[The lethal triad of hemorrhage]

Coagulopathy, acidosis and hypothermia form the lethal triad in trauma patients with acute hemorrhage. The prevention of this chain reaction relies on an adapted management from the first care in pre-hospital situation: rapid arrest of bleeding, fight against hypothermia, limited vascular filling with an early recourse to vasoactive amines. Pre-hospital transfusion is still rare, whereas in the hospital, an adapted transfusion strategy can wait for or support a surgical or radiological hemostasis procedure.

[The ABC's of the tactical tourniquet]

Uncontrolled bleeding is the leading cause of preventable death. After rapid diagnosis of the injury, early stoppage of the bleeding and maintenance of effective coagulation are, in the pre-hospital setting, the two mainstays of treatment of hemorrhagic shock. The latter requires a trained and experienced medical and paramedical team to prevent patient morbidity and mortality.

[Conditioning of the patient by the nurse in the emergency reception service]

The role of the nurse in the emergency reception service has become more complex in recent years in view of the evolution of these services. The particularity of this position lies in its autonomy, adaptation, adjustment, capacity for anticipation and participation in the diagnosis. Illustration of the central role of the nurse in the multidisciplinary care chain of a patient with limb trauma.

[Management of a patient with severe limb trauma]

The management of a patient with limb trauma begins with a rapid assessment of the lesions in order to prioritise the treatment of life-threatening lesions, primarily haemorrhage. Severe limb trauma is defined by the presence of specific severity criteria and requires the injured person to be referred to a specialised severe trauma centre. The prognosis is twofold, both vital and functional, based on the speed as well as the quality of immediate pre-hospital care, specific hospital care and the prevention of secondary complications.