• MeSH
• embolie tuková MeSH
• fraktury kostí komplikace   MeSH
• koagulopatie MeSH
• lidé MeSH
• lipidy krev   MeSH
• tachykardie MeSH
• úrazy a nehody MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Damage control surgery j e soubor život zachraňujících, etapových úkonů k ošetření závažných nitrobřišních poranění. Cílem časného ošetření je omezení vlivu „smrtelné“ triády- acidózy, hypotermie, hypokoagulace. Definitivní ošetření poranění tkání je v tomto konceptu odsunuto až na okamžik hemodynamické a hemokoagulační stability poraněného.

Damage control surgery is a complex of life-saving, multiple-phase procedures for treating serious internal abdominal injuries. The goal of timely treatment is to limit the influence of the „trauma triad of death“- hypothermia, acidosis and coagulopathy. The definitive treatment of the injured tissues is, as per this concept, postponed until the patient is stable in terms of haemodynamics and haemocoagulation.

• MeSH
• acidóza komplikace   MeSH
• časové faktory MeSH
• gastrointestinální krvácení * etiologie   chirurgie   MeSH
• hemodiluce škodlivé účinky   MeSH
• hypotermie komplikace   MeSH
• koagulopatie * etiologie   komplikace   mortalita   prevence a kontrola   terapie   MeSH
• krevní transfuze metody   MeSH
• laparotomie metody   MeSH
• lidé MeSH
• parciální tromboplastinový čas metody   normy   MeSH
• poranění břicha * chirurgie   komplikace   MeSH
• potransfuzní reakce MeSH
• protrombinový čas metody   normy   MeSH
• Check Tag
• lidé MeSH

• MeSH
• akutní nemoc terapie   MeSH
• koagulopatie * etiologie   farmakoterapie   patofyziologie   MeSH
• kyselina tranexamová aplikace a dávkování   MeSH
• lidé MeSH
• poruchy koagulačních proteinů diagnóza   etiologie   farmakoterapie   patofyziologie   MeSH
• rány a poranění klasifikace   komplikace   MeSH
• tromboelastografie metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH

Acute coagulopathy of trauma has only been described relatively recently. Developing early in the postinjury phase, it is associated with increased transfusion requirements and poor outcomes. This review examines the possible initiators, mechanism and clinical importance of acute coagulopathy. RECENT FINDINGS: Acute coagulopathy of trauma occurs in patients with shock and is characterized by a systemic anticoagulation and hyperfibrinolysis. Dilution, acidemia and consumption of coagulation proteases do not appear to be significant factors at this stage. There is evidence to implicate activation of the protein C pathway in this process. Diagnosis of acute coagulopathy currently relies on laboratory assessment of clotting times. These tests do not fully characterize the coagulopathy and have significant limitations, which reduce their clinical utility. SUMMARY: Acute coagulopathy results in increased transfusion requirements, incidence of organ dysfunction, critical care stay and mortality. Recognition of an early coagulopathic state has implications for the care of shocked patients and the management of massive transfusion. Identification of novel mechanisms for traumatic coagulopathy may lead to new avenues for drug discovery and therapeutic intervention.

• MeSH
• akutní nemoc MeSH
• fibrinolýza MeSH
• hemokoagulace MeSH
• koagulopatie diagnóza   etiologie   patofyziologie   MeSH
• krevní transfuze MeSH
• lidé MeSH
• protein C MeSH
• rány a poranění komplikace   MeSH
• rizikové faktory MeSH
• skóre závažnosti úrazu MeSH
• šok komplikace   MeSH
• vyšetření krevní srážlivosti MeSH
• Check Tag
• lidé MeSH

