scholarly journals 707 Principles of Damage Control Surgery in Trauma and Beyond: Experience at A Tertiary Centre

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Y L Quake ◽  
C Strong ◽  
A Okpala ◽  
M Shaaban
Keyword(s):  
Septic Shock ◽  
Trauma Patient ◽  
Road Traffic ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Colonic Injury ◽  
Tertiary Centre ◽  
Life Threatening ◽  
Abdominal Packing ◽  
Polytrauma Patient

Abstract Damage control surgery (DCS) is an abbreviated laparotomy used as a temporising measure in critically unwell patients who have limited physiological reserves to tolerate complex definitive surgeries. The aim of DCS is to address life-threatening haemorrhage and manage abdominal contamination. Following an abbreviated laparotomy, patients are continuously resuscitated in intensive care unit until physiological stability can be maintained for definitive surgeries. The role of DCS in the trauma setting is well-described; however, its principles can also be applied in General Surgery for a variety of indications such as mesenteric ischaemia, uncontrolled haemorrhage, and secondary peritonitis. Judicious selection of the non-trauma patient who will benefit from this strategy is paramount. We present two cases of a polytrauma patient (Patient A), and non-trauma patient with abdominal septic shock (Patient B) who underwent DCS at our tertiary centre. Patient A is a 49-year-old male involved in a road traffic accident who sustained multiple injuries including liver laceration, splenic laceration, and colonic injury. Intra-abdominal packing and repair of serosal tears were performed, with a re-look laparotomy 48 hours later -- no further bleeding or visceral injuries were identified. Patient B is a 51-year-old gentleman who re-presented in septic shock due to infected retroperitoneal collection following a bleeding duodenal ulcer, initially managed radiologically. A T tube was inserted into the duodenum with two abdominal drains at initial DCS. After thorough washout, a feeding jejunostomy was sited at the re-look laparotomy. 30-days mortality is 0% and both patients are under follow-up.

scholarly journals DAMAGE CONTROL SURGERY

2009 ◽  
Vol 16 (01) ◽  
pp. 12-16
Author(s):  
MUHAMMAD ATEEQ ◽  
SHAZIA JAHAN ◽  
M. HANIF
Keyword(s):  
Teaching Hospital ◽  
Damage Control ◽  
Penetrating Trauma ◽  
Damage Control Surgery ◽  
Pelvic Trauma ◽  
Biliary Fistula ◽  
Phase Iii ◽  
Severely Injured ◽  
Life Threatening ◽  
Abdominal Packing

Objective: To analyze the role of damage control in surgery in severely injured and polytrauma patients. D e s i g n:Descriptive study. S e t t i n g : Surgical unit of District Headquarter (teaching) Hospital, Rawalpindi. P e r i o d : January 2000 to December 2007.Patients a n d m e t h o d s : This study included 28 severely injured patients who presented in the accident and emergency department ofDistrict Headquarters (teaching) Hospital, Rawalpindi. These patients were unstable because of life threatening hemorrhage following someblunt or penetrating trauma. After immediate shifting to operation theater, resuscitation and operative intervention was done simultaneously.Different procedures of damage control surgery like abdominal packing for hepatic and pelvic trauma, major vascular ligation for vascularinjuries of neck and extremities were adopted in phase I. In phase II patients were managed in ITC for coagulopathy and hypothermia.Definitive treatment was done in Phase III after 24-72 hours once patients got stable. R e s u l t s : Total 28 patients included in the study. In18 patients abdominal packing for hepatic injury (n=11) and pelvic fractures (n=7) was done. Major vascular ligations in n=11 and temporaryintestinal clamping in n=1 patient. Planned re-exploration after 24-72 hours in n=16 and unplanned re-exploration within 24 hours in n=5patients was done. Complications included ongoing hemorrhage (n=5), coagulopathy (n=2), controlled biliary fistula (n=1), abdominalcompartment syndrome (n=1), cerebral ischemia (n=1) and gangrene of abdominal wall (n=1). Two patients died.

scholarly journals Resuscitation and coagulation in the severely injured trauma patient

