Download PDF
Semin intervent Radiol 2010; 27(1): 081-098
DOI: 10.1055/s-0030-1247894
© Thieme Medical Publishers

Tips and Tricks for the Trauma Patient

Anthony D. Goei1 , Brian H. Ching2 , Mark W. Meyermann2 , Timothy Nunez3 , David Sacks4
  • 1Department of Radiology, Brooke Army Medical Center, San Antonio, Texas
  • 2Department of Radiology, Tripler Army Medical Center, Honolulu, Hawaii
  • 3Department of Surgery, Brooke Army Medical Center, San Antonio, Texas
  • 4Advanced Interventional Radiology, The Reading Hospital and Medical Center, West Reading, Pennsylvania
Further Information

Publication History

Publication Date:
13 March 2010 (online)

Also available at
    Permissions and Reprints

ABSTRACT

Interventions on the trauma patient are an essential component of the complete scope of care that is provided to the multiply injured patient today. The active participation by the interventional radiologist along the entire spectrum of clinical care is very important to optimize patient outcomes. Suggestions on how to establish a clinical presence are presented. A few of the newer concepts and terminology applicable to trauma care are reviewed. Tips useful in the trauma room, in the interventional radiology suite, and during the postprocedural period are discussed.

KEYWORDS

Clinical care - damage control laparotomy - damage control resuscitation - embolization - prophylactic inferior vena cava filter - superior vena cava filter

