A novel algorithm for shock treatment in patients with injuries

Aim. To improve the algorithm for diagnosis, intensive care and anesthesia in the acute period of traumatic disease at pre-hospital and hospital stages.

Methods. The first group included 60 patients who were admitted in 2009-2010 (standart treatment approach), the second group included 41 patient who were injured at 2011-2012 (transition period), the third group consisted of 55 patients treated using a novel algorithm in 2013. Systemic circulation parameters were measured in all patients. To characterize the severity of polytrauma, ISS (Injury Severity Score; Baker S.P., 1974) was used.

Results. Using the routine approach to shock treatment in the first group of patients (2009-2010) with shock both on pre-hospital and hospital stages had increased the duration and severity of acute shock period. Surgical interventions were performed only in life-threatening situations, and osteosynthesis surgeries were postponed. During the transition period, a specialized trauma center was formed for providing in-patient care, allowing new surgical approaches in treatment of acute shock stage. Although in 2013 mostly high energy injuries were observed (the number of separate injuries per patient increased up to 7.38±4.2), a newly introduced algorithm together with decreased transportation time to the hospital down to 20 minutes allowed to achieve more stable indicators of central circulation on pre-hospital stage (mean blood pressure 69.939±15.009 mm Hg, heart rate 97.991±9.931 per minute, stroke volume 85.815±13.667 ml, heart index 4569.862±1240.153 ml/min/m2). This allowed to imply the tactics of early surgical interventions in patients with polytrauma and improved the outcomes. A novel algorithm use decreased the hospital stay of patients with polytrauma both in the intensive care unit (from 2.98 to 1.86 days) and in the department (from 13.12 to 11.78 days).

Conclusion. The changed algorithm of care applied in 2013, is rational and effective from the practical point of view, ensures continuity of medical aid provided to patients with polytrauma both on pre-hospital and hospital stages.