A 2 pound jab could save thousands of trauma patients from bleeding to death | Daily Mail Online

2021-12-16 07:14:41 By : Mr. haibiao chen

Erin Dean writes for the Sunday Mail

Published: November 20, 2021 at 17:04 EDT | Updated: November 20, 2021 at 18:55 EDT

She is the patient who continues to define the career of Professor Ian Roberts. On a sunny afternoon in 1990, a 10-year-old girl was rushed into the emergency doctor's ward.

When an SUV tried to overtake another car on the other side of the road at a speed of 70 miles per hour, she kept sitting in the back seat of her parents' car.

As a result, there was a frontal collision, and the car carrying the little girl was the first to bear the brunt. Both her parents were pronounced dead at the scene.

She survived the impact, but there was bleeding in her stomach-the result of the seat belt pressing on her abdomen.

She was fully awake, and he was sure she would do it. However, an hour later, a colleague told him that the girl was dead. She bleeds heavily during stomach repair surgery and eventually died of excessive blood loss.

"I was shocked, there was nothing we could do," said Professor Roberts, who later became one of the leading experts in severe blood loss in the UK.

A drug that releases a compound that prevents blood clotting can save a third of people who suffer from severe blood loss-but only 5% of British patients are given this drug (photo of a car accident)

"Serious bleeding is so common, I don't understand why there is no simple hemostatic solution. We have many tools that can effectively deal with relatively small bleeding-so why not use heavy bleeding?

"At that moment, I became addicted to researching treatments to end unnecessary deaths caused by blood loss."

But 20 years later, Professor Roberts warned that similar scenes are still being played out across the country-despite the extensive and effective treatment methods.

A cheap drug called tranexamic acid or TXA can save a third of people who suffer from severe blood loss without side effects.

The drug costs £2 per dose to the NHS and can be injected directly into the thigh muscles — or through a vein in the arm — and prevents the release of compounds that prevent blood clotting.

It is used all over the world to treat victims of road accidents and other major traumatic events. However, according to a new study, only 5% of British patients may benefit from the accident.

The clear findings published by Professor Roberts and his colleagues at the London School of Hygiene and Tropical Medicine also showed that only 3% of people received the drug within the critical first hour.

A cheap drug called tranexamic acid or TXA can save a third of people who suffer from severe blood loss without side effects

In the public investigation into the 2017 Manchester Arena terrorist attack, this kind of non-use of the drug has now become the main line of interrogation. ) Was killed at a concert.

The family criticized the care provided by the nursing staff that night, and Professor Roberts wrote to Chairman Sir John Sanders suggesting that if TXA is used effectively, more people may be saved.

Since that intervention, paramedics have been questioning whether they are treating patients with this drug-especially in the case of 28-year-old John Atkinson, who was lying unattended on the floor of the hall while lying on his legs. He was injured severely and lost blood and died 47 minutes.

His family accused the emergency services of allowing "precious time to fade" when John bleeds to death.

The investigation learned that the first paramedic who cared for Mr. Atkinson "lost" his medicine bag, while the second paramedic did use TXA to control bleeding, but more than an hour after Mr. Atkinson was injured.

Lawyers for the Atkinsons said that there was no evidence that TXA would save John, but he did "admit that it would save lives in some cases."

Professor Roberts, the current professor of epidemiology at the London School of Hygiene and Tropical Medicine, said that the reluctance to use TXA results in hundreds of preventable deaths every year. This is a nationwide scandal.

"Our research on more than 100,000 trauma victims shows that currently less than 10% of patients can benefit," he said.

'This is shocking, because there is no scientific objection to its life-saving benefits.

'The problem is poor execution. Not enough people get it, and if they do, it's usually too late. Thousands of people all over the world bleed unnecessarily to death every year. This is wrong.

The 42-year-old dairy farmer Jonathan Willis (Jonathan Willis) is a patient who can prove the life-saving coagulation benefits of tranexamic acid (TXA).

In October 2020, the father of five children was unloading a trailer on his Cambridgeshire farm.

When he walked out of the cab to check the load, his forklift rolled forward, and one of the three-foot-long steel nails forced through his abdomen, piercing him into the trailer.

Piercing: Surgeons Emmanuel Huguet and Jonathan Willis and Dingding

After Jonathan’s wife Wendy madly dialed 999, the paramedics rushed to the scene within 7 minutes and found that the fork had pierced his intestines, only a few millimeters away from other organs and major blood vessels, making the situation life-threatening.

The first medicine provided by medical staff from the East Anglia air ambulance was TXA, which was injected into a vein in Jonathan's arm to prevent internal bleeding.

Throughout the ordeal, Jonathan was awake and used an angle grinder to cut the fork from the forklift, but the fork still pierced his body. When he arrived at the hospital, before the seven-hour major operation, he was given another dose of TXA.

Jonathan was discharged from the hospital two weeks later, although it took nearly five months for his wound to heal completely.

A year after the accident, both he and Wendy felt "very lucky" to have all the tools available to save Jonathan's life-including TXA.

Wendy said: "If the air ambulance team did not improve their skills that day, Jonathan would not go to the hospital."

