Hemostatic abnormalities after trauma resuscitation: challenges and strategies in caring for the critically injured patient.

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Abstract

Conflict of interest statement: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing Interests: CR has no competing interests. NC has received research funding from the NIHR, Wellcome Trust, MRC, SOBI, CSL Behring, and Octapharma. She has received consulting fees from Octapharma, SOBI, LFB, CSL Behring, and Bayer. NJ reports an unrestricted investigator-initiated research grant from Octapharma on endotheliopathy. MN serves as the Chief Medical Officer for Haima Therapeutics. He has received research funding from the NIH, DoD, DARPA, Takeda, and Haemonetics. He has received consulting fees from Haemonetics, Takeda, Octapharma, and CellPhire. 11. Injury. 2020 May;51 Suppl 2:S10-S14. doi: 10.1016/j.injury.2019.12.024. Epub 2019 Dec 17. Fracture fixation in the polytrauma patient: Markers that matter. Moore TA(1), Simske NM(1), Vallier HA(2). Author information: (1)MetroHealth Medical Center, Cleveland, OH, USA. (2)MetroHealth Medical Center, Cleveland, OH, USA. Electronic address: hvallier@metrohealth.org. Timing and type of fracture fixation in the multiply-injured trauma patient have been important and controversial topics. Ideal care for these patients come from providers who communicate well with one another in a team fashion and view the whole person, rather than focusing on injury to individual systems. This group encompasses a wide range of musculoskeletal and other injuries, further complicated by the broad spectrum of patients, with variability in age, medical and social comorbidities, all of which may have profound impact upon outcomes. The concept of Early Total Care arose from the realization that early definitive fixation of femur fractures provided pulmonary and systemic benefits to most patients. However, insufficient assessment and understanding of the physiological status of polytraumatized patients at the time of major orthopaedic procedures, potentially with inclusion of multiple other procedures in the same setting resulted in more morbidity, swinging the pendulum of care toward initial Damage Control Orthopaedics to minimize surgical insult. More recently, iterative assessment of response to resuscitation using Early Appropriate Care guidelines, suggests definitive fixation of most axial and femoral injuries within 36 h after injury appears safe in resuscitated patients, as measured by improvement of acidosis. Copyright © 2019. Published by Elsevier Ltd. DOI: 10.1016/j.injury.2019.12.024