traumatic hemorrhage
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Trauma ◽  
2021 ◽  
pp. 146040862110464
Author(s):  
John D Inouye ◽  
Ahmed R Mohsen ◽  
Benjamin A Hirsch ◽  
Swapna Chaudhuri

This report describes a 90-year-old man who sustained blunt chest trauma that progressed to circulatory failure from an enlarging anterior mediastinal hematoma. Emergent sternotomy was performed, revealing a hematoma primarily involving the thymus that was promptly evacuated. Extrapericardial cardiac tamponade is an uncommon event that occurs when fluid collects within the mediastinum but outside the pericardium. Hemodynamically significant hemorrhage of the thymus is rare because the gland begins to involute early in development. To our knowledge, cardiac tamponade secondary to traumatic hemorrhage of the thymus has not been previously described. Early recognition and hematoma evacuation can be lifesaving.


Author(s):  
Henry T. Beaman ◽  
Ellen Shepherd ◽  
Joshua Satalin ◽  
Sarah Blair ◽  
Harry Ramcharran ◽  
...  

2021 ◽  
pp. 000313482110488
Author(s):  
Alison A. Smith ◽  
Rahaf Alkhateb ◽  
Maxwell Braverman ◽  
Charles P. Shahan ◽  
Benjamin Axtman ◽  
...  

Whole blood (WB) transfusion for trauma patients with severe hemorrhage has demonstrated early successful outcomes compared to conventional component therapy. The objective of this study was to demonstrate WB transfusion in the non-trauma patient. Consecutive adult patients receiving WB transfusion at a single academic institution were reviewed from February 2018 to January 2020. Outcomes measured were mortality and transfusion-related reactions. A total of 237 patients who received WB were identified with 55 (23.2%) non-trauma patients. Eight patients (14.5%) received pre-hospital WB. The most common etiology of non-traumatic hemorrhage was gastrointestinal bleeding (43.6%, n = 24/55). Approximately half of the non-trauma patients (n = 28/55) received component therapy. Transfusion-related events occurred in 3 patients. This study demonstrated that non-trauma patients could receive WB transfusions safely with infrequent transfusion-related events. Future studies should focus on determining if outcomes are improved in non-trauma patients who receive WB transfusions and defining specific transfusion criteria for this population.


2021 ◽  
pp. 80-82
Author(s):  
Pallab Mandal

Various anemic disorders which shows different orofacial manifestations are iron deciency anemia,plummer Vinson syndrome,megaloblastic anemia,sickle cell anemia,thalassemia and aplastic anemia.These orofacial manifestations are facial pallor,atrophic glossitis,angular stomatitis,magenta tongue,midface growth etc. Spontaneous & post traumatic hemorrhage,prolong bleeding after tooth extraction are sign of different hemostatic disorder such as VonWillebrand disease or Hemophilia. Oral manifestations of most of the hematological diseases are nonspecic. In this article I have reviewed various literatures to identify orofacial manifestations of various hematological disorders.


2021 ◽  
Author(s):  
Pierre Bouzat ◽  
Jean-Luc Bosson ◽  
Jean-Stéphane David ◽  
Bruno Riou ◽  
Jacques Duranteau ◽  
...  

