Torso damage control for ongoing hemorrhage: Tips and tricks as a SOS supplement to Technical considerations/toolbox for hemorrhage control by Dr Chad Ball and Dr Kelly Vogt.

Primary Means ◽

Underlying Mechanisms ◽

Trauma Deaths ◽

Exsanguination occurs rapidly after trauma (median 2 to 3 hours after admission) and is the leading cause of preventable trauma deaths. The modern treatment for traumatic hemorrhagic shock is simultaneous mechanical hemorrhage control and damage control resuscitation (DCR), which emphasizes using plasma as the primary means for volume expansion. Other core DCR principles include minimization of crystalloid, permissive hypotension, and goal-directed resuscitation. The treatment of traumatic hemorrhage is complicated by trauma-induced coagulopathy (TIC); DCR is thought to address TIC directly despite incomplete understanding of the underlying mechanisms. Recent data point to a 1:1:1 ratio of plasma and platelets to red blood cells as the optimal blood product ratio for acute traumatic hemorrhage. However, this paradigm may soon be supplanted by a transition back to whole blood. Although it is intuitive to apply these same protocols and algorithms to patients with nontraumatic hemorrhage, the scientific evidence is lacking. Key words: endotheliopathy, hemorrhage, massive transfusion, trauma-induced coagulopathy

Transfusion Therapy

10.2310/7ccsp.8342 ◽

2017 ◽

Author(s):

Ronald Chang ◽

John B. Holcomb

Keyword(s):

Damage Control ◽

Scientific Evidence ◽

Hemorrhage Control ◽

Transfusion Therapy ◽

Primary Means ◽

Underlying Mechanisms ◽

Trauma Deaths ◽

Exsanguination occurs rapidly after trauma (median 2 to 3 hours after admission) and is the leading cause of preventable trauma deaths. The modern treatment for traumatic hemorrhagic shock is simultaneous mechanical hemorrhage control and damage control resuscitation (DCR), which emphasizes using plasma as the primary means for volume expansion. Other core DCR principles include minimization of crystalloid, permissive hypotension, and goal-directed resuscitation. The treatment of traumatic hemorrhage is complicated by trauma-induced coagulopathy (TIC); DCR is thought to address TIC directly despite incomplete understanding of the underlying mechanisms. Recent data point to a 1:1:1 ratio of plasma and platelets to red blood cells as the optimal blood product ratio for acute traumatic hemorrhage. However, this paradigm may soon be supplanted by a transition back to whole blood. Although it is intuitive to apply these same protocols and algorithms to patients with nontraumatic hemorrhage, the scientific evidence is lacking. Key words: endotheliopathy, hemorrhage, massive transfusion, trauma-induced coagulopathy

Transfusion Therapy

10.2310/tywc.8342 ◽

2018 ◽

Author(s):

Ronald Chang ◽

John B. Holcomb

Keyword(s):

Damage Control ◽

Scientific Evidence ◽

Hemorrhage Control ◽

Transfusion Therapy ◽

Primary Means ◽

Underlying Mechanisms ◽

Trauma Deaths ◽

Exsanguination occurs rapidly after trauma (median 2 to 3 hours after admission) and is the leading cause of preventable trauma deaths. The modern treatment for traumatic hemorrhagic shock is simultaneous mechanical hemorrhage control and damage control resuscitation (DCR), which emphasizes using plasma as the primary means for volume expansion. Other core DCR principles include minimization of crystalloid, permissive hypotension, and goal-directed resuscitation. The treatment of traumatic hemorrhage is complicated by trauma-induced coagulopathy (TIC); DCR is thought to address TIC directly despite incomplete understanding of the underlying mechanisms. Recent data point to a 1:1:1 ratio of plasma and platelets to red blood cells as the optimal blood product ratio for acute traumatic hemorrhage. However, this paradigm may soon be supplanted by a transition back to whole blood. Although it is intuitive to apply these same protocols and algorithms to patients with nontraumatic hemorrhage, the scientific evidence is lacking. Key words: endotheliopathy, hemorrhage, massive transfusion, trauma-induced coagulopathy

The Evolution of Damage Control in Concept and Practice

Clinics in Colon and Rectal Surgery ◽

10.1055/s-0037-1602177 ◽

2017 ◽

Vol 31 (01) ◽

pp. 030-035 ◽

Cited By ~ 1

Author(s):

Brian Beldowicz

Keyword(s):

Medical Decision Making ◽

Damage Control ◽

Damage Control Surgery ◽

Strategy Implementation ◽

Medical Decision ◽

Metabolic Dysfunction ◽

Damage Control Resuscitation ◽

Hemorrhage Control ◽

Threat To Life ◽

Critically Ill Surgical Patients

AbstractDamage control surgery (DCS) began as an adjunct approach to hemorrhage control, seeking to facilitate the body's innate clotting ability when direct repair or ligation was impossible, but it has since become a valuable instrument for a broader collection of critically ill surgical patients in whom metabolic dysfunction is the more immediate threat to life than imminent exsanguination. Modern damage control is a strategy that combines the principles of DCS with those of damage control resuscitation. When used correctly, damage control may improve survival in previously unsalvageable patients; when used incorrectly, it can subject patients to imprudent risk and contribute to morbidity. This review discusses the evolution of damage control in both concept and practice, summarizing available literature and experience to guide patient selection, medical decision-making, and strategy implementation throughout the preoperative, intraoperative, and early postoperative periods.

