses to thrombotic phenotype at the late stage of trauma, followed by microvascular thrombosis, leading to organ dysfunction. Another type of pathological hemostatic change is acute coagulopathy of trauma shock (ACOTS), which gives rise to activated protein C–mediated systemic hypocoagulation, resulting in bleeding. ACOTS occurs only in trauma associated with shock-induced hypoperfusion and there is nothing to suggest DIC in this phenomenon. This review will provide information about the recent advances in hemostasis and thrombosis in trauma and will clarify the pathogeneses of the pathological processes observed in trauma patients.

scholarly journals Analyzing fat embolism syndrome in trauma patients at AIIMS Apex Trauma Center, New Delhi, India

2011 ◽  
Vol 4 (3) ◽  
pp. 337 ◽  
Author(s):  
Nita D′souza ◽  
Kamran Farooque ◽  
Pramendra Agrawal ◽  
Babita Gupta ◽  
Chhavi Sawhney ◽  
...  
Keyword(s):  
Trauma Center ◽  
Fat Embolism ◽  
New Delhi ◽  
Trauma Patients ◽  
Fat Embolism Syndrome ◽  
Embolism Syndrome

scholarly journals Fat embolism syndrome in blunt trauma patients with extremity fractures

2020 ◽  
Vol 21 ◽  
pp. 475-480
Author(s):  
Miriam Alpert ◽  
Areg Grigorian ◽  
John Scolaro ◽  
James Learned ◽  
Matthew Dolich ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Fat Embolism ◽  
Trauma Patients ◽  
Fat Embolism Syndrome ◽  
Embolism Syndrome

Non-bronchoscopic protected bronchoal veolar lavage (NB-pBAL) for rapid diagnosis of fat embolism syndrome (FES) in trauma patients

1996 ◽  
Vol 22 (S1) ◽  
pp. S108-S108
Author(s):  
M. Valente ◽  
G. Mancinelli ◽  
C. Münch ◽  
D. Corsi ◽  
G. Sambo ◽  
...  
Keyword(s):  
Fat Embolism ◽  
Rapid Diagnosis ◽  
Trauma Patients ◽  
Fat Embolism Syndrome ◽  
Embolism Syndrome

Risk factors for fat embolism syndrome in multiple trauma patients

2006 ◽  
Vol 17 (3-4) ◽  
pp. 75-79
Author(s):  
K. Mjahed ◽  
A. Bouhouri ◽  
Y. Alaoui ◽  
I. Tazi ◽  
A. R. El Adib ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multiple Trauma ◽  
Fat Embolism ◽  
Trauma Patients ◽  
Fat Embolism Syndrome ◽  
Embolism Syndrome ◽  
Multiple Trauma Patients

scholarly journals Use of Early Inhaled Nitric Oxide Therapy in Fat Embolism Syndrome to Prevent Right Heart Failure

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Evgeni Brotfain ◽  
Leonid Koyfman ◽  
Ruslan Kutz ◽  
Amit Frenkel ◽  
Shaun E. Gruenbaum ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Right Heart Failure ◽  
Fat Embolism ◽  
Inhaled Nitric Oxide ◽  
Long Bone ◽  
Trauma Patients ◽  
Severe Hypoxemia ◽  
Fat Embolism Syndrome ◽  
Embolism Syndrome ◽  
Threatening Condition

Fat embolism syndrome (FES) is a life-threatening condition in which multiorgan dysfunction manifests 48–72 hours after long bone or pelvis fractures. Right ventricular (RV) failure, especially in the setting of pulmonary hypertension, is a frequent feature of FES. We report our experience treating 2 young, previously healthy trauma patients who developed severe hypoxemia in the setting of FES. Neither patient had evidence of RV dysfunction on echocardiogram. The patients were treated with inhaled nitric oxide (NO), and their oxygenation significantly improved over the subsequent few days. Neither patient developed any cardiovascular compromise. Patients with FES that have severe hypoxemia and evidence of adult respiratory distress syndrome (ARDS) are likely at risk for developing RV failure. We recommend that these patients with FES and severe refractory hypoxemia should be treated with inhaled NO therapy prior to the onset of RV dysfunction.

scholarly journals Cerebral fat embolism after traumatic bone fractures: a structured literature review and analysis of published case reports

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Luigi Vetrugno ◽  
Elena Bignami ◽  
Cristian Deana ◽  
Flavio Bassi ◽  
Maria Vargas ◽  
...  
Keyword(s):  
Bone Fracture ◽  
Bone Fractures ◽  
Case Reports ◽  
Burst Fracture ◽  
Fat Embolism ◽  
Fracture Site ◽  
Male Gender ◽  
Trauma Patients ◽  
Embolism Syndrome ◽  
The Mean

Abstract Background The incidence of cerebral fat embolism (CFE) ranges from 0.9–11%, with a mean mortality rate of around 10%. Although no univocal explanation has been identified for the resulting fat embolism syndrome (FES), two hypotheses are widely thought: the ‘mechanical theory’, and the ‘chemical theory’. The present article provides a systematic review of published case reports of FES following a bone fracture. Methods We searched MEDLINE, Web of Science and Scopus to find any article related to FES. Inclusion criteria were: trauma patients; age ≥ 18 years; and the clinical diagnosis of CFE or FES. Studies were excluded if the bone fracture site was not specified. Results One hundred and seventy studies were included (268 cases). The male gender was most prominent (81.6% vs. 18.4%). The average age was 33 years (±18). The mean age for males (29 ± 14) was significantly lower than for females (51 ± 26) (p < 0.001). The femur was the most common fracture site (71% of cases). PFO was found in 12% of all cases. Univariate and multivariate regression analyses showed the male gender to be a risk factor for FES: RR 1.87 and 1.41, respectively (95%CI 1.27–2.48, p < 0.001; 95%CI 0.48–2.34, p < 0.001). Conclusions FES is most frequent in young men in the third decades of life following multiple leg fractures. FES may be more frequent after a burst fracture. The presence of PFO may be responsible for the acute presentation of cerebral embolisms, whereas FES is mostly delayed by 48–72 h.

scholarly journals The fat embolism syndrome as a cause of paraplegia

2018 ◽  
Vol 6 ◽  
pp. 2050313X1878931 ◽  
Author(s):  
Siert TA Peters ◽  
Marieke J Witvliet ◽  
Anke Vennegoor ◽  
Birkitt ten Tusscher ◽  
Bauke Boden ◽  
...  
Keyword(s):  
Damage Control ◽  
Vena Cava ◽  
Damage Control Surgery ◽  
Fat Embolism ◽  
Trauma Patients ◽  
Optimal Care ◽  
Fat Embolism Syndrome ◽  
Femur Fractures ◽  
Embolism Syndrome ◽  
Accident Victim

The fat embolism syndrome is a well-known complication in trauma patients. We describe a rare case of traumatic fat embolism that leads to paraplegia. A 19-year-old male motorcycle accident victim was presented to our hospital. After stabilization and trauma survey, he was diagnosed with bilateral femur fractures, a spleen laceration and a tear in the inferior vena cava, for which damage control surgery was performed. Post-operatively, the patient became paraplegic and developed a fluctuating consciousness, respiratory distress and petechiae. Fat embolism syndrome was considered as the most plausible cause of the paraplegia. The fat embolism syndrome is seen in approximately 1% of trauma patients, mostly those with bilateral fractures of the femur. Prevention of the syndrome depends on early stabilization of fractures. However, even with optimal care, this syndrome can still occur and may have dramatic consequences, as we demonstrate in this case.

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