Part 2 book “Essentials of trauma anesthesia” has contents: Anesthetic considerations for adult traumatic brain injury, anesthetic considerations for spinal cord injury, anesthetic considerations for ocular and maxillofacial trauma, anesthetic considerations for chest anesthetic considerations for chest, and other contents. | Section 1 Chapter 11 Core Principles in Trauma Anesthesia Coagulation Monitoring of the Bleeding Trauma Patient Marc P. Steurer and Michael T. Ganter Introduction Blood coagulation is a complex and tightly regulated physiologic network of interacting proteins and cells. If deranged, it may dramatically influence outcome. A comprehensive understanding of normal hemostasis and its pathophysiology is necessary for anesthesiologists working in the perioperative field. Treatment of a massive trauma bleeding requires an interdisciplinary approach for both trauma surgeons and anesthesiologists. Modern transfusion strategies and coagulation management are based on a detailed understanding of coagulation physiology and specific coagulation monitoring. Besides the patients’ medical history, clinical presentation and laboratory tests, bedside coagulation analyses (point-of-care, POC) are increasingly being used to assess hemostasis. Consequently, specific, individualized, and goal-directed hemostatic interventions are becoming more and more feasible. Abnormal hemostasis is not limited to bleeding. Hypercoagulability and thrombosis are further phenotypes of disturbed hemostasis. The coagulation system represents a delicate balance of forces supporting coagulation (coagulation, antifibrinolysis) and forces inhibiting coagulation (anticoagulation, fibrinolysis) (Figure ). The distinctive challenge is to assess and quantify both sides of this balance and to maintain an equilibrium. Specific coagulation interventions can be made on either side, with the goal of preventing both overt bleeding and thrombosis. Figure . Coagulation balance. Normal blood coagulation exists when procoagulant and anticoagulant forces are in balance. 154 18:17:51, subject to the Cambridge Core .012 Chapter 11: Coagulation Monitoring 155 Current Concepts of the Coagulation System Hemostasis is the process that causes bleeding to stop after a vessel injury. It is maintained in the body by
