Gestione non farmacologica delle emorragie nel setting pre-ospedaliero

Davide Sorrentino, Massimo Guasconi, Federica Calò, Enrico Lucenti


L’emorragia esterna continua ad essere una grande sfida nel setting pre-ospedaliero perché spesso di difficile gestione. Essa è generalmente dovuta a traumi e se non controllata numerose possono essere le complicanze che determina. A tal proposito sono stati ideati diversi presidi che hanno come obiettivo il controllo precoce dell’emorragia e quindi la sopravvivenza del paziente. L’obiettivo di questo studio è indagare sui metodi non farmacologici per trattare le emorragie in ambito pre-ospedaliero da parte dell’infermiere di emergenza territoriale

Riferimenti bibliografici

Boulton AJ, Lewis CT, Naumann DN, Midwinter MJ. Prehospital haemostatic dressings for trauma: a systematic review. Emerg Med J. 2018 Jul;35(7):449–57.

Kauvar DS, Lefering R, Wade CE. Impact of hemorrhage on trauma outcome: An overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma - Inj Infect Crit Care. 2006;60(6 SUPPL.):3–11.

Hickman DA, Pawlowski CL, Sekhon UDS, Marks J. Biomaterials and Advanced Technologies for Hemostatic Management of Bleeding. 2017;1700859:1–40.

Michelle HS, Jacob PM, Keith G, Joseph DL, Charles EW, John BH, Bryan AC. Safety and Appropriateness of Tourniquets in 105 Civilians. Prehosp Emerg Care. 2016; 20(6):712-722.

Huei TJ, Mohamad Y, Lip HTC, Noh NM, Alwi RI. Prognostic predictors of early mortality from exsanguination in adult trauma: A Malaysian trauma center experience. Trauma Surg Acute Care Open. 2017;2(1):1–5.

Day MW. Control of traumatic extremity hemorrhage. Crit Care Nurse. 2016;36(1):40–51.

Guven HE. Topical hemostatics for bleeding control in pre-hospital setting: Then and now. Ulus Travma Acil Cerrahi Derg. 2017 Sep;23(5):357–61.

Grissom TE, Fang R. Topical hemostatic agents and dressings in the prehospital setting. Curr Opin Anaesthesiol. 2015 Apr;28(2):210–6.

Grant MJ, Booth A. A typology of reviews: An analysis of 14 review types and associated methodologies. Health Info Libr J. 2009;26(2):91–108.

Tanaka KA, Bolliger D, Guzzetta NA. Clinical and Practical Aspects of Restoring Thrombin Generation in Acute Coagulopathic Bleeding. Vol. 124, Anesthesia and analgesia. United States; 2017. p. 701.

Smith IM, Crombie N, Bishop JR, McLaughlin A, Naumann DN, Herbert M, et al. RePHILL: protocol for a randomised controlled trial of pre-hospital blood product resuscitation for trauma. Transfus Med. 2018 Oct;28(5):346–56.

Bennett BL. Bleeding Control Using Hemostatic Dressings: Lessons Learned. Wilderness Environ Med. 2017 Jun;28(2S):S39–49.

Butler FK, Bennett B, Wedmore CI. Tactical Combat Casualty Care and Wilderness Medicine: Advancing Trauma Care in Austere Environments. Emerg Med Clin North Am. 2017 May;35(2):391–407.

Littlejohn L, Bennett BL, Drew B. Application of current hemorrhage control techniques for backcountry care: part two, hemostatic dressings and other adjuncts. Wilderness Environ Med. 2015 Jun;26(2):246–54.

Drew B, Bennett BL, Littlejohn L. Application of current hemorrhage control techniques for backcountry care: part one, tourniquets and hemorrhage control adjuncts. Wilderness Environ Med. 2015 Jun;26(2):236–45.

Chang R, Eastridge BJ, Holcomb JB. Remote Damage Control Resuscitation in Austere Environments. Wilderness Environ Med. 2017 Jun;28(2S):S124–34.

