Thromboelastography in different mechanisms of injuries/organ injuries in traumatized patients in Southern Thailand

Background: Trauma is the second most common cause of death in Thailand, relatively with massive blood loss. Coagulopathy plays a role in blood loss. Differences in mechanisms and organs injured can affect coagulopathy stage and blood loss. Thromboelastometry is a measuring instrument for accurate and rapid detection of coagulopathy. We hypothesized that thromboelastometry in traumatized patients who require surgery in Songklanagarind Hospital will help with early detection of coagulopathy and assess anticipated blood loss. Methods: After approval from the Institutional Ethics Committee, patients aged above 18 years who had American Society of Anesthesiologists Physical Status (ASA) IEVE, activated by trauma team and sent for emergency surgery. Anesthesia was induced and maintained, and invasive procedures were done as anesthesiologist's consideration. Thromboelastometry, prothrombin time (PT), partial thromboplastin time (PTT), complete blood count, platelets, arterial blood gas, lactate, and base deficit were assessed and recorded at the emergency room and after Massive Transfusion Protocol (MTP) was activated at 1 and 2 MTP, respectively. Results: Most traumatized patients who were operated on in Songklanagarind Hospital during the study period were male, the most common cause of their injuries was a motorcycle accident, and the most common organ associated with massive blood loss and blood transfusion was the head. After the patients received PRCs of 5 and 11 units, the hematocrit level and platelet count decreased from baseline, while PT and PTT were prolonged. pH, base deficit, and lactate were worse. Clot formation time (CFT), A10, and maximum clot firmness (MCF) of EXTEM were statistically significantly different among the three time periods. Clotting times, CFT, A10, and MCF of INTEM were statistically significantly different among three time periods. A10 and MCF of FIBTEM were statistically significantly different among three time periods. Conclusion: Most baseline laboratory tests in the traumatized patients who received massive blood transfusion and underwent surgery were worse after they received 1 and 2 MTP. These parameters including thromboelastometry could be guided for preparing proper blood components for patients requiring massive transfusion

Myocardial Dysfunction in Acute Traumatic Brain Injury Relieved by Surgical Decompression

Traumatic brain injury (TBI) is a major public health issue and is a leading cause of death in North America. After a primary TBI, secondary brain insults can predispose patients to a worse outcome. One of the earliest secondary insults encountered during the perioperative period is hypotension, which has been directly linked to both mortality and poor disposition after TBI. Despite this, it has been shown that hypotension commonly occurs during surgery for TBI. We present a case of intraoperative hypotension during surgery for TBI, where the use of transthoracic echocardiography had significant diagnostic and therapeutic implications for the management of our patient. We then discuss the issue of cardiac dysfunction after brain injury and the implications that echocardiography may have in the management of this vulnerable patient population

Case Report Myocardial Dysfunction in Acute Traumatic Brain Injury Relieved by Surgical Decompression

Traumatic brain injury (TBI) is a major public health issue and is a leading cause of death in North America. After a primary TBI, secondary brain insults can predispose patients to a worse outcome. One of the earliest secondary insults encountered during the perioperative period is hypotension, which has been directly linked to both mortality and poor disposition after TBI. Despite this, it has been shown that hypotension commonly occurs during surgery for TBI. We present a case of intraoperative hypotension during surgery for TBI, where the use of transthoracic echocardiography had significant diagnostic and therapeutic implications for the management of our patient. We then discuss the issue of cardiac dysfunction after brain injury and the implications that echocardiography may have in the management of this vulnerable patient population