Razvoj letalnog trijasa

master's thesis

• Title: Razvoj letalnog trijasa : koagulopatije, acidoze i hipotermije u bolesnika s traumom
• Title (english): Development of the lethal triad : coagulopathy, acidosis and hypothermia in trauma patients
• Author: Mislav Kasalo
• Mentor: Daniela Bandić Pavlović (mentor)
• Committee member: Mladen Perić (predsjednik povjerenstva)
• Committee member: DINKO TONKOVIĆ (član povjerenstva)
• Committee member: Daniela Bandić Pavlović (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Anaesthesiology, Resuscitation and Intensive Care in Surgical Specialities); Zagreb
• Defense date and country: 2019-09-10, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Anesthesiology and Reanimatology

Abstract

Trauma se nalazi na trećem mjestu po broju smrti u svijetu te predstavlja vodeći uzrok smrtnosti u dobnoj skupini do 45 godina. Udio politraumatiziranih bolesnika u ukupnom broju zabilježenih ozljeda iznosi 3%, a stopa smrtnosti među tim bolesnicima je visoka i iznosi 16 do 22%. U prvom razdoblju, unutar prvoga sata, bolesnici umiru zbog težine ozljeda i to najčešće na mjestu nesreće ili u transportu do bolnice. U drugom razdoblju, jedan do dva sata nakon ozljede, umiru od traumatskog šoka i zatajenja organa, najčešće po dolasku u bolnicu ili za vrijeme hitnog operativnog zahvata. U trećem razdoblju, koje traje dva do četiri tjedna nakon nastanka ozljeda, bolesnici umiru zbog zatajenja organa. Veliki problem predstavlja disfunkcija koagulacijskog sustava uzrokovana promjenom acidobaznog statusa i razvojem hipotermije. Utjecaj hipotermije i acidoze na koagulopatiju još nije u potpunosti poznat, ali zna se da su u početnom stadiju učinci reverzibilni, te se liječenjem hipotermije i acidoze sprječava nastanak koagulopatije. Postoje brojni načini liječenja svih komponenti letalnog trijasa, te pravilan izbor načina liječenja, ali i prvavovremeno započinjanje liječenja smanjuju smrtnost u bolesnika s traumom. Razvojem moderne tehnologije, ali i uvođenjem novih dijagnostičkih kriterija nastoji se rano prepoznati razvoj letalnog trijasa, još u fazi kada je koagulopatija reverzibilna. Ranom primjenom lijekova, ponajprije traneksamične kiseline značajno se smanjuje smrtnost.

Abstract (english)

Trauma is the third most often cause of death worldwide and the leading cause of death in people under 45 years of age. 3% of all injured patients are those with polytrauma with mortality rates between 16 and 22%. In the first period, within the first hour, patients die primarily due to the severity of the injuries, most often on the scene of the accident or during the transportation. In the second period, one or two hours after the accident, the patients primarily died due to traumatic shock and organ failure, most often after being admitted to the hospital or during an emergency operative procedure. In the third period, 2 to 4 weeks after the accident, the leading cause of death is organ failure. A big problem is the development of coagulation dysfunction caused by acid-base dysfunction and hypothermia. The effects of acid-base dysfunction and hypothermia on the coagulation system is not fully known, but in the early stages those effects are reversible. By treating hypothermia and acidosis the development of coagulopathy can be prevented. There are many treatment options available to treat each of the components of the lethal triad. Choosing the right treatment option in the appropriate time leads to lower mortality rates. Modern technology and new diagnostic criteria help in early detection of lethal triad development, while it is still reversible. Early admission of drugs, primarily tranexamic acid significantly reduces mortality rates.

• Keywords: letalni trijas; koagulopatija; acidoza; hipotermija
• Keywords (english): lethal triad; coagulopathy; acidosis; hypothermia
• Language: croatian
• URN:NBN: urn:nbn:hr:105:148021
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2020-02-25 08:26:50