REFERENCES

  • 1 Mueller P R. The evolution of image-guided percutaneous abscess drainage: a short history.  Semin Intervent Radiol. 2003;  20 171-176
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 From technicians to clinicians. Interventional News 2004; 14:1 (serial on line). Available at http://www.cxvascular.com/in-archives/interventional-news-14/from-technicians-to-clinicians Accessed November 24, 2009
    Google Scholar
  • 3 Baerlocher M O, Asch M R. The future interventional radiologist: clinician or hired gun?.  J Vasc Interv Radiol. 2004;  15 1385-1390
    PubMedGoogle Scholar
  • 4 Brohi K, Singh J, Heron M, Coats T. Acute traumatic coagulopathy.  J Trauma. 2003;  54 1127-1130
    CrossrefPubMedGoogle Scholar
  • 5 MacLeod J B, Lynn M, McKenney M G, Cohn S M, Murtha M. Early coagulopathy predicts mortality in trauma.  J Trauma. 2003;  55 39-44
    CrossrefPubMedGoogle Scholar
  • 6 Maegele M, Lefering R, Yucel N AG Polytrauma of the German Trauma Society (DGU) et al. Early coagulopathy in multiple injury: an analysis from the German Trauma Registry on 8724 patients.  Injury. 2007;  38 298-304
    CrossrefPubMedGoogle Scholar
  • 7 Rugeri L, Levrat A, David J S et al.. Diagnosis of early coagulation abnormalities in trauma patients by rotation thrombelastography.  J Thromb Haemost. 2007;  5 289-295
    CrossrefPubMedGoogle Scholar
  • 8 Niles S E, McLaughlin D F, Perkins J G et al.. Increased mortality associated with the early coagulopathy of trauma in combat casualties.  J Trauma. 2008;  64 1459-1463 discussion 1463-1465
    CrossrefPubMedGoogle Scholar
  • 9 Tieu B H, Holcomb J B, Schreiber M A. Coagulopathy: its pathophysiology and treatment in the injured patient.  World J Surg. 2007;  31 1055-1064
    CrossrefPubMedGoogle Scholar
  • 10 Hess J R, Brohi K, Dutton R P et al.. The coagulopathy of trauma: a review of mechanisms.  J Trauma. 2008;  65 748-754
    CrossrefPubMedGoogle Scholar
  • 11 Holcomb J B, Jenkins D, Rhee P et al.. Damage control resuscitation: directly addressing the early coagulopathy of trauma.  J Trauma. 2007;  62 307-310
    CrossrefPubMedGoogle Scholar
  • 12 Cotton B A, Gunter O L, Isbell J et al.. Damage control hematology: the impact of a trauma exsanguination protocol on survival and blood product utilization.  J Trauma. 2008;  64 1177-1182 discussion 1182-1183
    CrossrefPubMedGoogle Scholar
  • 13 Hess J R, Zimrin A B. Massive blood transfusion for trauma.  Curr Opin Hematol. 2005;  12 488-492
    CrossrefPubMedGoogle Scholar
  • 14 Armand R, Hess J R. Treating coagulopathy in trauma patients.  Transfus Med Rev. 2003;  17 223-231
    CrossrefPubMedGoogle Scholar
  • 15 Fox C J, Gillespie D L, Cox E D et al.. The effectiveness of a damage control resuscitation strategy for vascular injury in a combat support hospital: results of a case control study.  J Trauma. 2008;  64(2 Suppl) S99-S106 discussion S106-S107
    CrossrefPubMedGoogle Scholar
  • 16 Gonzalez E A, Moore F A, Holcomb J B et al.. Fresh frozen plasma should be given earlier to patients requiring massive transfusion.  J Trauma. 2007;  62 112-119
    CrossrefPubMedGoogle Scholar
  • 17 O’Keeffe T, Refaai M, Tchorz K, Forestner J E, Sarode R. A massive transfusion protocol to decrease blood component use and costs.  Arch Surg. 2008;  143 686-690 discussion 690-691
    CrossrefPubMedGoogle Scholar
  • 18 Repine T B, Perkins J G, Kauvar D S, Blackborne L. The use of fresh whole blood in massive transfusion.  J Trauma. 2006;  60(6 Suppl) S59-S69
    CrossrefPubMedGoogle Scholar
  • 19 Stone H H, Strom P R, Mullins R J. Management of the major coagulopathy with onset during laparotomy.  Ann Surg. 1983;  197 532-535
    CrossrefPubMedGoogle Scholar
  • 20 Rotondo M F, Schwab C W, McGonigal M D et al.. ‘Damage control’: an approach for improved survival in exsanguinating penetrating abdominal injury.  J Trauma. 1993;  35 375-382 discussion 382-383
    CrossrefPubMedGoogle Scholar
  • 21 Beekley A C. Damage control resuscitation: a sensible approach to the exsanguinating surgical patient.  Crit Care Med. 2008;  36(7 Suppl) S267-S274
    CrossrefPubMedGoogle Scholar
  • 22 Hirshberg A, Dugas M, Banez E I, Scott B G, Wall Jr M J, Mattox K L. Minimizing dilutional coagulopathy in exsanguinating hemorrhage: a computer simulation.  J Trauma. 2003;  54 454-463
    CrossrefPubMedGoogle Scholar
  • 23 Lucas C E, Ledgerwood A M, Saxe J M, Dombi G, Lucas W F. Plasma supplementation is beneficial for coagulation during severe hemorrhagic shock.  Am J Surg. 1996;  171 399-404
    CrossrefPubMedGoogle Scholar
  • 24 Bormanis J. Development of a massive transfusion protocol.  Transfus Apheresis Sci. 2008;  38 57-63
    CrossrefPubMedGoogle Scholar
  • 25 Stainsby D, MacLennan S, Hamilton P J. Management of massive blood loss: a template guideline.  Br J Anaesth. 2000;  85 487-491
