Table 4 Treatment pathway checklist
From: Management of bleeding and coagulopathy following major trauma: an updated European guideline
Treatment phase | Yes | No | N/A | Reason for variance | |
|---|---|---|---|---|---|
Initial assessment and management | Â | Â | Â | Â | |
| Â | Extent of traumatic hemorrhage assessed | â–¡ | â–¡ | â–¡ | Â |
| Â | Patient in shock with identified source of bleeding treated immediately | â–¡ | â–¡ | â–¡ | Â |
| Â | Patient in shock with unidentified source of bleeding sent for further investigation | â–¡ | â–¡ | â–¡ | Â |
| Â | Coagulation, haematocrit, serum lactate, base deficit assessed | â–¡ | â–¡ | â–¡ | Â |
| Â | Antifibrinolytic therapy initiated | â–¡ | â–¡ | â–¡ | Â |
| Â | Patient history of anticoagulant therapy assessed (vitamin K antagonists, antiplatelet agents, oral anticoagulants) | â–¡ | â–¡ | â–¡ | Â |
Resuscitation | Â | Â | Â | Â | |
| Â | Systolic blood pressure of 80 to 100 mmHg achieved in absence of TBI | â–¡ | â–¡ | â–¡ | Â |
| Â | Measures to achieve normothermia implemented | â–¡ | â–¡ | â–¡ | Â |
| Â | Target Hb level 7 to 9 g/dL achieved | â–¡ | â–¡ | â–¡ | Â |
Surgical intervention | Â | Â | Â | Â | |
| Â | Abdominal bleeding control achieved | â–¡ | â–¡ | â–¡ | Â |
| Â | Pelvic ring closed and stabilised | â–¡ | â–¡ | â–¡ | Â |
| Â | Peritoneal packing, angiographic embolisation or surgical bleeding control completed in haemodynamically unstable patient | â–¡ | â–¡ | â–¡ | Â |
| Â | Damage control surgery performed in haemodynamically unstable patient | â–¡ | â–¡ | â–¡ | Â |
| Â | Local haemostatic measures applied | â–¡ | â–¡ | â–¡ | Â |
| Â | Thromboprophylactic therapy recommended | â–¡ | â–¡ | â–¡ | Â |
Coagulation management | Â | Â | Â | Â | |
| Â | Coagulation, haematocrit, serum lactate, base deficit, calcium reassessed | â–¡ | â–¡ | â–¡ | Â |
| Â | Target fibrinogen level 1.5 to 2 g/L achieved | â–¡ | â–¡ | â–¡ | Â |
| Â | Target platelet level achieved | â–¡ | â–¡ | â–¡ | Â |
| Â | Prothrombin complex concentrate administered if indicated due to vitamin-K antagonist or viscoelastic monitoring | â–¡ | â–¡ | â–¡ | Â |