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Predicting the need to pack early for severe intra-abdominal hemorrhage 55th Annual Meeting of the American-Association-for-the-Surgery-of-Trauma / 13th Annual Meeting of the Trauma-Association-of-Canada Garrison, J. R., Richardson, J. D., HILAKOS, A. S., Spain, D. A., Miller, F. B., Fulton, R. L. LIPPINCOTT WILLIAMS & WILKINS. 1996: 923–27

Abstract

To determine if the decision to pack for hemorrhage could be refined.Seventy consecutive trauma patients for whom packing was used to control hemorrhage were studied. The patients had liver injuries, abdominal vascular injuries, and bleeding retroperitoneal hematomas. Preoperative variables were analyzed and survivors compared with nonsurvivors.Packing controlled hemorrhage in 37 (53%) patients. Significant differences (p < 0.05) between survivors and nonsurvivors were Injury Severity Score (29 vs. 38), initial pH (7.3 vs. 7.1), platelet count (229,000 vs. 179,000/mm3), prothrombin time (14 vs. 22 seconds), partial thromboplastin time (42 vs. 69 seconds), and duration of hypotension (50 vs. 90 minutes). Nonsurvivors received 20 units of packed red blood cells before packing compared to 13 units for survivors.Patients who suffer severe injury, hypothermia, refractory hypotension, coagulopathy, and acidosis need early packing if they are to survive. Failure to control hemorrhage is related to severity of injury and delay in the use of pack tamponade. A specific protocol that mandates packing when parameters reach a critical limit should be considered.

View details for Web of Science ID A1996UQ50500017

View details for PubMedID 8656478