| The acute coagulopathy of trauma shock: clinical relevance. | |
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MedLine Citation:
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PMID: 20400026 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Recent observational studies have identified an acute coagulopathy in trauma victims that is present on arrival in the emergency room. It has been associated with a four-fold increase in mortality and increased incidence of organ failure. Conventional trauma resuscitation and transfusion protocols are designed for dilutional coagulopathy and appear inadequate in the management of acute traumatic coagulopathy and massive transfusion. Acute Coagulopathy of Trauma Shock (ACoTS) is caused by a combination of tissue injury and shock, and may occur without significant fluid administration, clotting factor depletion or hypothermia. The mechanism through which acute coagulopathy develops is unclear but activation of the protein C pathway has been implicated. Standard coagulation tests do not identify cases in a timely fashion and ACoTS should be suspected in any trauma patient with a significant magnitude of injury and shock, as evidenced by an abnormal admission base deficit on blood gas. Development of point of care coagulometers and whole blood coagulation analysers, such as rotational thromboelastometry, may enable earlier laboratory identification of this group. Retrospective studies performed by the American military indicate that resuscitation of severely injured patients with higher ratios of plasma given early may improve outcome and reduce overall blood product use. The place of adjunctive pharmaceutical agents within this strategy remains unclear. There is an acute coagulopathy associated with trauma and shock that is an independent predictor of outcomes. Delineation of this entity, with directed management protocols should lead to a reduction in avoidable deaths from haemorrhage after trauma. |
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Authors:
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Daniel Frith; Karim Brohi |
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Publication Detail:
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Type: Journal Article; Review Date: 2010-02-06 |
Journal Detail:
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Title: The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland Volume: 8 ISSN: 1479-666X ISO Abbreviation: Surgeon Publication Date: 2010 Jun |
Date Detail:
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Created Date: 2010-04-19 Completed Date: 2010-07-22 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101168329 Medline TA: Surgeon Country: Scotland |
Other Details:
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Languages: eng Pagination: 159-63 Citation Subset: IM |
Copyright Information:
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Copyright (c) 2009 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved. |
Affiliation:
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Trauma Clinical Academic Unit, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, UK. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Blood Coagulation Blood Coagulation Disorders / blood, etiology* Humans Prognosis Protein C / metabolism Shock, Traumatic / complications* |
| Chemical | |
Reg. No./Substance:
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0/Protein C |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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