2011 ◽  
Vol 366 (1562) ◽  
pp. 192-203 ◽  
Author(s):  
Mark J. Midwinter ◽  
Tom Woolley
Keyword(s):  
Trauma Patient ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Physiological Status ◽  
Trauma Patients ◽  
Severely Injured ◽  
Mortality And Morbidity ◽  
Tissue Hypoperfusion ◽  
Coagulation Status ◽  
Haemostatic Resuscitation

Developments in the resuscitation of the severely injured trauma patient in the last decade have been through the increased understanding of the early pathophysiological consequences of injury together with some observations and experiences of recent casualties of conflict. In particular, the recognition of early derangements of haemostasis with hypocoagulopathy being associated with increased mortality and morbidity and the prime importance of tissue hypoperfusion as a central driver to this process in this population of patients has led to new resuscitation strategies. These strategies have focused on haemostatic resuscitation and the development of the ideas of damage control resuscitation and damage control surgery continuum. This in turn has led to a requirement to be able to more closely monitor the physiological status, of major trauma patients, including their coagulation status, and react in an anticipatory fashion.

scholarly journals Damage control in the emergency department, a bridge to life

2021 ◽  
Vol 52 (2) ◽  
pp. e4004801
Author(s):  
Laureano Quintero ◽  
Juan Jose Melendez-Lugo ◽  
Helmer Emilio Palacios-Rodríguez ◽  
Natalia Padilla ◽  
Luis Fernando Pino ◽  
...  
Keyword(s):  
Emergency Department ◽  
Trauma Patient ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Hemodynamic Instability ◽  
Massive Hemorrhage ◽  
Severely Injured ◽  
Airway Injury ◽  
Hemostatic Resuscitation ◽  
Altered State Of Consciousness

Patients with hemodynamic instability have a sustained systolic blood pressure less or equal to 90 mmHg, a heart rate greater or equal to 120 beats per minute and an acute compromise of the ventilation/oxygenation ratio and/or an altered state of consciousness upon admission. These patients have higher mortality rates due to massive hemorrhage, airway injury and/or impaired ventilation. Damage control resuscitation is a systematic approach that aims to limit physiologic deterioration through a group of strategies that address the physiologic debt of trauma. This article aims to describe the experience earned by the Trauma and Emergency Surgery Group (CTE) of Cali, Colombia in the management of the severely injured trauma patient in the emergency department following the basic principles of damage control surgery. Since bleeding is the main cause of death, the management of the severely injured trauma patient in the emergency department requires a multidisciplinary team, which should perform damage control maneuvers aimed at rapidly control bleeding, hemostatic resuscitation and/or prompt transfer to the operating room, if required.

scholarly journals The Pathophysiology and Management of Hemorrhagic Shock in the Polytrauma Patient

2021 ◽  
Vol 10 (20) ◽  
pp. 4793
Author(s):  
Alison Fecher ◽  
Anthony Stimpson ◽  
Lisa Ferrigno ◽  
Timothy H. Pohlman
Keyword(s):  
Blood Loss ◽  
Whole Blood ◽  
Damage Control ◽  
Clinical Information ◽  
Fresh Frozen Plasma ◽  
Practical Reasons ◽  
Freeze Dried ◽  
Life Threatening ◽  
Sudden Decrease ◽  
Polytrauma Patient

The recognition and management of life-threatening hemorrhage in the polytrauma patient poses several challenges to prehospital rescue personnel and hospital providers. First, identification of acute blood loss and the magnitude of lost volume after torso injury may not be readily apparent in the field. Because of the expression of highly effective physiological mechanisms that compensate for a sudden decrease in circulatory volume, a polytrauma patient with a significant blood loss may appear normal during examination by first responders. Consequently, for every polytrauma victim with a significant mechanism of injury we assume substantial blood loss has occurred and life-threatening hemorrhage is progressing until we can prove the contrary. Second, a decision to begin damage control resuscitation (DCR), a costly, highly complex, and potentially dangerous intervention must often be reached with little time and without sufficient clinical information about the intended recipient. Whether to begin DCR in the prehospital phase remains controversial. Furthermore, DCR executed imperfectly has the potential to worsen serious derangements including acidosis, coagulopathy, and profound homeostatic imbalances that DCR is designed to correct. Additionally, transfusion of large amounts of homologous blood during DCR potentially disrupts immune and inflammatory systems, which may induce severe systemic autoinflammatory disease in the aftermath of DCR. Third, controversy remains over the composition of components that are transfused during DCR. For practical reasons, unmatched liquid plasma or freeze-dried plasma is transfused now more commonly than ABO-matched fresh frozen plasma. Low-titer type O whole blood may prove safer than red cell components, although maintaining an inventory of whole blood for possible massive transfusion during DCR creates significant challenges for blood banks. Lastly, as the primary principle of management of life-threatening hemorrhage is surgical or angiographic control of bleeding, DCR must not eclipse these definitive interventions.

