HEMORRHAGIC SHOCK AFTER RADICAL PROSTATECTOMY

Proposal Number:

MCC-7138 

Proposal Type:

Medically Challenging Case Report Poster 

Author:

Mónica Giménez Hernández  
Fundación Jiménez Diaz

Co-Author(s):

Marcia Cabrera  
Hospital Fundación Jiménez diaz
Maria Montes Fernández-Micheltorena  
Fundación Jiménez Díaz

Abstract:

Massive bleeding is a frequent entity that is associated with high morbidity and mortality. The main learning objectives are:

- The evaluation of the extent and / or severity of bleeding require clinical examination and the application of prediction scales for massive transfusion.

- To highlight the importance of training the teams involved and periodically evaluate their compliance and effectiveness.

- The need for protocols for the management of hypothermia, monitoring and replacement of volemia, hypotensive resuscitation and damage containment surgery, administration of hemocomponents and hemostatics.

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Our case is about a 56-year-old male with a personal history of hypertension, non-insulin-dependent diabetes mellitus and prostate tumor, who is intervened on a scheduled basis for laparoscopic radical prostatectomy.

After surgery, the patient enters resuscitation where he presents hypotension refractory to fluid therapy and bolus administration of vasoconstrictors, with anemization of 3 points in less than 30 minutes, so it is decided to perform urgent laparatormia.

The massive hemorrhage protocol is activated and the patient is connected to the rapid fluid infusion device. Hemoderivatives are administered early (including red blood cells, fresh plasma, platelets and fibrinogen concentrates), in addition to the simultaneous correction of hypovolemia and requiring perfusion of norepinephrine and adrenaline boluses. In addition, tranexamic acid, calcium and bicarbonate are administered.

After several hours of surgery, bleeding from the surgical site and the left epigastric artery is controlled, the patient is transferred to the post-surgical critical care unit

Professional Category:

Resident/Trainee

Keywords:

Critical Care

Enter up to two references.

  Reference
1. D. Stainsby, S. MacLennan, P.J. Hamilton.Management of massive blood loss: A template guideline. Br J Anaesth., 85 (2000), pp. 487-491
2. F. Hardy, P. de Moerloose, C.M. Samama, Members of the Groupe d’Interet en Hemostase P. Massive transfusion and coagulopathy: Pathophysiology and implications for clinical management. Can J Anaesth., 53 (2006), pp. S40-S58