BACKGROUND: Severe trauma represents a major global public health burden and the management of post-traumatic bleeding continues to challenge healthcare systems around the world. Post-traumatic bleeding and associated traumatic coagulopathy remain leading causes of potentially preventable multiorgan failure and death if not diagnosed and managed in an appropriate and timely manner. This sixth edition of the European guideline on the management of major bleeding and coagulopathy following traumatic injury aims to advise clinicians who care for the bleeding trauma patient during the initial diagnostic and therapeutic phases of patient management. METHODS: The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma included representatives from six European professional societies and convened to assess and update the previous version of this guideline using a structured, evidence-based consensus approach. Structured literature searches covered the period since the last edition of the guideline, but considered evidence cited previously. The format of this edition has been adjusted to reflect the trend towards concise guideline documents that cite only the highest-quality studies and most relevant literature rather than attempting to provide a comprehensive literature review to accompany each recommendation. RESULTS: This guideline comprises 39 clinical practice recommendations that follow an approximate temporal path for management of the bleeding trauma patient, with recommendations grouped behind key decision points. While approximately one-third of patients who have experienced severe trauma arrive in hospital in a coagulopathic state, a systematic diagnostic and therapeutic approach has been shown to reduce the number of preventable deaths attributable to traumatic injury. CONCLUSION: A multidisciplinary approach and adherence to evidence-based guidelines are pillars of best practice in the management of severely injured trauma patients. Further improvement in outcomes will be achieved by optimising and standardising trauma care in line with the available evidence across Europe and beyond.

• MeSH
• koagulopatie * MeSH
• konsensus MeSH
• krvácení * MeSH
• lidé MeSH
• multiorgánové selhání MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Geografické názvy
• Evropa MeSH

BACKGROUND: Severe traumatic injury continues to present challenges to healthcare systems around the world, and post-traumatic bleeding remains a leading cause of potentially preventable death among injured patients. Now in its fifth edition, this document aims to provide guidance on the management of major bleeding and coagulopathy following traumatic injury and encourages adaptation of the guiding principles described here to individual institutional circumstances and resources. METHODS: The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004, and the current author group included representatives of six relevant European professional societies. The group applied a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were re-examined and revised based on scientific evidence that has emerged since the previous edition and observed shifts in clinical practice. New recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated. RESULTS: Advances in our understanding of the pathophysiology of post-traumatic coagulopathy have supported improved management strategies, including evidence that early, individualised goal-directed treatment improves the outcome of severely injured patients. The overall organisation of the current guideline has been designed to reflect the clinical decision-making process along the patient pathway in an approximate temporal sequence. Recommendations are grouped behind the rationale for key decision points, which are patient- or problem-oriented rather than related to specific treatment modalities. While these recommendations provide guidance for the diagnosis and treatment of major bleeding and coagulopathy, emerging evidence supports the author group's belief that the greatest outcome improvement can be achieved through education and the establishment of and adherence to local clinical management algorithms. CONCLUSIONS: A multidisciplinary approach and adherence to evidence-based guidance are key to improving patient outcomes. If incorporated into local practice, these clinical practice guidelines have the potential to ensure a uniform standard of care across Europe and beyond and better outcomes for the severely bleeding trauma patient.

• MeSH
• encefalokéla prevence a kontrola   MeSH
• hemokoagulace účinky léků   fyziologie   MeSH
• krvácení farmakoterapie   MeSH
• lidé MeSH
• medicína založená na důkazech metody   trendy   MeSH
• rány a poranění komplikace   farmakoterapie   MeSH
• směrnice jako téma * MeSH
• umělé dýchání metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH

Massive posttraumatic bleeding is the leading cause of potentially preventable death among patients with severe trauma. Immediate diagnosis and treatment of traumatic coagulopathy and its differentiation from surgical bleeding after major trauma are critical in the management of such patients. In this case report, we present a 33-year-old woman who had multiple injuries to the head and trunk in motor vehicle collision, resulting in severe bleeding and necessitating emergency surgery. We demonstrate how repeated rotational thromboelastometry and thromboelastography analyses were used to direct the choice of therapy to stabilize her circulatory system for surgery and to differentiate surgical bleed from coagulopathy. Therapy based on massive transfusion protocol and on laboratory coagulation tests would be insufficient to stop bleeding. We conclude that rotational thromboelastometry/thromboelastography analysis plays a critical role in the management of traumatic bleeding and helps us provide more aggressive and targeted therapy for coagulopathy both in the acute and later phases of treatment of severe bleeding.

