Various drugs
- PDF / 151,884 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 17 Downloads / 203 Views
1 S
Lack of efficacy: case report A 41-year-old man exhibited lack of efficacy during treatment with fibrinogen, plasma, prothrombin complex concentrate and tranexamic acid for coagulopathy. The man was admitted to the ICU after a motorcycle accident.On the accident scene, the emergency team found a state of cardiac arrest, and cardiopulmonary resuscitation was performed for 20 minutes before return of spontaneous circulation. Upon arrival to the emergency room (ER), he was comatose, severely hypotensive, showed impairment of gas exchange and had severe mixed respiratory and metabolic acidosis. In ER, he underwent aggressive fluid resuscitation and vasoactive support. He was transfused RBC together with plasma [fresh frozen plasma]. Initial coagulopathy management also required fibrinogen, tranexamic acid and prothrombin complex concentrates based on thromboelastometry. At ICU admission, he developed haemodynamic instability in spite of aggressive fluid infusion, vasoactive support and RBC transfusion, consistently with trauma-induced coagulopathy and severe maxillofacial injuries. He also showed poor neurological status with bilateral dilated pupils and absent brainstem reflexes. His general condition deteriorated. Due to respiratory and haemodynamic failure, extracorporeal life support (ECLS) was implemented. Owing to severe coagulopathy confirmed by thromboelastometry, circuit and patient anticoagulation could not be established. After ECLS initiation, a substantial amelioration in respiratory and haemodynamic parameters was observed. Over the following 6 hours, he showed persistent bleeding because of poor source control and coagulopathy, which necessitated administration of fluids, platelets, RBC, plasma, tranexamic acid and fibrinogen as appropriate. Over a 36-h period, a total of 8L of plasma, 26U of RBC, 2L of platelet, 2g of tranexamic acid and 3g of fibrinogen were transfused. In the following hours, his neurologic status was unchanged with absent brain stem reflexes. A preliminary electroencephalogram showed the absence of cortical activity. After 6-hours of observation, he was declared brain dead and his organs were donated following discussion with family members. Balsorano P, et al. Extracorporeal life support and multiorgan donation in a severe polytrauma patient: A case report. International Journal of Surgery Case Reports 9: 803509616 109-111, Jan 2015. Available from: URL: http://doi.org/10.1016/j.ijscr.2015.02.054
0114-9954/20/1827-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
Reactions 24 Oct 2020 No. 1827
Data Loading...