scholarly journals Management of Destructive Colon Injuries after Damage Control Surgery

2017 ◽  
Vol 31 (01) ◽  
pp. 036-040 ◽  
Author(s):  
Priya Prakash ◽  
William Symons ◽  
Jad Chamieh
Keyword(s):  
World War Ii ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Standard Of Care ◽  
Fecal Diversion ◽  
Trauma Patients ◽  
Stoma Formation ◽  
Diverting Stoma ◽  
Life Threatening ◽  
Colon Injuries

AbstractAfter the World War II, fecal diversion became the standard of care for colon injuries, although medical, logistic, and technical advancements have challenged this approach. Damage control surgery serves to temporize immediately life-threatening conditions, and definitive management of destructive colon injuries is delayed until after appropriate resuscitation. The bowel can be left in discontinuity for up to 3 days before edema ensues, but the optimal repair window remains within 12 to 48 hours. Delayed anastomosis performed at the take-back operation or stoma formation has been reported with variable results. Studies have revealed good outcomes in those undergoing anastomosis after damage control surgery; however, they point to a subgroup of trauma patients considered to be “high risk” that may benefit from fecal diversion. Risk factors influencing morbidity and mortality rates include hypotension, massive transfusion, the degree of intra-abdominal contamination, associated organ injuries, shock, left-sided colon injury, and multiple comorbid conditions. Patients who are not suitable for anastomosis by 36 hours after damage control may be best managed with a diverting stoma. Failures are more likely related to ongoing instability, and the management strategy of colorectal injury should be based mainly on the patient's overall condition.

scholarly journals Damage control surgery: it's evolution over the last 20 years

2012 ◽  
Vol 39 (4) ◽  
pp. 314-321 ◽  
Author(s):  
Brett H Waibel ◽  
Michael MF Rotondo
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
Primary Treatment ◽  
Trauma Patients ◽  
Permissive Hypotension ◽  
Visceral Injury ◽  
Core Concepts ◽  
Life Threatening ◽  
Surgical Conditions ◽  
Original Application

In less than twenty years, what began as a concept for the treatment of exsanguinating truncal trauma patients has become the primary treatment model for numerous emergent, life threatening surgical conditions incapable of tolerating traditional methods. Its core concepts are relative straightforward and simple in nature: first, proper identification of the patient who is in need of following this paradigm; second, truncation of the initial surgical procedure to the minimal necessary operation; third, aggressive, focused resuscitation in the intensive care unit; fourth, definitive care only once the patient is optimized to tolerate the procedure. These simple underlying principles can be molded to a variety of emergencies, from its original application in combined major vascular and visceral trauma to the septic abdomen and orthopedics. A host of new resuscitation strategies and technologies have been developed over the past two decades, from permissive hypotension and damage control resuscitation to advanced ventilators and hemostatic agents, which have allowed for a more focused resuscitation, allowing some of the morbidity of this model to be reduced. The combination of the simple, malleable paradigm along with better understanding of resuscitation has proven to be a potent blend. As such, what was once an almost lethal injury (combined vascular and visceral injury) has become a survivable one.

