Management of Noncompressible Hemorrhage Using Vena Cava Ultrasound
Abstract
This is a study of patients admitted with major traumatic injuries. Such patients may develop inadequate blood circulation to the organs as a result of internal bleeding. Early detection of internal bleeding can be difficult as physical examination alone may miss patients with significant blood loss. About 6%-7% of major trauma victims will arrive with low blood pressure; these patients are usually given 2 liters of intravenous fluid to determine if their blood pressure will recover. If the blood pressure does not rise or if it drops again later, the blood loss can be assumed to be severe, and the patient will likely need transfusions, surgery, and other interventions. However, this fluid treatment method can lead to delays and complications as some patients may initially respond but then continue to bleed. About 15% of patients with significant internal injuries, including internal bleeding, arrive with a normal blood pressure. This is most common in physically fit individuals such as military personnel. Vital signs may not disclose the severity of injury in such patients, and additional tests and imaging are required. The inferior vena cava is the large vein draining blood from the lower body to the heart. The inferior vena cava is known to empty when the patient has had significant blood loss. The vena cava diameter can be seen using ultrasound. This study intends to perform ultrasound to examine the vena cava diameter on patients just after arriving with major trauma. After the patient has been given the 2 liter intravenous fluid treatment, the inferior vena cava diameter will be measured again. A third examination 8-24 hours after admission will determine if the inferior vena cava diameter has returned to normal as the patient has been made stable. We propose that measuring the inferior vena cava in this manner can predict those patients who are likely to continue bleeding and require interventions such as surgery. The ultrasound examination is a non-invasive test with no risks in application. Early detection in these patients may avoid delays in treatment, complications, and excess mortality. Because this examination can be done with handheld ultrasound machines, it could be done outside hospitals and in military combat casualty care environments. We anticipate the study will take about 2 years to complete.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Apr 04, 2016
- Source ID
- W81XWH1510709
Entities
People
- Donald Jenkins
Organizations
- National Trauma Institute
- United States Army