• MeSH
• dospělí MeSH
• fraktury femuru komplikace   MeSH
• koagulopatie diagnóza   etiologie   MeSH
• kraniocerebrální traumata komplikace   MeSH
• krvácení etiologie   terapie   MeSH
• lidé MeSH
• polytrauma komplikace   MeSH
• poranění břicha komplikace   MeSH
• poškození plic komplikace   MeSH
• tromboelastografie metody   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Výskyt závažných extrakraniálních komplikací v prvních deseti dnech po úrazu a jejich vliv na poúrazový pirůběh byl vyhodnocen u 150 pacientů, ošetřených pro kraniocerebrální poranění vletech 994-1996. Závažné komplikace se vyskytly u 76 pacientů (51 %). Častější výskyt komplikací byl u poranění s podílem mozkové kontuze (63 %) a u polytratunat (71 %). Nejčastější extrakraniální komplika¬ ce byly pneumonic a respirační komplikace (29 %), iontové dysbalance (17 %) a koagulopatie (15 %). Většina těchto komplikací byla 2krát až 6krát častější u skupiny pacientů s GCS <,S. V pacientů s komplikacemi a GCS <, 8 došlo v časném pi^běhu hospitalizace ke zhoršení klinického stavu nebo k exitu u 7 %, respektive u 21 %. U pacientů bez komplikací a s GCS < 8 došlo k exitu ve 20 %. Ostatní pacienti této skupiny se buď zlepšili, nebo se jejich stav nezměnil. U lehčích úrazů (GCS > 8) došlo v případě komplikací ke zhoršení v 15 % a k exitu v 5 % případů. Nebyly-li v této skupině komplikace, nedošlo ani ke zhoršení stavu, ani k exitu. Nejvíce ovlivnily časné výsledky koagulopatie, které způsobily zhoršení klinického stavu nebo exitus v 55 % a plieni komplikace v 33 %. Komplikace způsobily prodloužení piůuněmé dobv hosnitalizace na neurochirurgii z 9 na 12,8 dne (p < 0,01). Závěrem se domníváme, že prevence, včasná diagnostika a intenzivní léčba extrakraniálních komplikací po úrazech hlavy může zlepšit výsledky léčby a zkrátit dobu hospitalizace na neurochirurgii.

The incidence of serious extracranial complications during the first ten days after injury and their influence on the post-traumatic course was evaluated in 150 patients, treated on account of craniocerebral injuries in 1994-1996. Serious complications were recorded in 76 patients (51 %). Complications were more firequent in injuries with cerebral contusion (63 %) and in multiple injuries (71 %). The most frequent extracranial complications were pneumonia and respiratory complications (29 %), ion disbalance (17 %) and coagulopathies (15 %). The majority of these complications was twice to six times more ft*equent in the group of patients with GCS:^8. In patients with complications and GCS< 8 during the early period of hospitalization deterioration of the clinical condition or death occurred in 7 % and 21 % resp. In patients without complications and with GCS:S8 death occurred in 20 %. The other patients of this group either improved or their state did not change. In less severe injuries (GCS> 8) in case of complications deterioration occurred in 15 % and death in 5 %. If in this group no complications developed neither deterioration nor death occurred. The early results were influenced most by coagulopathies which cause deterioration of the clinical condition or death in 55 % and by pulmonary complications in 33 %. Complications caused a prolongation of the mean period of hospitalization at the neurosurgical department fi-om 9 to 12.8 days (p < 0.01). The authors conclude that prevention, early diagnosis and intensive treatment of extracranial complications after head injuries can improve the therapeutic results and reduce the hospitalization peiiod at a neurosurgical department.

