PREDICTING THE NEED TO PACK EARLY FOR SEVERE INTRAABDOMINAL HEMORRHAGE

Objective: To determine if the decision to pack for hemorrhage could b e refined. Materials and Methods: Seventy consecutive trauma patients for whom packing was used to control hemorrhage were studied. The pati ents had liver injuries, abdominal vascular injuries, and bleeding ret roperitoneal hematomas. Preoperative variables were analyzed and survi vors compared with nonsurvivors. Results: Packing controlled hemorrhag e in 37 (53%) patients. Significant differences (p < 0.05) between sur vivors and nonsurvivors were Injury Severity Score (29 vs. 38), initia l pH (7.3 vs. 7.1), platelet count (229,000 vs. 179,000/mm(3)), prothr ombin time (14 vs. 22 seconds), partial thromboplastin time (42 vs. 69 seconds), and duration of hypotension (50 vs. 90 minutes). Nonsurvivo rs received 20 units of packed red blood cells before packing compared to 13 units for survivors. Conclusion: Patients who suffer severe inj ury, hypothermia, refractory hypotension, coagulopathy, and acidosis n eed early packing if they are to survive. Failure to control hemorrhag e is related to severity of injury and delay in the use of pack tampon ade. A specific protocol that mandates packing when parameters reach a critical limit should be considered.