Abstract Background: Optimal management of severe trauma patients with active hemorrhage relies on adequate initial resuscitation. Early administration of coagulation factors improves post-traumatic coagulation disorders and four-factor prothrombin complex concentrate (PCC) might be useful in this context. Our main hypothesis is that four-factor PCC in addition to a massive transfusion protocol decrease blood product consumption at day one in severe trauma patients with major bleeding.Methods This is a prospective, randomized, multicenter, double-blind, parallel, controlled superiority trial. Eligible patients are trauma patients with major bleeding admitted to a French level-I trauma centre. Patients randomized in the treatment arm receive 1 mL/kg four-factor PCC within one-hour post-admission while patients randomized in the controlled group receive 1 mL/kg of saline solution 0.9% as a placebo. The primary endpoint is the amount of blood products transfused in the first 24 hours post-admission (including red blood cells, frozen fresh plasma and platelets). The secondary endpoints are the amount of each blood product transfused in the first 24 hours, time to achieve prothrombin time ratio < 1.5, time to hemostasis, number of thrombo-embolic events at 28 days, mortality at 24 hours and 28 days, number of intensive care unit (ICU)-free days, number of ventilator-free days during ICU stay, number of hospital-free days within the first 28 days, hospitalization status at day 28, Glasgow outcome scale extended for patients with brain lesions on initial cerebral imaging, and cost of each strategy at day 8 and 28. Inclusions have started in December 2017 and are expected to be complete by June 2021. Discussion: If PCC reduces total blood consumption at day one after severe trauma, this therapy, in adjunction to a classic massive transfusion protocol, may be used empirically on admission in patients at risk of massive transfusion to enhance coagulation. Moreover, this treatment may decrease blood product related complications and may improve clinical outcome after post-traumatic hemorrhage. Trial registration: This study has been prospectively registered on clinical trial on July 14, 2017 NCT03218722


2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Alexandre Tran ◽  
Tyler Lamb ◽  
Monica Taljaard ◽  
Shannon M. Fernando ◽  
Kenji Inaba ◽  
...  

2021 ◽  
Vol 186 (Supplement_1) ◽  
pp. 316-323
Author(s):  
Alec D Emerling ◽  
William Bianchi ◽  
Michael Krzyzaniak ◽  
Travis Deaton ◽  
Darin Via ◽  
...  

ABSTRACT Introduction Rapid sequence intubation of patients experiencing traumatic hemorrhage represents a precarious phase of care, which can be marked by hemodynamic instability and pulseless arrest. Military combat trauma guidelines recommend reduced induction dose and early blood product resuscitation. Few studies have evaluated the role of induction dose and preintubation transfusion on hemodynamic outcomes. We compared rates of postintubation systolic blood pressure (SBP) of &lt; 70 mm Hg, &gt; 30% drop in SBP, pulseless arrest, and mortality at 24 hours and 30 days among patients who did and did not receive blood products before intubation and then examined if induction agent and dose influenced the same outcomes. Materials and Methods A retrospective analysis was performed of battle-injured personnel presenting to surgical care facilities in Iraq and Afghanistan between 2004 and 2018. Those who received blood transfusions, underwent intubation, and had an Injury Severity Score of  ≥15 were included. Intubation for primary head, facial, or neck injury, burns, operative room intubations, or those with cardiopulmonary resuscitation in progress were excluded. Multivariable logistic regression was performed with unadjusted and adjusted odds ratios for the five study outcomes among patients who did and did not receive preintubation blood products. The same analysis was performed for patients who received full or excessive versus partial induction agent dose. Results A total of 153 patients had a mean age of 24.9 (SD 4.5), Injury Severity Score 29.7 (SD 11.2), heart rate 122.8 (SD 24), SBP 108.2 (SD 26.6). Eighty-one (53%) patients received preintubation blood products and had similar characteristics to those who did not receive transfusions. Adjusted multivariate analysis found odds ratios as follows: 30% SBP decrease 9.4 (95% CI 2.3-38.0), SBP &lt; 70 13.0 (95% CI 3.3-51.6), pulseless arrest 18.5 (95% CI 1.2-279.3), 24-hour mortality 3.8 (95% CI 0.7-21.5), and 30-day mortality 1.3 (0.4-4.7). In analysis of induction agent choice and comparison of induction agent dose, no statistically significant benefit was seen. Conclusion Within the context of this historical cohort, the early use of blood products conferred a statistically significant benefit in reducing postintubation hypotension and pulseless arrest among combat trauma victims exposed to traumatic hemorrhage. Induction agent choice and dose did not significantly influence the hemodynamic or mortality outcomes.


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