Khan MA, Mujahid M. A review on recent advances in chitosan based composite for hemostatic dressings. Int J Biol Macromol. 2019 Mar;124:138–47.

Kragh JFJ, Dubick MA. Bleeding Control With Limb Tourniquet Use in the Wilderness Setting: Review of Science. Wilderness Environ Med. 2017 Jun;28(2S):S25–32.

Lier H, Bernhard M, Knapp J, Buschmann C, Bretschneider I, Hossfeld B. [Approaches to pre-hospital bleeding management : Current overview on civilian emergency medicine]. Anaesthesist. 2017 Nov;66(11):867–78.

Kauvar DS, Dubick MA, Walters TJ, Kragh JFJ. Systematic review of prehospital tourniquet use in civilian limb trauma. J Trauma Acute Care Surg. 2018 May;84(5):819–25.

Kluj P, Aleksandrowicz D, Machala W, Gaszynski T. [Advanced methods of prehospital bleeding management based on the experience and standards of tactical medicine]. Pol Merkur Lekarski. 2015 Sep;39(231):186–90.

Hawk AJ. How hemorrhage control became common sense. J Trauma Acute Care Surg. 2018 Jul;85(1S Suppl 2):S13–7.

Blix SW, Melau J, Lund-Kordahl I. Performance of Norwegian civilian EMTs and army medics in penetrating trauma: a controlled simulation-based assessment. Acta Anaesthesiol Scand. 2017 Aug;61(7):848–53.

Mckee JL, Lakshminarasimhan P, Atkinson I, LaPorta AJ, Kirkpatrick AW. Evaluation of Skin Damage from Accidental Removal of a Hemostatic Wound Clamp (The iTClamp). Prehosp Disaster Med. 2017 Dec;32(6):651–6.

Ramly E, Runyan G, King DR. The state of the union: Nationwide absence of uniform guidelines for the prehospital use of tourniquets to control extremity exsanguination. J Trauma Acute Care Surg. 2016 May;80(5):787–91.

Kue RC, Temin ES, Weiner SG, Gates J, Coleman MH, Fisher J, et al. Tourniquet Use in a Civilian Emergency Medical Services Setting: A Descriptive Analysis of the Boston EMS Experience. Prehospital Emerg care Off J Natl Assoc EMS Physicians Natl Assoc State EMS Dir. 2015;19(3):399–404.

Travers S, Lefort H, Ramdani E, Lemoine S, Jost D, Bignand M, et al. Hemostatic dressings in civil prehospital practice: 30 uses of QuikClot Combat Gauze. Eur J Emerg Med. 2016 Oct;23(5):391–4.

Schauer SG, April MD, Naylor JF, Maddry JK, Arana AA, Dubick MA, et al. Prehospital Application of Hemostatic Agents in Iraq and Afghanistan. Prehospital Emerg care Off J Natl Assoc EMS Physicians Natl Assoc State EMS Dir. 2018;22(5):614–23.

Lyon M, Johnson D, Gordon R. Use of a Novel Abdominal Aortic and Junctional Tourniquet to Reduce or Eliminate Flow in the Brachial and Popliteal Arteries in Human Subjects. Prehospital Emerg care Off J Natl Assoc EMS Physicians Natl Assoc State EMS Dir. 2015;19(3):405–8.

King DR, Larentzakis A, Ramly EP. Tourniquet use at the Boston Marathon bombing: Lost in translation. J Trauma Acute Care Surg. 2015 Mar;78(3):594–9.

Shina A, Lipsky AM, Nadler R, Levi M, Benov A, Ran Y, et al. Prehospital use of hemostatic dressings by the Israel Defense Forces Medical Corps: A case series of 122 patients. J Trauma Acute Care Surg. 2015 Oct;79(4 Suppl 2):S204-9.

