Itamar Ashkenazi1, Roger Sevi2, Fernando Turégano-Fuentes3, Michael S Walsh4,5, Oded Olsha6, William P Schecter7, Ricardo Alfici8. 1. Hillel Yaffe Medical Center, P.O.B. 169, 38100, Hadera, Israel. i_ashkenazi@yahoo.com. 2. Orthopedic A Surgery Department, Hillel Yaffe Medical Center, Hadera, Israel. 3. Emergency Surgery Department, Hospital Universitario General Gregorio Marañon, Madrid, Spain. 4. Surgery Department, School of Medicine at the University of Botswana, Gaborone, Botswana. 5. , Plot 1836 Princess Marina Hospital, North Ring Road, Gaborone, Botswana. 6. Surgery Department, Shaare Zedek Medical Center, Jerusalem, Israel. 7. UCSF Department of Surgery, San Francisco General Hospital, San Francisco, USA. 8. Hillel Yaffe Medical Center, P.O.B. 169, 38100, Hadera, Israel.
Abstract
BACKGROUND: Extremities are commonly injured following bomb explosions. The main objective of this study was to evaluate the prevalence of hemorrhagic shock (HS) in victims of explosion suffering from extremity injuries. METHODS: Retrospective study based on a cohort of patient records maintained in one hospital's mass casualty registry. RESULTS: Sixty-six victims of explosion who were hospitalized with extremity injuries were identified and evaluated. Sixteen (24.2%) of these were hemodynamically unstable during the first 24 h of treatment. HS could be attributed to associated injuries in seven of the patients. In the other nine patients, extremity injury was the only injury that could explain HS in seven patients and the extremity injury was a major contributor to HS together with another associated injury in two patients. In those 9 patients, in whom the extremity injury was the sole or major contributor to HS, a median of 10 (range 2-22) pRBC was transfused during the first 24 h of treatment. Six of the nine patients were in need of massive transfusion. Fractures in both upper and lower extremities, Gustilo IIIb-c open fractures and AIS 3-4 were found to be risk factors for HS. CONCLUSIONS: Ample consideration should be given to patients with extremity injuries due to explosions, as these may be immediately life threatening. Tourniquet use should be encouraged in the pre-hospital setting. Before undertaking surgery, emergent HS should be considered in these patients and prevented by appropriate resuscitation.
BACKGROUND: Extremities are commonly injured following bomb explosions. The main objective of this study was to evaluate the prevalence of hemorrhagic shock (HS) in victims of explosion suffering from extremity injuries. METHODS: Retrospective study based on a cohort of patient records maintained in one hospital's mass casualty registry. RESULTS: Sixty-six victims of explosion who were hospitalized with extremity injuries were identified and evaluated. Sixteen (24.2%) of these were hemodynamically unstable during the first 24 h of treatment. HS could be attributed to associated injuries in seven of the patients. In the other nine patients, extremity injury was the only injury that could explain HS in seven patients and the extremity injury was a major contributor to HS together with another associated injury in two patients. In those 9 patients, in whom the extremity injury was the sole or major contributor to HS, a median of 10 (range 2-22) pRBC was transfused during the first 24 h of treatment. Six of the nine patients were in need of massive transfusion. Fractures in both upper and lower extremities, Gustilo IIIb-c open fractures and AIS 3-4 were found to be risk factors for HS. CONCLUSIONS: Ample consideration should be given to patients with extremity injuries due to explosions, as these may be immediately life threatening. Tourniquet use should be encouraged in the pre-hospital setting. Before undertaking surgery, emergent HS should be considered in these patients and prevented by appropriate resuscitation.
Authors: Paul D Biddinger; Aaron Baggish; Lori Harrington; Pierre d'Hemecourt; James Hooley; Jerrilyn Jones; Ricky Kue; Chris Troyanos; K Sophia Dyer Journal: N Engl J Med Date: 2013-05-01 Impact factor: 91.245
Authors: Matthias Eikermann; George Velmahos; Suhny Abbara; Paul L Huang; Shawn P Fagan; Ronald E Hirschberg; John Y Kwon; Vania Nosé Journal: N Engl J Med Date: 2014-04-10 Impact factor: 91.245
Authors: Sharon Einav; Zvi Feigenberg; Charles Weissman; Daniel Zaichik; Guy Caspi; Doron Kotler; Herbert R Freund Journal: Ann Surg Date: 2004-03 Impact factor: 12.969
Authors: Edward Passos; Brittany Dingley; Andrew Smith; Paul T Engels; Chad G Ball; Samir Faidi; Avery Nathens; Homer Tien Journal: Injury Date: 2013-12-04 Impact factor: 2.586
Authors: Alec C Beekley; James A Sebesta; Lorne H Blackbourne; Garth S Herbert; David S Kauvar; David G Baer; Thomas J Walters; Philip S Mullenix; John B Holcomb Journal: J Trauma Date: 2008-02
Authors: Brian J Eastridge; Robert L Mabry; Peter Seguin; Joyce Cantrell; Terrill Tops; Paul Uribe; Olga Mallett; Tamara Zubko; Lynne Oetjen-Gerdes; Todd E Rasmussen; Frank K Butler; Russ S Kotwal; Russell S Kotwal; John B Holcomb; Charles Wade; Howard Champion; Mimi Lawnick; Leon Moores; Lorne H Blackbourne Journal: J Trauma Acute Care Surg Date: 2012-12 Impact factor: 3.313