Trauma múltiple

Objetivos de resucitación

● Blood pressure: Maintain MAP above 65 mmHg for penetrating trauma, and above 105 mmHg for blunt trauma
● Heart rate: Maintain between 60 and 100 beats per minute
● Oxygen saturation: Maintain above 94 percent
● Urine output: Maintain above 0.5 mL/kg/hour
● Central venous pressure: Maintain between 8 and 12 mmHg
● Lactate and base deficit: Monitor serum lactate and serum bicarbonate every four hours to ensure end-organ perfusion is adequate or improving with resuscitation
● Mixed central venous oxygen saturation: Monitor every four hours to ensure end-organ perfusion is adequate or improving with resuscitation; goal is to maintain above 70 percent Transfusion of blood products in patients without massive bleeding undergoing prolonged resuscitation of trauma-related shock may be performed using the following guidelines:
● Hemoglobin: Transfuse 2 units PRBCs if hemoglobin falls below 8 g/dL for patients without risk for acute coronary syndrome (ACS), or below 10 g/dL for patients at risk for ACS [76]
● Platelets: Transfuse 1 unit of apheresis platelets, or 6 units of random donor platelets, if the serum concentration falls below 50,000/microL
● International normalized ratio (INR): Transfuse 2 units of FFP if INR rises above 2
● Fibrinogen: Transfuse 10 units of cryoprecipitate if the fibrinogen concentration falls below 100 mg/dL.
Se recomienda una proporción de hemoderivados 1:1:1 (hematies/plaquetas/plasma)