Transfusion Therapy

10.2310/fm.8342 ◽

2018 ◽

Author(s):

Ronald Chang ◽

John B. Holcomb

Keyword(s):

Damage Control ◽

Scientific Evidence ◽

Hemorrhage Control ◽

Transfusion Therapy ◽

Primary Means ◽

Underlying Mechanisms ◽

Trauma Deaths ◽

Exsanguination occurs rapidly after trauma (median 2 to 3 hours after admission) and is the leading cause of preventable trauma deaths. The modern treatment for traumatic hemorrhagic shock is simultaneous mechanical hemorrhage control and damage control resuscitation (DCR), which emphasizes using plasma as the primary means for volume expansion. Other core DCR principles include minimization of crystalloid, permissive hypotension, and goal-directed resuscitation. The treatment of traumatic hemorrhage is complicated by trauma-induced coagulopathy (TIC); DCR is thought to address TIC directly despite incomplete understanding of the underlying mechanisms. Recent data point to a 1:1:1 ratio of plasma and platelets to red blood cells as the optimal blood product ratio for acute traumatic hemorrhage. However, this paradigm may soon be supplanted by a transition back to whole blood. Although it is intuitive to apply these same protocols and algorithms to patients with nontraumatic hemorrhage, the scientific evidence is lacking. Key words: endotheliopathy, hemorrhage, massive transfusion, trauma-induced coagulopathy

Surgical Services and Transformation of Civil Hospital During “August War 2008” in Georgia

International Surgery ◽

10.9738/1335.1 ◽

2011 ◽

Vol 96 (1) ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

M. A. Kiladze ◽

N. G. Lominadze ◽

V. T. Goderdzishvili ◽

G. I. Kcherodinashvili ◽

T. I. Mgeliashvili ◽

...

Keyword(s):

Foreign Bodies ◽

Damage Control ◽

Neck Region ◽

Hemorrhage Control ◽

Civil Hospital ◽

Surgical Services ◽

Combined Operations ◽

Short Period ◽

Surgery Department ◽

Combat Casualties

Abstract Structural transformation of a civil hospital into a military one during “August War 2008” (August 8–12) in Georgia is presented. Damage-control principles, such as hemorrhage control, liver-packing and abdominal tamponade, gastrointestinal tract resection without formation of anastomoses, and other temporary interventions were prioritized. This provided a chance to empty the hospital in a short period to provide the admission of an increased number of combat casualties. There were soldiers from Georgian troops, civilians, and captives of war. The number of total admitted patients was 739. Fifty-two patients were operated on in the surgery department. The following operations were carried out: removal of foreign bodies from the neck region, 6 cases; isolated thoracotomy, pulmorrhaphy, and drainage, 2 cases; laparotomy, hepatorrhaphy, gastrorrhaphy, splenectomy, resection of small intestine, and colostomy, 18 cases; combined operations (thoracotomy plus laparotomy), 9 cases; extended debridement and dressing of wounds, 11 cases; angiosurgical operations, 4 cases; and coloplasty, 2 cases. There were 2 cases of mortality, 1 case of rethoracotomy, and 3 cases of relaparotomy: 2 because of intracavital bleeding and 1 because of sanation.

Hepatic Compartment Syndrome Treated with Damage Control Surgery and Transarterial Embolization: A Case Report

10.21203/rs.3.rs-910646/v1 ◽

2021 ◽

Author(s):

Motoo Fujita ◽

Takeaki Sato ◽

Kei takase ◽

Tomomi Sato ◽

Hajime Furukawa ◽

...

Keyword(s):

Compartment Syndrome ◽

Nonoperative Management ◽

Damage Control ◽

Transarterial Embolization ◽

Damage Control Surgery ◽

Surgical Decompression ◽

Intraparenchymal Hemorrhage ◽

Combination Strategy ◽

Hemorrhage Control ◽

Hepatocellular Damage

Abstract Background: Hepatic compartment syndrome (HCS) is a complication of nonoperative management in patients with blunt hepatic injury. Although decompression of elevated intrahepatic pressure through surgical exploration or drainage and hemorrhage control are required to manage this condition, evidence for such a management for this complication is insufficient. Herein, we report a pediatric patient treated with a planned combination strategy of surgical decompression with perihepatic packing to reduce intrahepatic pressure and subcapsular hemorrhage control as well as angioembolization to control intraparenchymal hemorrhage. Case presentation: A 12-year-old boy was referred to our emergency department 5 h after sustaining severe bruising in the upper abdomen in a traffic accident. Computed tomography (CT) showed an intraparenchymal hematoma in the right lobe of the liver; nonoperative management was selected based on stable hemodynamic status. Two days after the injury, he complained of severe abdominal pain and shock. CT showed an intraparenchymal and large subcapsular hematoma with right branch compression of the portal vein and extravasation of contrast material. Laboratory data showed progression of hepatocellular damage. We successfully managed this patient with a planned combination strategy of surgical decompression with perihepatic packing for reduction of intrahepatic pressure and subcapsular hemorrhage control, followed by angioembolization for control of intraparenchymal hemorrhage. Conclusion: Our study suggests that for the management of HCS, a planned combination strategy of damage control surgery and angioembolization is a therapeutic option.