Tachycardic and non-tachycardic responses in trauma patients with haemorrhagic injuries.
Background: Analyses of large databases have demonstrated that the association between heart rate (HR) and blood loss is weaker than what is taught by Advanced Trauma Life Support training. However, those studies had limited ability to generate a more descriptive paradigm, because they only examined...
| Publicado en: | Injury Vol. 49; no. 9; pp. 1654 - 1661 |
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| Autores principales: | , , , , , |
| Formato: | research Journal Article |
| Publicado: |
Elsevier B.V.
Sep2018
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=131295200&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 131295200 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201383 JGC jtl: Injury issn: 00201383 maglogo: N pubinfo: dt: Sep2018 vid: 49 iid: 9 pid: 467 pub: Elsevier B.V. place: New York, New York artinfo: ui: 131295200 131295200 NLM29729820 131295200 10.1016/j.injury.2018.04.032 NLM29729820 131295200 ppf: 1654 ppct: 7 formats: tig: atl: Tachycardic and non-tachycardic responses in trauma patients with haemorrhagic injuries. aug: au: Reisner, Andrew T. Edla, Shwetha Liu, Jianbo Liu, Jiankun Khitrov, Maxim Y. Reifman, Jaques affil: Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA sug: subj: Shock, Hemorrhagic Physiopathology Heart Rate Physiology Hemorrhage Physiopathology Tachycardia Diagnosis Wounds and Injuries Physiopathology Advanced Trauma Life Support Care Tachycardia Physiopathology Human Shock, Hemorrhagic Therapy Wounds and Injuries Complications Adult Young Adult Medical Practice, Evidence-Based Hemorrhage Therapy Trauma Severity Indices Retrospective Design Middle Age Hemorrhage Etiology Male Wounds and Injuries Therapy Female Validation Studies Comparative Studies Evaluation Research Multicenter Studies Adult: 19-44 years Middle Aged: 45-64 years Male Female ab: Background: Analyses of large databases have demonstrated that the association between heart rate (HR) and blood loss is weaker than what is taught by Advanced Trauma Life Support training. However, those studies had limited ability to generate a more descriptive paradigm, because they only examined a single HR value per patient.Methods: In a comparative, retrospective analysis, we studied the temporal characteristics of HR through time in adult trauma patients with haemorrhage, based on documented injuries and transfusion of ≥3 units of red blood cells (RBCs). We analysed archived vital-sign data of up to 60 min during either pre-hospital or emergency department care.Results: We identified 133 trauma patients who met the inclusion criteria for major haemorrhage and 1640 control patients without haemorrhage. There were 55 haemorrhage patients with a normal median HR and 78 with tachycardia. Median ΔHR was -0.8 and +0.7 bpm per 10 min, respectively. Median time to documented hypotension was 8 and 5 min, respectively. RBCs were not significantly different; median volumes were 6 (IQR: 4-13) and 10 units (IQR: 5-16), respectively. Time-to-hypotension and mortality were not significantly different. Tachycardic patients were significantly younger (P < 0.05). Only 10 patients with normal HR developed transient/temporary tachycardia, and only 11 tachycardic patients developed a transient/temporary normal HR.Conclusions: The current analysis suggests that some trauma patients with haemorrhage are continuously tachycardic while others have a normal HR. For both cohorts, hypotension typically develops within 30 min, without any consistent temporal increases or trends in HR. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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