Principles of Initial Trauma Management and Evaluation

2018 ◽  
Author(s):  
Shelby Resnick ◽  
Brian Smith ◽  
Patrick Reilly
Keyword(s):  
Trauma Patient ◽  
Damage Control ◽  
Penetrating Trauma ◽  
Injured Patient ◽  
The United States ◽  
Rapid Sequence Intubation ◽  
Multidisciplinary Teams ◽  
Rapid Sequence ◽  
Life Threatening ◽  
Secondary Survey

Trauma accounts for almost 10% of deaths worldwide and is the fourth most common cause of death in the United States. Treatment of the injured patient requires multiple unique resources, including multidisciplinary teams, surgical subspecialties, and dedicated resuscitation areas. Evaluation and initial management of the trauma patient is performed systematically to quickly identify and treat life-threatening injuries. This review serves as an introduction to care for the critically injured patient. It covers the initial steps for evaluation, resuscitation, diagnosis and treatment of the trauma patient and provides a brief overview of various injury patterns resulting from both blunt and penetrating trauma. This review contains 6 figures, 6 tables and 49 references Key Words: blunt trauma, damage control resuscitation, FAST exam, lateral canthotomy, penetrating trauma, primary survey, rapid sequence intubation, secondary survey, trauma systems

Principles of Initial Trauma Management and Evaluation

2018 ◽  
Author(s):  
Shelby Resnick ◽  
Brian Smith ◽  
Patrick Reilly
Keyword(s):  
Trauma Patient ◽  
Damage Control ◽  
Penetrating Trauma ◽  
Injured Patient ◽  
The United States ◽  
Rapid Sequence Intubation ◽  
Multidisciplinary Teams ◽  
Rapid Sequence ◽  
Life Threatening ◽  
Secondary Survey

Trauma accounts for almost 10% of deaths worldwide and is the fourth most common cause of death in the United States. Treatment of the injured patient requires multiple unique resources, including multidisciplinary teams, surgical subspecialties, and dedicated resuscitation areas. Evaluation and initial management of the trauma patient is performed systematically to quickly identify and treat life-threatening injuries. This review serves as an introduction to care for the critically injured patient. It covers the initial steps for evaluation, resuscitation, diagnosis and treatment of the trauma patient and provides a brief overview of various injury patterns resulting from both blunt and penetrating trauma. This review contains 6 figures, 6 tables and 49 references Key Words: blunt trauma, damage control resuscitation, FAST exam, lateral canthotomy, penetrating trauma, primary survey, rapid sequence intubation, secondary survey, trauma systems

Trauma

2020 ◽  
pp. 197-228
Author(s):  
Sarah Hodges ◽  
Sanja Janjanin ◽  
Judith Kendell ◽  
Nur Lubis ◽  
David Nott ◽  
...  
Keyword(s):  
Road Traffic ◽  
Damage Control ◽  
Head Injuries ◽  
Damage Control Surgery ◽  
Armed Conflicts ◽  
Difficult Patient ◽  
Middle Income ◽  
Middle Income Countries ◽  
High Resource ◽  
Resource Limited

In low- and middle-income countries, trauma, often from road traffic collisions, is one of the leading causes of morbidity and mortality. The approach to treating trauma in resource limited settings can be quite different to that in high-resource settings, requiring a lot of improvisation. The concepts of damage control surgery and resuscitation are covered, as are considerations for difficult patient groups such as head injuries, burns, and spinal injuries. The injury patterns seen as a result of armed conflicts (gun shots, blast injuries) will be unfamiliar to most anaesthetists and are also addressed in the chapter.

scholarly journals Novel reconstruction of an open pilon fracture with significant bone loss

2019 ◽  
Vol 12 (7) ◽  
pp. e227660
Author(s):  
Saleem Mastan ◽  
Anand Pillai
Keyword(s):  
Bone Loss ◽  
Damage Control ◽  
Distal Tibia ◽  
Damage Control Surgery ◽  
Pilon Fracture ◽  
Terror Attack ◽  
Improvised Explosive Device ◽  
Explosive Device ◽  
Polytrauma Patient ◽  
Improvised Explosive

This is a case of how a polytrauma patient was managed successfully. This 47-year-old woman was a victim of a detonated improvised explosive device in a terror attack. She had multiple injuries and underwent damage control surgery. She suffered significant bone loss with an open distal tibia pilon fracture, which we reconstructed with novel techniques. About 18 months postoperative, she is mobilising without the use of any aids.

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