Surgical Strategies in Trauma
Traumatic hemorrhage is a major cause of trauma-related death in both the civilian and military settings. Given the preventable nature of the consequences of hemorrhage, significant energy has been dedicated to better therapeutic considerations. Trunkey et al. stratified traumatic deaths a trimodal distribution: immediate death from massive neurologic or cardiovascular injuries, early death from noncompressible torso trauma and hemorrhage, and late death related to organ failure and death. This concept has been challenged with recent studies suggesting that severely injured patients have only a small percentage of late deaths, with death primarily occurring within the first 6 h of admission. This may be attributed to better postoperative care and hospital systems. These findings place emphasis on the importance of early events in the management of bleeding patients. The basic principles of the contemporary approach to the bleeding trauma patient include:
