1 / 15

Faffing or fixing ? (Part1)

Faffing or fixing ? (Part1). “ I’m stuck in x-ray, fiddling around with a bleeder” “X-ray is not a safe environment for anaesthetics”. “Have you done something?, the blood pressure has recovered”. Recent mixed reviews. Background. 30-40% of early trauma deaths due to haemorrhage

heaton
Download Presentation

Faffing or fixing ? (Part1)

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Faffingor fixing?(Part1)

  2. “I’m stuck in x-ray, fiddling around with a bleeder” “X-ray is not a safe environment for anaesthetics” “Have you done something?, the blood pressure has recovered” Recent mixed reviews

  3. Background • 30-40% of early trauma deaths due to haemorrhage • 62% of all in hospital deaths within 4hrs • Haemorrhage either primary cause or contributing factor • “Majority of preventable deaths after injury occur from unrecognised and hence untreated haemorrhage, particularly within the abdominal cavity making it perhaps the single most important reversible cause of death in the trauma population”. Trauma: Who cares? A report of the National Confidential Enquiry into Patient Outcome and Death (2007)

  4. Haemorrhage control concepts • Aims • Stop the bleeding (with surgery or IR) • Restore circulating volume • Damage control surgery • Staged approach in exsanguinating patients • Permissive hypotension • Maintenance of vital functions without increasing risk of further haemorrhage

  5. Imaging signs of active bleeding • Contrast extravasation

  6. 2 False aneurysm

  7. 3 Missing vessel

  8. 4 Big hole in vessel

  9. IR treatment of active bleeding • Contrast extravasation No treatment Patient died in A&E

  10. Treatments • False aneurysm False aneurysm Filled with glue

  11. Treatments • Missing vessel Selective angiogram Vessel coiled

  12. Treatments • 4 Big hole in vessel • Gelfoam slurry • No improvement • Vessel glued

  13. Shock • Inadequate tissue perfusion • Haemorrhage leading cause • Coagulopathy • Acidosis • Hypothermia • All independently predict poor outcome

  14. Treatment • Recognition • Stop bleeding • Restore circulatory volume • Improved oxygenation • Better outcome ? • Prompt intervention, not last resort

  15. Outcomes • 72 hour mortality • Patients who had surgery 22.7% (25/110) • No surgery 13.7% (92/670). • Patients who had timely intervention to control bleeding the 72 hour mortality was • 23.8% (15/63) • 33.3% (8/24) where intervention was considered delayed. Trauma: Who cares? A report of the National Confidential Enquiry into Patient Outcome and Death (2007)

More Related