    PubMedGoogle Scholar
  • 26 Borgman M A, Spinella P C, Perkins J G et al.. The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital.  J Trauma. 2007;  63 805-813
    CrossrefPubMedGoogle Scholar
  • 27 Duchesne J C, Hunt J P, Wahl G et al.. Review of current blood transfusions strategies in a mature level I trauma center: were we wrong for the last 60 years?.  J Trauma. 2008;  65 272-276 discussion 276-278
    CrossrefPubMedGoogle Scholar
  • 28 Holcomb J B, Wade C E, Michalek J E et al.. Increased plasma and platelet to red blood cell ratios improves outcome in 466 massively transfused civilian trauma patients.  Ann Surg. 2008;  248 447-458
    PubMedGoogle Scholar
  • 29 Maegele M, Lefering R, Paffrath T, Tjardes T, Simanski C, Bouillon B. Working Group on Polytrauma of the German Society of Trauma Surgery (DGU) . Red-blood-cell to plasma ratios transfused during massive transfusion are associated with mortality in severe multiple injury: a retrospective analysis from the Trauma Registry of the Deutsche Gesellschaft für Unfallchirurgie.  Vox Sang. 2008;  95 112-119
    CrossrefPubMedGoogle Scholar
  • 30 Malone D L, Hess J R, Fingerhut A. Massive transfusion practices around the globe and a suggestion for a common massive transfusion protocol.  J Trauma. 2006;  60(6 Suppl) S91-S96
    CrossrefPubMedGoogle Scholar
  • 31 Sperry J L, Ochoa J B, Gunn S R Inflammation the Host Response to Injury Investigators et al. An FFP:PRBC transfusion ratio >/=1:1.5 is associated with a lower risk of mortality after massive transfusion.  J Trauma. 2008;  65 986-993
    CrossrefPubMedGoogle Scholar
  • 32 Stinger H K, Spinella P C, Perkins J G et al.. The ratio of fibrinogen to red cells transfused affects survival in casualties receiving massive transfusions at an army combat support hospital.  J Trauma. 2008;  64(2 Suppl) S79-S85 discussion S85
    CrossrefPubMedGoogle Scholar
  • 33 Gunter Jr O L, Au B K, Isbell J M, Mowery N T, Young P P, Cotton B A. Optimizing outcomes in damage control resuscitation: identifying blood product ratios associated with improved survival.  J Trauma. 2008;  65 527-534
    CrossrefPubMedGoogle Scholar
  • 34 Kashuk J L, Moore E E, Johnson J L et al.. Postinjury life threatening coagulopathy: is 1:1 fresh frozen plasma:packed red blood cells the answer?.  J Trauma. 2008;  65 261-270 discussion 270-271
    CrossrefPubMedGoogle Scholar
  • 35 Meranze S et al. Arterial Embolotherapy. Presented at: Society of Interventional Radiology workshop at the 32nd annual meeting Seattle, WA; 2007: 147
    PubMedGoogle Scholar
  • 36 Dondelinger R F, Rossi P, Kurdziel R C. Interventional Radiology. Thieme New York, NY; 1990: 296-297
    PubMedGoogle Scholar
  • 37 Hagiwara A, Minakawa K, Fukushima H, Murata A, Masuda H, Shimazaki S. Predictors of death in patients with life-threatening pelvic hemorrhage after successful transcatheter arterial embolization.  J Trauma. 2003;  55 696-703
    CrossrefPubMedGoogle Scholar
  • 38 Velmahos G C, Chahwan S, Hanks S E et al.. Angiographic embolization of bilateral internal iliac arteries to control life-threatening hemorrhage after blunt trauma to the pelvis.  Am Surg. 2000;  66 858-862
    PubMedGoogle Scholar
  • 39 Jander H P, Russinovich N A. Transcatheter Gelfoam embolization in abdominal, retroperitoneal, and pelvic hemorrhage.  Radiology. 1980;  136 337-344
    PubMedGoogle Scholar
  • 40 Ring E J, Athanasoulis C, Waltman A C, Margolies M N, Baum S. Arteriographic management of hemorrhage following pelvic fracture.  Radiology. 1973;  109 65-70
    PubMedGoogle Scholar
  • 41 Travis T, Monsky W L, London J et al.. Evaluation of short-term and long-term complications after emergent internal iliac artery embolization in patients with pelvic trauma.  J Vasc Interv Radiol. 2008;  19 840-847
    CrossrefPubMedGoogle Scholar
  • 42 Takahira N, Shindo M, Tanaka K, Nishimaki H, Ohwada T, Itoman M. Gluteal muscle necrosis following transcatheter angiographic embolisation for retroperitoneal haemorrhage associated with pelvic fracture.  Injury. 2001;  32 27-32
    CrossrefPubMedGoogle Scholar
  • 43 Ramirez J I, Velmahos G C, Best C R, Chan L S, Demetriades D. Male sexual function after bilateral internal iliac artery embolization for pelvic fracture.  J Trauma. 2004;  56 734-739 discussion 739-741
    CrossrefPubMedGoogle Scholar
  • 44 Kearon C, Kahn S R, Agnelli G, Goldhaber S, Raskob G E, Comerota A J. American College of Chest Physicians. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).  Chest. 2008;  133(6, Suppl) S454-S545
    CrossrefPubMedGoogle Scholar

Anthony D GoeiM.D. F.A.C.S. 

Department of Radiology

Brooke Army Medical Center, San Antonio, TX 78234

Email: anthony.goei@amedd.army.mil

      >