From the Guidelines
In cases of big T trauma, prompt and effective management of post-traumatic bleeding and coagulopathy is crucial to prevent potentially preventable multiorgan failure and death. Big T trauma refers to significant traumatic events that can lead to life-threatening injuries, and the management of major bleeding and coagulopathy following such trauma is a critical aspect of care 1. The sixth edition of the European guideline on the management of major bleeding and coagulopathy following traumatic injury provides evidence-based recommendations for clinicians caring for bleeding trauma patients 1.
Key aspects of management include:
- Prompt diagnosis and treatment of post-traumatic bleeding and coagulopathy
- Use of evidence-based guidelines to inform management decisions 1
- Multidisciplinary approach to care, involving trauma surgeons, intensivists, and other specialists as needed
- Focus on preventing multiorgan failure and improving patient outcomes
In terms of specific management strategies, the European guideline provides recommendations on the use of tranexamic acid, fibrinogen concentrate, and other interventions to manage major bleeding and coagulopathy 1. The guideline emphasizes the importance of timely and appropriate intervention to prevent complications and improve patient outcomes. By following these evidence-based recommendations, clinicians can provide optimal care for patients with big T trauma and improve their chances of survival and recovery 1.
From the Research
Big T Trauma
- Big T trauma refers to traumatic injuries that can cause significant harm or death, often requiring immediate medical attention.
- Hemorrhage is a leading cause of preventable trauma-associated mortality, and interventions that improve prehospital hemorrhage control and resuscitation are needed 2.
- Tranexamic acid (TXA) has been shown to reduce mortality in trauma patients when administered upon hospital admission, and early dosing confers maximum benefit 2, 3.
Trauma Team Activation
- Specialized trauma teams have been shown to improve outcomes in critically injured patients 4.
- Trauma team activation criteria may include vital signs, type and extent of injury, mechanism of injury, interventions, and combined criteria 5.
- The utilization of trauma team activation protocols and subsequent management by the trauma team can be critical factors in the successful recovery of patients 4.
Tranexamic Acid in Trauma Patients
- TXA has been shown to decrease mortality after severe trauma and improve patients' functional status when administered in the emergency department 3.
- The use of TXA in trauma patients is supported by high-level evidence, and its implementation in the prehospital setting may offer a survival advantage to many patients, particularly when evacuation to surgical care may be delayed 2, 6.
- However, the adoption of TXA in some countries was delayed due to concerns about knowledge and evidence gaps, and subsequent nonrandomized controlled trials questioned the liberal use of TXA in trauma patients 6.