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【論文摘要】執行到院前輸血來提升創傷患者的預後
【論文摘要】Using prehospital blood transfusion to improve the prognosis of trauma patients
摘要
研究背景：現行國內對於創傷大出血的輸血均在醫院急診端執行，但往往在第一現場救護人員便察覺患者為大出血或根據骨折位置或身體檢查判斷為內出血，就目前規定可執行技術有針對出血處止血及0.9%n/s輸液，如果可以將輸血開放至第一現場操作可以加速患者體液的補充藉此提升存活率。案例描述：男性27歲因騎機車與汽車車禍路人報案送醫，現場救護人員評估患者意識不清，左手開放性傷口，有耳漏及流鼻血，車上二評發現右眼熊貓眼右大腿腫，顏面部及大腿疑似骨折，GCS:E3V2M5後送台大醫院，到院後經影像學確認為顏面部、左外耳道及骨盆骨折，急診給予給藥、輸血後會診骨科、放射科及整形科評估，後續患者因符合嚴重外傷而轉入ICU。案例討論：創傷所造成的大出血往往都是造成死亡的主要原因，以此案例的現場評估可以發現疑似右大腿骨折出血量最多可至1000C.C，現場可以給予輸液給藥，另外再依據病患的生命徵象回報醫院提前啟動MTP，但如果可以經評估判斷出血量然後給予輸血，藉此提升患者的存活率及提高預後的恢復。
並列摘要
Background: Current practices in Taiwan for transfusing blood in cases of major bleeding due to trauma are typically carried out in hospital emergency rooms. However, often, emergency medical personnel detect significant bleeding at the scene or determine internal bleeding based on the location of fractures or physical examinations. According to existing regulations, the permitted techniques at the scene include hemorrhage control at the bleeding site and the administration of 0.9% normal saline solution. Allowing blood transfusion to be performed at the scene would accelerate fluid resuscitation for patients, thereby potentially increasing survival rates. Case presentation: A 27-year-old male was involved in a motorcycle-car accident, as reported by bystanders who witnessed the incident. Emergency medical personnel assessed the patient at the scene and found him to be disoriented with an open wound on his left hand, ear bleeding, and nasal bleeding. During the on-site evaluation, it was observed that his right eye exhibited raccoon eyes, and his right thigh was swollen. Suspected fractures were noted on his face and thighs. The Glasgow Coma Scale (GCS) score was E3V2M5. He was subsequently transferred to National Taiwan University Hospital. Upon arrival, imaging studies confirmed fractures in the face, left external auditory canal, and pelvis. In the emergency department, the patient received medication and blood transfusion before being evaluated by orthopedics, radiology, and plastic surgery. Due to the severity of his injuries, the patient was later transferred to the intensive care unit (ICU). Case Discussion: Trauma-induced massive hemorrhage is often the leading cause of death. In this case, the on-site assessment suggests a suspected right thigh fracture with a potential hemorrhage volume of up to 1000 mL. At the scene, fluid resuscitation and medication administration can be provided. Additionally, based on the patient's vital signs, activating a Massive Transfusion Protocol (MTP) at the hospital can be initiated earlier. However, if hemorrhage volume can be assessed and blood transfusion provided accordingly, it could potentially increase the patient's survival rate and improve their prognosis for recovery.