Scerbo MH, Holcomb JB, Taub E, Gates K, Love JD, Wade CE, et al. The trauma center is too late: Major limb trauma without a pre-hospital tourniquet has increased death from hemorrhagic shock. J Trauma Acute Care Surg. 2017 Dec;83(6):1165–72.

Inaba K, Siboni S, Resnick S, Zhu J, Wong MD, Haltmeier T, et al. Tourniquet use for civilian extremity trauma. J Trauma Acute Care Surg. 2015 Aug;79(2):232–3.

Scerbo MH, Mumm JP, Gates K, Love JD, Wade CE, Holcomb JB, et al. Safety and Appropriateness of Tourniquets in 105 Civilians. Prehospital Emerg care Off J Natl Assoc EMS Physicians Natl Assoc State EMS Dir. 2016;20(6):712–22.

Mckee JL, Mckee IA, Ball CG, Tan E, Moloff A, McBeth P, et al. The iTClamp in the treatment of prehospital craniomaxillofacial injury: a case series study. J Inj Violence Res. 2019 Jan;11(1):29–34.

Leonard J, Zietlow J, Morris D, Berns K, Eyer S, Martinson K, et al. A multi-institutional study of hemostatic gauze and tourniquets in rural civilian trauma. J Trauma Acute Care Surg. 2016 Sep;81(3):441–4.

Teixeira PGR, Brown CVR, Emigh B, Long M, Foreman M, Eastridge B, et al. Civilian Prehospital Tourniquet Use Is Associated with Improved Survival in Patients with Peripheral Vascular Injury. J Am Coll Surg. 2018 May;226(5):769-776.e1.

Ross EM, Mapp JG, Redman TT, Brown DJ, Kharod CU, Wampler DA. The Tourniquet Gap: A Pilot Study of the Intuitive Placement of Three Tourniquet Types by Laypersons. J Emerg Med. 2018 Mar;54(3):307–14.

Callaway DW, Robertson J, Sztajnkrycer MD. Law enforcement-applied tourniquets: a case series of life-saving interventions. Prehospital Emerg care Off J Natl Assoc EMS Physicians Natl Assoc State EMS Dir. 2015;19(2):320–7.

Paquette R, Bierle R, Wampler D, Allen P, Cooley C, Ramos R, et al. External Soft-Tissue Hemostatic Clamp Compared to a Compression Tourniquet as Primary Hemorrhage Control Device in Pilot Flow Model Study. Prehosp Disaster Med. 2019 Apr;34(2):175–81.

Haider AH, Piper LC, Zogg CK, Schneider EB, Orman JA, Butler FK, et al. Military-to-civilian translation of battlefield innovations in operative trauma care. Surgery. 2015 Dec;158(6):1686–95.

Te Grotenhuis R, Van Grunsven PM, Heutz WMJM, Tan ECTH. Use of Hemostatic Nasal Plugs in Emergency Medical Services in the Netherlands: A Prospective Study of 33 Cases. Prehospital Emerg Care. 2018;22(1):91–8.

NCT03035695. Studying Safety & Efficacy of Axiostat® Dressing in Acute Hemorrhage Due to Trauma-Comparative Study. Https:// [Internet]. 2017; Available from:

Te Grotenhuis R, Van Grunsven PM, Heutz WMJM, Tan ECTH. Prehospital use of hemostatic dressings in emergency medical services in the Netherlands: A prospective study of 66 cases. Injury. 2016 May;47(5):1007–11.

Ode G, Studnek J, Seymour R, Bosse MJ, Hsu JR. Emergency tourniquets for civilians: Can military lessons in extremity hemorrhage be translated? J Trauma Acute Care Surg. 2015 Oct;79(4):586–91.

Tan ECTH, Peters JH, Mckee JL, Edwards MJR. The iTClamp in the management of prehospital haemorrhage. Injury. 2016 May;47(5):1012–5.


  • Non ci sono refbacks, per ora.