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Blood Failure: Pathophysiology and Diagnosis

  • Nathan J. White
  • Kevin R. WardEmail author
Chapter

Abstract

Hemorrhage is the leading cause of preventable death in both civilian and military environments. It is now known that impaired coagulation in the setting of traumatic shock that increases hemorrhage has been identified in 20–30% of trauma victims shortly after injury and when present can increase the incidence of organ failure, intensive care utilization, and even death. New insights into the field of traumatic shock have led to a recent and growing concept that blood and its endothelial interface should be considered an organ system and that when injured sufficiently can fail. This chapter will define the critical elements and pathophysiology of trauma-induced hemorrhagic blood failure including the physiology of shock and oxygen debt, reperfusion injury, the role of the endothelium, and resulting hemostatic dysfunction including its diagnosis. This framework will assist in understanding the process by which blood failure develops and also offer a base from which to work to develop new prevention, diagnostic, and treatment strategies for blood failure as they apply to the challenges of remote damage control resuscitation and other settings.

Keywords

Blood failure Shock Oxygen debt Oxygen deficit Microcirculation Endothelium Trauma Trauma-induced coagulopathy Hemorrhage Traumatic shock Thromboelastography Viscoelastic Hemostatic assay Platelet dysfunction Lactate Hemostasis Remote damage control resuscitation Hemostatic dysfunction Damage control resuscitation 

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Emergency MedicineUniversity of WashingtonSeattleUSA
  2. 2.Departments of Emergency Medicine and Biomedical EngineeringMichigan Center for Integrative Research in Critical Care, University of MichiganAnn ArborUSA

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