• MeSH
• poranění mozku komplikace   patologie   MeSH

PURPOSE OF REVIEW: Recombinant factor VIIa (rFVIIa) and thromboelastography have acquired increasing importance in patients with severe bleeding and coagulopathy. This article reviews the current opinions regarding their use, with the purpose of clarifying the ambiguities that exist in dealing with trauma patients. RECENT FINDINGS: Recent evidence encourages the early use of rFVIIa and thromboelastography in the severe trauma patient with hemorrhagic shock, as a component of the damage control strategy. rFVIIa may decrease short-term mortality and the rate of required blood components during resuscitation, with no apparent increase in thromboembolic complications. Thromboelastometry enables better and earlier recognition of the coagulopathy accompanying such trauma patients. In patients with traumatic brain injury and coagulopathy, rFVIIa may delay or even halt the need for surgery, with no proven decrease in mortality. In those who needed urgent neurosurgical intervention, rFVIIa may rapidly correct the coagulopathy, enabling earlier and safer surgical intervention. SUMMARY: Thromboelastometry may guide the medical staff when and to whom rFVIIa could be administered. Evidence also encourages the use of rFVIIa in traumatic brain injury. More research is required to prove decreases in mortality using both thromboelastography and rFVIIa in trauma, with a focus on clear end points and goal-directed therapy.

• MeSH
• faktor VIIa kontraindikace   terapeutické užití   MeSH
• klinické protokoly MeSH
• krvácení etiologie   farmakoterapie   krev   MeSH
• lidé MeSH
• poranění mozku farmakoterapie   krev   MeSH
• rány a poranění farmakoterapie   komplikace   krev   MeSH
• rekombinantní proteiny kontraindikace   terapeutické užití   MeSH
• směrnice jako téma MeSH
• traumatické intrakraniální krvácení farmakoterapie   krev   MeSH
• tromboelastografie MeSH
• výběr pacientů MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Intrakraniální krvácení je popisováno u cca 10 % pacientů s lehkým mozkovým poraněním, kterým bylo provedeno CT mozku. Cílem práce bylo retrospektivně vyhodnotit incidenci intrakraniálního krvácení u pacientů přijatých na naši kliniku s diagnózou komoce mozku během jednoho roku. V roce 2009 bylo na naší klinice hospitalizováno 274 takových pacientů. Před přijetím k observaci bylo vyžádáno CT mozku u 188 z nich. Indikací byl věk nad 60 let, fraktura lebky, koagulopatie či nebezpečný mechanizmus úrazu (autonehoda apod.). U 41 pacientů vyšetřených na CT (21,8 %) bylo i přes dobrý klinický stav nalezeno intrakraniální krvácení. U dvou z nich došlo během hospitalizace ke zhoršení klinického stavu a museli být operováni. Cílem práce je upozornit na záludnost těchto úrazů, kdy i u pacientů v dobrém klinickém stavu může být přítomno intrakraniální krvácení, které může ve vzácných případech vyžadovat operační intervenci.

Intracranial bleeding is revealed by CT scan in about 10% of patients who are examined after mild traumatic brain injury. The objective of this study is to analyze retrospectively the incidence of intracranial haemorrhage in patients admitted to our department with a diagnosis of concussion. A total of 274 patients were admitted to our department with such a diagnosis during the year 2009. CT examinations were requested in 188 cases. The indication criteria were age over 60 years, skull fracture, coagulopathy or dangerous mechanism of injury (e.g. traffic accident). Intracranial bleeding had occurred in 41 patients (21.8%) examined by CT scan even if their clinical status appeared good. Two of them had to be operated upon in the light of deterioration in their neurological findings. The purpose of this study is to warn against the danger intrinsic to these injuries, because even if the patient’s clinical status appears good, they may have intracranial bleeding, which may, in turn – if rarely – require operation.

• Klíčová slova
• otřes mozku, nitrolební komplikace,
• MeSH
• financování organizované MeSH
• fraktury lebky MeSH
• koagulopatie MeSH
• komoce mozku diagnóza   komplikace   MeSH
• lidé MeSH
• neurochirurgické výkony MeSH
• počítačová rentgenová tomografie metody   využití   MeSH
• poranění mozku diagnóza   komplikace   MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• statistika jako téma MeSH
• traumatické intrakraniální krvácení diagnóza   komplikace   MeSH
• věkové faktory MeSH
• výsledky a postupy - zhodnocení (zdravotní péče) MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• kazuistiky MeSH