Emergency Department, Derriford Hospital, Plymouth PL68DH, UK.
Emerg Med J. 2011 Oct;28(10):870-2. doi: 10.1136/emj.2009.088138. Epub 2010 Oct 28.
Uncontrolled haemorrhage is the leading cause of potentially reversible early in-hospital death following trauma. Approximately 25% of trauma patients arriving in the emergency department have evidence of early coagulopathy. It is vital that staff within the emergency department understand the basic pathophysiological consequences of massive blood loss in trauma and are familiar with when and how to administer blood and specific blood components in trauma resuscitation.
A structured questionnaire designed to test knowledge of the use of blood and blood components in trauma resuscitation was distributed to the emergency physicians attending a regional conference in the South West of England. The questionnaire consisted of 16 questions, both multiple choice and short answer format, referenced via Medline.
32/32 questionnaires distributed were completed and returned. Massive transfusion protocols existed in 4/11 hospitals surveyed. 5/32 doctors were able to define the term 'massive transfusion' while 9/32, 6/32 and 3/32 were consistent with current guidelines in their prescription of platelets, fresh frozen plasma, and cryoprecipitate. 20/32 were consistent with current guidelines in identifying optimal haemoglobin levels. When asked more specifically about blood component therapy, 18/32 correctly identified target fibrinogen levels, 27/32 knew that fibrinogen is a component of fresh frozen plasma or cryoprecipitate and 1/32 correctly identified that fibrinogen is a component of both. 10/32 identified indications for beriplex and 5/32 doctors correctly identified indications for the use of recombinant factor VIIa. 20/32 doctors guessed >50% of the answers and the remaining 12/32 guessed 50%.
The survey found that emergency physicians lacked core knowledge about the use of blood and blood component therapy in the context of massive haemorrhage following trauma. Doctors were unaware of how to prevent and treat early coagulopathy. Educational resources specifically for use by emergency physicians are limited on this topic. The use of massive transfusion protocols--that standardised blood component therapy is automatically delivered at specific points within resuscitation--would not only guide doctors, but be a clear step towards minimising the complications associated with massive transfusion.
失血性休克是创伤后早期院内潜在可逆转死亡的主要原因。大约 25%到达急诊的创伤患者有早期凝血病的证据。了解大量失血对创伤后基本病理生理后果的影响，熟悉何时以及如何在创伤复苏中给予血液和特定血液成分，这对急诊医生至关重要。
设计了一份测试在创伤复苏中使用血液和血液成分知识的结构化问卷，分发给在英格兰西南部举行的区域会议的急诊医生。该问卷由 16 个问题组成，包括多项选择和简答题，通过 Medline 引用。
分发的 32/32 份问卷完成并返回。调查的 11 家医院中有 4 家制定了大量输血方案。5/32 名医生能够定义“大量输血”一词，而 9/32、6/32 和 3/32 名医生在开具血小板、新鲜冷冻血浆和冷沉淀方面符合当前指南。20/32 名医生在确定最佳血红蛋白水平方面符合当前指南。当被问及更具体的血液成分治疗时，18/32 名医生正确识别目标纤维蛋白原水平，27/32 名医生知道纤维蛋白原是新鲜冷冻血浆或冷沉淀的组成部分，1/32 名医生正确识别纤维蛋白原是两者的组成部分。10/32 名医生识别了贝立普的适应症，5/32 名医生正确识别了使用重组因子 VIIa 的适应症。20/32 名医生猜测了>50%的答案，其余 12/32 名医生猜测了 50%。
调查发现，急诊医生在创伤后大量出血的情况下缺乏核心血液和血液成分治疗知识。医生不知道如何预防和治疗早期凝血病。关于这个主题，专门为急诊医生使用的教育资源有限。使用大量输血方案——即在复苏过程中的特定点自动提供标准化的血液成分治疗——不仅可以指导医生，而且是朝着减少大量输血相关并发症迈出的明确一步。
