Select a Community
Are you sure you want to trigger topic in your Anconeus AI algorithm?
You are done for today with this topic.
Would you like to start learning session with this topic items scheduled for future?
John may lose an average of 1200ml of blood from his injuries. For Jane, airway control is the first step.
13%
233/1757
John may lose an average of 1200ml of blood from his injuries. For Jane, control of bleeding is the first step.
19%
331/1757
John may lose an average of 2000ml of blood from his injuries. For Jane, airway control is the first step.
22%
389/1757
John may lose an average of 2000ml of blood from his injuries. For Jane, control of bleeding is the first step.
38%
665/1757
John may lose an average of 3000ml of blood from his injuries. For Jane, control of bleeding is the first step.
6%
110/1757
Select Answer to see Preferred Response
Average blood loss in closed femur and tibia fractures is 1250ml and 750ml, respectively. For exsanguinating external hemorrhage, control of massive hemorrhage takes precedence over assessment of airway/breathing/fluid resuscitation. A screaming/crying patient has a patent airway. The estimated blood loss for closed fractures of the femur and tibia are 1000-1500ml and 500-1000ml, respectively. Blood loss can double in open fractures. In the presence of exsanguinating external hemorrhage, control of hemorrhage should take precedence over the ABCDE primary survey. Delays in performing assessment of airway and breathing would put the patient at risk of death from blood loss. Lieurance et al. retrospectively reviewed 53 patients with isolated femur fractures. They found that 21 patients required transfusion of an average of 2.5units PRBCs. Estimated blood loss was 1276cc and not affected by fracture pattern or high/low energy pattern. They concluded that preoperative hemorrhage contributed to transfusion need more than intraoperative blood loss. Lee and Porter reviewed prehospital management of lower limb fractures. They recommend a stepwise control of bleeding: direct pressure, elevation, wound packing, windlass technique (place a pen under a circumferential knot and rotate the pen until tight), indirect pressure (traction splint), tourniquet. In the presence of compressible/controllable bleeding, they recommend resuscitation to normal physiological parameters. In the presence of non-controllable bleeding, they recommend hypotensive resuscitation (SBP 80mmHg or to restore the radial pulse). Illustration A shows the priorities of primary survey. Illustration B is an algorithm for prehospital management of fractures. (Both illustrations courtesy of Lee et al.) Incorrect Answers: Answers 1, 2, 3, 5: Closed femoral shaft fractures lose an average of 1250ml. Closed tibial shaft fractures lose an average of 750ml. Combined losses will average 2000ml (range, 1500 to 2500ml). In the presence of exsanguinating bleeding, control of hemorrhage is more important than securing an airway.
1.5
(30)
Please Login to add comment