Download Faffing or fixing? (Part1)

Faffing or fixing?
(Part1)
Recent mixed reviews
“I’m stuck in x-ray, fiddling “Have you done
around with a bleeder” something?, the blood
pressure has recovered”
“X-ray is not a safe
environment for
anaesthetics”
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)
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
Imaging signs of active bleeding
1) Contrast extravasation
2 False aneurysm
3 Missing vessel
• 4
Big hole in vessel
IR treatment of active bleeding
1) Contrast extravasation
No treatment
Patient died in A&E
Treatments
2 False aneurysm
False aneurysm
Filled with glue
Treatments
3 Missing vessel
Selective angiogram
Vessel coiled
Treatments
• 4
Big hole in vessel
• Gelfoam slurry
• No improvement
• Vessel glued
Shock
– Inadequate tissue perfusion
– Haemorrhage leading cause
• Coagulopathy
• Acidosis
• Hypothermia
– All independently predict poor outcome
Treatment
•
•
•
•
•
•
Recognition
Stop bleeding
Restore circulatory volume
Improved oxygenation
Better outcome ?
Prompt intervention, not last resort
Outcomes
• 72 hour mortality
– Patients who had surgery
– No surgery
22.7% (25/110)
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)