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    Damage Control in Trauma

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    vidro alif
    Damage control techniques have been used since 2004 for severely injured trauma patients, including damage control surgery and damage control resuscitation. Damage control surgery focuses on rapidly stopping bleeding, contamination, and temporary abdominal closure. Damage control resuscitation focuses on early treatment of coagulopathy and other factors in the lethal triad. The document outlines management protocols for bleeding injuries, complex extremity injuries, use of rFVIIa, and discusses trauma as a multisystem disease involving immune dysfunction. It also discusses damage control sequencing and considerations for optimal timing of return to the operating room.

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    Damage Control in Trauma

    Uploaded by

    vidro alif
    5 views5 pages
    Damage control techniques have been used since 2004 for severely injured trauma patients, including damage control surgery and damage control resuscitation. Damage control surgery focuses on rapidly stopping bleeding, contamination, and temporary abdominal closure. Damage control resuscitation focuses on early treatment of coagulopathy and other factors in the lethal triad. The document outlines management protocols for bleeding injuries, complex extremity injuries, use of rFVIIa, and discusses trauma as a multisystem disease involving immune dysfunction. It also discusses damage control sequencing and considerations for optimal timing of return to the operating room.

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    DAMAGE CONTROL IN TRAUMA

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    Damage control techniques have been used since 2004 for severely injured trauma patients, including damage control surgery and damage control resuscitation. Damage control surgery focuses on rapidly stopping bleeding, contamination, and temporary abdominal closure. Damage control resuscitation focuses on early treatment of coagulopathy and other factors in the lethal triad. The document outlines management protocols for bleeding injuries, complex extremity injuries, use of rFVIIa, and discusses trauma as a multisystem disease involving immune dysfunction. It also discusses damage control sequencing and considerations for optimal timing of return to the operating room.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    5 views5 pages

    Damage Control in Trauma

    Uploaded by

    vidro alif
    Damage control techniques have been used since 2004 for severely injured trauma patients, including damage control surgery and damage control resuscitation. Damage control surgery focuses on rapidly stopping bleeding, contamination, and temporary abdominal closure. Damage control resuscitation focuses on early treatment of coagulopathy and other factors in the lethal triad. The document outlines management protocols for bleeding injuries, complex extremity injuries, use of rFVIIa, and discusses trauma as a multisystem disease involving immune dysfunction. It also discusses damage control sequencing and considerations for optimal timing of return to the operating room.

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    of 5

    DAMAGE CONTROL IN TRAUMA

    AND THE PROSPECT OF DAMAGE CONTROL RESUSCITATION VERSION 07-07

    Two types of damage control (since 2004 after


    starting Iraqi large scale conflict)
     DAMAGE CONTROL SURGERY
     Stop bleeding
     Stop contamination
     Temporary abdominal closure
     DAMAGE CONTROL RESUSCITATION
     Early management of coagulopathy
     And other component of lethal triad

    MANAGEMENT TREE FOR BLEEDING INTRAPERITONEAL


    INJURIES
    Hemodynamically Hemodynamically
    ATLS protocol
    stable unstable

    Hollow viscus or
    CT scan
    Diaphragmatic injuries US-fast

    Contrast extravasation celitomy

    If:
    Acidosis
    Hypothermia
    Ongoing > 8 PRBC
    Angiography-embolization
    bleeding coagulopathy

    N.O.M D.C.S

    NOM: nonoperative management


    DCS:damage control surgery
    Chiara, O, Cimbanasi S and Vesconi S : Critical Bleeding in Blunt Trauma
    US : Ultrasound
    Patients in 2006 Year Book of Intensive Care and Emergency Medicine,
    PRBC: Pached red blood cells Springer 2006
    MANAGEMENT TREE OF COMPLEX INJURIES OF THE
    EXTREMITIES
    Extremity injury

    Stop hemorrhage

    Check for:
    Peripheral perfusion
    Motor/sensory function
    Bone integrity
    Soft tissue integrity

    Three or more
    Components
    involved

    DCO:
    no yes Damage control
    orthopedics
    Systemic injuries
    With higher priority DCO
    successful unsuccessful
    no yes

    Definitive Early
    repair amputation
    Chiara, O, Cimbanasi S and Vesconi S : Critical Bleeding in Blunt Trauma Patients in 2006 Year Book of Intensive Care and Emergency Medicine,Springer 2006

    PROTOCOL FOR THE USE OF rFVIIa IN


    CRITICAL HEMORRHAGE IN THE BLUNT TRAUMA PATIENT

    Traumatic bleeding in patient on


    Non-mechanical bleeding in:
     Pelvic ring disruption
    pre-injury anticoagulant therapy
     Intraperitoneal injury
     Injury of extremities and
     Multiple transfusions (> 8 PRBC
    within 4 h)

    1. Infuse FFP 10 ml/kg Still rFVIIa 90 µg/kg


    2. Give PLT (> 50.000) bleeding
    3. Correct fibrinogen Still bleeding after 120 min
    (>50 mg/dl)
    4. Correct pH (>7.2)
    Still
    5. Check again for
    surgical bleeding rFVIIa 90 g/kg
    bleeding

    Exclude (futile administration) If:


    INR: International Normalized Ratio 1. pH < 7.1
    FFP: Fresh Frozen Plasme 2. Lactate > 13 mmol/l
    PLT: Platelets 3. Previous or impending CPR
    CPR: Cardio pulmonary resuscitation

    Chiara, O, Cimbanasi S and Vesconi S : Critical Bleeding in Blunt Trauma Patients in 2006 Year Book of Intensive Care and Emergency Medicine, Springer 2006
    TRAUMA IS MULTISYSTEM DISEASE AND IMMUNE DYSFUNCTION DISEASE
    Three peaks of trauma related deaths

    First peak
    Laceration of brain
    Third peak
    brainstem
    Sepsis
    aorta
    Multi organ failure
    spinal cord
    Second peak
    heart
    Extradural
    Subdural
    Hemopneumothorax
    Pelvic fractures
    Long bone fractures
    Abdominal injuries
    DEATHS

    s s
    eek eek
    2w 4w
    1 hour 3 hours

    DSTC / KT- IKABI


    Damage Control Sequence
    PART III - OR
    PART
    pack III - OR
    removal
    pack removal
    definitive repair
    PART I - OR definitive repair
    PARThemorrhage
    control I - OR
    controlcontamination
    control hemorrhage
    control contamination
    intraabdominal packing
    intraabdominal
    closurepacking
    temporary
    temporary closure
    Transfer problems
    PART II - ICU
    PART
    core II - ICU
    rewarming
    core rewarming
    correct coagulopathy
    correct coagulopathy
    maximize hemodynamics
    Transfer problems maximize support
    ventilatory hemodynamics
    ventilatory
    injury support
    identification
    injury identification
    (tertiary survey)
    (tertiary survey)
    DAMAGE CONTROL
     Deciding on an optimal time to return to the operating room
    involves making some judgment calls
     The time period may be only 2 to 6 hours, although it may
    be necessary to delay to return to the OR for as long as 24
    to 48 hours in order to attain a stable physiologic state

    CONVENTIONAL TRAUMA LAPAROROTOMY FOR


    ESSENTIAL PARTS
    1. Control of Bleeding
    2. Identification of Injury
    3. Control of Contamination
    4. Reconstruction

    Operative Management Of Small Bowel Fistulae Associated With


    Open Abdomen

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