Blood Loss in Trauma
SPECIAL FEATURES OF TRAUMATIC BLEEDING
Multiple sources of bleeding
Blood loss in trauma commonly presents clinical features differing markedly from those seen in experimental bleeding and those arising in the course of disease. Severe traumatic oligaemia rarely arises from one area of bleeding as it does in, say, haematemesis or experimental work. In most cases multiple foci of haemorrhage in soft tissues or into body cavities exist, many of them not amenable to surgical haemostasis; this feature greatly alters the clinical picture and increases the difficulty of assessment of blood loss. Difficulties of diagnosis in trauma are frequently caused by the obscuration of signs of one injury by those of another (particularly in cranial or thoracic trauma) and by the development of complications, such as fat embolism or tension pneumothorax, in the course of resuscitation.
Progressive nature of bleeding
Bleeding into the tissues, other than that which can be staunched operatively, frequently continues for at least 24 hours after injury and the