2017年9月7日 星期四

The European Guideline on Management of Major Bleeding and Coagulopathy Following Trauma: 4E



The European Guideline on Management of Major Bleeding and Coagulopathy Following Trauma: Fourth Edition

Rossaint et al. Critical Care (2016) 20:100
DOI 10.1186/s13054-016-1265-x


Major Bleeding
  • FAST, CT 找出血
  • Damage control surgery if shock or coagulopathy
  • Damage control resuscitation 直到找到出血來源並控制
  • Restricted volume replacement: target SBP: 80-90 mmHg; severe TBI (GCS ≤8): MAP ≥80 mmHg
  • Tranexamic acid (TXA) as early as possible (< 3hr): loading dose TXA 1 g over 10 min, followed by TXA 1 g over 8 h
Transfusion
  • Restrictive RBC transfusion: target Hb 7–9 g/dl
  • FFP-RBC ratio >1:2
  • Fibrinogen maintain at 1.5–2 g/l
  • FFP administered to maintain PT and APTT ≤ 1.5 times the normal control
  • Platelet count >100K
  • PCC administered in patients pre-treated with warfarin or direct-acting oral coagulants
  • Off-label use of rFVIIa only if major bleeding and traumatic coagulopathy persist despite standard attempts to control bleeding and best practice use of conventional hemostatic measures.

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