"They controlled the situation-it was like my worst nightmare-and made all the right decisions."

At the same time, Jonathan said: "I am very, very grateful that there are so many expert teams who can help me through the difficulties.

"Otherwise I believe the results may be very different. I will always thank all those who participated in saving my life. 

The expert’s warning comes amid recent reports of a shortage of ambulances across the country-160,000 patients face long delays in emergency care each year. This situation may mean that fewer people can get TXA in time to save their lives.

According to data from the National Institute of Health and Care Excellence (NICE), major trauma is the leading cause of death for people under 45 in the UK and an important cause of disability.

According to the Royal Accident Prevention Association, more than 14,000 Britons die every year from wounds caused by severe falls or traffic accidents.

When a blood vessel or organ ruptures, the rapid blood loss through the skin and inside will lead to rapid death, because this means that the chance of the heart pumping blood around the body is reduced, leaving the organ lacking oxygen and other important nutrients.

Without blood, organs will fail. In the past 30 years, the treatment of severe blood loss has changed a lot.

Historically, doctors would inject other fluids to replace the lost blood to maintain the correct pressure around the organs. But research shows that this tends to make things worse.

Other widely used blood loss treatments (which are still part of the caregiver’s kit today) include tourniquets (tight bands that restrict blood flow out of the body) and professional dressings for external bleeding, and artificial blood replacements.

Then, in 1962, Japanese scientists studied treatments to prevent women from dying in childbirth due to severe bleeding, and found that TXA was proven to be very effective in helping blood clot.

Another study conducted in 2011 at the base camp of the British Armed Forces in Afghanistan found that more soldiers who lost blood after the use of TXA survived than those who did not use TXA.

In the past ten years, it has been promoted internationally for use in surgery, obstetrics, military and emergency medical care.

Professor Tim Natbim, a Plymouth emergency medicine consultant, also worked with Devon Air Ambulance. He said that in the event of an accident, giving TXA was "the first thing I did."

He added: “This is an important part of treatment. We now understand that the sooner it is given, the better. But healthcare professionals are not taking full advantage of it, nor are they using it fairly, and providing it to everyone who can benefit. people.

So why are few doctors using TXA correctly? Experts say the problem lies in the stereotypes of trauma patients.

"When doctors think of the risk of trauma and bloodshed, they think of young people in a car accident, or victims of multiple stabbings," said Professor Nutbim.

"Nursers are more likely to provide TXA to young people, especially young people. But they often cannot give TXA to women and the elderly because they will benefit from it.

'Elderly persons who trip on paving slabs may be at risk of severe trauma and internal bleeding.

"But these are not situations that some caregivers think are traumatic, so they won't consider providing medications."

Experts refer to these patients as victims of "silver injuries". According to NHS data, one-third of Britons over 65 and half of people over 80 have a fall at least once a year. The chilling thing is that, according to government data, falls are the most common cause of injury and death for people over 65 years of age.

There is also some debate about the severity of injuries that require TXA injections. Currently TXA is only recommended for "severe bleeding".

But for internal bleeding, it is difficult to determine the severity without the help of a scan. Experts suggest that if the word "serious" is deleted from the guide, more people will benefit.

Professor Roberts said: "TXA has no side effects, so giving this drug to people who are less obvious or severely injured will not have any negative effects."

"Normally, the injury may be more serious than the caregiver realizes at first, so it makes sense to provide it just in case."

Tony Stone, who is in charge of emergency care at the College of Nursing Staff, said finding an elderly patient at risk of major bleeding can be a challenge.

Obvious signs include pale, cold or clammy skin, rapid heart rate, shortness of breath, shallowness, and dizziness. "You may not be able to detect this from a 999 call," he said.

Stone added that medications commonly used by the elderly can further complicate matters. For example, beta blockers used in heart disease can slow the heart rate and mask one of the signs of internal bleeding.

At the same time, blood-thinning drugs make them more susceptible to catastrophic bleeding.

A study published this month in the Journal of Emergency Medicine revealed many reasons why nurses refuse patients to take medication.

This includes lack of knowledge and experience of TXA, unclear when not to give it, and difficulty in identifying patients at risk of life-threatening bleeding.

Experts say that some of the confusion may lie in recent changes to guidelines on how caregivers manage medications.

Previously, it had to be administered slowly within ten minutes. But earlier this year, after the publication of a study, the official guidelines for caregivers changed. The study showed that TXA is safe and effective when given to the thigh as an injection, making it easier and faster to use.

Now, British doctors are developing a solution to help any public provide TXA quickly in times of crisis.

The autoinjector—a pen-like device containing a single dose of TXA—has proven to be very effective in early research involving the military. This means that even if there is no medical staff present, lives can still be saved.

Professor Roberts hopes to achieve such innovations in the next few years, but at the same time introducing the goal of rapid use of TXA will save lives.

"The ambulance has to reach the time goal of sending stroke patients to specialist centers," he said.

'TXA is really important, but it is not the only step-the health system must be realigned around this treatment.

"We need to clearly define who should get this drug and check if they do."

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